Endoscopic thoracic sympathotomy for primary hyperhidrosis: predictors of outcome over a 10-year period.

BACKGROUND: Endoscopic thoracic sympathectomy/sympathotomy is gold standard of treatment for primary hyperhidrosis. Compensatory hyperhidrosis following surgery and partial response to surgery in some patients can significantly affect surgery outcome and patient satisfaction. In this study we investigated predictors of success rate, side effects, and satisfaction of our patients following ETS over a 10-year period. METHODS: We retrospectively reviewed result of 200 Endoscopic thoracic sympathotomy surgeries that was performed in a single center to treat craniofacial, palmar, or axillary primary hyperhidrosis over a 10-year period. Patients were asked to report success of surgery to resolve their primary hyperhidrosis, development of compensatory hyperhidrosis, its severity, and their overall satisfaction with surgery. RESULTS: Palmar hyperhidrosis was resolved in 167 (94%) patients. Craniofacial hyperhidrosis was resolved in 66 (84%) patients. Axillary hyperhidrosis was resolved in 68 (50%) patients. Compensatory hyperhidrosis developed in 176 (88%) patients. 44 (22%) patients had mild CHH, 79 (40%) patients developed moderate CHH, and 52 (26%) patients experienced severe CHH. A total of 173 (87%) patients were satisfied with surgery. 19 (9%) patients were not satisfied with ETS and 8 (4%) patients regretted ETS. Lower body mass index and grade IV primary hyperhidrosis were found to be independent predictors of patient satisfaction. Pure axillary primary hyperhidrosis was a negative predictor of patient satisfaction. CONCLUSION: Best results of ETS are achieved in patients with grade IV PHH and lower body mass indexes. Outcome of ETS for treating axillary PHH is not favorable.

Reliability and Educational Value of Laparoscopic Sleeve Gastrectomy Surgery Videos on YouTube.

INTRODUCTION: Many surgery videos can be found in different social networks and video sharing websites. Watching surgeries performed by different surgical experts of various institutions can be an invaluable supplement to traditional methods of learning surgery. YouTube is a quite popular video sharing website, and many surgeons and trainees refer to it as a source of surgery videos. However, since its content is not peer-reviewed, there is a concern over reliability and educational value of its surgical videos. In this study, we aimed to investigate the reliability and educational value of laparoscopic sleeve gastrectomy (LSG) videos on YouTube. METHODS: We searched YouTube for videos of "Laparoscopic sleeve gastrectomy" on 20 July 2018. In order to assess videos, we evaluated ten key steps in laparoscopic sleeve gastrectomy. The videos were reviewed by two experienced surgeons in the field of bariatric surgery to determine their reliability. RESULTS: A total of 74 videos were selected. After reviewing videos, 32 (43%) of them were considered as reliable. There was no relationship between reliability and views, likes, dislikes, resolution, and year of upload and affiliation of videos. Only 6 (8% of all) reliable videos showed operation setup and port placement and included voice commentary. CONCLUSION: Importance of online media in the education of surgery cannot be overestimated. However, trainees are advised to search for peer-reviewed contents dedicated to education.

Comparing the effectiveness of fractional CO2 laser and the combination therapy with micro-needling and topical 10% trichloroacetic acid to remove infra-orbital dark circles in Tehran women.

BACKGROUND: Infra orbital dark circles are now recognized as being a cosmetic problem that should be considered in treatment issue. The present study aimed to assess and compare the clinical efficiency of the combination of micro-needling and 10% trichloroacetic acid (TCA) cream as well as carbon dioxide laser in the management of infra-orbital dark circles. METHODS: This randomized clinical trial was performed on women aged 28-62 years who complained of infra-orbital dark circles. The patients were randomly assigned to be treated with micro-needling combined with 10% TCA cream topically or CO2 laser. The treatment period in each group included three sessions with an interval of one month between sessions. The assessment was based on both subjective and objective methods. RESULTS: the mean of ΔE (the difference in the intensity of darkening at infra-orbital points and other points of the face) was significantly higher in the laser group than in the other group in all sessions. The patients who were treated with laser were found to have a higher level of satisfaction in the fifth visit when compared to those who received the other treatment method. CONCLUSION: Regarding clinical effectiveness and the patients' compliance, fractional CO2 laser was more preferred in the combination therapy with micro-needling and topical TCA for removing infra-orbital dark circles.

