Hepatic myxosarcoma in a domestic shorthair cat.

Myxosarcomas are rare malignant neoplasms of soft connective tissues, and there are no reports of hepatic myxosarcomas in cats. An eight-year-old male, neutered, domestic shorthair cat presented with progressive hyporexia, lethargy, and weight loss. An ultrasonography study showed a large abdominal mass connected to the liver. The cat underwent a laparotomy and the mass was removed. Histopathological evaluation of the mass supported the diagnosis of a myxosarcoma. Tumour cells were positive with vimentin and alcian blue stain, and negative with PAS, pan-cytokeratin, s100, epithelial membrane antigen, and α-smooth muscle actin. The Ki-67 index by immunohistochemistry was 6%. The cat was euthanased due to severe lethargy and recumbency. Myxoid soft tissue neoplasms are very rare in cats, and to the best of our knowledge, this is the first report of a hepatic myxosarcoma in a cat. In the present case, the diagnosis was made based on histopathological and immunohistochemical findings and an alcian blue-positive supporting matrix.

Aflibercept in clinical practice; visual acuity, injection numbers and adherence to treatment, for diabetic macular oedema in 21 UK hospitals over 3 years.

INTRODUCTION: Randomised controlled trials provide evidence that a treatment works. Real world evidence is required to assess if proven treatments are effective in practice. METHOD: Retrospective data collection on patients given aflibercept for diabetic macular oedema over 3 years from 21 UK hospitals: visual acuity (VA); Index of multiple deprivation score (IMD); injection numbers; protocols used, compared as a cohort and between sites. RESULTS: Complete data: 1742 patients (from 2196 eligible) at 1 year, 860 (from 1270) at 2, 305 (from 506) at 3 years. The median VA improved from 65 to 71, 70, 70 (ETDRS letters) at 1, 2 and 3 years with 6, 9 and 12 injections, respectively. Loss to follow-up: 10% 1 year, 28.8% at 3. Centres varied: baseline: mean age 61-71 years (p < 0.0001); mean IMD score 15-37 (p < 0.0001); mean VA 49-68 (p < 0.0001). Only four centres provided a loading course of five injections at monthly intervals and one 6. This did not alter VA outcome at 1 year. Higher IMD was associated with younger age (p = 0.0023) and worse VA at baseline (p < 0.0001) not total number of injections or change in VA. Lower starting VA, higher IMD and older age were associated with lower adherence (p = 0.0010). CONCLUSIONS: The data showed significant variation between treatment centres for starting age, VA and IMD which influenced adherence and chances of good VA. Once treatment was started IMD did not alter likelihood of improvement. Loading dose intensity did not alter outcome at one year.

Effect of root canal irrigant (sodium hypochlorite & saline) delivery at different temperatures and durations on pre-load and cyclic-loading surface-strain of anatomically different premolars.

AIM: To evaluate the effect of NaOCl (5%) and saline (control) irrigant delivery at different temperatures and durations on pre-load and cyclic-loading tooth-surface-strain (TSS) on anatomically different premolars. METHODOLOGY: Single-rooted premolars (n = 36), root-canal-prepared in standard manner, were randomly allocated to six irrigation groups: (A1) NaOCl-21 °C; (A2) NaOCl-60 °C; (A3) saline-21 °C then NaOCl-21 °C; (A4) saline-60 °C then NaOCl-21 °C; (A5) saline-21 °C then NaOCl-60 °C; (A6) saline-60 °C then NaOCl-60 °C. A1-2 received nine 10-min irrigation periods (IP) with NaOCl; A3-6 received nine 10-min IP with saline, followed by 9 IP with NaOCl at different temperature combinations. Premolars (n = 56) with single, fused or double roots prepared by standard protocol, were stratified and randomly allocated to: (B1) saline-21 °C; (B2) saline-80 °C; (B3) NaOCl-21 °C; (B4) NaOCl-80 °C. TSS (µÑ”) was recorded pre-irrigation, post-irrigation and pre-load for each IP and during cyclic loading 2 min after each IP, over 30-274 min, using strain-gauges. Generalised linear mixed models were used for analysis. RESULTS: Baseline TSS in double-rooted premolars was significantly (p=0.001) lower than in single/fused-rooted-premolars; and affected by mesial-wall-thickness (p=0.005). There was significant increase in loading-TSS (µÑ”) after NaOCl-21 °C irrigation (p=0.01) but decrease after NaOCl-60 °C irrigation (p=0.001). TSS also increased significantly (p = 0.005) after Saline-80 °C irrigation. Pre-load "strain-shift" was noted only upon first saline delivery but every-time with NaOCl. Strain-shift negatively influenced loading-TSS after saline or NaOCl irrigation (A3-6) but was only significant for saline-21 °C. CONCLUSIONS: Tooth anatomy significantly affected its strain characteristics, exhibiting limits within which strain changes occurred. Intra-canal introduction of saline or NaOCl caused non-random strain shifts without loading. Irrigation with NaOCl-21 °C increased loading tooth strain, as did saline-80 °C or NaOCl-80 °C but NaOCl-60 °C decreased it. A "chain-link" model was proposed to explain the findings and tooth biomechanics.

