Journal of Isfahan Medical School
Year:2007 | Volume:25 | Issue:9 (SUPPLEMENT)|Papers Count:14

Background: Chronic supporative otitis media (CSOM) is one of the common chronic infectious diseases worldwide. Treatment of CSOM is improved as a result of availability of effective otic and oral antibiotics. Fluoroquinolons such as ciprofloxacin have improved the therapeutic possibility and the concentration of antibiotic in the middle ear. In this study, we wanted to determine if there is any crystallization after administration of topical ciprofloxacin in external auditory canal (EAC) in order to avoid possible clinical misdiagnosis between fungal infections and the crystals. Methods: In this prospective clinical trial, 61 affected ears with chronic supportive otitis media without cholesteatoma were included. Patients were randomly divided into 3 groups as follows: 1) otic ciprofloxacin3 drops per dose TDS, 2) otic ciprofloxacin5 drops per dose TDS and 3) ethanol 70% 3 drops per dose TDS. Then, the probable adverse effects of these agents were compared. After filling out data collection forms, the second appointments were scheduled. On the 2nd visit, any material in EAC was sampled by otorhinolaryngologist. The samples were examined for crystal determination by XRPD technique (X-ray power diffraction) and for fungal pathogens. Data were analyzed by SPSS software. Findings: Overall, 41 affected ears were treated with ciprofloxacin and 20 were treated with ethanol 70%. In ciprofloxacin group, 22 ears were treated with 3 drops per dose TDS and 19 ears were treated with 5 drops per dose TDS. Crystallization in EAC was found in 29 ears in ciprofloxacin groups (15 ears in 3-drop group and 14 ones in 5-drop group). In ethanol 70% group, no crystallization was seen. Two ears were affected with fungal otitis externa in ciprofloxacin 3-drop group. Conclusion: Ciprofloxacin drop can be crystallized in EAC. This complication should be differentiated from fungal otitis externa.

Alveolar echinococcosis is a rare disease mostly found in Europe, Siberia, Alaska and Eskimos. In Human being, it is fatal and its growth is like a carcinoma. In this report we present a case of hepatic alveolar echinococcosis with obstructive jaundice in a 48 year-old woman from Northwest of Iran. Left lobe and other parts of liver and retroperitoneal lymph nodes of posterior head of the pancreas were involved. Serologic study for echinococcus antibody was positive. Her abdominal CT scan showed a cystic-like mass suspicion to hydatid cyst in the left lobe of the liver (90 x 120 mm) and another mass with central necrosis in the right posterior lobe of the liver. At laparotomy, multiple masses (hydatid cysts) of the left lobe with variable sizes were seen. On choledochal exploration, tumoral invasion of hilum, obstructed the left and right hepatic ducts. Pathologic examination of the mass biopsies revealed alveolar echinococcosis. This type of echinococcosis is uncommon in Iran and rarely has been reported.

Background: The purpose of this study was to determine the frequency of clinical and laboratory findings in children with idiopathic thrombocytopenic purpura (ITP) and to compare the treatment response between corticosteroid and intravenous immunoglobulin. Methods: From treatment records of patients with diagnosis of ITP, 100 cases were selected. Response to treatment and some other demographic, clinical and laboratory findings were analyzed. Subjects were divided into four groups with three different treatment protocols comprising corticosteroid, intravenous immunoglobulin (IVIG), a combination of both and a group with no drug therapy. Response to treatment was assessed based on thrombocytecount. Findings: Corticosteroid agents were prescribed for 41% of the patients while IVIG was used in 35% and the combination therapy in 6%. However, 18% received no drug therapy and were observed conservatively. A statistically significant association was found between the age of subjects and the treatment protocol in a way that younger patients received IVIG more than receiving corticosteroid agents. Totally, good response was reported in 58% of the patients, 25% showed average response and 17% did not respond to treatment at all. A statistically significant correlation was observed between the treatment protocol and the response to treatment, in a way that IVIG alone was reported to increase the platelet count more than that of other methods. Conclusion: IVIG was reported to augment the platelet count more effectively compared to corticosteroids. However, considering the limitations of IVIG prescription, corticosteroids were usually the first-line treatment choice.

