Abdominal wall closure in bladder exstrophy complex repair by rectus flap.

BACKGROUND AND OBJECTIVES: The Exstrophy Complex (EC) is a serious malformation of midline abdominal wall. Wide pubis prevents approximating the lateralized rectus muscle and leads to dehiscence and fistula formation. Our aim was to recommend an easier method for abdominal wall closure in the Bladder Exstrophy (BE) complex repair. MATERIALS AND METHODS: From November 2007 to April 2010, we had three case of Cloacal Exstrophy (CE) and 10 BE, in which early bladder closure and coverage were performed by wide mobilization of bladder and rectus muscle flap closure in the midline without pubic closure. RESULTS: Two cases of CE had only minor wound dehiscence and bladder prolapsed later. One of the 10 BE cases developed vesicocutaneous fistula and the other two had minor wound dehiscence. CONCLUSIONS: Our Technique reconstructed the abdominal wall with less morbidity and hospitalization because of tensionless closure.

Split liver transplantation in Shiraz Transplant Center.

BACKGROUND: Cadaveric organ splitting emerged from an improved understanding of the surgical anatomy of the liver as a possible mechanism to expand the organ pool. In this study, we have reported our first series of split liver transplantations (SLT). MATERIALS AND METHODS: From June 2006 to June 2008, we performed 17 pairs of SLT: 70.6% ex situ and 29.4% in situ. The mean age of the donors (32 males, 2 females) was 23.15 +/- 9 years. All of them had been stable at the time of harvest according to vital signs, liver function tests, electrolytes, and urine output. The decision on splitting was made by the surgical team according to the donor's status and the urgency of the recipient. RESULTS: The main indications were biliary atresia (17.6%) followed by Wilson disease (14.7%) and cryptogenic cirrhosis (14.7%). The left lateral segment and the left lobe were used in 6 and 11 cases, respectively. In-hospital mortalities for the pediatric and adult groups were 68.4% and 26.7%, respectively. Primary graft nonfunction (52.9%), vascular complications (29.4%), sepsis (11.8%), and biliary complications (5.9%) were the main causes of mortality. CONCLUSION: Our experience indicated that SLT showed a high rate of mortality and morbidity.

Botulinium toxin, as bridge to transanal pullthrough in neonate with Hirschsprungs disease.

AIMS AND OBJECTIVES: The aim of this study is to find easier way of home care while obviating the colostomy before single stage pull through operation. MATERIALS AND METHODS: From August 2005 to December 2006, eight cases of neonatal Hirschsprung disease were treated. Mean age 4.5 (2-6) day/old with absent anorectal inhibitory reflex, rectosigmiod disease in Barium enema, positive Acetylcholine esterase (Ache) staining, good response to rectal washout. They underwent botulinium toxin injection (5 unit /kg/quadrant) in four quadrant intrasphincteric. They were followed until pull through operation in 8-10 weeks post injection. RESULTS: Four of 8 (50%) cases only needed rectal washout for three to five days post injection until pull through operation, two had decrease in number of rectal washouts /day and the remaining two underwent colostomy five days post injection because of no response. CONCLUSION: Botulinium toxin injection can help in palliative care in patients with Hirschsprung disease who are waiting for colostomy or definitive pullthrough. It gives an option of eaiser home care for these patients.

Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample.

We evaluated the serum levels of IgG antibodies to Helicobacter pylori, Chlamydia pneumoniae and cytomegalovirus and the level of the inflammatory markers C-reactive protein and fibrinogen in 57 patients with acute coronary syndrome, 65 with unstable angina, 60 with stable angina and 44 healthy controls, and whether these markers were associated with cardiac instability 6 months after admission. acute There was a significant increased risk of late coronary events (cardiac death or readmission with coronary events) associated with seropositivity to C. pneumoniae (adjusted odds ratio 2.12; 95% confidence interval: 1.16-4.08). Other parameters were not significantly associated with late cardiac events after adjustment for age, sex, diabetes mellitus, hypertension, hyperlipidaemia and smoking behaviour.

Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample

We evaluated the serum levels of IgG antibodies to Helicobacter pylori, Chlamydia pneumonia and cytomegalovirus and the level of the inflammatory markers C-reactive protein and fibrinogen in 57 patients with acute coronary syndrome, 65 with unstable angina, 60 with stable angina and 44 healthy controls, and whether these markers were associated with cardiac instability 6 months after admission. There was a significant increased risk of late coronary events [cardiac death or readmission with acute coronary events] associated with seropositivity to C. pneumoniae [adjusted odds ratio 2.12; 95% confidence interval: 1.16-4.08]. Other parameters were not significantly associated with late cardiac events after adjustment for age, sex, diabetes mellitus, hypertension, hyperlipidaemia and smoking behaviour

Does donor's fatty liver change impact on early mortality and outcome of liver transplantation.

BACKGROUND: The effect of donor fatty liver on graft survival is still uncertain. The aim of this study was to determine the influence of steatosis on the outcomes of OLT among our recipients. METHODS: In this retrospective study, we evaluated the effect of donor liver steatosis on postoperative liver function and prognosis. Data obtained from liver transplantation data registry of our organ transplant center. Liver biopsies taken before transplantation were reviewed by two pathologists. Pathology reports were divided into four groups: normal pathology; mild fatty change (10%-30%); moderate (30%-60%); and severe steatosis (>60%). Livers with severe steatosis were excluded from transplantation. Factors determining transplantation outcome, such as early mortality, duration of intensive care unit (ICU) and hospital stay, clinical rejection episodes, and graft surgical complications, were compared between subjects who received donor liver, with various degrees of steatosis. RESULTS: Three-month survival rates in recipients without donor liver fatty change, subjects with mild fatty change (10%-30%) and those with moderate (30%-60%) steatosis were 68%, 72%, and 76%, respectively, which were not significantly different (P>.05). Furthermore, short-term (hospital) mortality (20%, 14.3%, and 21.2%), hospital stay (30.89, 29.93, and 23.62 days), and length of ICU admission (5.06, 5.89, and 4.39 days) were not significantly different. In addition, Child score of recipients, pre- and postoperative liver function enzyme changes were similar. CONCLUSION: Mild-to-moderate (up to 60%) liver fatty change was not found to be associated with a worse prognosis in OLT.

Comparison of early outcome and histologic findings of enteric drainage with bladder drainage in pancreas transplantation of dogs.

BACKGROUND: The clinical and pathological findings of enteric-drained (ED) versus bladder-drained (BD) pancreas transplantation are still controversial. In this study, we compared early outcome and histological findings of these 2 methods. METHODS: In an experimental animal model, after diabetization, 16 dogs were randomly divided into 2 groups. In the first group, the pancreas was transplanted with enteric drainage, and in the second group, with bladder drainage. We evaluated early clinical and pathological outcomes. RESULTS: The mean survival time was 11.25 +/- 5.0 (range, 5-20) days for group 1 and 13.6 +/- 7.2 (range, 3-23) days for group 2 (P>.05). Fasting blood sugar values (FBS) before transplantation were 279 +/- 26.8 mg/dL versus 278 +/- 41.6 mg/dL, respectively (P>.05). Two weeks postoperative serum FBS had decreased to 84.9 +/- 2.9 versus 84.2 +/- 0.98, respectively (P>.05). Serum amylase in the BD and ED groups were 378.5 +/- 328 versus 422.6 +/- 54.7 mg/dL, respectively (P>.05). Early leakage was not observed in dogs with BD, whereas it was 37.5% among dogs with ED (P<.05). Clinical and pathological evidences of pancreatic necrosis occurred in 37.5% of dogs with BD versus 62.5% of dogs with ED (P>.05). DISCUSSION: Although the early outcomes of these drainage methods (ED vs BD) were statistically similar more dogs with ED experienced early complications than with BD.

