فهرست مطالب

Journal of Research in Medical Sciences
Volume:18 Issue: 9, Sep 2013

  • تاریخ انتشار: 1392/08/06
  • تعداد عناوین: 20
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  • Saeed Abbasi, Hossein Mahjoubipoor, Parviz Kashefi, Gholamreza Massumi, Omid Aghadavoudi, Ziba Farajzadegan, Parvin Sajedi Page 733
    Background
    The aim of this study was to investigate the efficacy of lidocaine solution in the cuff of the endotracheal tube in reducing mucosal damage following tracheal intubation.
    Materials And Methods
    This was a randomized controlled trial study undertaken in the intensive care unit patients. Participants, who met all eligibility criteria, were randomly assigned to one of two groups of patients, according to whether lidocaine or air was used to fill the tracheal tube cuff. The tracheal mucosa at the site of cuff inflation was inspected by fiberoptic bronchoscopy and scored at the 24 h and 48 h after intubation.
    Results
    In all, 51 patients (26 patients in the lidocaine group and 25 patients in the control group) completed the study. After 24 h, erythema and/or edema of tracheal mucosa were seen in 2 patients (7.7%) of lidocaine group and 6 patients (24%) of air group (P = 0.109). Binary logistic regression analysis showed that lidocaine has a significant protective effect against mucosal damage (odds ratio = 0.72, confidence interval = 0.60-0.87).
    Conclusion
    The inflation of the tracheal tube cuff with lidocaine was superior to air in decreasing the incidence of mucosal damage in the 24 h and 48 h post intubation.
    Keywords: Intubation, lidocaine, mechanical ventilation, mucosal damage
  • Hassan Joulaei, Emeka Nwagwu, Aliasghar Nasihatkon, Leila Azadbahkt, Razieh Shenavar, Vahid Keshtka, Seyed Mehdi Ahmadi Page 739
    Background
    The present study was carried out to assess the effects of community nutrition intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz, Iran.
    Materials And Methods
    This case-control nutritional intervention has been done between 2008 and 2009 on 2897 primary and secondary school boys and girls (7-13 years old) based on advocacy approach in Shiraz, Iran. The project provided nutritious snacks in public schools over a 2-year period along with advocacy oriented actions in order to implement and promote nutritional intervention. For evaluation of effectiveness of the intervention growth monitoring indices of pre- and post-intervention were statistically compared.
    Results
    The frequency of subjects with body mass index lower than 5% decreased significantly after intervention among girls (P = 0.02). However, there were no significant changes among boys or total population. The mean of all anthropometric indices changed significantly after intervention both among girls and boys as well as in total population. The pre- and post-test education assessment in both groups showed that the student’s average knowledge score has been significantly increased from 12.5 ± 3.2 to 16.8 ± 4.3 (P < 0.0001).
    Conclusion
    This study demonstrates the potential success and scalability of school feeding programs in Iran. Community nutrition intervention based on the advocacy process model is effective on reducing the prevalence of underweight specifically among female school aged children.
    Keywords: Malnutrition, public health advocacy, school age children
  • Farhad Mokhtarinejad, Saeed Soheili Pour, Mohammad Hussein Nilforoush, Mahsa Sepehrnejad, Susan Mirelahi Page 746
    Background
    Bone conduction (BC) threshold depression is not always by means of sensory neural hearing loss and sometimes it is an artifact caused by middle ear pathologies and ossicular chain problems. In this research, the influences of ear surgeries on bone conduction were evaluated.
    Materials And Methods
    This study was conducted as a clinical trial study. The ear surgery performed on 83 patients classified in four categories: Stapedectomy, tympanomastoid surgery and ossicular reconstruction partially or totally; Partial Ossicular Replacement Prosthesis (PORP) and Total Ossicular Replacement Prosthesis (TORP). Bone conduction thresholds assessed in frequencies of 250, 500, 1000, 2000 and 4000 Hz pre and post the surgery.
