JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2011 | Volume:16 | Issue:9|Papers Count:20

BACKGROUND: The purpose of this study is to compare validity of 5 diagnostic tests of helicobacter pylori with each other: stool antigen test, urea breath test (UBT), rapid urease test (RUT), serology and histology.METHODS: A total of 94 patients who had indication of endoscopy entered the study. All of the 5 tests were performed for each patient. When the results of at least 2 tests were positive (except serology), Helicobacter pylori infection was considered to be positive. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under receiver operating characteristic (ROC) curve of these 5 tests were determined.RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under ROC curve of these 5 tests are as below, respectively. Histology: 89%, 78%, 93%, 91%, 85% and 0.881, RUT: 93%, 75%, 95%, 94%, 86% and 0.831, serology: 50%, 54%, 46%, 61%, 52% and 0.563, stool antigen test: 96%, 83%, 98%, 96%, 91% and 0.897, UBT: 89%, 73%, 92%, 90%, 82% and 0.892.CONCLUSIONS: Stool antigen test is the most accurate test for Helicobacter pylori diagnosis before eradication of these bacteria.

BACKGROUND: The purpose of present study was to create and test a model that illustrates variables that influence the development of addiction susceptibility and determine how different styles of parenting may indirectly influence the addiction susceptibility of children through the mediators of attachment style and self-regulation.METHODS: Using random cluster sampling, 508 adolescent high school boys and girls aged 14-19 years were enrolled.Data were analyzed using structural equations modeling (path analysis).RESULTS: The results showed that authoritative and permissive parenting styles were associated with secure attachment whereas authoritarian and neglectful parenting styles were associated with insecure attachment. Insecure attachment was associated with a low level of self-regulation whereas secure attachment was associated with a high level of selfregulation.We found that a low level of self-regulation increased the adolescent's addiction susceptibility whereas a high level of self-regulation decreased their addiction susceptibility.CONCLUSIONS: The findings of present study suggest the authoritative and permissive parenting styles as the most efficient styles and authoritarian and neglectful parenting styles as the most inefficient styles in terms of addiction susceptibility.Accordingly, efficient parenting style training to parents should be the main goal of drug demand reduction program.

BACKGROUND: The aim of this study was to compare the usefulness of ultrasonography and scintigraphy in diagnosing the etiology of primary congenital hypothyroidism (CH).METHODS: The newborns that were examined by both thyroid scintigraphy and ultrasonography during CH screening program in Isfahan were included in this study. The ultrasonographic findings were compared with the scintigraphic findings and the sensitivity and specificity of the ultrasonography was determined.RESULTS: During this study, 102 CH newborns were studied. According to the ultrasonographic results, 61.8%, 26.5%, 2.9% and 8.8% of them had normal thyroid gland, agenesia, ectopia and hypoplasia, respectively, and according to scintigraphic results, 55.9%, 35.3% and 8.8% of them had normal thyroid gland, agenesia and ectopia, respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 77%, 92%, 89%, 84%, 9.6 and 0.25, respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100%, respectively.CONCLUSIONS: Though thyroid ultrasonography failed to diagnose 67% of ectopic cases and nonfunctioning thyroid gland, it had the ability to determine the anatomy of thyroid gland. So, considering some limitations of scintigraphy, we concluded that ultrasonography is a relatively appropriate imaging tool for diagnosing CH etiologies, especially in the initial phase of CH screening.