Trichohepatoenteric Syndrome or Syndromic Diarrhea-Report of Three Members in a Family, First Report from Iran.

Introduction. Intractable diarrhea of infancy (IDI) includes several types of early onset diarrhea; one of the rare etiologies is trichohepatoenteric (THE) syndrome, also known as syndromic diarrhea (SD) which was primarily described by Stankler et al. Hereby we report a family with several affected members which to our knowledge is the first case report from Iran. Report of Cases. A three-year-old boy referred with short stature, poor weight gain, and intermittent steatotic diarrhea to our center. He was born to healthy, relative parents (cousins). He did not gain any weight after four months of age and began having intermittent steatotic diarrhea, abdominal distension, and fever. He was hospitalized several times. Two other children in the family also showed somewhat similar symptoms. Two sweat tests were negative for cystic fibrosis. Workup for Celiac disease was performed several times which was negative; however, gluten-free diet was tried several times which was not effective. Workup for Hirschsprung's disease was performed but colon was ganglionic. Evidence of liver involvement was approved by elevated liver enzymes and coarse echo of liver on sonography. Discussion. Trichoenterohepatic syndrome should be put in mind in cases of intractable diarrhea presenting in a family with several affected members. Early diagnosis would save patients from unnecessary workups.

Toxicity of entomopathogenic fungi, Beauveria bassiana and Lecanicillium muscarium against a field-collected strain of the German cockroach Blattella germanica (L.) (Dictyoptera: Blattellidae).

The German cockroach, Blattella germanica (L.) has been recognized as a serious health problem throughout the world. Control failures due to insecticide resistance and chemical contamination of environment have led some researchers focus on the other alternative strategy controls. Microbial insecticides such as those containing entomo pathogenic fungi could be of high significance. Lecanicillium muscarium and Beauveria bassiana grow naturally in soils throughout the world and act as a parasite on various arthropod species, causing white muscardine disease. Thus, these two species could be considered as entomopathogenic fungi. The current study conducted to evaluate the toxicity of Beauveria bassiana and Lecanicillium muscarium against German cockroach, Blattella germanica. Conidial formulations of L. muscarium (PTCC 5184) and B. bassiana (PTCC5197) were prepared in aqueous suspensions with Tween 20. Bioassays were performed using two methods including submersion of cockroaches in conidial suspension and baiting. Data were analyzed by Probit program and LC50 and LC90 were estimated. The obtained results indicated that both fungi species were toxic against German cockroach however; Beauveria bassiana was significantly 4.8 fold more toxic than L. muscarium against German cockroach using submersion method.

Production of low-fat shrimps by using hydrocolloid coatings.

Production of low-fat fried foods by using hydrocolloid coatings is a common method to avoid excessive oil absorption during deep-fat frying. The aim of this work was to evaluate the influence of hydrocolloid coatings (carboxymethyl cellulose, guar, tragacanth and zedo gum) on the oil content and quality parameters of shrimp after deep-fat frying. The hydrocolloid solutions (0.5, 1.0 and 1.5 % w/v) were used for coating. Coated and uncoated (control) samples were packaged and stored at -20 and after a week were fried at 170 °C for 90 s in sunflower oil. The results showed that all hydrocolloid coatings reduced oil content of fried shrimp. The coated shrimps with 1.5 % tragacanth solution had highest coating pick up and moisture content, and lowest oil content than the other samples. The coated samples had darker color and softer texture than the control sample. Sensory evaluation indicated that all coated and uncoated shrimps were acceptable.

