Acute and chronic pathological effects of sulfur mustard on genitourinary system and male fertility.

PURPOSE: To review the acute and chronic pathological effects of sulfur mustard on the genitourinary system and male fertility. MATERIALS AND METHODS: We searched PubMed and Google Scholar to find studies related to the sulfur mustard-induced genitourinary effects and male infertility. Information in the abstracts of non-English related papers as well as those in the proceedings of congresses on sulfur mustard were reviewed as well. RESULTS: In acute phase after sulfur mustard exposure, evidences are in favor of microscopic and macroscopic renal lesions, very low androgen levels, and impaired spermatogenesis. Several years following sulfur mustard exposure, the long-term pathological effects vary from the renal function impairment to the gonadal damage, in particular the spermatogenesis. Nevertheless, carcinogenic effect of sulfur mustard on the genitourinary system as well as the prevalence of male infertility among sulfur mustard-exposed veterans in the chronic post-exposure phase is still unclear. CONCLUSION: Sulfur mustard causes both acute and chronic injuries to different parts of the genitourinary system.

Prevalence and risk factors of hepatitis B infection among hemodialysis patients in Tabriz: a multicenter report.

Hepatitis B virus (HBV) infection is an important issue in hemodialysis. Risk factors and local prevalence varies between different regions. The current study was undertaken to determine the prevalence of HBV infection and its associated risk factors among hemodialysis patients from five hemodialysis centers in Tabriz, a Northwestern Iranian city. Hepatitis B serologic markers were evaluated in chronic hemodialysis patients. Patients (n = 412) were divided into two groups: Group 1--patients with positive hepatitis B surface antigen (HBsAg) and Group 2--patients with negative HBsAg. The median age was 54.9 years (range, 13-90 years). Thirteen patients (3.2%) were found to be positive for HBsAg. Among the studied factors, the history of war injury was significantly associated with the risk of HBV infection (P = 0.023). In conclusion, our study shows that the risk of HBV infection among Tabrizian hemodialysis patients is a factor of dialysis-independent parameters.

Anatomy in ancient India: a focus on the Susruta Samhita.

This review focuses on how the study of anatomy in India has evolved through the centuries. Anatomical knowledge in ancient India was derived principally from animal sacrifice, chance observations of improperly buried human bodies, and examinations of patients made by doctors during treatment. The Vedic philosophies form the basis of the Ayurvedic tradition, which is considered to be one of the oldest known systems of medicine. Two sets of texts form the foundation of Ayurvedic medicine, the Susruta Samhita and the Charaka Samhita. The Susruta Samhita provided important surgical and anatomical information of the understanding of anatomy by Indians in the 6th century BCE. Here we review the anatomical knowledge known to this society.

Varicella-zoster virus reactivation from multiple ganglia: a case report.

INTRODUCTION: Simultaneous involvements of multiple cranial nerve ganglia (geniculate ganglion and peripheral ganglia of cranial nerves VIII, IX and X) by varicella-zoster virus and its subsequent activation may result in the characteristic eruptions of herpes zoster cephalicus. Coexistence of facial palsy and involvement of upper cervical dermatomes by varicella-zoster virus is quite rare. CASE PRESENTATION: Here, we report a 71-year-old Iranian man with involvement of multiple sensory ganglia (geniculate ganglion and upper dorsal root ganglia) by varicella-zoster virus. He presented with right-sided facial weakness along with vesicular eruptions on the right side of his neck, and second and third cervical dermatomes. CONCLUSION: The present case is an example of herpes zoster cephalicus with cervical nerve involvement. Although resembling Ramsay Hunt syndrome with presence of facial nerve paralysis and accompanying vesicles, involvement of cervical dermatomes is not a feature of the classic Ramsay Hunt syndrome.

Renal involvement in Behcet's disease.