BACKGROUND: Various methods have been applied to prevent maternal hypotension after spinal anesthesia for cesarean delivery. We compared the efficacy of three combinational methods in this regard in the current study.METHODS: In this randomized comparative trial, 150 candidates of elective cesarean delivery under spinal anesthesia were assigned to three groups: crystalloid preload and leg bandage, colloid preload and leg bandage, and ephedrine and leg bandage. Maternal hemodynamic changes during 60 minutes after spinal injection and neonatal condition were compared among the groups.RESULTS: The cumulative incidence of hypotension was 54%, 64%, and 36% in groups 1 to 3, respectively (p=0.018).Spinal injection to hypotension interval was similar among the groups (p=0.828). Heart rate in group 3 was significantly lower at the most time measures after anesthesia compared with the other two groups (p<0.05 to<0.001). Regarding neonatal outcomes, the interval between the birth and the first breath was longer and the Apgar score at minute 1 was lower in group 3 compared with the other groups (p<0.001 and 0.038, respectively) but it was not clinically important.Umbilical cord blood pH was similar among the three groups (p=0.248).CONCLUSIONS: Among the three studied methods, administration of ephedrine plus bandage of the lower extremities was the most effective one in reducing the incidence of post-spinal hypotension. The groups were not clinically different concerning the effect of treatment on newborn health.

BACKGROUND: Midazolam has analgesic properties. The aim of the present study was to assess the analgesic effect of midazolam when added to lidocaine in intravenous regional anesthesia (IVRA).METHODS: Sixty patients undergoing hand surgery were randomly allocated into two groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the control group (group lidocaine saline  ~ LS, n=30) or 50mg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam group (group lidocaine midazolam ~ LM, n=30). Before and after the tourniquet application, hemodynamic variables, tourniquet pain, sedation, and analgesic use were recorded.RESULTS: Shortened sensory and motor block onset time [4.20 (0.84) vs.5.94 (0.83) min, p=0.001 and 6.99 (0.72) vs.9.07 (0.99) min, p=0.001 in LM and LS groups, respectively], prolonged sensory and motor block recovery times [8.41 (0.94) vs.5.68 (0.90) min, p=0.001 and 11.85 (1.18) vs.7.06 (0.82) min, p=0.001 in LM and LS groups, respectively], shortened visual analog scale (VAS) scores of tourniquet pain (p<0.05), and improved quality of anesthesia were found in group LM (p<0.05). VAS scores were lower in group LM in the postoperative period (p=0.001).Postoperative analgesic requirements were significantly smaller in group LM (p=0.001).CONCLUSIONS: The addition of 50 mg/kg midazolam to lidocaine for IVRA shortens the onset of sensory and motor block, and improves quality of anesthesia and perioperative analgesia without causing side effects.

BACKGROUND: The objective of this study was to determine the effects of nutritional educational program on glycemic control of elderly patients with type 2 diabetes.METHODS: In this parallel randomized controlled educational trial, 100 diabetic elderly patients (³60 years) were chosen (50 in control and 50 in test group). Nutrition education based on beliefs, attitudes, subjective norms and enabling factors (BASNEF model) was conducted. Dietary intake and glycemic indices as well as the components of the BASNEF model were assessed. The four 70-minute educational sessions were conducted in one month. Three months after training intervention, questionnaire was completed again and blood tests were performed.RESULTS: Increased intake in the mean daily servings of fruits (0.91 ± 0.82 vs.0.17±0.79, p<0.001), vegetables (0.87±0.86 vs.0.03±1, p<0.001) and dairy (0.35±0.52 vs. and 0.12±0.76, p<0.001) were reported in the intervention group compared to the control group (p<0.001). The amount of fruits, vegetables and dairy increased in the intervention group at the end of the study (p<0.001). However, it was not significantly changed in the control group. HbA1c and fasting blood sugar (FBS) levels decreased significantly in the interventional group compared to the control group (p<0.001). Comparing the amount of FBS and HbA1c at the end of the study with the baseline measurements showed significant reduction in interventional group (p<0.001). However, there was no significant change in control group in this regard.CONCLUSIONS: BASNEF–based nutritional educational intervention improved dietary intakes as well as glycemic control, 3 months after intervention.