Measles vaccination coverage and seroprevalence of anti-measles antibody in south-east Islamic Republic of Iran.

Discrepancies often exist between recorded immunization coverage and the real immunity level in a community. To estimate the vaccination coverage against measles in south-east Islamic Republic of Iran, a crosssectional study was conducted in 3 districts during summer 2011. Using probability proportional to size cluster sampling, 1368 children aged 30-54 months were selected. Serum samples of 663 who had received 2 injections of mumpsmeasles- rubella (MMR) vaccine were checked for anti-measles IgG. Vaccination coverage for the second dose of MMR vaccine was 93.7%. The prevalence of anti-measles IgG in those who had received at least 2 MMR vaccine doses was 94.6%. There was a statistically significant association between the serological results and variables that reflected poor accessibility to health services. Combining serological results with coverage data, the proportion of the community protected against measles was estimated as 88.6%, which was below the limits defined for the measles elimination goals.

Seroprevalence of poliovirus antibodies among 7-month-old infants after 4 doses of oral polio vaccine in Sistan-va-Baluchestan, Islamic Republic of Iran.

Despite high coverage rates of polio vaccine in the Islamic Republic of Iran, the seroconversion rates of infants may be inadequate. This study measured seroprevalence of antibodies against poliovirus serotypes 1 to 3 (PV1, PV2 and PV3) in 7-month-old infants who had received at least 4 doses of trivalent oral polio vaccine. A serosurvey was conducted in 2010 in rural areas of Chabahar, Sistan-va-Baluchestan province. Using cluster sampling, 72 eligible infants were tested for antibody against the 3 poliovirus serotypes according to WHO guidelines. Antibody titres ≥ 1:10 were considered positive. The seropositive rates for antibody against PV1, PV2 and PV3 were 84.7%, 95.8% and 70.8% respectively. Only 63.9% of participants were seropositive for antibodies against all 3 poliovirus serotypes. Except for PV2, the seroprevalence of antibody against the other 2 poliovirus serotypes, especially PV3, was unsatisfactory.

Predicting CCHF incidence and its related factors using time-series analysis in the southeast of Iran: comparison of SARIMA and Markov switching models.

Crimean-Congo haemorrhagic fever (CCHF) is endemic in the southeast of Iran. This study aimed to predict the incidence of CCHF and its related factors and explore the possibility of developing an empirical forecast system using time-series analysis of 13 years' data. Data from 2000 to 2012 were obtained from the Health Centre of Zahedan University of Medical Sciences, Climate Organization and the Veterinary Organization in the southeast of Iran. Seasonal autoregressive integrated moving average (SARIMA) and Markov switching models (MSM) were performed to examine the potential related factors of CCHF outbreaks. These models showed that the mean temperature (°C), accumulated rainfall (mm), maximum relative humidity (%) and legal livestock importation from Pakistan (LIP) were significantly correlated with monthly incidence of CCHF in different lags (P < 0·05). The modelling fitness was checked with data from 2013. Model assessments indicated that the MSM had better predictive ability than the SARIMA model [MSM: root mean square error (RMSE) 0·625, Akaike's Information Criterion (AIC) 266·33; SARIMA: RMSE 0·725, AIC 278·8]. This study shows the potential of climate indicators and LIP as predictive factors in modelling the occurrence of CCHF. Our results suggest that MSM provides more information on outbreak detection and can be a better predictive model compared to a SARIMA model for evaluation of the relationship between explanatory variables and the incidence of CCHF.