    Results
    In stapedectomy group, the average of BC threshold in all frequencies improved approximately 6 dB in frequency of 2000 Hz. In tympanomastoid group, BC threshold in the frequency of 500, 1000 and 2000 Hz changed 4 dB (P-value < 0.05). Moreover, In the PORP group, 5 dB enhancement was seen in 1000 and 2000 Hz. In TORP group, the results confirmed that BC threshold improved in all frequencies especially at 4000 Hz about 6.5 dB.
    Conclusion
    In according to results of this study, BC threshold shift was seen after several ear surgeries such as stapedectomy, tympanoplasty, PORP and TORP. The average of BC improvement was approximately 5 dB. It must be considered that BC depression might happen because of ossicular chain problems. Therefore; by resolving middle ear pathologies, the better BC threshold was obtained, the less hearing problems would be faced.
    Keywords: Bone conduction, hearing threshold improvement, partial ossicular replacement prosthesis, stapedectomy, total ossicular replacement prosthesis, tympanoplasty
  • Omid Aghadavoudi, Saeed Abbasi, Parviz Kashefi, Mohammadreza Habibzade, Mohammad Golparvar, Shadi Kazemi Page 750
    Background
    Based on the dramatic response of acute colonic pseudo-obstruction to neostigmine, we designed this study to evaluate the effect of neostigmine on the tolerance of enteral feeding in Intensive Care Unit (ICU) patients.
    Materials And Methods
    A total of 60 patients hospitalized in the ICU of Alzahra Hospital, Isfahan, Iran entered the study. They were randomly assigned to one of the two groups of case (who received intravenous neostigmine infusion) and control (normal saline). They were compared with respect to incidence of constipation, diarrhea, and vomiting. Arrhythmia, bronchospasm, mean arterial blood pressure (MAP), and heart rate (HR) were also evaluated at 0, 4, 8, 12, 16, 20, and 24 h.
    Results
    The frequency distribution of constipation, diarrhea, vomiting, and increase in gastric lavage volume in the intervention group was 20%, 33.3%, 46.7% and 43.3%, while these indices in the control group were 40%, 30%, 43.3%, and 63.3%, respectively (P > 0.05). Arrhythmia was observed in 3% and 6% in the case and control groups, respectively. Bronchospasm was not detected in any of patients.
    Conclusion
    There was no significance difference between neostigmine and normal saline with respect to tolerance of enteral nutrition in ICU patients.
    Keywords: Enteral feeding tolerance, Intensive Care Unit, neostigmine
  • Ali Ebrahimi, Fereshteh Salimi, Mansour Safaei, Hamid Melali, Amir Hosein Davarpanah Jazi, Mehdi Nematbakhsh, Mojgan Mokhtari, Hamidreza Rasooli Page 755
    Background
    After reestablishment of blood flow to ischemic limb recirculation of free radicals may cause ischemia-reperfusion injury in many organs. This study designed to investigate effects of hydrocortisone and alprostadil distant injury to kidneys by both measuring biochemical markers of oxidative stress and histopathologic examination in an experimental rat model of hind limb ischemia-reperfusion.
    Materials And Methods
    This study conducted in Isfahan University of Medical Sciences during 2011–2012. Ischemia was established by infra renal aortic clamping for 60 min in 32 male Wistar rats. Animals were divided into those receiving alprostadil (group ischemia-reperfusion plus alprostadil (IR/A), n = 8), those receiving hydrocortisone (group ischemia-reperfusion plus hydrocortisone (IR/H), n = 8), control group (group ischemia-reperfusion (IR), n = 8), and sham group (n = 8). After 120 min of reperfusion both kidneys were removed. Levels of superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH) as indirect markers of oxidative injury was measured. Finally all data in different groups were compared using the analysis of variance (ANOVA) test by Statistical Package for Social Sciences (SPSS) version 16.
    Results
    Administration of alprostadil or hydrocortisone does not improve the biochemical parameters of oxidative injury including MDA and SOD. However, statistically significant difference was seen in GSH level among sham and IR groups. Mean (± standard deviation (SD)) concentration of GSH in IR, IR/A, IR/H, and sham groups were 1028.77 (72.65), 924.82 (70.66), 1000.28 (108.77), and 846.69 (163.52), respectively (P = 0.015). Histopathological study of specimens did not show any significant changes between groups.
