Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses?

BACKGROUND: Deep neck space abscesses are common head and neck surgery emergencies. Traditionally, surgical incision and drainage has been the main treatment for deep neck abscesses. Recently, it has been suggested that ultrasound-guided drainage of neck abscesses can be an effective and less invasive alternative to incision and drainage. METHODS: Patients with deep neck space abscesses referred to the emergency department of Amiralam Hospital were assessed and enrolled to the study if they met the inclusion criteria. Patients were randomly assigned to incision and drainage or ultrasound-guided drainage groups using sealed envelopes. RESULTS: Sixty patients were evaluated, with 30 patients in each group. There was a significant difference (p < 0.001) in mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days). CONCLUSION: Ultrasound-guided drainage is an effective and safe procedure, leading to shorter hospital stay, and thus may be a suitable alternative to incision and drainage of deep neck abscesses.

Increased B Regulatory Phenotype in Non-Metastatic Lymph Nodes of Node-Positive Breast Cancer Patients.

Tumour-draining lymph nodes (TDLNs) are centre in orchestrating the immune responses against cancer. The cellularity and lymphocyte subpopulations change in the process of cancer progression and lymph node involvement. B lymphocyte subsets and their function in breast cancer-draining lymph nodes have not been well elucidated. Here, we studied the influence of tumour metastasis on the frequencies of different B cell subsets including naïve and memory B cells as well as those which are known to be enriched in the regulatory pool in TDLNs of 30 patients with breast cancer. Lymphocytes were obtained from a fresh piece of each lymph node and stained for CD19 and other B cell-associated markers and subjected to flow cytometry. Our investigation revealed that metastatic TDLN showed a significant decrease in active, memory and class-switched B cells while the frequencies of B cells with regulatory phenotypes were not changed. However, CD27(hi) CD25(+) and CD1d(hi) CD5(+) B regulatory subsets significantly increased in non-metastatic lymph nodes (nMLNs) of node-positive patients compared with node-negative patients. Our data provided evidence that in breast cancer, metastasis of tumour to axillary lymph nodes altered B cell populations in favour of resting, inactive and unswitched phenotypes. We assume that the lymphatic involvement may cause an increase in a subset of regulatory B cells in non-metastatic lymph nodes.

Germanene termination of Ge2Pt crystals on Ge(110).

We have investigated the growth of Pt on Ge(1 1 0) using scanning tunneling microscopy and spectroscopy. The deposition of several monolayers of Pt on Ge(1 1 0) followed by annealing at 1100 K results in the formation of 3D metallic Pt-Ge nanocrystals. The outermost layer of these crystals exhibits a honeycomb structure. The honeycomb structure is composed of two hexagonal sub-lattices that are displaced vertically by 0.2 Å with respect to each other. The nearest-neighbor distance of the atoms in the honeycomb lattice is 2.5 ± 0.1 Å, i.e. very close to the predicted nearest-neighbor distance in germanene (2.4 Å). Scanning tunneling spectroscopy reveals that the atomic layer underneath the honeycomb layer is more metallic than the honeycomb layer itself. These observations are in line with a model recently proposed for metal di-(silicides/)germanides: a hexagonal crystal with metal layers separated by semiconductor layers with a honeycomb lattice. Based on our observations we propose that the outermost layer of the Ge(2)Pt nanocrystal is a germanene layer.

Application of human amniotic membrane in canine penile tunica albuginea defect: first step toward an innovating new method for treatment of Peyronie's disease.

PURPOSES: To evaluate the efficacy of human amniotic membrane (AM) grafting in the canine penile tunica albuginea defect; we developed an animal model as the first step toward an innovating new method for the treatment of Peyronie's disease, penile cancers, and congenital deformities of the penis. MATERIAL AND METHODS: From August to September 2011, ten healthy male dogs were selected. A rhomboid incision about 3 x 2 cm over the tunica albuginea and its overlying squamous epithelium was made and then excised. The amniotic membrane was folded twice on itself and grafted on the defect. After 8 weeks, artificial erection was made for 5 dogs and for the other 5 dogs after 12 weeks. After artificial erection, partial penectomy was done and histopathological evaluation was performed on the grafts. RESULTS: Artificial erection performed successfully in all of the dogs. No infection or any other complication was seen. Histopathological examination showed complete re-epithelialization with squamous epithelium and collagen fiber deposition. Also, no dysplasia was seen. CONCLUSIONS: The amniotic membrane can be used as a suitable substitution for tunica albuginea. It is safe, inexpensive, biodegradable, and available and may be used for the treatment of Peyronie ' s disease, penile cancers, congenital penile deformities, and penile reconstructive surgery.