Measles vaccination coverage and seroprevalence of anti-measles antibody in south-east Islamic Republic of Iran

كثيراً ما توجد تباينات بين تغطية التطعيم المسجلة وبين المستوى الحقيقي للمناعة في المجتمع. ولتقدير تغطية التلقيح ضد الحصبة في جنوب شرق جمهورية إيران الإسلامية تم إجراء دراسة مقطعية في 3 مناطق خلال صيف عام 2011.فتم اختيار عينة عنقودية من 1368 طفلاً تتراوح أعمارهم ما بين 30-54 شهراً باستخدام الاحتمال المتناسب مع الحجم. وتم فحص عينات مصلية من 663 منهم - ممن تلقوا حقنتين من اللقاح الثلاثي ضد الحصبة والنكاف والحصبة الألمانية [MMR]- للتأكد من وجود الجلوبيولين المناعي G [IgG]المضاد للحصبة. لقد بلغت تغطية التطعيم بالجرعة الثانية من لقاح MMR 93.7%.وكان انتشار الجلوبيولين المناعي G المضاد للحصبة لدى أولئك الذين تلقوا جرعتين على الأقل من لقاح MMR 94.6%.وكان هناك ارتباط ذو دلالة إحصائية بين النتائج السيرولوجية وبين المتغيرات التي تعكس ضعف إمكانية الوصول إلى الخدمات الصحية. وبجمع النتائج السيرولوجية مع بيانات التغطية قُدِّرت نسبة الجمهور المحمي ضد الحصبة بـ 88.6%، والتي كانت أقل من الحدود المعينة لأهداف التخلص من الحصبة

Discrepancies often exist between recorded immunization coverage and the real immunity level in a community. To estimate the vaccination coverage against measles in south-east Islamic Republic of Iran, a crosssectional study was conducted in 3 districts during summer 2011. Using probability proportional to size cluster sampling, 1368 children aged 30–54 months were selected. Serum samples of 663 who had received 2 injections of mumpsmeasles-rubella (MMR) vaccine were checked for anti-measles IgG. Vaccination coverage for the second dose of MMRvaccine was 93.7%. The prevalence of anti-measles IgG in those who had received at least 2 MMR vaccine doses was 94.6%. There was a statistically significant association between the serological results and variables that reflected pooraccessibility to health services. Combining serological results with coverage data, the proportion of the community protected against measles was estimated as 88.6%, which was below the limits defined for the measles elimination goals.

Il existe souvent des écarts entre la couverture vaccinale enregistrée et le niveau réel d'immunité d'une communauté donnée. Afin d'estimer la couverture vaccinale antirougeoleuse dans le sud-est de la République islamique d'Iran, une étude transversale a été menée dans trois districts durant l'été 2011. En appliquantl'échantillonnage en grappes avec probabilité proportionnelle à la taille, 1368 enfants âgés de 30 à 54 mois ont été sélectionnés. Des prélèvements de sérum de 663 enfants de l'échantillonnage ayant reçu deux injections du vaccincontre la rougeole, les oreillons et la rubéole (ROR) ont été analysés à la recherche d'anticorps IgG antirougeoleux. La couverture vaccinale pour la deuxième dose de vaccin ROR était de 93,7 %. La prévalence des anticorps IgG antirougeoleux chez les enfants ayant reçu au moins deux doses du vaccin ROR était de 94,6 %. Il existait une association statistiquement significative entre les résultats sérologiques et les variables qui reflétaient l'accès insuffisant aux services de santé. En combinant les résultats sérologiques et les données de couverture, la proportion de la communauté protégée contre la rougeole a été estimée à 88,6 %, soit un taux inférieur aux seuils définis pour les objectifs d'élimination de la rougeole.

Toxicity of entomopathogenic fungi, Beauveria bassiana and Lecanicillium muscarium against a field-collected strain of the German cockroach Blattella germanica (L.) (Dictyoptera: Blattellidae)

The German cockroach, Blattella germanica (L.) has been recognized as a serious health problem throughout the world. Control failures due to insecticide resistance and chemical contamination of environment have led some researchers focus on the other alternative strategy controls. Microbial insecticides such as those containing entomopathogenic fungi could be of high significance. Lecanicillium muscarium and Beauveria bassiana grow naturally in soils throughout the world and act as a parasite on various arthropod species, causing white muscardine disease. Thus, these two species could be considered as entomopathogenic fungi. The current study conducted to evaluate the toxicity of Beauveria bassiana and Lecanicillium muscarium against German cockroach, Blattella germanica. Conidial formulations of L. muscarium (PTCC 5184) and B. bassiana (PTCC5197) were prepared in aqueous suspensions with Tween 20. Bioassays were performed using two methods including submersion of cockroaches in conidial suspension and baiting. Data were analyzed by Probit program and LC50 and LC90 were estimated. The obtained results indicated that both fungi species were toxic against German cockroach however; Beauveria bassiana was significantly 4.8 fold more toxic than L. muscarium against German cockroach using submersion method.