    Conclusion
    Alprostadil and hydrocortisone do not improve the kidney GSH, SOD, and MDA level and kidney releases its GSH reserve during ischemia-reperfusion event, and another point is that, 3 h of ischemia-reperfusion does not develop injury in kidney.
    Keywords: Alprostadil, hydrocortisone, ischemia, reperfusion injury, oxidative stress
  • Amin Doosti Irani, Jalal Poorolajal, Alireza Khalilian, Nader Esmailnasab, Zahra Cheraghi Page 759
    Background
    Several studies have investigated the prevalence of osteoporosis among general population in several parts of Iran. However, the results have been inconsistent. This meta-analysis was conducted to estimate the overall prevalence of osteoporosis.
    Materials And Methods
    International and national electronic databases were searched until April 2012, including Web of Knowledge, Medline, Scopus, Ovid, ScienceDirect, Science Information Database, IranMedex, MagIran, as well the relevant conference databases. The reference lists of included studies were screened as well. The cross-sectional studies addressing the prevalence of osteoporosis among Iranian general population were retrieved irrespective of age and sex. Bone mineral density (BMD) based on T-score was classified as follows: (a) normal (T-score ≥−1); (b) osteopenia (–2.5SD < T-score <−1SD); (c) osteoporosis (T-score ≤–2.5). Study quality was assessed using the recommended checklist of STROBE.
    Results
    Of 2598 retrieved studies, 31 studies comprising 34,814 people was used for meta-analysis. The overall prevalence of osteoporosis in lumbar spine was 0.17 (95% CI: 0.13, 0.20) and that of osteopenia was 0.35 (95% CI: 0.30, 0.39). The prevalence was higher in older age groups, in women, and in the northern regions of the country, with an increasing trend in recent years.
    Conclusion
    This meta-analysis indicated that osteoporosis and osteopenia are common problems among Iranian population older than 30 years. Furthermore, increasing trend of the diseases in recent years is promising a critical public health problem in Iran in the near future. However, due to the heterogeneity between the studies’ results, further evidence based on a national survey is needed to estimate the exact prevalence of the diseases in the country.
    Keywords: Iran, meta, analysis, osteopenia, osteoporosis, prevalence, systematic review
  • Ravish Kumar Muddaiah, Pratibha Malini James, Ravikumar Kadahalli Lingegowda Page 767
    Background
    Tuberculosis (TB), a dreadful disease known to mankind continues to be a problem in a developing country like India. The incidence of people getting infected with TB is on the rise due to compounding factors like coinfection with the human immunodefiency virus and multidrug-resistant strains. There is a definitive need for early diagnosis and treatment of TB to curb transmission of the infection. Direct smear microscopy, though cheap and rapid, lacks sensitivity. Isolation of Mycobacterium tuberculosis in culture requires a long time, because of which there is a need for a rapid method which has good sensitivity and specificity for the detection of M. tuberculosis. The present study was undertaken to determine the test which diagnoses TB rapidly and to compare the sensitivity of smear microscopy, concentration method, rapid slide culture, and Lowenstein - Jensen (LJ) culture.
    Materials And Methods
    Sputum samples of 200 patients were subjected to direct smear and concentration by modified Petroff’s method. The concentrated sputum was also taken for slide culture using human blood medium and inoculated on LJ media.
    Results
    LJ culture was positive in 47 (23.5%) cases, of which three were nontubercular mycobacteria. Using LJ culture as the standard method, the sensitivity of direct smear, concentration method, and rapid slide culture method was 68, 83, and 89%, respectively, and specificity was 100% in all the three tests.
    Conclusion
    Rapid slide culture showed good sensitivity which was comparable to and next in efficacy to LJ culture and this technique can be adopted in the Revised National Tuberculosis Control Program (RNTCP) as it is a rapid, cheap, sensitive, and specific method.
