Acta Medica Iranica
Volume:57 Issue: 12, Dec 2019

A totally implantable venous access port (TIVAP) plays a crucial role in the treatment of patients in oncology. Catheter fracture is a serious complication with an estimated incidence of 0, 1% - 1%. The objective of this systematic review is to analyze the mechanism of TIVAP fracture to make physicians aware of this fatal entity. A search of the literature between 1980 and 2019 was conducted using PubMed, Ovid, MEDLINE, and Cochrane Systematic Review databases. The search identified 18 case reports and 8 retrospective studies. Fracture of the middle part of the catheter may be induced by constant compression of the catheter between the first-rib and clavicle, which is called the pinch-off syndrome. Catheter fracture at the port-catheter junction may be caused by extrinsic compression near the port-catheter junction combined with material fatigue due to repeated bending of the catheter with shoulder movement. There is no specific cause for the fracture of a catheter tip. An annual chest X-ray is recommended for the early detection of TIVAP catheter fracture. Percutaneous endovascular retrieval of a dislodged Port-A catheter is both safe and effective.

Green peas protein hydrolysate is used in the treatment of kidney disease. Nephrotoxicity of gentamicin (GM) is known to be involved in kidney changes, dyslipidemia, and hematology. The aim of the present study is to evaluate the effects of three doses of green peas protein hydrolysate bromelain (GPPHB) as antinephrotoxicity and antihyperlipidemia on gentamicin (GM)-induced Wistar rats as an effort to find an effective dose for kidney diseases therapy. Nephrotoxicity was induced in female Wistar rats through intraperitoneal administration of GM 80 mg/kg/day for seven days. Nine treatment groups (n=6) were monitored to determine the effects of the concurrent administration of green peas protein hydrolysate at a dose of 50, 100, and 200 mg/kg/day given with GM toward kidney damage using serum creatinine and blood urea nitrogen as indicators. The parameters for nephrotoxicity of GM were kidney organ index (OI), histopathological: cloudy swelling tubular degeneration, nucleus necrosis, and hyaline cast; hematology profiles; and for hyperlipidemia were total cholesterol, low-density lipoprotein (LDL), and triglyceride. After 28 days of treatments, GPPHB at the dose of 50 mg/kgBW has a good effect on kidney OI, whereas, at a dose of 200 mg/kgBW, GPPHB significantly protects rat kidneys from GM-induced histopathological changes. The GPPHB dose of 100 and 200 mg/kgBW significantly lowered the total cholesterol, LDL, and triglyceride levels but had no significant effect on hematology profiles. Three doses of GPPHB had antihyperlipidemia and antinephrotoxicity effects in GM-induced nephrotoxicity Wistar rats.

Susceptibility weighted imaging (SWI) and time of flight (TOF) magnetic resonance angiography (MRA) techniques can be used in the detection of major vessel occlusion. Our aim was to compare diagnostic accuracies of SWI and TOF MRA in the detection of arterial thrombotic occlusion in acute ischemic stroke patients. In this prospective study, we included 63 consecutive patients presenting with acute ischemic stroke symptoms in whom diagnoses were based on clinical findings and diffusion-weighted imaging (DWI) studies performed within 24 hours of the onset of symptoms. The susceptibility vessel sign (SVS) and TOF MRA findings of the patients were statistically evaluated in terms of detecting acute thrombotic arterial occlusion. In  50 out of 63 patients, SVS on SWI in major intracranial artery territories and a corresponding occlusion or severe stenosis of vessels on TOF MRA were detected with a concordance. In 5 patients, although the SVS was available, TOF MRA did not reveal any occlusion or stenosis in the corresponding artery territory. On the contrary, 3 patients showed stenosis or occlusion on TOF MRA in whom SVS was negative. Finally, in the remaining 5 patients with acute infarct, neither SVS on SWI nor occlusion or stenosis on TOF MRA were displayed. SVS on SWI yielded slightly higher sensitivity than TOF MRA  in detecting intra-arterial thrombus in acute ischemic stroke patients. Although SWI and TOF MRA have similar diagnostic accuracies in the diagnosis of acute thrombotic occlusion in stroke patients, SWI has been found slightly superior to TOF MRA.

Appendicitis is one of the main causes of acute abdominal surgery; however, the accurate diagnosis of appendicitis has remained uncertain. This study aimed to investigate the serum calprotectin as a diagnostic indicator for acute appendicitis. This prospective study was conducted on 79 patients suspected of acute appendicitis who underwent an appendectomy and 70 healthy volunteers. The correlation of serum calprotectin level and histopathological results was investigated. Screening performance characteristics of calprotectin (CP) were calculated on patients suspected with acute appendicitis. The mean serum calprotectin level in the patients was 0.791±0.148 mg/dl with a minimum of 0.567 mg/dl and a maximum of 1.26 mg/dl. The serum calprotectin ranged from 0.10 mg/dl to 0.50 mg/l in the healthy group. The AUC of CP was 0.58 (95% CI: 0.43-0.73). At a 0.72 mg/dl cutoff value, CP had 70% (95% CI: 58-82) sensitivity and 50% (95% CI: 39-61) specificity. According to the main finding of our study, the accuracy and sensitivity of serum CP in the detection of patients with acute appendicitis is good, and it seems that it can be used beside clinical symptoms for the diagnosis of acute appendicitis.