Mucoromycosis and Wegner's Granulomatosis: A Case Report.

Wegener's granulomatosis is a rare vasculitis affecting the upper and lower respiratory tracts and kidneys. The cornerstone of treatment in these patients is immunosuppressive therapy, which may predispose the patient to super-infections such as fungal diseases per se. However, the fungal infection mimics the clinical manifestations of Wegener's diseases would lead to neglected course of the infection and subsequent morbidity and mortality especially if unusual organs are involved. Here we report a 21-yr-old female patient referred to a hospital, Tehran, Iran in 2013 with a neglected skin mucormycosis and the course of the disease and outcome with Wegener's granulomatosis.

Efficacy of Botox versus Placebo for Treatment of Patients with Major Depression.

BACKGROUND: Treatment of major depression is crucial to decrease the burden of disease. Hence, in this study, the efficacy of Botox was compared with placebo for treatment of patients with major depression. METHODS: In this randomized clinical trial, 28 consecutive patients with major depression were enrolled. The patients were randomly assigned to receive either Botox or placebo and the scores of Beck Depression Inventory were determined and compared at baseline and after two and six weeks in the groups and between the groups. In addition, the drug adverse effects were compared between groups. This study had been registered in TCTR with TCTR20170409001 code. RESULTS: There was a statistically significant difference two group for 6th week Beck Score (P=0.004), but at baseline and after two weeks, there was no significant difference (P>0.05). None of the patients experienced side effects. CONCLUSION: Finally, Botox is effective for treatment of patients with major depression and it has a high safety.

Drug-induced skin reactions: a 2-year study.

BACKGROUND: The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. METHODS: The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007-2009). In 84 cases, histopathologic examination of skin biopsies were also performed. RESULTS: Patients with drug reactions were found to be more commonly female (63%) than male (37%). Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most common clinical presentation (59.2%) followed by fixed drug eruptions (18.5%), and maculopapular eruptions (14.9%). CONCLUSION: Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes.

Efficacy of intralesional injection of mumps-measles-rubella vaccine in patients with wart.

BACKGROUND: In the previous studies, it has been shown that mumps-measles-rubella (MMR) vaccine resulted in regression of warts via immunomodulatory effect and induction of immune system. Due to the high prevalence of warts in various populations, we evaluated the efficacy of MMR vaccine injection in the treatment of cutaneous warts. MATERIALS AND METHODS: This double-blind randomized controlled clinical trial was conducted in Hazrat-e-Rasoul Hospital in Tehran in 2011-2012 on 24 patients with warts who were allocated to two groups including MMR group and normal saline group. MMR vaccine was injected intralesionally in the MMR group, whereas normal saline was injected into the lesions in the second group. These injections were repeated every 2 weeks intervals for maximum 3 injections. All patients were followed up every 15-day interval up to 45 days and then up to 6 months regarding relapses and finally, side effects, probable relapse, and therapeutic outcomes were evaluated and compared. RESULTS: At the end of follow-up period, therapeutic outcomes in the MMR group included no cure in 2 cases, relative cure in 4 cases, and complete cure in 18 cases. In normal saline group, these rates included no cure in seven cases, relative cure in nine cases, and complete cure in six cases (P < 0.001). No significant complication occurred in the two groups. CONCLUSION: MMR vaccine may result in desirable therapeutic response. The hypothesis that is considered here is that MMR vaccine, via induction of cellular and humoral immune system, accelerates the destruction of virus and infected host cells.

Should variation of serum lipid levels be considered a risk factor for the development of basal cell carcinoma?