Application of Human Amniotic Membrane in Canine Penile Tunica Albuginea Defect: First Step toward an Innovating New Method for Treatment of Peyronie?s Disease

Purposes To evaluate the efficacy of human amniotic membrane (AM) grafting in the canine penile tunica albuginea defect; we developed an animal model as the first step toward an innovating new method for the treatment of Peyronie’s disease, penile cancers, and congenital deformities of the penis. Material and Methods From August to September 2011, ten healthy male dogs were selected. A rhomboid incision about 3x2cm over the tunica albuginea and its overlying squamous epithelium was made and then excised. The amniotic membrane was folded twice on itself and grafted on the defect. After 8 weeks, artificial erection was made for 5 dogs and for the other 5 dogs after 12 weeks. After artificial erection, partial penectomy was done and histopathological evaluation was performed on the grafts. Results Artificial erection performed successfully in all of the dogs. No infection or any other complication was seen. Histopathological examination showed complete re-epithelialization with squamous epithelium and collagen fiber deposition. Also, no dysplasia was seen. Conclusions The amniotic membrane can be used as a suitable substitution for tunica albuginea. It is safe, inexpensive, biodegradable, and available and may be used for the treatment of Peyronie’s disease, penile cancers, congenital penile deformities, and penile reconstructive surgery. .

Analysis of phenolic compounds in Matricaria chamomilla and its extracts by UPLC-UV.

Chamomile (Matricaria chamomilla L.) is a widely used medicinal plant possessing several pharmacological effects due to presence of active compounds. This study describes a method of using ultra performance liquid chromatography (UPLC) coupled with photodiode array (PDA) detector for the separation of phenolic compounds in M. chamomilla and its crude extracts. Separation was conducted on C18 column (150 mm × 2 mm, 1.8 µm) using a gradient elution with a mobile phase consisting of acetonitrile and 4% aqueous acetic acid at 25°C. The method proposed was validated for determination of free and total apigenin and apigenin 7-glucoside contents as bioactive compounds in the extracts by testing sensitivity, linearity, precision and recovery. In general, UPLC produced significant improvements in method sensitivity, speed and resolution. Extraction was performed with methanol, 70% aqueous ethanol and water solvents. Total phenolic and total flavonoid contents ranged from 1.77 to 50.75 gram (g) of gallic acid equivalent (GAE)/100 g and 0.82 to 36.75 g quercetin equivalent (QE)/100 g in dry material, respectively. There was a considerable difference from 40 to 740 mg/100 g for apigenin and 210 to 1110 mg/100 g for apigenin 7-glucoside in dry material.

Evaluation of the accuracy of panoramic radiography in linear measurements of the jaws.

BACKGROUND/OBJECTIVE: Panoramic radiography has a great place among imaging techniques because of its enormous advantages. One of the characteristics of an ideal imaging technique is to supply precise measurement. The purpose of the current study was to evaluate the accuracy of linear measurements of the jaws on panoramic radiographs. PATIENTS AND METHODS: In this study, the vertical distances between the metal markers were measured by panoramic radiography in seven sites of two skulls in various head positions. Then the radiographic measurements were compared with the actual values. RESULTS: Eighty three percent of the measurements were underestimated, 8.5% were overestimated on panoramic radiography and 8.5% of the measurements had no difference with the real measurements. Overestimation was not greater than 1 mm. The difference between actual and radiographic measurements was less in the posterior areas and in the mandible . In all head positions, the greatest difference between actual and radiographic measurements occurred in the anterior area. CONCLUSION: Based on the results of this study, linear measurements on panoramic radiography are more reliable in the posterior areas and may be used in early clinical measurements.

Melting entropy of nanocrystals: an approach from statistical physics.

Considering size effect on the equations obtained from statistical mechanical theories for the entropy of crystal and liquid phases, a new model has been developed for the melting entropy of nanocrystals, including the effects of the quasi-harmonic, anharmonic and electronic components of the overall melting entropy. Then with the use of our suggested new proportionality between the melting point and the entropy temperature (θ(0)), the melting entropy of nanocrystals has been obtained in terms of their melting point. Moreover, for the first time, the size-dependency of the electronic component of the overall melting entropy, arising from the change in the electronic ground-state of the nanocrystal upon melting, has been taken into account to calculate the melting entropy of nanocrystals. Through neglecting the effect of the electronic component, the present model can corroborate the previous model for size-dependent melting entropy of crystals represented by Jiang and Shi. The present model has been validated by the available computer simulation results for Ag and V nanoparticles. Moreover, a fairly constant function has been introduced which couples the melting temperature, the entropy temperature and the atomic density of elements to each other.

Clinical and laboratory findings and therapeutic responses in children with nephrotic syndrome.