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine.

Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 (± 2) months who had received at least 5 doses of trivalent oral polio vaccine. Using cluster sampling, 365 children were enrolled for serological testing. Antibody titres ≥ 1:10 were considered positive. Seropositive rates for antibody against poliovirus serotypes 1, 2 and 3 were 94.1%, 96.7% and 78.3% respectively. The lowest seropositive rate was for antibody against polio serotype 3 (PV3) among boys (58.3%). Exclusive breastfeeding showed a direct relationship with antibody response to PV3 (OR = 2.0; 95% CI: 1.1-3.6). Improving community protection against PV3 is an urgent programme priority.

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine

تشعر جمهورية إيران الإسلامية بالقلق بسبب تحركات السكان من بلدان لم تحقق استئصال شلل الأطفال. وقد أجرى الباحثون دراسة مستعرضة مجتمعية في عام 2010 ، في مقاطعتي سيستان وبلوشستان التابعتين لولاية قريبة من الحدود الجنوبية الشرقية. وكان هدف الدراسة تحديد معدل الانتشار المصلي للأضداد لدى الأطفال بعمر 20 شهرا [+/- شهرين]، ممن تلقوا 5 جرعات على الأقل من لقاح شلل الأطفال. واستخدم الباحثون طريقة الاعتيان العنقودي، وأدرجوا في الدراسة 365 طفلا لإجراء الاختبارات المصلية؛ واعتبر الباحثون وجود عيارات تساوي أو تزيد على 1 إلى 10 نتيجة إيجابية. واتضح للباحثين أن معدلات الإيجابية المصلية لأضداد الأنماط المصلية لفيروس شلل الأطفال هي 94.1 % بالنسبة للنمط المصلي 1، وهي 96.7 % بالنسبة للنمط المصلي 2، وهي 78.3 % بالنسبة للنمط المصلي 3. وكان أخفض معدل للإيجابية المصلية للأضداد المضادة للنمط المصلي 3 بين الأطفال الذكور [58.3 %]. وقد اتضح أن الاقتصار على الرضاعة الطبيعية من الثدي له تأثر مباشر على الاستجابة بالأضداد المضادة للنمط المصلي الثالث من فيروس شلل الأطفال.[معدل الأرجحية = 0.2 ، فاصلة الثقة 95%، تراوح بين 1.1 و 3.6]. ويعد تحسن الحماية المجتمعية ضد النمط المصلي 3 لفيروس شلل الأطفال من الأولويات الملحة للبرنامج

ABSTRACT Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 (± 2) months who had received at least 5 doses of trivalent oral polio vaccine. Using cluster sampling, 365 children were enrolled for serological testing. Antibody titres ≥ 1:10 were considered positive. Seropositive rates for antibody against poliovirus serotypes 1, 2 and 3 were 94.1%, 96.7% and 78.3% respectively. The lowest seropositive rate was for antibody against polio serotype 3 (PV3) among boys (58.3%). Exclusive breastfeeding showed a direct relationship with antibody response to PV3 (OR = 2.0; 95% CI: 1.1–3.6). Improving community protection against PV3 is an urgent programme priority.

RÉSUMÉ Les déplacements de population en provenance d'autres pays où la poliomyélite n'a pas été éradiquée représentent une préoccupation en République islamique d'Iran. Une étude transversale communautaire a été menée en 2010 dans deux districts de la province du Sistan-Balouchistan près de la frontière du sud-est. L'objectif était de déterminer la séroprévalence des anticorps chez des enfants âgés de 20 (± 2) mois qui avaient reçu au moins cinq doses du vaccin antipoliomyélitique oral trivalent. L'échantillonnage en grappes était la méthode utilisée ; 365 enfants ont été recrutés pour une analyse sérologique. Des titres d'anticorps supérieurs ou égaux à 1:10 étaient considérés comme positifs. Les taux de séropositivité pour les anticorps dirigés contre les sérotypes des poliovirus 1, 2 et 3 étaient de 94,1 %, 96,7 % et 78,3 %, respectivement. Le taux de séropositivité le plus faible était celui correspondant aux anticorps contre le sérotype 3 du poliovirus chez les enfants de sexe masculin (58,3 %). L’allaitement au sein exclusif présentait un lien direct avec la réponse des anticorps au sérotype 3 du poliovirus (OR = 2,0 ; IC à 95 % : 1,1–3,6). Améliorer la protection de la communauté contre le sérotype 3 du poliovirus représente une priorité programmatique urgente.