    Keywords: Direct microscopy, Lowenstein, Jensen media, pulmonary tuberculosis, rapid slide culture
  • Reza Azizkhani, Seyed Mehdi Pourafzali, Elahe Baloochestani, Babak Masoumi Page 772
    Background
    Kidney stone is normally treated by opioids with a variety of side-effects including hypotension, respiratory depression and apnea, nausea and vomiting. Regarding less complications of intravenous acetaminophen, we aimed to compare it with intravenous morphine in management of renal colic pain.
    Materials And Methods
    A randomized controlled clinical trial was applied with a convenience sampling method, as 124 patients suffering from renal colic pain were randomly assigned into two groups of 62 patients. Pain was assessed using visual analog scale ruler. Results were analyzed by SPSS.18 using the descriptive statistic, Chi-square, ANOVA, independent t-test and logistic regression.
    Results
    According to the findings, 84 subjects (67.7%) were male. The mean age of participants were 39.06 (11.58). The mean of pain scores were not significantly different between two groups before administration of drugs (P = 0.415), while the more pain relief was achieved in morphine group after the intervention. Sex and age as influencing factors did not develop a significant difference in both groups. About the adverse effects, morphine had more complications and both groups showed a significant difference in occurrence of dizziness (P = 0.000) and hypotension (P = 0.014).
    Conclusion
    Comparing intravenous morphine and acetaminophen in renal colic pain reviled that morphine can develop greater pain relief, but more complications such as dizziness and hypotension. Acetaminophen can be also be effective in renal colic pain, so it is concluded that acetaminophen can be administered as a less harmful drug for patients with renal colic pain.
    Keywords: Acetaminophen, emergency department, morphine, renal colic
  • Ali Akdemir, Ahmet Mete Ergenog Lu, Levent Akman, Ahmet Qzgur Yeniel, Fatih Sendag Mehmet Kemal Qztekin Page 777
    Background
    The purpose of this study was to evaluate the feasibility and surgical outcome of a novel technique for laparoscopic removal of the fallopian tube using a homemade retrieval bag through a 10-mm transumbilical or 5-mm transabdominal port.
    Materials And Methods
    A total of 40 women with ruptured ectopic tubal pregnancy were randomized into a 10-mm transumbilical group (n = 20) or a 5-mm transabdominal group (n = 20) according to the port used for specimen removal. Fallopian tube removal was performed using a new method based on the use of a homemade surgical glove as a retrieval bag.
    Results
    There were no differences in the demographic characteristics between the two groups. The specimen retrieval time was significantly shorter in the transumbilical group than in the transabdominal group. Post-operative pain scores, assessed using a visual analog scale, were similar between the groups. No cases of rupture of the homemade retrieval bag were observed.
    Conclusion
    The laparoscopic removal of the fallopian tube through the 10-mm umbilical port using a homemade retrieval bag is associated with shorter operative time than retrieval through a 5-mm abdominal port. The present results showed the feasibility and safety of our homemade retrieval bag and novel technique.
    Keywords: Ectopic pregnancy, homemade retrieval bag, laparoscopy, specimen removal, transumbilical
  • Arash Mirabzadeh, Enayatollah Bakhshi, Mohammad Reza Khodae, Mohammad Reza Kooshesh, Bibi Riahi Mahabadi, Hossein Mirabzadeh, Akbar Biglarian Page 782
    Background
    Antipsychotic monotherapy or polypharmacy (concurrent use of two or more antipsychotics) are used for treating patients with psychiatric disorders (PDs). Usually, antipsychotic monotherapy has a lower cost than polypharmacy. This study aimed to predict the cost of antipsychotic medications (AM) of psychiatric patients in Iran.
    Materials And Methods
    For this purpose, 790 patients with PDs who were discharged between June and September 2010 were selected from Razi Psychiatric Hospital, Tehran, Iran. For cost prediction of AM of PD, neural network (NN) and multiple linear regression (MLR) models were used. Analysis of data was performed with R 2.15.1 software.