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm in human beings. Ultraviolet radiation is one of the most important predisposing factors for BCC. Although some recent investigations have shown a high serum level of phospholipids in actinic keratosis and BCC, this subject is still debated and needs approval. This study aimed to evaluate the association between serum lipid level and development of cutaneous BCC. MATERIALS AND METHODS: In this case-control study, lipid profile including triglyceride (TG), Cholesterol (CHOL), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were measured in 30 patients with BCC and 30 healthy controls. Data were analyzed by descriptive statistical tests including t tests and Chi square test. RESULTS: This study shows that the mean age of the case and control groups were 63.93 ± 12.09 and 61.57 ± 21.1 years (mean ± SD), respectively. The average amount of triglyceride, cholesterol, HDL and LDL in the BCC patients were 139.73 ± 69.11 mg/dl, 179.20 ± 43.42 mg/dl, 39.40 ± 9.30 mg/dl and 110.70 ± 34.13 mg/dl, respectively, whereas these amounts in the control group were 141.83 ± 80.41 mg/dl, 173.60 ± 96.32 mg/dl, 36.97 ± 6.35 mg/dl, 110.70 ± 34.13 mg/dl and 104.87 ± 30.85 mg/dl, respectively. No significant difference was found in the lipid profile of the case and control groups (P > 0.05%). CONCLUSION: This study shows that the serum lipid levels in patients with BCC has no significant difference in comparison with the control group and, therefore, relevance between BCC and serum lipid level is not proven. Further studies with a larger sample size are necessary for evaluating this subject.

Leech therapy for epidermoid cysts and review of the literature.

UNLABELLED: Hirudo medicinalis sucks blood directly through the external mammalian skin. We recently observed a healthy 64-year-old Iranian man, who presented with numerous asymptomatic multilobular oval-to-round well-defined 0.5 to 1.5 cm cystic lesions with central umbilication (central black eschar) over the upper portion of his chest. We made the diagnosis of epidermoid cyst, giant comedone and leech bite on the basis of the constellation of clinical features. The patient was treated with oral ciprofloxacin at a dose of 2 g daily, and 2% topical erythromycin solution. Despite improvement, the evidence of cystic lesions persisted. There was no history of similar lesions in any other family member. There was no history of trauma. The patient was not using any topical or systemic medication. Two weeks before his visit, he had a history of leech therapy under the supervision of a general practitioner. His medical history was significant for leech therapy of the lesions, five days previously. He was followed up for another two weeks and after disappearance of the inflammation, with the patient under local anesthesia, the well-circumscribed mass was completely evacuated with a sharp curette and comedone extractor. The patient was subsequently lost to follow-up. CONCLUSION: Considering the efficacy of leeches, it would be favorable to breed a germ-free leech. In Iran, the use of the leeches in surgery, in recent years, has been infrequent. It appears that the positive effects of this ancient remedy may now be explained through scientific methods, promising potentially even more uses of this admirable creature in medicine.

Glucose and fluoxetine induce fine structural change in human serum albumin.

Human serum albumin has been used as a model protein for protein folding and ligand binding studies over many decades. Due to its long life period and high concentration in plasma, HSA is highly sensitive to glycation. It is reported that 175 mg/dL glucose concentration is a threshold of kidney activity for the beginning of excretion of glucose. pH denaturation of HSA in absence and presence of different concentrations of glucose is studied and based on the Pace two-state model, the findings are analyzed. In addition, florescence emission data of albumin range in the period of 300-500 nm was depicted. The amounts of free energy change and [D]1/2 parameters of unfolding in correspond to florescence date indicate that glucose induces fine structural change in human serum albumin. Results showed that 175 mg/dL glucose concentration is a critical point for albumin structural and functional alteration.

Pachydermodactyly, a new case from Iran.

Pachydermodactyly (PDD) is a rare form of benign digital fibromatosis involving the proximal portion of lateral sides of fingers. It is characterized by asymptomatic and symmetrical soft tissue swellings of the radial and ulnar aspects of proximal PIP joints of second to fifth fingers. Herein we report a 15-year-old boy with this condition.

Clinical and histopathologic study of pilomatricoma in Iran between 1992 and 2005.