Causes of new cases of major thalassemia in sistan and balouchistan province in South-East of iran.

BACKGROUND: Thalassemia is the most common monogenic disease in South-East of Iran. Despite the 70% reduction in Iranian thalassemia cases after thalassemia control comprehensive program, 601 affected babies were born in Sistan and Balouchistan Province, Iran from 2002 to 2010, so this study aims at investigating the causes of new thalassemia cases. METHODS: Data from this retrospective cross-sectional study was collected through interviews and information in the patients' hospital records. RESULTS: Data revealed that 52.4% of fathers and 78.4% of mothers of thalassemic children had elementary education or less. In addition, 78.6% of the couples did not undergo premarital screening for thalassemia and 71.2% of the couples were not notified of their own minor thalassemia until a child was born with major thalassemia. Of the diagnosed minor couples, about 25% did PND and the others did not carry out because mothers were unaware of proper gestational age and of the importance of this issue, financial problems, and the husbands' disagreement to take the tests. Moreover, 16 mothers, in spite of being diagnosed of having a major fetus, refused to terminate the pregnancy. CONCLUSION: The most preventable causes for affected births include couples' unawareness of being minor and unawares of the PND importance and process.

Identification and genetic variation of fasciola species from tabriz, north- Western iran.

BACKGROUND: Fascioliasis is considered as the most important helminthic infection of cattle and sheep. Traditional approaches using morphological and biologic characters cannot cause a certainty in the accurate and precise identification and intra-specific differences of Fasciola spp. In this study, we identified Fasciola species using ITS-1 marker and described genetic variation of each species of the parasite in isolates from Tabriz slaughterhouse in West Azerbaijan Province, north- western Iran. METHODS: Overall, 100 samples (50 from sheep and 50 from cattle) morphologically detected as Fasciola worms were studied for identification of Fasciola species by PCR-RFLP method and intra-species variation of the parasite using RAPD-PCR technique. RESULTS: A region of approximately 460bp in all samples was successfully amplified. There were no identifiable variations among the size of PCR products. Two and three fragments in samples correspond to F. hepatica and F. gigantica was seen, respectively, through PCR-RFLP method. No difference was seen in digestion pattern according to host (sheep or cattle). Different types of each species of the parasite was observed using RAPD-PCR technique. CONCLUSION: We could have an estimate of frequency of F. hepatica and F. gigantic and different genotypes of the parasite in isolates from one locality in north- western of Iran. By extension of such studies in future to other animal hosts (buffalo and goat) and including more regions to sampling, the reliability of the results and their application for control programs in zoonotic diseases will be increased.

Papilloedema secondary to venous sinus thrombosis following glomus jugulare tumour surgery.

OBJECTIVE: We present a case of a patient who had undergone embolisation and resection of a left glomus jugulare tumour, who presented three weeks post-operatively with magnetic resonance venography confirmed symptomatic cerebral venous sinus thrombosis. METHOD: We present a case report and a review of the world literature concerning glomus jugulare tumours and cerebral venous sinus thrombosis. CASE REPORT: A 42-year-old man presented with blurred vision and reduced Snellen visual acuity just three weeks after glomus jugulare tumour surgery. Fundoscopy revealed bilateral haemorrhagic optic disc oedema. Urgent magnetic resonance venography confirmed a left lateral venous sinus thrombosis. It was felt that this was responsible for inadequate cerebrospinal fluid drainage, resulting in raised intracranial pressure and papilloedema. CONCLUSION: To the authors' knowledge, this is the first account of a magnetic resonance venography confirmed venous sinus thrombosis and secondary papilloedema following glomus jugulare tumour surgery. Patients undergoing surgery involving resection or manipulation of the internal jugular vein may be at higher risk of developing thrombosis superior to the level of resection, and magnetic resonance venography ought to be considered an important diagnostic adjunct.

