A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease.

BACKGROUND: Thromboangiitis Obliterans (TAO) is a disease of small and medium-sized arteries with an unclear natural course. This study aims to establish a national registry of the disease to gain a better understanding of its epidemiology and clinical course. METHOD: This study was a cohort study of 242 patients with a high probability of TAO admitted to Mashhad University of Medical Sciences (MUMS) hospitals from 2000 to 2015. Of these, 91 patients with a confirmed diagnosis were included in the study (90 males and 1 female) with a mean age of 35 ± 7.8 years. RESULTS: The most common symptom upon onset of the disease was paresthesia (29.7%), followed by cold sensitivity and paresthesia (93.4%) during the progression of the disease and Raynaud syndrome or vasospasm (93.9%) in the active phase. The right lower limb was the most commonly affected limb (46.2%), and presenting ischemic symptoms in 48.4%.Statistics indicated a positive correlation between the duration of Burger's disease and the number of affected limbs (p = 0.001). There was no effect of disease duration on the likelihood of amputations (p = 0.28). CONCLUSION: Some patients may experience mild, subtle symptoms for years before the initial signs and symptoms appear, which can be severe and rapidly progress to the point of requiring amputation.We suggest that the diagnostic criteria for Buerger's disease should be revised in light of the presence of atherosclerosis and its associated risk factors, which present a challenge in terms of diagnosis and treatment. Clinical experience will be of great importance in this regard.

Comparing color Doppler ultrasonography and angiography to assess traumatic arterial injuries of the extremities.

BACKGROUND: Traumatic events are one of the major causes of arterial injuries. Physical examination is not a good predictor of the extent of injuries and arteriography is considered as the gold standard for this purpose. In the recent years, noninvasive modalities are increasingly replacing diagnostic arteriography. Color Doppler ultrasonography (USG) is an excellent method to investigate arterial diseases. OBJECTIVES: The present study aimed to evaluate the diagnostic value of color Doppler USG compared to conventional angiography in traumatic arterial injuries of extremities. PATIENTS AND METHODS: Seventy-five patients with extremity trauma suspicious for arterial injury were examined by color Doppler USG just before angiography. Doppler pattern and flow states were assessed, then angiography was performed. The results of duplex USG were compared with angiography. RESULTS: Color Doppler USG had a sensitivity of 95% and specificity of 98% in diagnosis of arterial injury. Positive and negative predictive values of Doppler USG were 92.5% and 94.2%, respectively. CONCLUSIONS: Color Doppler USG can be used as a reliable modality with acceptable sensitivity and specificity values to screen hemodynamically stable patients with limb trauma suspicious for arterial injury.

Right Atrium Myxoma After Lung Adenocarcinoma.

INTRODUCTION: Heart secondary tumors are much more common than primary tumors. These two types of tumors differ not only by their source but also by their symptoms and location in heart chambers. CASE PRESENTATION: This report presents a 66-year-old heavy smoker female with a history of pulmonary lobectomy due to lung adenocarcinoma, hysterectomy due to myoma, and lumpectomy due to benign breast mass, who had symptoms of right heart failure for months. Physical examinations followed by imaging showed a mass in her right atrium, which was most likely, a myxoma. After a successful surgical excision, histopathological findings confirmed the diagnosis. More studies are needed to evaluate a possible combination between these soft tissue masses. CONCLUSIONS: A right atrium myxoma in a patient with a history of multiple soft tissue tumors has been limited to only a few cases. This may suggest a genomic affinity or similarity; if so, those with multiple different type soft tissue masses should be screened for a heart mass before the mass becomes complicated.

Characteristics of trauma in North East Iran and the prevention strategies.

