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.

Evaluation of diagnostic efficacy of serum sTfR assay in iron-deficiency anemia and Beta-thalassemia trait in Shafa hospital, Ahvaz, Iran 2010.

BACKGROUND AND OBJECTIVES: Soluble form of transferrin receptor (TFR) called soluble TFR (sTfR) is shed mainly from the erythroid precursors and with a slower rate from other tissues into the plasma. This process of release is intensified in situations characterized with a some degree of erythroid hyperplasia or body iron stores depletion, such as seen in beta-thalassemia trait (betaTT) and iron-deficiency anemia (IDA), respectively. Therefore, the employement of sTfR assay as a diagnostic tool for differentiating IDA from betaTT in case of co-existence of these two clinical entities seems to be questionable. In this work we decided to study the above-mentioned dilemma in our geographical area, south of Iran. MATERIALS AND METHODS: Whole blood (5 ml) and serum samples (2 ml) were collected from 30 patients with IDA, 30 individuals with betaTT and 30 apparently healthy cases as control group. Complete blood count (CBC) was done by blood analyzer and serum iron, serum ferritin and serum sTfR were assayed by biochemical, immunological (chemiluminescence) and Elisa Kit, respectively. RESULTS: Serum ferritin concentration in IDA group was significantly lower than the concentration seen in betaTT: 6.93 ± 4.16 vs 47.40+/=32.33 microg/ml. The findings for sTfR serum concentration in IDA group (3.25+/=1.60 microg/ml) and betaTT group (1.86+/=0.36 microg/ml) showed a significant difference between IDA and the control group (p < 0.001), with some overlap between IDA and betaTT groups. Serum ferritin concentration and serum sTfR concentration in the control group were (65.60 ± 58.53 microg/dl) and (1.51+/=0.22 microg/ml), respectively. The sTfR/ferritin ratio clearly showed a diagnostic superiority to ferritin assay in IDA diagnosis. CONCLUSIONS: The observed overlap in serum stfR concentrations between IDA and betaTT groups makes the sTfR assay unefficient tool for a differential diagnosis between IDA and betaTT in the early stages of IDA. An higher diagnostic potential was observed in the advanced stage of iron deficiency anemia. Calculated ratio of serum sTfR/ferritin showed the diagnostic superiority to ferritin assay alone in IDA diagnosis.

Prevalence of hemoglobin alpha-chain gene deletion in neonates in North of Iran.

OBJECTIVES: Alpha-thalassemia (alpha-thal) is one of the most common genetic disorders and in some populations has prevalence as high as 30%. Disorders in hemoglobin (Hb) synthesis lead to mild to severe reduction in alpha-chain synthesis. Diagnosis of alpha-thal by examining fresh blood taken from umbilical cord is a simple and appropriate approach, while in later stages its diagnosis will be difficult and costly. MATERIAL AND METHODS: This study examined the prevalence of alpha-thal gene deletion in neonates in Sari, Iran. Screening study was carried out by examining fresh blood samples obtained from excised umbilical cords of neonates born in Sari hospitals from June 2007 to March 2008. Complete blood count (CBC) was done and Hb electrophoresis and High Performance Liquid Chromatography (HPLC) were performed for detection of Hb Bart's band. For each case two slides were stained by vital stain, 20 and 120 minutes post blood collection. Prevalence of alpha-thal was calculated and statistically analyzed (p < 5%). RESULTS: 69 cases out of 680 (10.1%) were positive for Hb Bart's. In 16 out of 69 positive cases (22.3%) the results of two methods, electrophoresis and slide staining were in conformity. In 53 positive cases (77%) there was no visible band in Hb electrophoresis; however Hb Bart's was detected via vital staining method. If the ratio of mean corpuscular volume (MCV) to red blood cell (RBC) count is smaller than 23, risk of alpha-thal is 2.8 fold greater than cases with an MCV/RBC ratio below 23 (p < 0.05). None of the cases were reported to be positive for Hb H disease and hydrops fetalis. CONCLUSIONS: Considering high prevalence of alpha-thal gene deletions in neonates in Sari hospitals, it is recommended to screen newborns for alpha-thal in this city and similar areas with such a high prevalence. The sensitivity of cellulose acetate electrophoresis and HPLC methods is not adequately high to detect Hb Bart's in all positive cases and staining and examination of peripheral blood slides stained with vital staining is necessary.

Dye leakage study: comparing conventional and new techniques.

The purpose of this study was to compare the degree of dye penetration of Thermofil and Simplifill to standard lateral condensation using AH26 plus. Forty-five human maxillary incisors were instrumented and obturated with three different methods: Rotary Profile with the Thermofil method and AH-26 Plus sealer, Rotary Lightspeed with the Simplifill method and AH-26 Plus sealer, and hand file with lateral condensation and AH-26 Plus. An additional 45 teeth were used as positive controls in three separate but corresponding groups, and another 15 were in negative control group. Apical leakage was measured and evaluated on both the internal canal surfaces and the obturation material itself. The results showed that there was a significant difference between the control and obturated groups but no significant difference between any obturation groups.