    Results
    Mean ± standard deviation (SD) of the duration of hospitalization (days) in patients who were on monotherapy and polypharmacy was 31.19 ± 15.55 and 36.69 ± 15.93, respectively (P < 0.001). Mean and median costs of medication for monotherapy (n = 507) were $8.25 and $6.23 and for polypharmacy (n =192) were $13.30 and $9.48, respectively (P = 0.001). The important variables for cost prediction of AM were duration of hospitalization, type of treatment, and type of psychiatric ward in the MLR model, and duration of hospitalization, type of diagnosed disorder, type of treatment, age, Chlorpromazine dosage, and duration of disorder in the NN model.
    Conclusion
    Our findings showed that the artificial NN (ANN) model can be used as a flexible model for cost prediction of AM.
    Keywords: Linear regression, neural networks, psychiatric disorders, treatment cost
  • Halimeh Amiridumari, Hadi Sarir, Omid Fanimakki, Nazar Afzali Page 786
    Background
    Consumption of aflatoxin B1 (AFB1) contaminated products can pose a risk of development of various diseases in human and animals due to radical production. The scope of this work is to evaluate the efficacy of milk thistle seed (MTS), as a radical scavenger, on serum biochemistry, lipid profile and liver enzymes against AFB1 in broiler chickens contaminated with AFB1.
    Materials And Methods
    The effect of nine experimental treatments (3 × 3 factorial design) was assessed using 216 one-d-old Ross 308 male broiler chicks in a randomized complete design with four replicates of six birds for each dietary treatments: Control (T1), 250 ppb AFB1 (T2), 500 ppb AFB1 (T3), 0.5% MTS (T4), 0.5% MTS Plus 250 ppb AFB1 (T5), 0.5% MTS Plus 500 ppb AFB1 (T6), 1.0% MTS (T7), 1.0% MTS Plus 250 ppb AFB1 (T8), and 1.0% MTS Plus 500 ppb AFB1 (T9). The individual and combined effects of dietary AFB1 and MTS on serum biochemistry factors (Glucose, Calcium, Phosphorus, Iron, Creatinine, and Uric acid), lipid profile (Triglyceride, Cholesterol, Low density lipoprotein (LDL), and High density lipoprotein (HDL)) and liver enzymes aspartate amino-transferase and alanine amino-transaminase (ALT) in broilers were evaluated at 21 days of age. Also, statistical packages Macros-1.002 (2010) were used to perform the above analysis on computer.
    Results
    Consumption of 500 ppb AFB1 in to the diet significantly decreased HDL (58.13 ± 2.65), Calcium (7.11 ± 0.13), and Glucose (197.1 ± 7.42) compared to the control group (85.12 ± 1.95, 9.45 ± 0.17 and 223.1 ± 6.61, respectively), (P < 0.05). In contrast, it significantly increased creatinine (2.25 ± 0.011) and AST (244.51 ± 4.91). Using MTS together with AFB1 significantly reduced the effect of AFB1on the above parameters.
    Conclusion
    MTS can provide protection against the negative effects of AFB1 on broiler chicks.
    Keywords: Aflatoxin B1 (AFB1), fatty acid, liver enzymes, milk thistle seed (MTS), serum biochemistry
  • Gholamreza Mohajeri, Hessam Ghassemof, Mohammad Reza Mohajeri, Shahriar Adibi, Amir Hosein Davarpanah Jazi Page 791
    Background
    This study was proposed to evaluate a new method for autograft transplantation of liver tissue fragments (LTF) in the lung parenchyma and bronchus of dogs and to compare the results to find out if they are suitable sites for hepatocyte implantation or not.
    Materials And Methods
    The dogs were randomly assigned into two categories: LTF auto-transplantation to the lung parenchyma and into the bronchus. The suspensions of normal saline and LTF were injected and implanted into the lung parenchyma and the main bronchus of the right accessory lobe in first and second groups, respectively. Two weeks later the right accessory lobe was removed and sent for a histopathological study. All samples were checked under a light microscope with regard to the presence of hepatocytes, with both the Hematoxylin and Eosin (H and E) preparation and immunohistochemistry (IHC) method, using a CK-18 marker. All results were double-checked with a polymerase chain reaction (PCR).