Nephrotic syndrome (NS) is a clinical entity characterized by massive loss of urinary protein leading to hypoproteinemia and edema. This prospective cross sectional study was performed on 44 children with idiopathic nephrotic syndrome (INS). The objectives were to study the clinical and biochemical parameters at the time of diagnosis of nephrotic syndrome and to study the histopathological distribution of different subtypes of INS and drug response pattern. There were 29 (66%) males and 15 females (34%). The mean age of NS was 4.87±3.24 years. Facial edema was found in 42 (95%), microscopic hematuria in 10 (23%), gross hematuria in 2 (4.5%), and hypertension in 5 (11.2%) of patients. In 17 children who underwent biopsy, focal segmental glomerulosclerosis was the most common pathologic finding (41%). Other subtypes included minimal change in three (18%), membranoproliferative glomerulonephritis in 1(5.8%), diffuse proliferative glomerulonephritis in 2 (11.6%), membranous glomerulonephritis in 1 (5.8%), and diffuse mesangial proliferation in 3 (17.5%) of cases. At the time of hospital admission, peritonitis were present in five (11.4%), pneumonia and upper respiratory infection (sinusitis) in eight (18%), cellulitis in two (4.5%). Among 44 children with NS, 29 (66%) were steroid sensitive cases, nine (20.5%) were steroid resistant and six (13.5%) were steroid dependent. Among patients with steroid sensitive NS, 37% were without relapsers, 38.8% frequent relapsers and 26.4% were infrequent relapsers. These results suggest that there are differences between season of incidence, response to treatment with corticosteroid and pathologic findings in our study and other studies in Iran and other countries.

A province-based surveillance system for the risk factors of non-communicable diseases: A prototype for integration of risk factor surveillance into primary healthcare systems of developing countries.

OBJECTIVES: To establish a surveillance system for risk factors of non-communicable diseases, develop a valid tool and methodology for surveillance surveys, and build capacity in 41 provincial surveillance sites to design and conduct the surveys and provide provincially interpretable baseline data. STUDY DESIGN: Population-based national study. METHODS: The World Health Organization's STEPwise approach to non-communicable disease surveillance was adapted to design a national risk factor surveillance model. The first national population-based and cross-sectional study was conducted in 2005 in 41 universities of medical sciences in all 30 provinces of Iran. This involved multi-stage cluster sampling from 25-64 year-old Iranians and non-institutionalized populations. A national technical unit at the Ministry of Health and Medical Education supervised all study processes including data management and analysis. RESULTS: From the national results, the survey estimated that the prevalence of daily current smoking was 17.9%. Of the target population, 5% consumed at least five combined servings of fruit and vegetables per day. The median daily time spent undertaking transport-related physical activity (43.8 min) was significantly higher than the median time spent on work-related physical activity (27.5 min) or recreational physical activity (28.6 min). Overall, 54.7% of the target population were overweight or obese, and waist circumference was greater among women than men. The prevalence of hypertension was 23.8%, with a higher prevalence among women than men. In addition, 6% of the target population had a high fasting blood glucose (> or =126 mg/dl), and 45.1% had a total cholesterol level of at least 200 mg/dl. CONCLUSION: Integration of province-based surveillance activities into the Iranian primary healthcare system is feasible. Provincial reports could provide a baseline picture of the most important risk factors for non-communicable diseases. There are several important risks with a prominent burden that may cause a progressive epidemic of major non-communicable diseases in the future in the absence of quality interventions.

Spectrum of childhood nephrotic syndrome in Iran: A single center study.

Nephrotic syndrome (NS) is a clinical entity characterized by massive loss of urinary protein (primarily albuminuria) leading to hypoproteinemia (hypoalbuminemia) and its result, edema. Hyperlipidemia, hypercholesterolemia, and increased lipiduria are usually associated. Although not commonly thought of as part of the syndrome, hypertension, hematuria, and azotemia may be present. This prospective cross-sectional study was performed on 44 children (with age of onset up to 14 years) with idiopathic nephrotic syndrome (INS) in our center during 2000-2007. The objectives were to study the clinical and biochemical parameters and the histopathological distribution of different subtypes of INS and drug-response pattern in these patients. The study group included 44 children. There were 29 (66%) boys and 15 girls (34%). The mean age was 4.87 +/- 3.24 years. Facial edema was found in 42 (95%), microscopic hematuria in 10 (23%), gross hematuria in 2 (4.5%), and hypertension in 5 (11.2%) patients. In children who underwent biopsy, focal segmental glomerulosclerosis was the most common pathologic finding (41%). Other subtypes included minimal change disease in three (18%), membranoproliferative glomerulonephritis in one (5.8%), diffuse proliferative glomerulonephritis in two (11.6 %), membranous glomerulonephritis in one (5.8%), and diffuse mesangial proliferation in three (17.5%) cases. At the time of hospitalization peritonitis was present in five (11.4%), pneumonia and upper respiratory infection (sinusitis) in eight (18%), and cellulites in two (4.5%) patients. Twenty nine patients (66%) were steroid sensitive, 9 (20.5%) steroid resistant, and 6 (13.5%) steroid dependent. Among patients with steroid-sensitive NS, 37% were nonrelapsers, 38.8% frequent relapsers, and 26.4% were infrequent relapsers. Differences seems to exist between season of incidence, suitable response to treatment with corticosteroids, and pathologic findings of biopsy in our study and other studies from Iran and other countries.