BACKGROUND: Opioid and local anesthetic infusion by an epidural catheter is widely used as a postoperative pain management method after major abdominal surgeries. There are several agents nowadays to provide sufficient analgesia. The agents which cause less side effects but better quality of analgesia are more valuable. We aimed to postoperatively compare the analgesic, hemodynamic and arrhythmogenic effects of epidural levobupivacaine-fentanyl and bupivacaine-fentanyl solutions.METHODS: Fifty patients were scheduled to undergo major abdominal surgery in this clinical trial. The parameters were recorded pre- and post-operatively. In Group I (n=25), bupivacaine with fentanyl solution and in Group II (n=25), levobupivacaine with fentanyl solution was infused via epidural patient-controlled analgesia (PCA). According to the preoperative and postoperative holter recording reports, the arrhythmogenic effects were examined in four catagories: ventricular arrhythmia (VA), supraventricular arrhythmia (SVA), atrioventricular conduction abnormalities and pauses longer than two seconds.RESULTS: Mean visual analog scale (VAS) values of groups did not differ at all time. They were 6 at the end of the surgery (0. Min, p=0.622). The scores were 5 in Group I and 4 in Group II in 30. min (p=0.301). The frequency of SVA was higher in bupivacaine group.CONCLUSIONS: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

BACKGROUND: Hypertensive patients have higher morbidity and mortality from hemorrhage. In this study, we investigated hemodynamic responses and serum nitrite concentrations during graded hemorrhagic shock and resuscitation in hypertensive (HT) and normotensive (NT) rats.METHODS: Thirteen male rats were divided into two groups, namely HT (n=6) and NT (n=7). Hypertension was induced by deoxycorticosterone acetate (DOCA) -salt method in uninephrectomized rats. After 8 weeks, graded hemorrhagic shock was induced during 34 minutes in four steps separated by 8-minute intervals (totally 16 ml/kg). The animals were kept in this condition for 120 minutes (shock period). Then, they were resuscitated with blood withdrawal.Mean arterial pressure (MAP) and heart rate (HR) were measured throughout the experiment. Blood samples were taken before and after shock induction and at the end of the shock period.RESULTS: HT rats experienced more MAP and HR reduction during the shock period and less improvement of hemodynamic response after resuscitation compared with the NT group (p<0.05). The survival rate 72 hours post-hemorrhage in the HT group was significantly lower than the NT group (16.7% vs.71.4%, respectively) (p<0.05). Serum nitrite level in HT animals was lower than the NT group (2.45 ± 0.18 vs.3.35 ± 0.26 m mol/lit, respectively, p<0.05). In addition, it increased during the shock period in both NT and HT groups (p>0.05).CONCLUSIONS: More reduction of MAP after hemorrhagic shock, less improvement of MAP and HR after resuscitation and low survival rate in HT animals suggested the impairment of cardiovascular system adaptation of HT animals during blood loss and it should be considered in management of hypertensive subjects.

BACKGROUND: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction.METHODS: 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1: 200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded.After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests.RESULTS: The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics.In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery.CONCLUSIONS: Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is a valuable choice and is recommended to be added to other local anesthetics administrated drugs after this procedure.

BACKGROUND: One of the most important selection criteria for spinal metastases surgery is life expectancy and the most important system for this prediction has been proposed by Tokuhashi. The aim of this study was to evaluate predictive value of the Tokuhashi score for life expectancy in Iranian patients with spinal metastases one year after diagnosis.METHODS: From February 2007 to March 2009, of 180 patients suffering spinal metastatic tumors, 71 patients were excluded. This left a study population of 109 patients with known malignant metastases to spine (56 females and 53 males, mean age, 57 ± 12 years). Tokuhashi revised evaluation system for the prognosis of metastatic spinal tumors was used for all patients. The survival period predicted by this system for the prognosis and the actual survival period after 1 year follow up were evaluated.RESULTS: The predicted survival according to Tokuhashi prognostic scoring system was less than 6 months in 38 (34.9%) patients, 6-12 months in 39 (35.8%) patients and 1 year or more in 32 (29.4%) patients.39 (35.8%) patients died at first six-month of the follow up, 28 (25.7%) patients at the second six-month period and 42 (38.5%) patients were alive at the end of the year. There was no significant difference between predicted and actual survival time (p=0.116).CONCLUSIONS: Present study showed that the Tokuhashi revised scoring system may be practicable and highly predictive preoperative scoring system for patients with spinal metastases in Iran.