    Results
    The mean weight of all the dogs was 19.87 ± 0.93 kg and mean age was 3.58 ± 0.31 years. After 15 days, the H and E, IHC, and PCR studies revealed that in the first group, all the dogs (n = 4) had living liver tissue, which survived in the lung parenchyma successfully. In contrast, none of the dogs (n = 0) in the second group showed surviving hepatocytes in the bronchus (P < 0.001).
    Conclusion
    Implantation of the LTFs into the lung parenchyma could be a source of hepatic cell production.
    Keywords: Auto, transplantation, IHC, PCR
  • Mohammad Javad Fatemi, Hamid Salehi, Hossein Akbari, Faranak Alinejad, Mohsen Saberi Page 795
    Background
    Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection.
    Materials And Methods
    This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA) were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated.
    Results
    237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years) was 33.29 ± 11.39 years (Mean ± SD), and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8%) patients in the control group and 50 (58.8%) patients in the treatment group (P = 0.8).
    Conclusion
    According to this study, there was no significant relationship between improvement of mortality and levamisole consumption.
    Keywords: Burn, immunomodulation agent, infection, levamisole
  • Morteza Pourfarzam, Fouzieh Zadhoush Page 801
    Newborn screening is important for the early detection of many congenital genetic and metabolic disorders, aimed at the earliest possible recognition and management of affected newborns, to prevent the morbidity, mortality, and disabilities associated with an inherited metabolic disorder. This comprehensive system includes; testing, education, follow up, diagnosis, treatment, management, and evaluation. There are major differences among many of the disorders being considered for inclusion in newborn screening programs. In recent times, advances in laboratory technology such as tandem mass spectrometry (MS/MS), which is more specific, sensitive, reliable, and comprehensive than traditional assays, has increased the number of genetic conditions that can be diagnosed through neonatal screening programs at birth. With a single dried filter paper blood spot, MS/MS can identify more than 30 inherited metabolic disorders in around two to three minutes. Advances in the diagnosis and treatment and an increased understanding of the natural history of inborn errors of metabolism have produced pressure to implement expanded newborn screening programs in many countries. Even as many countries throughout the world have made newborn screening mandatory, in Iran, nationwide newborn screening for inherited metabolic disorders other than hypothyroidism has not been initiated, hence, there is little information about these diseases. This article aims to review the recent advances in newborn metabolic screening and its situation in Iran and other countries.
    Keywords: Disease prevention, metabolic disease, newborn screening, tandem mass spectrometry
  • Sima Ajami, Ahmad Rajabzadeh Page 809
    Background
    Radio frequency identification (RFID) systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID technology in improving patient safety and increasing the impact of it in healthcare.
    Materials And Methods
    This study was non-systematical review, which the literature search was conducted with the help of libraries, books, conference proceedings, PubMed databases and also search engines available at Google, Google scholar in which published between 2004 and 2013 during Febuary 2013. We employed the following keywords and their combinations; RFID, healthcare, patient safety, medical errors, and medication errors in the searching areas of title, keywords, abstract, and full text.
    Results
    The preliminary search resulted in 68 articles. After a careful analysis of the content of each paper, a total of 33 papers was selected based on their relevancy.
    Conclusion
    We should integrate RFID with hospital information systems (HIS) and electronic health records (EHRs) and support it by clinical decision support systems (CDSS), it facilitates processes and reduce medical, medication and diagnosis errors.