Multicentric familial cardiac myxoma.

Familial cardiac myxoma is a rare syndrome which constitutes approximately 10% or less of all myxomas. We describe a rare case of LA and LV mass simultaneously in a 35-year-old female presenting to our hospital for evaluation of recurrent cardiac myxoma. Echocardiography revealed both LA and LV mass. Surgery was done and histological findings confirmed the diagnosis of myxoma.

The usefulness of F-18 deoxyglucose whole-body positron emission tomography (PET) for re-staging of renal cell cancer.

PURPOSE: The use of whole-body PET for re-staging of renal cell carcinoma has not been investigated. The aim of the current study was to examine the diagnostic accuracy and clinical usefulness of whole-body PET imaging for re-staging of renal cell cancer. PATIENTS AND METHODS: Clinical PET was performed for re-staging in 36 patients with advanced renal cell cancer. Written reports of imaging studies (including CT, MRI, US, plain film and bone scan), patient history, and extensive chart notes were used to define the clinical stage before PET (pre-PET stage). The written PET report was used to define the clinical stage after PET (PET stage). Reports were used to determine the accuracy of PET for re-staging renal cell cancer and for defining biopsy proven lesions. Clinical parameters and biopsy proven lesions served as reference for the accuracy of PET for re-staging renal cell cancer. RESULTS: PET classified the clinical stage correctly in 32/36 patients (89%) and was incorrect in 4/36 (11%) (sensitivity and specificity: 87% and 100%). In 20 patients, 25 suspicious lesions were biopsied within 3.2 +/- 6.7 months of the PET study. Of these, 17 were malignant and 8 were benign. PET correctly classified 21/25 (84%) of the biopsied lesions (sensitivity and specificity: 88% and 75%). CONCLUSION: PET re-stages renal cell cancer with a diagnostic accuracy of 89%. Its diagnostic accuracy for classifying biopsy proven anatomic lesions as malignant or benign was 84%. These findings suggest that PET is useful in characterizing anatomic lesions of unknown significance in patients with renal cell cancer.

Conjunctival dysplasia in soldiers exposed to mustard gas during the Iraq-Iran war: scrape cytology.

OBJECTIVE: To describe the conjunctival scrape cytology findings in Iraq-Iran war veterans exposed to mustard gas and to detect malignant transformation at an early stage. STUDY DESIGN: Twenty-two male war veterans (29-54 years old) who were exposed to chemical bombing about 14 years earlier, formed the base of this study. All of them had chronic eye problems, such as dryness, conjunctival scarring and decreased visual acuity. Conjunctival scrape cytology was performed for cytologic study. RESULTS: Among 22 cases of conjunctival scarring, 9 were diagnosed as dysplasia. Mild inflammation and squamous metaplasia were also noted. Squamous cell carcinoma was not identified. CONCLUSION: Conjunctival scraping cytology is useful for the diagnosis of dysplasia in soldiers exposed to mustard gas during of the Iraq-Iran war. This method is also effective for follow-up study.

Subclassification of localized Leishmania lymphadenitis in fine needle aspiration smears.

OBJECTIVE: To describe the cytologic findings of localized Leishmania lymphadenitis and discuss the differential diagnosis. STUDY DESIGN: The study group consisted of 133 cases. All of them were diagnosed by fine needle aspiration (FNA) study. The ages ranged between 3 and 80 years, 102 were male and 31 female. Seventy lymph nodes were excised. RESULTS: The FNA smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, giant cells, abnormal plasma cells and tingible body macrophages. Leishman-Donovan (LD) bodies were identified in all cases, but their number differed from case to case. Granulomas, dendritic cells, mast cells and lymphoglandular bodies were identified in a substantial number of cases. Depending upon the presence of characteristic cytologic findings, the cases were divided into five major groups: acute inflammation with giant cells, histiocytic granulomas, epithelioid cell granulomas, plasma cell type and mixed histioplasmacytic type. CONCLUSION: Leishmaniasis is an uncommon cause of cervical lymphadenitis but should be considered in the differential diagnosis of unexplained lymphadenopathy in endemic countries. Demonstration of LD bodies is necessary for the diagnosis of this self-limited condition, for which no treatment is required.