The metabolic syndrome in hypertensive and normotensive subjects: the Isfahan Healthy Heart Programme.

INTRODUCTION: There are numerous correlations between hypertension and the metabolic syndrome, although this is not always the case. The objective of this study was to compare the prevalence of the metabolic syndrome and its different phenotypes among hypertensive and normotensive subjects. MATERIALS AND METHODS: This cross-sectional study was performed on a representative sample of adults living in 3 cities in Iran. Among the 12,514 subjects selected by multi-stage random sampling, 1736 (13.9%) were hypertensive. The prevalence of the metabolic syndrome [according to the Adult Treatment Panel (ATP) III criteria] was significantly higher in hypertensive than normotensive subjects (51.6% versus 12.9%, respectively; OR, 7.15; 95% CI, 6.4 to 7.9). The metabolic syndrome was more prevalent in normotensive and hypertensive subjects living in urban areas than those living in rural areas (14.2% and 53.9% versus 9.5% and 45.6%, respectively, P < 0.05). The mean age of hypertensive subjects, with or without the metabolic syndrome, was not significantly different (55.7 +/- 12 years versus 55.4 +/- 15.5 years, P = 0.6). Hypertension with the metabolic syndrome was more prevalent in women than men (72% versus 28% respectively, P < 0.000), and in subjects living in urban areas than those in rural areas (75.1% versus 24.9%, respectively, P = 0.002). CONCLUSION: The findings of this study indicate the need for metabolic screening in all hypertensive patients, and emphasise the importance of promoting primary and secondary prevention of high blood pressure and associated modifiable risk factors in order to counter the upcoming epidemic of non-communicable disease in developing countries.

Smoking, adolescents and health: Isfahan healthy heart programme-heart health promotion from childhood.

To evaluate the effect of some environmental factors on smoking, and to assess some health hazards of smoking in adolescents, this cross-sectional study was performed among 1950 students, agesll-18, selected by multi-stage random sampling from three cities in Iran. According to self-administered questionnaires, 12.9% of boys and 4% of girls reported to be smoker (OR = 3.34, 95% CI: 2.33, 4.77, p < 0.001). The mean values of total- and LDL-cholesterol were higher in smokers and their HDL-C was lower than non-smokers (163.33 +/- 33.83, 90.73 +/- 31 and 46.7 +/- 12.24 vs. 156 +/- 29.53, 85 +/- 26.5 and 49.4 +/- 13.7 mg/dl, respectively, p < 0.05). The mean systolic and diastolic blood pressures were higher in smokers than non-smokers (110.7 +/- 14.5, 67.6 +/- 11.55 vs. 104.9 +/- 14.3, 63.2 +/- 10.8 mmHg, respectively, p < 0.05). The smokers had higher BMI than non-smokers (20.34 +/- 3.84 vs. 19.55 +/- 3.66, p < 0.05). The mean food consumption frequency was lower for fruits and vegetables and higher for fat/salty snacks and fast foods in smokers than non-smokers. Logistic regression analysis showed significant association between sex, age, the number of family members and number of smokers in the family and smoking in students. The findings of this study have implications for future tobacco prevention strategies through community-based interventions.

Sildenafil (Viagra): is there an influence on psychological performance?