Pilomatricoma (calcifying epithelioma of Malherb) is a tumor of hair follicle matrix cells and is almost always benign. In this study we reviewed the clinical and histopathological features of 45 cases of pilomatricoma during 13 years (1992-2005). Although few malignant transformations have been reported in other studies, no evidence of malignancy or aggressiveness is observed in this study.

Neoplastic skin lesions in Iranian renal transplant recipients: the role of immunosuppressive therapy.

BACKGROUND: Immunosuppressive therapy is believed to be one of the most important risk factors in the development of skin cancer in renal transplant recipients. OBJECTIVE: Our purpose was to determine the types of neoplastic skin lesions encountered in Iranian renal transplant recipients and their associations with immunosuppressive regimens. METHODS: The entire bodies of renal transplant recipients attending an outpatient transplantation department were examined. RESULTS: Neoplastic skin lesions were diagnosed in 13.1% of the renal transplant recipients. Actinic keratoses, squamous cell carcinomas, and basal cell carcinomas were the most common neoplastic skin lesions observed. Transplant recipients exposed to immunosuppressive therapy for more than 5 years have a significantly higher risk of developing skin cancers than recipients with less than 5 years of immunosuppressive therapy. CONCLUSIONS: Our study confirmed the relatively high prevalence of neoplastic skin lesions among renal transplant recipients in the Iranian population.

Acute febrile neutrophilic dermatosis (Sweet's syndrome): a study of 15 cases in Iran.

BACKGROUND: Sweet's syndrome is well recognized by dermatologists and is not infrequently diagnosed in Iran; however, few case series have been reported. METHODS: A clinicopathologic study was carried out on 15 cases of Sweet's syndrome in Hamedan, in the west of Iran, between 1994 and 2004. RESULTS: The incidence of Sweet's syndrome was 3 per 10,000 amongst new dermatologic patients. All were women with a mean age of 58 years. All 15 cases were of the classic type, with no associated diseases. Fever was seen in only six (40%) patients. CONCLUSIONS: Sweet's syndrome has a broad spectrum of clinical and pathologic findings in various areas of the world. Further investigation is necessary to determine the etiology and effect of environmental factors in this disease.

A 10-year study of squamous cell carcinoma in Hamedan in the west of Iran (1993-2002).

BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer in Caucasians. Environmental factors, especially sunlight, play an important role in its pathogenesis. Aim To better define the frequency and characteristics of SCC in patients biopsied at Hamedan Sina Hospital in the west of Iran. METHODS: This descriptive cross-sectional study was carried out in patients diagnosed with SCC in the Department of Dermatology, Hamedan Sina Hospital, Hamedan, Iran, in the 10-year period from 1993 to 2002. RESULTS: From a total of 6846 biopsies, 669 skin cancers were diagnosed, including 449 (66.67%) basal cell carcinomas (BCC) and 179 (26.76%) SCC. The head and face were the most common sites of SCC location. Farming was the most common occupation. CONCLUSION: SCC is the second most common form of skin malignancy in the west of Iran. Sunlight may play a role in the etiology of this tumor.

Skin diseases in kidney transplant recipients.

INTRODUCTION: The aim of this study was to evaluate the frequency of skin diseases in kidney transplant recipients. MATERIALS AND METHODS: This cross-sectional study was performed on 233 kidney transplant recipients in Ekbatan Hospital of Hamedan in 2004. The patients were examined by a dermatologist and diagnosis was made on the basis of clinical observations. Biopsies and scraping of the lesions were taken whenever necessary. RESULTS: Of the patients, 226 (97%) suffered from one or more skin lesions. The most common lesions were drug related, including hypertrichosis, gingival hyperplasia, acne, and cushingoid feature which were detected in 86.7% of the patients. Also, infectious and premalignant or malignant lesions (actinic keratosis, squamous cell carcinoma, and basal cell carcinoma) were seen in 48.9% and 14.2% of the patients. The mean duration of immunosuppressive therapy was significantly higher in patients with infectious skin diseases (P < .001). CONCLUSION: Skin lesions are a significant problem in kidney transplant recipients. A careful monitoring of these patients is recommended in order to detect these lesions in early stages and treat them.