There are conflicting reports about the renal involvement in Behcet's disease (BD). In this study we aimed to study the frequency and type of renal involvement in a group of patients with BD in Azerbaijan province that is one of the prevalent areas of BD in Iran. All cases of BD were prospectively followed between June 2004 and January 2007, and evaluated for renal dys-function (serum creatinine > 1.7 mg/dL), glomerular hematuria and proteinuria. Those patients with proteinuria > 500 mg/day and serum creatinine level > 2 mg/dL, underwent renal biopsy. From a total number of 100 patients, six patients (6%) had obvious renal involvements. Four patients had glomerular hematuria and proteinuria. Renal biopsy in two of them revealed measangial proliferative glumerulonephritis with IgA deposit in one of them and membranoproliferative glumerolonephritis in another one. Two remaining patients had serum creatinine > 2 mg/dL without any hematuria or proteinuria. Serologic study for viral agents and collagen vascular disease were negative in all patients with renal involvements. In conclusion, renal involvement in BD is not infrequent, although in most cases it is mild in nature and may be missed.

The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula.

INTRODUCTION: Anastomotic leakage and respiratory complications are among the most common and potentially life-threatening complications following the surgical repair of esophageal atresia. Controversies exist regarding the efficacy of prophylactic extrapleural chest tube (EPCT) drainage in patients who have undergone repair of esophageal atresia. MATERIALS AND METHODS: In this prospective study, 50 newborns with esophageal atresia and distal tracheoesophageal fistula (EA-DTEF) were randomized into two groups, with no significant differences regarding gender ratio, birth body weight and delivery status. Group 1 (n = 29) underwent a right thoracotomy and a single-stage extrapleural esophageal anastomosis. Group 2 (n = 21) received additionally an intraoperative EPCT next to the anastomosis. These groups were then compared with regard to postoperative respiratory complications (such as respiratory distress, pneumonia, pneumothorax, lung collapse, and apnea), anastomotic leakage, need for mechanical ventilation, time on mechanical ventilation, and outcome. Statistical analyses were performed with Mann-Whitney U test, Fisher's exact test, and binary logistic regression analysis. RESULTS: The rates of respiratory complications and anastomotic leakage, need for mechanical ventilation, time on mechanical ventilation, and mortality rate were comparable between the two groups (P > 0.05). Mortality was associated with respiratory complications (P = 0.003) and anastomotic leakage (P = 0.007). CONCLUSION: It seems that prophylactic EPCT drainage does not decrease the early postoperative respiratory complications and mortality rates in newborns with EA-DTEF.

Radiological findings in renal tuberculosis: a report from northwest of Iran.

Tuberculosis (TB) of the kidney and urinary tract has non-specific symptoms and is easily overlooked. We performed this retrospective study to analyze different findings on excretory urography (IVP) of patients with renal TB. The IVP slides of 25 patients (14 females/11 males, age range 12-63 years) with renal TB diagnosed over a 20-years period were studied for the presence of characteristic findings. They included: renal parenchymal mass, autonephrectomy, hydronephrosis, ureteral stricture and dilatation, and bladder involvement and fibrosis. In our study, the most common findings were ureteral stricture and dilation (13/25, 52%), bladder involvement 13/25 (52%), autonephrectomy 12/25 (48%) and renal parenchymal calcification 10/25 (40%). The most common combined pattern was ureteral stricture-dilation with contralateral autonephrectomy and bladder irregularities. We conclude that kidney TB remains undiagnosed until the advanced stages and awareness about the IVP imaging pattern could help in early diagnosis of this entity.

Factitial pemphigus-like lesions.

The maxillofacial region is rarely subjected to self-inflicted conditions such as factitious disease. Nasal ulceration, facial emphysema, periorbital ecchymosis, mandibular subluxation, gingival and mucosal ulceration, dental and salivary gland pain and glossopharyngeal neuralgia have been reported as possible manifestations of factitious disease. We report a case of a young woman who presented with unilateral bullous and ulcerative oral and erythematous facial lesions that were initially diagnosed as pemphigus vulgaris but was later determined to be secondary to self-inflicted injuries. To the best of the authors knowledge, this clinical scenario has not been previously reported in the context of a factitious disease and, therefore, may be considered in the differential diagnosis of oral vesiculobullous disorders.