Background: Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endonasal endoscopic techniques when surgical repair is necessary. We present our data of endoscopic repairs of CSF rhinorrhea with long-term follow-up. Methods: Retrospective study of patients with CSF rhinorrhea who underwent endoscopic repair was carried out. Data were analyzed to determine the prevalence of different etiologies, locations, surgical techniques and surgical outcomes. Findings: Fifteen known cases of CSF rhinorrhea who underwent endoscopic repair over a 6-year period. Eight were males and 7 were females. The average age was 24.4 (range of 8 to 60) years. Average follow up was 20 (range of 6-61) months. The etiology of CSF leak was traumatic in 10 patients (66.66%), idiopathic in 3 (20%) and neurosurgical procedures in 2 (13.33%). The most common locations of the defects were sphenoid sinus (n=5, 33.33%) and ethmoid roof (n=5, 33.33%) followed by cribriform plate (n=4, 26.66%). Endoscopic repair was successful in all patients. No major complications were encountered. Conclusion: The intranasal endoscopic approach is an effective and safe approach in surgical management of CSF rhinorrhea. Long-term success rate in our patient population was complete.

Background: Pneumatic and holmium-YAG laser lithotripsy have proved more efficient than ultrasonic or electrohydraulic lithotripsy for large (>3 cm) bladder calculi. They may, however, be associated with relatively long operative times. Percutaneous cystolithotomy has thus been advocated for large vesical stone burdens with anticipated prolonged operative times. Probes for the pneumatic lithotrities, ranges from 0.8 to 2.5 mm We report our preliminary experience with a 4 mm probe for the treatment of large (>3 cm) bladder calculi. Methods: Ten men with bladder stones larger than 3 cm (mean stone burden 35 mm, range: 30-42 mm) underwent transurethral pneumatic lithotripsy using a 4 mm probe manufactured at our institution. Mean patient age was 64 years (range: 44-78 years). Stone fragments larger than 4 mm were evacuated during and at the end of procedure. Findings: Mean operative time was 59 minutes (range: 25-99 minutes). There were no perioperative complications. All patients were rendered stone free at the end of the procedure. Conclusion: Pneumatic lithotripsy of bladder calculi larger than 3 cm using a 4 mm probe was associated with relatively short operative times and may be an appropriate alternative to percutaneous cystolithotomy for the management of these calculi.

Background: Pre-eclampsia is a major cause of death in pregnant women and newborn babies worldwide. Calcium and vitamin C metabolism may play a role in pre-eclampsia. To compare serum vitamin C and calcium levels between preeclamptic and normotensive pregnant women this study was carried out.Methods: In a case-control study 60 pregnant 18-35 year old women (30 preeclamptic and 30 normotensive) on their 28-48th weeks of pregnancy were randomly selected from the patients of Kowsar Health Center, Qazvin, Iran. Serum vitamin C and calcium levels were measured colorimetrically. Nutrient intake was assessed by 24-hour dietary recall and food frequency questionnaire. The data were analysed by student t-test, ANOVA, Pearson correlation coefficient and analysis of covariance.Findings: There was no significant difference in energy and nutrient intake between the two groups. Systolic blood pressure, serum vitamin C and calcium levels were significantly different in preeclamptic women compared to normotensive women (p=0.001, p=0.01and p=0.001, respectively). There was a negative correlation between infants birth weight and the severity of the disease (p=0.001).Conclusion:Serum vitamin C and calcium levels in preeclampsia pregnant women were lower than those in normotensive pregnant women.

