Effect of Adding Intravenous Somatostatin to Rectal Indomethacin on Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis in High-risk Patients: A Double-blind Randomized Placebo-controlled Clinical Trial.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has an important role in the treatment of pancreaticobiliary disorders. GOALS: Considering the high prevalence and importance of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) and the controversial findings, we aimed to determine the effect of adding intravenous somatostatin to rectal indomethacin on the incidence of PEP in high-risk patients. STUDY: In this prospective study, 530 patients underwent ERCP during March 2018 and February 2019. Patients were randomized into 2 groups. The intervention group received a bolus injection of 250 µg somatostatin followed by an infusion of 500 µg of somatostatin for 2 hours. In both groups, 100 mg of pre-ERCP suppository indomethacin was administrated. All patients were screened for PEP symptoms and signs for 24 hours after ERCP (Iranian Registry of Clinical Trials code: IRCT20080921001264N11). RESULTS: A total of 376 patients were finally analyzed. PEP was the most common adverse event with 50 (13.2%) episodes, including 21 (5.5%) mild, 23 (6.1%) moderate, and 6 (1.2%) severe. The rate of PEP was 15.2% in the control group and 11.4% in the intervention group ( P =0.666). The incidence of post-ERCP hyperamylasemia was 21.7% in the control group and 18.2% in the intervention group ( P =0.395). No death occurred. CONCLUSIONS: In this study administration of somatostatin plus indomethacin could safely reduce the rate of post-ERCP hyperamylasemia and PEP in the intervention group compared with the control group, but the differences were not significant. Further studies with larger sample sizes are required.

Catalase-negative Staphylococcus aureus isolated from a diabetic foot ulcer.

We report a catalase-negative Staphylococcus aureus isolated from a 56-year-old male diabetic patient with foot ulcer who attended our surgery ward. Species identification was confirmed by Gram staining, standard biochemical tests and PCR amplification of the nuc and fem genes. Antibiotic susceptibility showed that the strain was sensitive to imepenem, chloramphenicol, amoxicillin, vancomycin and resistant to oxacillin, penicillin, ceftriaxone, erythromycin, clindamycin, and amikacin. Clinicians and microbiologists must be encouraged to identify and report these atypical strains and the infections associated with them in order to establish their role in pathogenesis.

Socioeconomic status of Iranian living unrelated kidney donors: a multicenter study.

Renal transplantation is the best treatment modality for end-stage renal disease (ESRD) patients. In Iran, a living unrelated donor (LURD) transplant program was started in 1988, because of the shortage of living related and cadaver donors. In this study, we evaluated the socioeconomic status of LURD in Iran. We enrolled 478 LURDs from 30 transplant centers between October 2005 and March 2006. The demographic data, education, employment, motivation, and satisfaction status were asked. Economic status was assessed using criteria of the statistics center of Iran. Ninety-six percent of donors were referred from the Kidney Foundation of Iran (KFI). The mean age of the donors was 27 +/- 4.8 years and 85% were men (n=408). Fifty-one percent were smokers, 82% married, and 79% the breadwinner; 29% were unemployed; 2.7%, 90.8%, and 6.5% were illiterate, school graduates, and university graduates, respectively. Coercion was documented for only one donor. Financial issues were the most frequent motive. Among them, 91% were satisfied with the donation. Finally, 53% suggested kidney donation to others. Of donors, 62% were living below the poverty line. In the Iran model, the KFI is a bridge that connects recipients and donors. As a result, there is no middle man or broker introducing donors to recipients. The transplantation team knows nothing about money transactions between recipient and donor. Most donors were satisfied with the donation. However, establishment of a government-regulated program for social support of donors, such as lifelong health insurance may be a compensation for donors.

Clinical course of a renal transplant recipient with malignant fibrous histiocytoma: a case report.

Organ transplant (Tx) recipients are susceptible to develop various malignancies, most of which are uncommon in the general population. We present a case of post-Tx malignant fibrous histiocytoma with complete remission of tumor and excellent allograft function 3 years after cessation of cyclosporine.

Surgical treatment results of Iranian abdominal trauma casualties in the Iran and Iraq war.

INTRODUCTION: Military medicine is a field to which a great deal of manpower, time, and effort is devoted. Abdominal traumatic injuries in field hospitals are among the major lesions to be treated, and laparotomies have a special role in the treatment of these injuries. This study was performed to assess the care of abdominal lesions in Iranian troops so that the results can be used in future planning programs. MATERIALS AND METHODS: In a cross-sectional descriptive-analytical study, 522 cases of laparotomies were studied by the census method. These troops were injured from 1982 to 1987. Primary site of injury, general medical condition, location of the hospitals, and ensuing complications were studied. RESULTS: Most of the patients were younger than 30 years, and the mortality rate was greater in rearward hospitals. Seventy-four patients had poor general condition at the time of admission; 30% of them ultimately died, which showed a statistically significant difference between the patients in field hospitals and those in rearward hospitals with regard to final prognosis (p > 0.05). The colon, small intestine, and thorax were the most common sites of injuries. The trend of complications somewhat followed the trend of the primary lesions, with some specific variations. DISCUSSION: This study offers a full review of a great number of the abdominal surgical cases, their modes of treatment, and the ensuing complications. Also, the role of field hospitals is emphasized. Patients with poor initial general conditions should receive vigorous attention. In all patients, even the least common sites of injury should not be neglected or lethal complications could ensue.

Coeliac artery aneurysm: a case report.

Coeliac artery aneurysm is a rare but potentially fatal disease. In this paper a case of coeliac artery aneurysm is presented which was diagnosed before rupture and treated electively by resection and graft replacement between the aorta, common hepatic artery and superior mesenteric artery.

Drug-induced haemolysis and renal failure in children with glucose-6-phosphate dehydrogenase deficiency in Afghanistan.

Twenty children (18 boys and 2 girls) with a proven or presumptive diagnosis of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency developed intravascular haemolysis following administration of antimalarials in 9, chloroquine and chloramphenicol in 1, chloroquine, chloramphenicol and aspirin in 1, chloramphenicol and aspirin in 3, and aspirin alone in 4. Eleven of these children developed acute renal insufficiency. All were managed with supportive care, including blood transfusion, forced diuresis and peritoneal dialysis wherever indicated. Only 16 children recovered completely. The occurrence of G-6-PD deficiency is being reported for the first time in Afghanistan.