مجله دانشکده پزشکی اصفهان
پیاپی 375 (هفته سوم اردیبهشت 1395)

Intraoperative consultation by frozen section method has an important role in decision making about the type and extent of surgery in almost all types of tissues and organs. This study was done to determine the diagnostic value of frozen section compared to permanent pathology in breast and ovarian masses.
In a cross sectional investigation, 153 breast and ovarian specimens were studied. The specimens had been submitted for frozen section to pathology lab of Alzahra Hospital, Isfahan, Iran during 2009-2014. Frozen section reports were compared with permanent pathology results as the gold standard method for accurate diagnosis.
Findings: There was an agreement of 96.7% between frozen section and permanent pathology. Sensitivity, specificity, false positive, false negative, positive predictive value, negative predictive value and accuracy of frozen section were 96.6%, 96.8%, 3.4%, 3.2%, 95.0%, 97.8% and 96.7%, respectively.
The results show high accuracy of frozen section for intraoperative diagnosis of breast and ovarian masses. Intraoperative consultation by frozen section can be used as a standard and valuable method to determine the type and extent of surgery in breast and ovarian masses.

Haemophilus influenzae type b (Hib) is an encapsulated bacterium cause meningitis in infants worldwide. The capsular Polysaccharide antigen of this organism is a polymer made of ribosylribitol phosphate and is the most important virulence factor and the causative agent of many infections in children under 2 up to 5 years of age. The capsular Polysaccharide conjugated to a carrier protein is effective in the prevention of such infections.
In this study Hib strain Atf2which was isolated and identified from a child with meningitis (previous studies), was cultured in a bioreactor (13-L Bio flo 2000(New Bruns Wick Scientific Co. USA)) containing Giolitti-Cantoni broth (GC broth). The culture was inactivated and polyribosylribitol phosphate (PRP) was extracted by various methods from the bacterial pellet and ultimately filtered through 0.25 µm filter. The filtrate was conjugated with tetanus toxoid (TT) as protein carrier and injected in to sepharos CL-4B gel. Fractions between 11 to 19 was pooled and used as a conjugate product (PRP-TT).
Findings: The amount of 402 µg PRP was extracted from 109cfu/ml of bacteria. The amount of protein and nucleic acid was under 1% which is the amount recommended by World Health Organization (WHO) .The PRP recovery after conjugation which was measured by sodium deoxycholate (DOC) was 58%. The antibody response against PRP-TT raised in infant rats showed the highest titer against itself compare to extracted PRP in our own lab and the PRP purchased from National Institute for Biological Standards and Control (NIBSC). The similarity between standard PRP and extracted PRP, was shown by antibody titer in 1/200 dilution.
The amount of 402 µg PRP was extracted from 109cfu/ml of bacteria. The amount of protein and nucleic acid was under 1% which is the amount recommended by World Health Organization (WHO). The PRP recovery after conjugation which was measured by DOC was 58%. The antibody response against PRP-TT raised in infant rats showed the highest titer against itself compare to extracted PRP in our own lab and the PRP purchased from NIBSC. The similarity between standard PRP and extracted PRP, was shown by antibody titer in 1/200 dilution.

Prediction of difficult laryngoscopy is an essential part of airway management in general anesthesia .The purpose of the present study was comparison of commonly used tests of prediction of difficult laryngoscopy and endotracheal intubation ratio of height to thyromental distance (RHTMD), Modified Mallampati test (MMT), upper lip bite test (ULBT), ratio of neck circumference to thyromental distance (NC/TMD) with acromio-axillo-suprasternal notch index (AASI) in general anesthesia.
A total of 728 patients scheduled for surgery under general anesthesia with endotracheal intubation were enrolled in this study. The dimensional predictive test measurements (AASI, ULBT, RHTMD, NC/TMD, MMT) were accomplished on all patients. The laryngoscopic view was graded with Cormack-Lehane (CL) grading system. Receiver operating characteristic (ROC) curve, Sensitivity, specificity, and Positive predictive value (PPV) were used to compare the tests.
Findings: Our study showed that the incidence of difficult view laryngoscopy (DVL) is about 2.9%. AASI had the highest specificity, positive likelihood ratio, PPV and NPV in comparison with the other predictive tests. AASI with cutoff point ≤ 0.6 had the higher cut off point. AASI has the highest ROC with significant difference to other prediction tests. RHTMD had the least sensitivity.
Our study showed that AASI can be a good screening test to predict difficult laryngoscopy in general anesthesia.

Today, gynecologic and orthopedic surgeries under spinal anesthesia are widely used in the world but hypotension during anesthesia is abundantly accrued. Hence, several methods are prescribed to cure and prevent hypotension. Physical method such as leg wrapping or elevation of lower limb during surgery is one of the used methods, but its effects are suspected yet. Thus, the aim of this study was comparing the effects of different degrees of elevation of lower limb to prevent hypotension in patients under lower abdomen surgery with spinal anesthesia.
In a clinical trial study, 105 candidates for lower abdomen surgery were selected and randomly divided in three groups. In the first group, patients’ legs were not elevated but in the second and third groups, they were elevated for 15 and 30 degrees, respectively and incidence of hypotension was compared between the three groups. The SPSS software was used for data analysis.
Findings: According to the results of this study, systolic and diastolic blood pressure and heart rate in the above three groups was decreased to the same extent. And according to one way ANOVA, no statistically difference between the three groups was seen. The mean of systolic blood pressure before anesthesia were 136.2 ± 24.4, 131.5 ± 32.0 and 140.4 ± 25.3, respectively in the three groups (P = 0.24). Also the mean of systolic blood pressure in 60th min were 109.8 ± 19.3, 118.6 ± 18.5 and 114.4 ± 16.8, respectively in the three groups
(P = 0.64).
According to results of our study, elevation of patients’ legs during surgery under spinal anesthesia does not prevent hypotension but according to other studies, this action may help to prevent hypotension during spinal anesthesia; thus, other studies are need to approve this method.

Cell encapsulation is a method of entrapping cells in a semi-permeable polymer that allows influx of oxygen and nutrients, but effectively avoids immune cells and antibodies from reaching the graft, preventing rejection. Since the invention of cell encapsulation technology, many researchers bet on this biotechnology as a promising alternative to protect encapsulated cells from host immune response. The main purpose of technology is to solve the existing problem of transplant rejection and thus decrease the necessity of long-term use of immunosuppressant drugs after an organ transplant to reduce adverse effects. We carried out a search of published literature to review current information regarding cell encapsulation technology and how this technology could improve cell and drug delivery for therapeutic applications.
A computer-based literature search was performed using PubMed for relevant publications. Only English-language papers were considered.
Findings: Current concepts of cell encapsulation technology including a historical perspective, its application for the treatment of diseases, research findings, and important parameters involved in this technique were discussed.
Different features of this technique would allow widening the applications from drug delivery to cell delivery. In this way, enclosed cells work as customized factories, synthesizing and releasing the desired therapeutic factor. Looking forward to the future, this technology is expected to evolve significantly. The substantial potential of cell encapsulation has increased with the boom in regenerative medicine and tissue engineering.