Regarding the importance of non-alcoholic fatty liver disease (NAFLD) and the high prevalence of vitamin D3 deficiency in different societies. This study aimed to evaluate the distribution of Vit D3 deficiency in individuals with non-alcoholic fatty liver disease. In this cross-sectional study, 122 individuals with non-alcoholic fatty liver disease were selected by a simple sampling method. After collecting demographic data, serum Vit 25(OH) D3 level was measured by the ELFA method. Blood lipids level (TG, cholesterol, HDL, LDL), FBS, AST, ALT, alkaline phosphatase, total and direct bilirubin, albumin, and PT were measured by the enzymatic method. To analyze the data, descriptive and analytical methods and SPSS software version 16 were used. The study cases are comprised of 122 individuals (57.4% male). The average age of cases was 42.4±11.7 years, and the mean of serum Vit D3 level was 19.8±22 ng/dl (3-220 ng/dl). Regarding the serum 25(OH) D3 levels data showed 66.4% of cases were Vit D3 deficient (Vit D3 level< 20 ng/dl), 18% had insufficient level (Vit D3 level=20-30 ng/dl), and the remained 15.6% had sufficient level (Vit D3 level> 30 ng/dl). HDL level was higher in individuals with 25(OH) D3 sufficiency compared to those with 25(OH) D3 insufficiency and Vit D3 deficiency (P=0.019). There was no significant relationship between serum Vit D3 level and other investigated variables. The results of this study indicated that most individuals with non-alcoholic fatty liver disease had Vit D3 deficiency. Further studies are suggested.

As women go through menopause, serum estrogen decreases, and ferritin increases. Ferritin is an essential component of the body, but many studies have stated that ferritin, which exceeds the normal physiological range, may potentially cause health problems in women. The aim of this study is to investigate the relationship between bone mineral density and serum ferritin levels in post-menopausal women and to evaluate serum ferritin levels as a potential biomarker for postmenopausal osteoporosis. Serum ferritin levels were measured in 62 postmenopausal women with low bone mineral density, and in 18 postmenopausal healthy control women using a standardized Enzyme-Linked Immune Sorbent Assay (ELISA) kit. Bone mineral density BMD was assessed at the lumbar spine and femoral neck. The mean serum ferritin level was significantly higher in the postmenopausal women with low BMD group (group 1) than in the normal control group (group 2), respectively (mean=262.69 vs. 181.44 ng/ml, (P<0.05), and serum ferritin level was negatively correlated with BMD among low BMD postmenopausal women's group (R= -0.628, P=0.0001), and in the healthy postmenopausal group (R= -0.052, P=0.838). A comparison of the BMD between spine and femur neck sites shows that the frequency of low BMD in the spine site is higher than the femur neck site. Our findings show that increased serum ferritin levels were associated with low bone mineral density in postmenopausal osteoporosis.

Chorionic villus sampling (CVS) is an invasive method for identifying genetic and metabolic diseases, which is done in the first trimester of pregnancy and can cause many complications. The aim of this study is the evaluation of the correlation between Transabdominal chorionic villus sampling and fetal distress in color Doppler sonography. This study is experimental (before and after). All pregnant women with minor thalassemia in which their husbands were suffering from minor thalassemia or have a history of a child with major thalassemia and after the 12th week of pregnancy were referred to the ultrasound department. RI for fetal Middle Cerebral Artery (MCA) and Umbilical Artery (UA) before and after of CVS were measured and then statistically analyzed using SPSS 22. CVS did not cause a significant increase in RI for the fetal middle cerebral artery (P>0.05). CVS did cause a significant increase in RI for the umbilical artery (P<0.05). Then, CVS did cause a significant decrease in the ratio of RI for fetal Middle Cerebral Artery to RI for Umbilical Artery (P<0.05). Based on these results, it seems that CVS can cause distress in the fetus.

Aortic rupture and pseudoaneurysm formation in the anterior arch of congenital double aortic arch anomaly associated with a coarctation is an exceedingly rare complication of aortic vascular ring. This is a case report of a double aortic arch with an anterior arch pseudoaneurysm, presenting with chest pain, respiratory distress, and hypotension. The patient underwent open-heart surgery with resection of the anterior arch pseudoaneurysm and bypassing of the coarctation with ascending aorta to descending aorta connection with a Dacron tube graft. Posterior aortic arch entering to pseudoaneurysm by a vertical artery also connected to the main Dacron tube by another small size of the Dacron tube. The postoperative course was complicated by chylothorax and respiratory distress that managed with prolonged preservation of chest tubes, chest physiotherapy, and low lipid content diet. One year follow-up with C_T angiography revealed the patency of both the Dacron tube and patient was in good condition.

Ovarian steroid cell tumors are rare, life-threatening neoplasms that make about 0.1% of all primary ovarian tumors. They frequently present in premenopausal women with the manifestation of virilization. We report a 58-year-old postmenopausal woman that referred to our clinic with clinical manifestation of virilization. Laboratory findings showed markedly elevated serum testosterone level and ultrasound showed 2 follicles with 7 mm diameters in the left ovary. She treated by bilateral salpingo-oophorectomy and synchronous hysterectomy. Histological pathology confirmed a benign steroid cell tumor. The presentation of new-onset and rapid progressive hyperandrogenism is rare in postmenopausal women. In diagnosis, we must consider adrenal and ovarian malignancies. Stromal luteoma is a rare benign ovarian tumor, Which is treated with surgical treatment.

Normal-pressure hydrocephalus (NPH) has rarely been reported to be associated with trigeminal neuralgia (TN). We report a case of NPH with trigeminal neuralgia, whose symptoms completely resolved after endoscopic third ventriculostomy. We will notify another surgical management of trigeminal neuralgia, considering the different pathophysiology of TN and a brief review of the literature.