Unusual origins of accessory pericallosal arteries in man: case report.

The authors report an adult individual found to have very unusual origins of additional left and right pericallosal arteries that are normally only branches of the anterior cerebral artery. These vessels both arose from the vertebrobasilar system. The right accessory pericallosal artery was found to originate from the ipsilateral posterior inferior cerebellar artery and the left accessory pericallosal artery was found to originate from the ipsilateral posterior cerebral artery. To our knowledge, this variation has not been previously reported. The embryological and surgical implications of this finding are discussed.

Multiple myeloma presented as acute interstitial nephritis and rheumatoid arthritis-like polyarthritis.

Acute interstitial nephritis and rheumatoid arthritis (RA) or RA-like polyarthritis are among the very rare paraneoplastic manifestations of multiple myeloma (MM). A 47-year-old man with acute renal failure due to interstitial nephritis was admitted to our university hospital and successfully treated with corticosteroid. He later developed a symmetric distal polyarthritis with morning stiffness mimicking RA. On follow-up, the patient had a rise in serum creatinine, hypercalcemia, anemia, and a monoclonal spike (Bence Jones protein) on the urine protein electrophoresis. Bone marrow biopsy demonstrated a diffuse neoplastic plasma cell infiltration. Diagnosis of MM was made and the patient received chemotherapy. After four-course chemotherapy, the patient's articular manifestations resolved, urine monoclonal spike disappeared, and serum creatinine returned to a near normal level. We hypothesize that in this case, immunologic hypersensitivity reactions to the light-chain molecules or other tumoral antigens deposited within the kidney or joint spaces, in the context of MM cytokine milieu may have resulted in this unusual presentation. Ultimately, clinicians and pathologists should consider MM in the differential diagnosis of the acute interstitial nephritis and RA-like polyarthritis.

The First Year Medical Students' Perception of and Satisfaction from Problem-based Learning Compared to Traditional Teaching in Gross Anatomy: Introducing Problem-based Anatomy into a Traditional Curriculum in Iran.

Problem-based learning (PBL) is still a controversial teaching method. A study of the effectiveness of PBL compared to traditional teaching in gross anatomy courses of first year medical students was evaluated by comparing the examination performances and student's responses to the questionnaires. It was hypothesised that the PBL method would result in improved scores and satisfaction for students. A total of 89 first year medical students at Tabriz Medical University, Iran were taught gross anatomy with traditional teaching for one half of a semester and PBL for the other one half. Examination scores from both methods and an assessment of completed questionnaires were evaluated by the present study. The PBL method resulted in better examination scores than did traditional teaching for the same students. Students were more satisfied with PBL and believed that this method increased their problem solving abilities. Our study found that PBL was more successful than traditional teaching of gross anatomy.

Ansa cervicalis as a variant of spinal accessory nerve plexus: a case report.

The ansa cervicalis is a neural loop in the neck formed by the union of two main nerve roots, namely superior and inferior roots, derived from ventral rami of the cervical nerves. With the expanding use of the ansa cervicalis for reinnervation procedures and the fact that it is located in the vicinity of major nerves and vessels of the neck, knowledge of the topography and morphology of this loop is quite necessary in the modern era. Any variation in the course, contributing roots or branching pattern of the ansa cervicalis, potentially alters and perhaps complicates the course of the procedures involving this nerve such as neurorrhaphy, skull base surgery, neck dissection, and anterior cervical spinal approach. Here, we present an unusual case of an ansa cervicalis encountered upon routine dissection of an adult male cadaver. In this case, the inferior root of the ansa cervicalis was formed by the joining of two rootlets, one originating from spinal accessory nerve and the other from a branch of the cervical plexus to the sternocleidomastoid muscle. The fibers traversing the branch of spinal accessory nerve were derived from the first segments of the cervical spinal cord. This case demonstrates a variant of the spinal accessory nerve plexus that contributed to the formation of the ansa cervicalis. Review of the literature was performed to reveal the possible clinical aspects of this anatomical variation.