    Keywords: Identification, medical errors, patients, radio, safety, technology
  • Liming Zhu, Cong Luo, Wei Wu, Jier Ying, Haijun Zhong Page 814
    Cervical regional nodal involvement, as the first manifestation of prostatic cancer, has been rarely reported. Prostate cancer metastasis to the supraclavicular lymph nodes with negative immunohistochemical stain of PSA is even rarer. We report a case of prostate cancer with negative immunohistochemical stain of prostate-specific antigen presenting with left supraclavicular node enlargement. A 63-year-old man was referred to our hospital for a left supraclavicular mass. He had a family history of gastric cancer (two brothers had died of gastric cancer). Enhanced computed tomography of the abdomen revealed retroperitoneal lymph node enlargement. Gastroscopy revealed no evidence of any gastric tumor. Biopsy of the left-sided supraclavicular lymph nodes revealed metastatic adenocarcinoma with a negative prostate-specific antigen (PSA) stain. The serum tumor markers were examined, revealing PSA levels of 21.820 ng/ml. Biopsy of the prostate disclosed poorly-to-moderately differentiated adenocarcinoma (Gleason 4 + 4 = 8). Although rare, prostate cancer should be considered in the differential diagnoses of elderly men with undetermined original adenocarcinoma, metastatic to the supraclavicular lymph nodes. Rectal examination, serum PSA and pelvic image can be helpful to lead the diagnosis. PSA stain may be weak or negative in some poorly differentiated patients, however, it is still a sensitive and specific marker of prostatic differentiation and must be routinely applied.
    Keywords: Metastasis, prostate cancer, prostate, specific antigen, supraclavicular lymph node
  • Sajid Malik, Muhammad Afzal Page 818
    Ulnar hypoplasia is a rare longitudinal limb deficiency in which the ulna shows various degrees of deficiency. The condition is normally associated with radial defects, and in severe cases there is a reduction of postaxial/ulnar digits. Ulnar deficiency is an integral part of several syndromic malformations like Weyer’s oligodactyly syndrome, limb/pelvis hypoplasia/aplasia syndrome, and ulnar-mammary syndrome. Here, we report an isolated unilateral ulnar deficiency in a boy who was a product of a consanguineous marriage. The subject demonstrated mesomelic shortening of the left arm with reduced zeugopod and autopod, and preaxial absence of two fingers. Additional findings in the affected limb were severe flexion contracture at the elbow joint, reduced and narrow palm, hypoplastic digits, and clinodactyly. Roentgenographic study revealed rudimentary ulna, dysplastic and posteriorly dislocated radius, crowding of carpals, and complete absence of digit rays of the thumb and index finger. Despite this anomaly, the subject could manage his daily life activities well. We present detailed clinical features and differential diagnosis of this rare limb malformation.
    Keywords: Finger reduction, longitudinal defect, limb deficiency, oligodactyly, Pakistani subject, radial dysplasia, ulnar aplasia
  • Hossein Saneian, Emad Bahraminia Page 822
    Congenital chloride diarrhea (CCD) is a rare autosomal recessive disease which is characterized by intractable diarrhea of infancy, failure to thrive, high fecal chloride, hypochloremia, hypokalemia, hyponatremia and metabolic alkalosis. In this case report, we present the first female and the second official case of CCD in Iran. A 15-month-old girl referred to our hospital due to failure to thrive and poor feeding. She had normal kidneys, liver and spleen. Treating her with Shohl’s solution, thiazide and zinc sulfate did not result in weight gain. Consequently, pseudo-Bartter syndrome was suspected, she was treated with intravenous (IV) therapy to which she responded dramatically. In addition, hypokalemia resolved quickly. Since this does not usually happen in patients with the pseudo-Bartter syndrome, stool tests were performed. Abnormal level of chloride in stool suggested CCD and she was thus treated with IV fluid replacement, Total parentral nutrition and high dose of oral omeprazole (3 mg/kg/day). She gained 1 kg of weight and is doing fine until present. CCD is a rare hereditary cause of intractable diarrhea of infancy. It should be considered in infants with unknown severe electrolyte disturbances.
    Keywords: Congenital chloride diarrhea, hypochloremic, hypokalemic metabolic alkalosis, infants, pseudo, Bartter syndrome
  • Shaghayegh Haghjooy Javanmard Page 825
  • Kalenahalli Jagadish Kumar, Mathod Ganeshrao Anil Kumar, Pocha Shyamala, M. Prashanth Kumar Page 826