مجله دانشکده پزشکی اصفهان
پیاپی 224 (هفته دوم فروردین 1392)

Primary manifestations of Wilson disease are diverse and may cause delayed diagnosis of the disease which will in turn defer treatment and result in subsequent neurologic and gastrointestinal complications such as dysphagia. Case Report: The patient was a 15-year-old boy who had been visited by several gastroenterologists because of dysphagia and sialorrhea. He had been prescribed with different drugs. Upper gastrointestinal tract radiography and two endoscopies were performed. After all clinical manifestations، low serum ceruloplasmin، low copper، high 24-hour copper excretion، and Kayser-Fleischer rings led to diagnosis of Wilson disease. Treatment by D-penicillamine was started. Dysphagia was cured after a few days of treatment. Neurologic symptoms improved following one-two weeks of treatment. Early diagnosis of Wilson disease when different manifestations are present may help in prevention of neurologic and gastrointestinal complications.

The most common postoperative complications are pain، vomiting، and nausea. They may in turn lead to other complications such as wound damage. On the other hand، the use of opioid analgesics has unwanted effects on patients. This study evaluated the effects of intravenous infusion of lidocaine on the need for anesthetics during the operation and analgesics after the operation in patients undergoing ophthalmologic surgeries.

This clinical trial study was performed in Feiz Hospital (Isfahan، Iran) during 2011. Overall، 80 patients who were scheduled for eye surgery under general anesthesia were selected and randomly allocated to two groups to be infused with either intravenous lidocaine or placebo during the operation. Pain، nausea، and vomiting were assessed every 15 minutes in the recovery room. Visual analogue scales (VAS) were used to measure the mentioned parameters. Finally، the collected data was analyzed with SPSS.

The mean dose of analgesics in the lidocaine and placebo groups was 6. 25 ± 11. 00 and 9. 65 ± 14. 5 mg/kg، respectively (P = 0. 22). Based on the VAS، the intensity of vomiting was 1. 09 ± 2. 70 in the lidocaine group and 1. 75 ± 3. 60 in the placebo group (P > 0. 05).

According to our findings، intravenous administration of lidocaine during eye surgeries cannot effectively reduce pain and postoperative complications. However، since it decreased the need for anesthetics during the operation، it can be recommended for ophthalmologic surgeries under general anesthesia. Nevertheless، more research in this field is warranted.

Tracheal anastomoses are common parts of upper respiratory airway surgeries. Anastomosis is currently performed using Vicryl sutures or staples. Due to the high prevalence of postoperative tracheal stenosis، efforts have been made to find alternative methods. This study compared the use of new fibrin glue in tracheal anastomosis with the classic method. Eight dogs of similar sex، weight، and race were included in this experimental trial. The surgery was performed in two different stages. In each stage، two rings of trachea were resected. In the first stage، anastomosis was performed with the new fibrin glue. In the second stage، the anastomosis was performed classically. After two weeks، the regions of anastomosis were resected for pathologic evaluations. There was a statistically significant difference in the mean duration of operation between the two methods (5. 94 minutes using the fibrin glue method and 9. 75 minutes using the classic method) and the mean tracheal diameter after anastomosis (25. 59 mm and using the fibrin glue method and 24. 14 mm using the classic method). In gross evaluation، there was not a significant difference between two different types of anastomosis. According to microscopic study، attachment was performed completely in all cases. Anastomosis with new fibrin glue was faster and with less postoperative stenosis and fewer complications compared to the classic method. Therefore، we claim this method as a suitable substitute for the classic method of tracheal anastomosis.

Spinal anesthesia is often recommended as a safe and preferred substitute for general anesthesia. The hemodynamic benefits of spinal anesthesia over general anesthesia include a minimum decrease in myocardial contractility and only modest decreases in blood pressure and cardiac output. However، spinal anesthesia is associated with some complications (such as unstable hemodynamic status) during surgery that may lead to mortality in patients under operation. Hydroxyethyl starch (Voluven) is a substance used to preserve a patient’s hemodynamic stability during surgery. This study compared the use of lactated Ringer’s solution and Voluven as preload in patients under spinal anesthesia. This clinical trial study was performed in Kashani Hospital (Isfahan، Iran) during 2012. We selected 80 patients who were scheduled for lower extremity orthopedic procedures under spinal anesthesia. The subjects were randomly allocated to two groups and preloaded with either lactated Ringer’s solution or Voluven for 20 minutes. Hemodynamic indexes including blood pressure، heart rate، and oxygen saturation were monitored before the surgery and at the first، third، fifth، tenth، fifteenth، and thirtieth minutes after the operation. The collected data was analyzed with SPSS. The mean systolic blood pressure in the lactated Ringer’s solution group was 129. 3 ± 16. 7 mmHg at baseline and 113. 2 ± 16. 2 mmHg at the end of the operation. The corresponding values in the Voluven group were 128. 1 ± 14. 3 and 113. 8 ± 16. 1 mmHg. No statistically significant differences were observed between the two groups in terms of systolic or diastolic blood pressure، heart rate، and oxygen saturation. Although using Voluven in spinal anesthesia is supposed to result in better hemodynamic stability، we failed to find a significant difference between Voluven and lactated Ringer’s solution. Therefore، either of them can be used for preloading based on their cost and availability.

A relationship between chronic kidney disease (CKD) and thyroid dysfunction has been previously suggested. This study compared serum levels of thyroid markers in patients receiving alternative treatments for CKD with those of healthy people. In 2012، sampling was performed from patients over 18 years of age who referred to dialysis centers in Isfahan، Iran. These patients had been on dialysis (hemodialysis: three times a week and peritoneal dialysis: four times a day) for at least three months before the study We measured serum levels of thyroxine (T4)، triiodothyronine (T3)، free thyroid hormone 4 (fT4)، thyroid-stimulating hormone (TSH)، triiodothyronine resin uptake (T3RU)، and albumin، in four groups of patients on hemodialysis، patients on peritoneal dialysis، and their control groups. A total number of 115 subjects، including 63 men (54. 5%) and 52 women (45. 5%)، participated in this study. The mean age of the participants was 54. 3 ± 11. 5 years. The mean levels of TSH، T4، and T3RU were higher in both groups of patients than in control groups. However، the difference was only significant in case of T3RU (P < 0. 001). The mean levels of T3، fT4، and albumin were lower in patients than in controls. The differences in levels of T3 and Albumin were statistically significant (P < 0. 001 for both). T4 levels were significantly higher in patients on peritoneal dialysis than in control groups (P = 0. 020). TSH levels were higher in patients on peritoneal dialysis than in controls، but the difference was not significant (P = 0. 09). As TSH levels of patients and healthy controls were not significantly different، hypo- or hyperthyroidism cannot be specifically determined in patients on dialysis. Lower T3 levels in patients on alternative treatments may indicate the inhibition of peripheral conversion of T4 to T3 because of uremia or drugs. Lower serum albumin level in patients on alternative treatments can be due to malnutrition or loss of albumin and thyroxine-binding globulin during peritoneal dialysis.