BACKGROUND: Acne scarring is treatable by a variety of modalities. Ablative carbon dioxide laser (ACL), while effective, is associated with undesirable side effect profiles. Newer modalities using the principles of fractional photothermolysis (FP) produce modest results than traditional carbon dioxide (CO2) lasers but with fewer side effects. A novel ablative CO2 laser device use a technique called ablative fractional resurfacing (AFR), combines CO2 ablation with a FP system. This study was conducted to compare the efficacy of Q-switched 1064-nm Nd: YAG laser and that of fractional CO2 laser in the treatment of patients with moderate to severe acne scarring.METHODS: Sixty four subjects with moderate to severe facial acne scars were divided randomly into two groups. Group A received Q-Switched 1064-nm Nd: YAG laser and group B received fractional CO2 laser. Two groups underwent four session treatment with laser at one month intervals. Results were evaluated by patients based on subjective satisfaction and physicians’ assessment and photo evaluation by two blinded dermatologists. Assessments were obtained at baseline and at three and six months after final treatment.RESULTS: Post-treatment side effects were mild and transient in both groups. According to subjective satisfaction (p=0.01) and physicians' assessment (p<0.001), fractional CO2 laser was significantly more effective than Q-Switched 1064- nm Nd: YAG laser.CONCLUSIONS: Fractional CO2 laser has the most significant effect on the improvement of atrophic facial acne scars, compared with Q-Switched 1064-nm Nd: YAG laser.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavioral disorder causing hyperactivity, attention deficit and education decline among students. The teachers may not have enough knowledge about this disorder and are in a real need in this field. Teachers' education is one of the ways to get knowledge about this disorder. Nowadays, finding a way like a short term nonattendance education method is highly in demand.Therefore, the aim of the study was to compare effectiveness of nonattendance and workshop education of primary school teachers on their knowledge, attitude, and function towards ADHD students.METHODS: Sixty seven primary school teachers from the First Districts of Education Department of Isfahan were randomly selected and put into two groups of workshop education (33 participants) and nonattendance education (34 participants).At first, both groups filled demographic date questionnaires and then, were given a pretest. Post tests were given after a two day education in workshop group and after ten days in nonattendance group who had studied the related booklet. Finally, the mean post test scores of knowledge, attitude and knowledge of function were compared between the two groups using ANCOVA analysis.RESULTS: After intervention, the mean scores of knowledge between the two groups was not significantly different whereas the mean scores of attitude and the mean scores of knowledge of function showed a significant difference between the two groups.CONCLUSIONS: Nonattendance education was as effective as workshop education in promotion of teachers' knowledge, but workshop education was more effective in attitude change and promotion of teachers' knowledge of function about dealing with ADHD students.

BACKGROUND: Student counseling centers are responsible for physical, mental and social health of university students.Therefore, this study was conducted to assess the key stakeholders' opinions on different aspects of the activities performed in these centers.METHODS: This qualitative study used focus group discussion. Key stakeholders including university students and key informants from nine randomly selected medical universities participated in the study. After data saturation, thematic analysis was conducted. Themes were drawn out through constant comparative method.RESULTS: Based on 243 extracted codes and through comparative analysis, four categories were determined, namely students' need for students counseling centers, successes and limitations of student counseling centers, student counseling services priorities, and suggestions for service promotion.CONCLUSIONS: According to stakeholders' opinions, youth participation in needs assessment and priority setting processes in real-based situations leads to better performance of counseling services. Empowering the counselors is another point required for better outcomes. In addition, strategic planning and monitoring, along with evaluation of programs, could promote the provided services.