Background: We aimed to estimate the prevalence and differentiating features of patients with noninfectious fever (NIP) admitted to the infectious ward of Al-Zahra Hospital, Isfahan, Iran. Is there any way to diagnose NIP at preliminary clinical examination?Methods: This was a cross-sectional survey covering 350 cases with fever admitted to the Infectious Ward of AI-Zahra Hospital. Participants were adult patients with oral temperature exceeding 37.7°c. We excluded patients with a known infectious etiology or unknown diagnosis. Findings: Fifty-one subjects (15%) presented with fever had a well known uninfectious disease. Neoplasms, drugs and connective tissue disorders were among the most common etiologies of NIP. Conclusion: Although admissions such as the above-mentioned ones seem to be inevitable in infectious ward, taking careful history and ordering proper and new laboratory tests can reduce the number of these admissions or shorten the duration of hospital stay in infectious ward.

Background: Open fracture, a disruption of soft tissue and exposure of fractured bone to surrounding environment is a high risk condition for infection and is recommended to treat it by irrigation, surgical debridement and antibiotic therapy as soon as possible. Since the role of each of the above mentioned factors and the interval between admission and debridement is still in debate, the present study is designed to determine the difference between early and delayed debridement in open fracture.Methods: A prospective, double blind study was performed on 379 patients with 381 open fractures. Location of fracture, interval (time between the injury and debridement) and Gustilo or Duncan classifications of open fractures were recorded. For all patients irrigation and antibiotic therapy started with standard protocol. Early (less than 6 hours) and delayed (more than 6 hours after injury) debridement’s were done in group A with 289 and group B with 92 patients, respectively and all patients were followed up for early infection. Findings: Seven patients (2/4%) in group A and 4.3% (4 of 92) in group B had early infection and this difference was not significant (p=0.34). Conclusion: Conclusion: The result of early and delayed debridement is almost the same in open fractures.

Background: Treatment of full thickness idiopathic macular hole (IMH) is deep vitrectomy with internal limiting membrane (ILM) peeling. This study was conducted to evaluate ILM visibility with trypan blue during surgery. Methods: A retrospective study with 0.06% trypan blue (TB) assisted ILM peeling in 25 patients was carried out. The intraoperative visibility of the ILM was scored as poor, moderate, good, or excellent according to the report of surgeon. Findings: Visibility score was excellent in 40%, good in 20%, moderate in 32% and poor in 6%. No acute adverse effect related to the TB staining was observed. Conclusion: The use of 0.06% TB, increased visibility of ILM significantly and helped complete peeling of ILM.

There have been several reported cases of inserted sewing needles in the brain as a type of child abuse. Based on review of the literature, only 22 cases have been reported so far. We present a new one, a 2.5- year-old girl, who had mild head injury due to fall, admitted for her repeated vomiting. Routine skull radiographs showed an about 5 cm needle in the right frontal lobe, near the midline. Fontanels were closed; thus, the needle was introduced when the fontanels were still open. The patient's companions took her out of hospital before any further assessment.

Isolated developmental coxa vara is a relatively rare condition. The pattern of inheritance in the reported familial cases is compatible with the dominant condition. However, our finding in a family with three affected offsprings without previous history of coxa vara suggested a horizontal pattern and most probably with an autosomal recessive inheritance. Piling up these reports in the literature would be helpful in the future for determination of a distinct pattern of inheritance for coxa vara.

High-flow priapism is a rare disease usually secondary to traumatic injury to the genitoperineal area and laceration of cavernous artery and its branches. In this paper we report a case of priapism with unknown cause successfully treated by embolization. Along with presentation of this case, we discuss its radiologic treatment.

Olanzapine has become one of the most commonly prescribed atypical antipsychotic drugs in Iran. Hypersensitivity syndrome is a rare side effect of this drug. In this article, a case of this syndrome is reported. A 54 year old man, who was a known case of schizophrenia, was under treatment with olanzapine. Five days after beginning the treatment, a drug-skin-reaction appeared and on day 10, he showed Guillain-Barre syndrome. The patient was treated with plasma exchange and improved in a few weeks.

Dubin-Johnson syndrome (DJS) is a rare recessively inherited conjugated hyperbilirubinemia. We present reports of two patients with DJS. Our first patient, a young girl of 16 years presented with complaints of persistent jaundice since childhood, while the second patient, a young gentleman of 25 years presented with complaints of repeated episodes of jaundice. The diagnosis in both cases was confirmed by histopathology.