BACKGROUND: Sildenafil (Viagra) is a well-introduced medicine for erectile dysfunction; many studies about effects and side effects are published. Beside these aspects of treatment the influence of sildenafil on psychophysical performance is of interest. cGMP is one of the most important second messengers in the central nervous system (CNS), so even very small changes of the intracellular cGMP-level caused by phosphodiesterases inhibition may be relevant for CNS-function. We wanted to verify the hypothesis whether sildenfail influences human psychomotor performance, especially under the aspect of traffic safety, or not. METHODS: Designed as a pilot study we tested 6 male healthy volunteers using a test battery of 7 different psychophysical performances tests. Each individual did the test battery twice, once without drug and once after a single oral dose of 100-mg sildenafil. 3 persons did the first and 3 others did the second experiment under the influence of drug (UID). All results (37 parameters) were analysed by t-test for paired samples using a confidence interval of 95%. RESULTS: Only two parameters of 2 different tests showed significant differences. In the simple choice reaction test (DR2) the mean reaction time got better in the group with sildenafil; in the multiple choice reaction test with stress induction (RST3) the amount of wrong answers indicated a weak influence of performance without statistical significance, six parameters (dominantly in the speed anticipation test (DEST)) represented an increase and one other (RST3 second part) showed a decrease UID. The uppermost parameters (76% of all items) stayed on equal levels for both groups. CONCLUSION: Sildenafil showed no important impairment of psychophysical performance, no strong improvement was found as well. With a look at the therapeutically indication of sildenafil the improvement in sexual activity may indicate no incapacity in traffic and other psychomotoric/psychophysical functions.

Localization of constitutive nitric oxide synthase isoforms and the nitric oxide target enzyme soluble guanylyl cyclase in the human bladder.

PURPOSE: Nitric oxide is a free radical gas synthesized from L-arginine by a family of isoenzymes called nitric oxide synthase that has an important role in smooth muscle relaxation. L-arginine, the substrate for nitric oxide synthase, may be beneficial under pathophysiological conditions in the bladder, as in interstitial cystitis. We determined the localization of nitric oxide synthase and the target enzyme of NO, soluble guanylyl cyclase, in the human bladder. MATERIALS AND METHODS: Benign bladder tissues were obtained from 18 patients with localized superficial bladder tumors undergoing transurethral bladder resection. Histochemical nicotinamide adenine dinucleotide phosphate-diaphorase staining, nitric oxide synthase immunohistochemical testing and soluble guanylyl cyclase immunoreactivity studies were performed in all benign tissue specimens. RESULTS: A different pattern of nitric oxide synthase expression was confirmed by nicotinamide adenine dinucleotide phosphate-diaphorase staining and immunohistochemical testing for endothelial and neuronal nitric oxide synthase. In addition to endothelial nitric oxide synthase expression, detrusor smooth muscle was recognized as an important location of endothelial nitric oxide synthase, while the urothelium had only small endothelial nitric oxide synthase positive cell clusters. Neuronal nitric oxide synthase expression was only found in nitrinergic fibers of the submucosal surface and between muscle cells. Detrusor and vascular smooth muscle as well as interstitial cells, nerve fibers and transitional epithelium were recognized as targets of nitric oxide, as shown by soluble guanylyl cyclase expression. CONCLUSIONS: The distribution of constitutive nitric oxide synthase isoforms and soluble guanylyl cyclase provides evidence of nitric oxide-cyclic guanosine monophosphate mediated regulation of detrusor smooth muscle relaxation, neurotransmission and blood flow. Furthermore, the urothelium may also be a target of nitric oxide.

Perceptions of change in the health care industry.

Cost containment, governmental regulations, and managed care are leading factors driving change in the delivery of health care services. Job insecurity and stress are frequently felt by the allied health professional in times of such change. This investigation measured the perceptions of change in the health care industry. A survey tool measuring attitudes and beliefs about the state of health care was distributed to health professionals in Arkansas. Voluntary responses were coded using a four-point Likert scale. Data were processed from an overall response rate of 34.6% (n = 203) using descriptive frequencies, analysis of variance (ANOVA), and a post-hoc Scheffé test to determine significances of differences between professional groups. Differences were found between professional groups' perceptions of the overall quality of health care, job security, and having a sense of control to positively impact the future of health care. When dealing with changes, professionals must maintain a balance of ethics and efficacy. They need to be agents of change, promoting quality and efficiency. Their role should be to shape health care, not simply to react to change.