عبدالهادی جهانشاهی

Hydatid cyst is a worldwide zoonotic disease caused by the larval stages ofEchinococcus granulosus. The aim of this study was to investigate the demographic, clinical and radiologicalcharacteristics of hydatidosis patients undergoing surgery in hospitals in Ahvaz during.

This study is a retrospective descriptive cross-sectional study based on the informationrecorded in the patients' files. Data were analyzed using SPSS software, descriptive statistics andChi-square test.

Of the 107 patients with a mean age of 36.78 years, 42.1% were male and 57.9% were female.The highest frequency was related to the age group of 31-40 and the lowest was related to the patientsunder 10 years old. 52.3% lived in the rural areas and 47.7% lived in the urban areas. In 70.1% of thepatients, liver was involved and recurrence was reported in 14%. In 59.8% of the patients, only one cystwas reported and in 40.2% more than one cyst was reported. The cysts size was 10 to 180 mm and about50% of the patients had CE2 cysts. The diagnostic method of all patients was imaging techniques anddrainage method was the most common method used.

This study showed that hydatid cyst in Khuzestan Province is still one of the important healthproblems that raise the need for educational programs based on the prevention and control of parasiticinfections, especially parasites transmitted by dogs. Observation of 14% recurrence also raises the importanceof choosing the appropriate surgical method by surgeons.

The most common tumors of mediastinum are neurogenic tumors, while mediastinal tumors are common in adolescent and middle ages. Lymphoma is a common cause of mediastinal tumors in children. We observed an increase in prevalence of lymphoma in adults. This study was to evaluate mediastinal masses over 5 years duration.Subjects and The study was carried out over five years stated from 1382 (2003) in three sugery departments of Ahvaz University of Medical Sceinces, Iran. Patients with mediastinal mass were evaluated for age, gender, signs and symptoms, chest X-ray, chest CT scan and the methods of removal and the pathological reports of results of tissue samples. Sixty patients were evaluated and there was no difference in gender. Mediastinal masses were most common in 3rd and 4th decades of life. Anterior mediastinum was the most common involved site. Anterior mediastinotomy was the most common operation from which large tissue samples were taken from 78. 33 % and 51.67 % of the mediastinal masses were lymphoma. The best method to take large tissue of these tumors is anterior mediastinotomy. The most common pathology in mediastinal masses is lymphoma. Lymphoma must be suspected in young patients with fever, cough, dyspnea and a mediastinal mass.

Lung abscess is a debilitating disease with high mortality and morbidity that needs medical and surgical treatment with extensive follow up. In this study 82 patients with lung abscess in the Hospitals of Jundishapour medical University of Ahwaz (Imam khomeini– Golestan and Razi) were avaluated in eight years (1374-1381). 62 patients (75.6%) were male and 20 (24,4%) were female. Most patients were in 6th and 7th decade of life. Most were rural (63.4%) and during spring season (84%). Fever and tachycardia were most clinical findings (63%).Difinite diagnosis of the disease in 75 cases had been done by chest x-Ray, CT scan and bronchoscopy.Most predisposing factors in this study were aspiration of gastric contents and oropharyngeal cavity (60%) that frequently happened after general anesthesia and tracheal intubation. Rt lower lobe is the location of most lung abscess in this study (20 cases). Most treatments were medical therapy by antibiotic alone (84%) and those who needed surgery were 14 cases for whom the best procedure was tube thoracostomy.

Serological diagnosis of cystic echinococcosis (CE), caused by Echinococcus granulosus, has been performed by different techniques. The lack of a standardised method for antigen preparation affects the sensitivity and specificity of the tests. The aim of this study was to assess the usefulness of Echinococcus granulosus protoscolex antigen, obtained from naturally infected sheep, using ELISA and immunoblot techniques. Overall we tested 353 serum samples comprising: one hundred sera from surgically confirmed cystic echinococcosis, 200 sera from native healthy sheep and 53 heterologous sera were evaluated. ELISA results showed 86 of samples of hydatidosis sera were positive and 14 samples showed negative. While 14 samples of heterologous group showed cross reaction. The sensitivity and specificity of ELISA obtained 86% and 75.5% respectively. On the other hand, protoscolex of Echinococcus granulosus, after electerophoresis by SDS-PAGE, showed 13 antigenic bands of 28-112 KDa that reacted with serum samples. With immunoblot test, 93 samples of hydatidosis sera showed positive reaction with antigenic bands and 7 samples were negative. The 38 KDa band showed good immunoblot specificity and 59KDa antigen showed high sensitivity. Overall cystic echinococcosis diagnosis by immunoblotting indicated 93% and 64.1% sensitivity and specificity respectively. The findings from the present study suggest that protoscolex can be considered as a good source of antigenic component in serological cystic Echinococcos granulosus. Furthermore, the use of the combination of ELISA and immunoblot techniques for confirmation of laboratory diagnosis of human echinococcosis is advantagous. In addiiton, 38 KDa antigen is the most specific fraction of protoscolex in immunological tests

Central vein catheterization for providing an efficient access for haemodialysis, is a known procedure with many complications. In order to constructing a good circulatory access, temporary or long lasting one, we would be able to use trans jugular, subclavian or femoral vein roots. Inserting the catheter through these ways to access the central circulation necessitates passing through the vital anatomical elements as arteries, nerves, lymphatics and relative vessels that contain possibility of predisposing to complications such as bleeding, hematoma, arterio-venous fstula, pseudoaneurysm, nerve bandle injury, hemo-pneumothorax, cardio-conductive disability or air embolism. Most of these complications are directly related to the capability of introducers. Today, cannulation with the guide of radiologic facilities or ultrasonography could be able to eliminate the complications. Progressive hematoma due to arterial puncture and bleeding are the most common early complications and so common carotid artery and its branches, subclavian artery and neighboring branches are the most involved elements. Pseudoaneurysms, arterio-venous fistulas and also nerve injuries are rarely reported as late complications. The most dangerous is pseudoaneurysm that potentially endangers the patient because of compressing effect on vital organs. This paper reports a rare primary nerve injury which was accompanied by a rare positional pseudoaneurysm in the proximal base of common carotid artery produced by indwelling central vein catheter for hemodialysis via right internal jugular vein.