Comparison of naproxen with placebo for the management of noncyclical breast pain: a randomized, double-blind, controlled trial.

BACKGROUND: Breast pain is a common symptom in patients attending breast clinics. Although most patients experience mastalgia of mild to moderate severity, approximately 15% of patients suffer from severe pain that causes significant distress and some disturbance in their daily life that lead them to seek treatment. Despite a considerable number of drugs suggested for decreasing the severity of mastalgia, there is no standard treatment for the complaint. In this study, we investigated the effect of naproxen on reducing the complaint of breast pain compared with placebo. METHODS: Eighty-one women suffering from noncyclic breast pain were recruited to a randomized, double-blind, clinical trial between January 2002 and September 2004. All patients were suffering from this complaint for at least 3 months before the study. Patients were randomly assigned to two groups. Patients in the case group received naproxen 250 mg BD. Patients in the placebo group took placebo in a similar manner. The intensity of mastalgia was assessed before and twice after intervention by using a Visual Analogue Scale. RESULTS: Forty-two of 81 patients were recruited randomly as cases and the remaining 39 were assigned placebo. Of these 24 and 22 patients fulfilled the study protocol respectively. The mean age of patients was 35 (SD = 7.5; range, 19-55) years. The mean pain severity at the beginning of the study was 5.8 and 6.1 in naproxen and placebo groups, respectively. The severity of pain was decreased significantly at the end of the study in both groups (3.9 in patients and 3.7 in controls (P = 0.005 and 0.0001)). Although the decrease in pain severity in each individual group was statistically significant, it was not significant compared with one another (P = 0.64). CONCLUSIONS: Breast pain is a complex symptom that can be relieved significantly with reassurance. According to the result of this study, naproxen has no superiority over placebo in reducing noncyclic breast pain.

Study of the effect of renal transplantation on methacholine challenge test in patients with end-stage renal failure in Shahid Doctor Labafinejad Hospital in Tehran, Iran.

Pulmonary complications are common in patients with chronic renal failure (CRF). The objective of this study was determine the effect of renal transplantation on pulmonary function, using a methacholine challenge test. This interventional study included 14 CRF patients on maintenance dialysis who underwent serial spirometry and astography before and after renal transplantation. None of them was known to have clinically important pulmonary or heart disease. The results of spirometry, astography, echocardiography, and chest X-ray were normal. Five patients were men and all others were women. The overall age range was 15 to 45 years (mean age = 28.6 +/- 10.9). For every patient four times astography was done. The mean values of spirometric and astography indices before and after renal transplantation were within normal limit. But by repeated measure analysis of variance, the results actually showed improved airway responsiveness (although within normal limits). The most common pathological lung condition in CRF is pulmonary edema, usually due to a combination of fluid overload and abnormal permeability of the pulmonary microcirculation. However, our patients had no symptomatic pulmonary edema, but minor degrees of fluid retention are virtually impossible to detect clinically and could not be excluded. Therefore, it seems that disappearance of subclinical pulmonary edema was the likeliest cause of an increase in minimum dose of methacholine, and therefore improvement in airway responsiveness after renal transplantation.

Use of Frost sutures in an orbital trauma patient with extensive conjunctival oedema and pseudoproptosis.

Frost sutures are temporary suspension sutures conventionally used in oculoplastics. The case is presented here of a patient with multiple orbital fractures who developed worsening conjunctival chemosis and pseudoproptosis. This patient was managed successfully with Frost sutures. To the best of the authors' knowledge, there is no documented use of Frost sutures in this type of case. It is emphasized that this technique should only be considered following rigorous exclusion of retrobulbar pathology and careful attention towards early detection of raised intraocular pressure.

Bilateral posterior dislocation of the crystalline lens after a head injury sustained during a seizure.

This article presents a case of bilateral posterior dislocations of the crystalline lens in a patient with epilepsy who presented with reduced vision and anisocoria 2 weeks after having sustained head injuries during a seizure. The possibility of lens dislocation was raised only at this time, and subsequently confirmed on computed tomography. Such patients may require prompt referral to the ophthalmologist to treat complications such as functional aphakia, uveitis and more seriously pupillary block glaucoma. This case highlights the importance of ocular examination of head injuries to rule out possible ophthalmological pathology.