BACKGROUND: The efficacy of subpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated the efficacy of two types of subpleural analgesia.METHODS: This prospective, controlled, randomized, double-blind trial was performed in Department of Thoracic Surgery of Alzahra Hospital associated with Isfahan University of Medical Sciences from June 2009 until August 2010. After posterolateral thoracotomy and admission to the ICU, patients were randomly assigned into two groups of subpleural patient-controlled analgesia (SPCA) (0.02 cc/kg/h of 0.5% bupivacaine) and subpleural intermittent analgesia (SIA) (0.1cc/kg/6h of 0.5% bupivacaine). The data regarding age, sex, visual analog scale (VAS) (at 8, 16 and 24 hours after initiation of analgesia), morphine consumption, systemic adverse effects, length of ICU and hospital stay, complications, public health service (PHS) criteria, and cost was recorded. Data was analyzed by Mann-Whitney U-test, repeated measured test, chi-square test and the Fisher’s exact test. A p<0.05 was considered significant.RESULTS: The study population consisted of 90 patients. There were no significant differences in sex, age, weight, intraoperative analgesics, duration of one-lung ventilation, and adverse effects between the SPCA and SIA groups. Although pain scores were significantly reduced at 16 hours after the first subpleural instillation of bupivacaine 0.5% with patient-controlled analgesia, comparison between mean pain scores in the two groups at 8 and 24 hours after the first subpleural instillation of bupivacaine 0.5% revealed no significant difference. In addition, no significant difference was found in VAS scores at the three evaluated times (p<0.05).CONCLUSIONS: Optimal use of SPCA bupivacaine for postoperative pain treatment is more effective in pain reduction than SIA bupivacaine. The consumption rate of opioid and bupivacaine was also decreased in SPCA group.

BACKGROUND: Tinnitus is a chronic and bothering problem which in some patients may lead to some psychological reactions. While tinnitus may be caused due to some definable structural abnormalities, sometimes no structural etiologic defect can be found. This study aimed to evaluate the therapeutic effects of acupuncture on the inner ear originated tinnitus in the latter mentioned group.METHODS: This prospective clinical trial study has been done in Alzahra and Kashani hospitals in Isfahan, Iran during 2010-2011. Simple sampling was used to select patients who were then divided into two groups of true acupuncture group and placebo group. The number of patients in each group was 27. The hospital anxiety and depression scale (HADS), tinnitus severity index questionnaire, and tinnitus loudness scale were completed by the patients. Two latter questionnaires were completed again after the 5th and 10th sessions of acupuncture treatment. The case group was treated with effective acupuncture with true acupuncture needles while the control group was treated ineffectively, i.e.similar to the usual acupuncture method but with fake needles. Independent t-test was used to compare the mean of tinnitus severity index and loudness scores between the two groups. We also used repeated measures ANOVA test to compare the mean of tinnitus severity index and loudness for different assessments in either group.RESULTS: After the 5th and 10th sessions of treatment, the mean of tinnitus severity index reduced significantly only in the case group (p=0.002, and p=0.001, respectively). In addition, the quality of life in the case group also improved after the treatment. Moreover, the mean of tinnitus loudness also reduced significantly only in the case group after 5 and10 sessions of treatment (p=0.001, and p<0.001, respectively).CONCLUSIONS: It seems that acupuncture can improve tinnitus in some selected patients.

BACKGROUND: A difference more than 15-40% in birth weight of twins can predict perinatal complications. As significant difference in twins growth has a very important effect on pregnancy and perinatal complications, this study aimed to evaluate crown-rump length discordance (DCRL) in the first trimester of pregnancy and its correlation with perinatal complications.METHODS: A total number of 118 women in the first trimester of twin pregnancy underwent ultrasound examination to measure DCRL. Then, at the time of delivery, perinatal complications in twins were recorded and the correlation between DCRL and perinatal complications were evaluated.RESULTS: Among 118 studied mothers with twin pregnancy, DCRL was normal (<11%) in 96 cases (81.4%) and high (³ 11%) in 22 cases (18.6%). Birth weight discordance was normal (<20%) in 103 cases (87.3%) and above normal ( ³ 20%) in 15 cases (12.7%). The results revealed a significant correlation between higher frequency of small for gestational age (SGA) and high DCRL (more than 11%) (p=0.01).CONCLUSIONS: Our study concluded that SGA has a significant relationship with high DCRL (>11%).