BACKGROUND: The increase in mortality and morbidity of traumatized patients in developing countries might be due to disorganized medical services and credit tightness. This study was designed to describe the characteristics of injury, the strategies for the trauma prevention, and to improve the healthcare system.  METHODS: This was part of a national research project about trauma, conducted in the main trauma center of Mashhad, in North East Iran; it was a prospective cross-sectional study which comprised of all consecutively admitted patients to the emergency department from December 2003 through July 2004.  RESULTS: Most of the traumatized patients were male, uneducated, housewives, or workers. Motor vehicle accidents (during the time when fastening seat belts and wearing helmets were not compulsory) and falling (height less than four meters and falling on the ground) were considered as the most common mechanisms. Almost 68.5% of the patients transferred to the hospitals did not have prehospital care. With an average injury severity score (ISS) value of 10.3, lower extremities and head and neck were the most common traumatized anatomic areas leading to their related morbidity and mortality.  CONCLUSION: A large number of traumatized cases among uneducated and nonoccupational population makes the role of mass media more prominent. Public education about traffic law, streets, and vehicle security check seems to be crucial to decrease the mortality and morbidity.

Lateral Traumatic Esophago-Cutaneous fistula in a Child; Platelet-Rich Fibrin Glue Challenge.

INTRODUCTION: The endoscopic fibrin glue or platelet-rich fibrin glue (PRFG) injection is an easy, safe and effective technique for the fistula. So far, the use of fibrin glue has been limited to selected cases. CASE REPORT: Our case is a three years old male child with a neck trauma resulting in a Esophago-Cutaneous fistula after a 3 month period of follow up we decided to use PRFG for this lesion after fine debridement of the fistula tract, and the surrounding fibrosed tissue twice with a one week interval. Our visit after two weeks showed complete recovery and normal general condition. A contrast study revealed complete disappearance of the lesion. CONCLUSIONS: In our case the PRFG completely resolved a long-standing fistula resistant to exhaustive conservative management. The treatment with PRFG has been proved to be effective in the selected cases and it seems that traumatic esophago-cutaneous fistula may be one of these selections. Application of fibrin sealant should be considered early in the management of these difficult clinical problems.

Study of the Radical vs. Conservative Surgical Treatment of the Hepatic Hydatid Cyst: A 10-Year Experience.

The hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for the treatment of hydatid cyst of the liver. There is controversy regarding efficacy of radical versus conservative surgical approaches. In this study, we aimed to evaluate the two surgical methods in patients treated for the hepatic hydatid cyst. This is a retrospective review of the medical records of 135 patients who underwent surgery for the hepatic hydatid cyst from 1993 to 2003. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers) and radical methods (total excision of the cyst and removal of its outer layer). One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%), whereas, the remaining 64 patients (47%) underwent radical surgery. Local recurrence rate of the cysts was lower in the radical versus conservative surgery group and the mean length of hospital stay was shorter in the radical surgery group. Radical surgery of the hepatic hydatid cyst may be the preferred treatment because of its low rate of local recurrence, as well as short hospital stay.

Pattern of compensatory hypertrophy in contralateral testis after unilateral orchiectomy in immature rabbits.

INTRODUCTION: Our aim was to evaluate effects of hemicastration in immature rabbits on the histology of the contralateral testis after puberty. MATERIALS AND METHODS: Eighteen immature male rabbits were randomly divided into two groups. The first group underwent right or left hemicastration and the second, sham operation. After their puberty, the rabbits underwent the second operation. In the former group the contralateral testis and in the latter, the right or left testis was removed and sent for pathologic examination. The two groups were compared in terms of Leydig cell count, testis volume, and seminiferous tubule count and diameter. RESULTS: The mature rabbits' mean weight at the orchiectomy time, seminiferous tubule count, and seminiferous tubules diameter did not show significant differences between two groups. However, testis volumes and Leydig cell count were significantly higher in the first group with hemicastration prior to puberty. The mean testis volume was 3.24 +/- 2.06 mL in the first group and 1.4689 +/- 0.85701 mL in the second group (P = .03), and the mean Leydig cell count in every 5 microscopic high-power fields was 86.22 +/- 54.96 and 42.00 +/- 18.09, respectively (P = .04). CONCLUSION: Our research demonstrated that prepubertal hemicastration in rabbits led to the compensatory hypertrophy in the contralateral testis after puberty and an increase in the number of the Leydig cells.