BACKGROUND: Cancer incidence rate is increasing in the world particularly in developing countries. The awareness regarding cancer incidence and distribution helps policy makers and researchers to design comprehensive plan for controlling cancer. The aim of this study was to determine the incidence rate and trend of cancer in Isfahan area, one of the most importance provinces of Iran.METHODS: Data of Isfahan cancer registry were derived from 2005 to 2010. Direct standardization through world standard population produced by the world health organization was used and adjusted standard rate (ASR) was calculated.The Poisson regression analysis was employed to estimate cancer incidence trend during 5 years.RESULTS: The new cases of cancer were 24771 patients from 2005 to 2010. Mean age of these patients was 56.1 ± 18.0 years and 54.6% were male. Male patients were approximately 7 years older than females. The most frequent cancer was gastrointestinal in men and breast cancer in women. The rate of cancer increased approximately 4 per 1000 population and incidence rate ratio (IRR) was 1.004 (95%CI: 1.002-1.005).CONCLUSIONS: The rate of cancer is increasing rapidly in Isfahan province. Cancer control and comprehensive prevention plan for Isfahan is necessary.

Pediatric pre-hypertension (pre-HTN) has a complex multifactorial etiology. Although most cases are secondary to other disorders, a substantial number of children and adolescents have primary or essential HTN and pre-HTN. The genegene and gene-environment interactions should be considered in this context. The strong relationship of pre-HTN with environmental factors such as air pollution, noise pollution and passive smoking and obesity suggest that its prevalence will be escalating.Exposure to ambient particulate matters may increase blood pressure (BP) within hours to days. The underlying biologic pathways include autonomic nervous system imbalance and arterial vascular dysfunction or vasoconstriction because of systemic oxidative stress and inflammation. Likewise, tobacco smoke exposure of pregnant mothers increases systolic BP of their offspring in early infancy. Parental smoking also independently affects systolic BP among healthy preschool children. Noise exposure, notably in night, is associated with catecholamine secretion, increased BP and a pre-HTN state even in pre-school age children.Excess weight is associated with dysfunction of the adipose tissue, consisting of enlarged hypertrophied adipocytes, increased infiltration by macrophages and variations in secretion of adipokines and free fatty acids. These changes would result in chronic vascular inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone system and sympathetic response, and ultimately to pre-HTN from childhood.Prevention and control of the modifiable risk factors of pre-HTN from prenatal period can have long-term health impact on primordial and primary prevention of chronic non-communicable diseases. This review presents a general view on the diagnosis, prevalence and etiology of pre-HTN along with practical measures for its prevention and control.

Rosai-Dorfman disease (RDD) is a rare lymphoproliferative disorder with nodal and extranodal involvements. Here we report a case of RDD in a 15-year-old female who presented with epigastric pain, fatigue, Raynaud phenomenon in fingers, submandibular lymphadenopathy, proptosis, hepatosplenomegaly, and round shape painless patches on the extensor surfaces. Histological examination of the submandibular lymph nodes and skin biopsy demonstrated evidences of RDD. Patient was treated with prednisone and thereafter, with azathioprine. After one year, prednisone was discontinued and all of the symptoms and signs, except proptosis, were resolved. This report highlights the extranodal manifestations of RDD. The presentation, differential diagnosis, and treatment are discussed.

We read with interest the article1 depicting the use of prostate-specific antigen (PSA) as a diagnostic tool in polycystic ovarian disease. While serum PSA levels in females are much lower than in males, and often need ultrasensitive immunoassays for quantification, 2 their importance cannot be overlooked. Indeed, PSA has come up as a potential serological diagnostic and prognostic tool in women recently.