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1.  Non-alcoholic steatohepatitis and influence of age and gender on histopathologic findings 
AIM: To characterize the histopathologic specifications of non-alcoholic steatohepatitis (NASH) according to age and gender.
METHODS: An analytical cross-sectional study was conducted in two private gastroenterology clinics on biopsy proven patients suffering from NASH. Biopsy histopathologic findings as well as demographic and laboratory data of the patients at the time of biopsy were gathered retrospectively from clinical records. The grading and staging of histopathologic findings were performed according to the Brunt method after reevaluation of the slides by a pathologist. Patients were divided into two groups according to age (below and above 55 years). Mean quantitative grade of all pathologic findings were also calculated according to Brunt scoring values.
RESULTS: A total number of 77 NASH patients, consisting of 58 males (75.3%) and 19 (24.7%) females with a mean age of 41.99 ± 11.80 years (range, 18-70 years), were enrolled. The mean age (48.72 ± 13.99 years vs 39.74 ± 10.16 years, P = 0.004) and aspartate aminotransferase level (75.11 ± 29.68 U/L vs 52.78 ± 25.00 U/L, P = 0.002) was significantly higher in female patients. Mean quantitative grade of hepatosteatosis was significantly higher in females (2.00 ± 0.82 vs 1.59 ± 0.68, P = 0.031) compared to males. Fifty four percent (34/65) of young patients had mild hepatosteatosis (Grade I) while only one patient (11.2%) in the older group had grade I hepatosteatosis. Patients aged ≥ 55 had significantly more severe hepatosteatosis (Grade III) (44.4% vs 9.5%, P = 0.007) and the mean quantitative grade of hepatosteatosis was significantly higher among them (2.33 ± 0.71 vs 1.56 ± 0.67, P = 0.002). Multivariate analysis after omitting the confounding role of age revealed a higher grade of hepatosteatosis in female patients (P = 0.010).
CONCLUSION: These findings point toward the possible influence of age in the severity of steatohepatitis, portal and lobar inflammation in patients suffering from NASH while gender independently might contribute to the level of steatohepatitis.
doi:10.3748/wjg.v16.i33.4169
PMCID: PMC2932921  PMID: 20806434
Non-alcoholic steatohepatitis; Age; Gender; Histopathologic findings
2.  Colonic diverticular abscess presenting as chronic diarrhea: a case report 
Cases Journal  2009;2:9389.
Introduction
Several complications have been reported with diverticular disease of colon. Perforation of the diverticulum of colon may lead to development of abdominal abscesses which can have diverse manifestations.
Case presentation
This report describes a 72 year-old woman presented with a one month history of non-bloody diarrhea, abdominal pain, and low grade fever. Computed tomography scan confirmed presence of a large local air-fluid level within the culdesac area. Laparotomy revealed a large pelvic abscess which was surrounded between rectosigmoid and uterus with severe tissue necrosis of rectosigmoid colon and uterus.
Conclusion
Although rarely reported, abdominal abscesses due to colonic diverticulitis may present as refractory chronic diarrhea.
doi:10.1186/1757-1626-2-9389
PMCID: PMC2806879  PMID: 20076780
3.  Delorme's Procedure: An Effective Treatment for a Full-Thickness Rectal Prolapse in Young Patients 
Annals of Coloproctology  2013;29(2):60-65.
Purpose
Delorme's procedure is infrequently applied in young adults because of its assumed higher recurrence rate. The aim of this prospective study was to assess the efficacy of the Delorme's technique in younger adults.
Methods
Fifty-two consecutive patients were entered in our study. We followed patients for at least 30 months. Their complaints and clinical exam results were noted.
Results
Our study included 52 patients (mean age, 38.44 years; standard deviation, 13.7 years). Of the included patients, 41 (78.8%) were younger than 50 years of age, and 11 (21.1%) were older than 50 years of age. No postoperative mortalities or major complications were noted. Minor complications were seen in 5 patients (9.6%) after surgery. The mean hospital stay was 2.5 days. In the younger group (age ≤50 years), fecal incontinence was improved in 92.3% (12 out of 13 with previous incontinence) of the patients, and recurrence was seen in 9.75% (4 patients). In the older group (age >50 years), fecal incontinence was improved in 20% (1 out of 5 with previous incontinence) of the patients, and recurrence was seen in 18.2% (2 patients). In 50% of the patients with a previous recurrence (3 out of 6 patients) following Delorme's procedure as a secondary procedure, recurrence was observed.
Conclusion
Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases.
doi:10.3393/ac.2013.29.2.60
PMCID: PMC3659244  PMID: 23700572
Rectal prolapse; Aged; Recurrence; Fecal incontinence
4.  Biochemical and hematological findings of Khorasan veterans 23 years after sulfur mustard exposure 
Background:
Sulfur mustard (SM) is an incapacitating chemical warfare agent, which has been widely employed in particular regions including Iran. We investigated and reported delayed biochemical and hematological complications of SM in severely toxic Iranian veterans 23 years after exposure.
Materials and Methods:
Forty-two Iranian veterans, residents of Khorasan Razavi, poisoned by SM, and suffering from clinical complications were investigated. A total of 30 healthy male volunteers were also selected as a control group. Biochemical and hematological variables were measured for the case and control groups. Data were analyzed using a Student's t-test by InStat software (GraphPad Inc., San Diego, CA) to determine significant differences between the data from the two groups.
Results:
The percentages of reticulocytes were significantly higher in patients (0.82 ± 0.04, P < 0.05). Total protein and albumin levels were significantly lower in veterans (total protein: 7.58 ± 0.07 g/dL, albumin: 4.97 ± 0.04 g/dL, P < 0.01). In addition, we observed a significant increase in serum cholesterol (226.74 ± 5.23 mg/dL, P < 0.01), triglyceride (173.53 ± 17.05 mg/dL, P < 0.05), and gamma-glutamyl transferase (GTT) activity of the patients (44.04 ± 3.35 IU/L, P < 0.05).
Conclusion:
Results showed that SM can cause long-term effects on some biochemical factors of veterans. As many of the functional tests of liver and kidney between two groups were statistically unchanged, it seems that the observed biochemical changes may be secondary to delayed respiratory complications of the patients.
PMCID: PMC3897068  PMID: 24497855
Albumin; complications; Khorasan Razavi; sulfur mustard; veterans
5.  Correlation between blood lead concentration and iron deficiency in Iranian children 
Background:
Iron deficiency anaemia is the most common nutritional anaemia among children. Lead toxicity is a serious health threat, especially in developing countries due to environmental pollution. It was thus aimed to investigate correlation between blood lead concentration and iron deficiency in children of Mashhad, Iran.
Materials and Methods:
This cross sectional study was performed on children between 1 year and 10 years, in Imam Reza teaching hospital of Mashhad, Iran, in 2010. Indeed during complete blood count (CBC), we measured iron and total iron binding capacity (TIBC) by colorimetric methods, ferritin by radioimmune assay and blood lead concentration by atomic absorption method. Results were analysed by Statistical Package for Social Sciences (SPSS) (version 11.5), using statistical tests including independent sample t-test, Mann-Whitney U test, Spearman's test and analysis of variance (ANOVA) and Pearson's or Spearman's correlation coefficient. P value ≤ 0.05 was considered as a significant level.
Results:
We studied 223 cases including 98 control children and 125 patients. All children had lead intoxication. Mean (±SD) blood lead concentration in the control group was 57.1 ± 25.3 (ranged 20-212) μg/dl and in the patient group was 57 ± 20.4 (ranged 10.9-159) μg/dl with no significant difference (P value = 0.713). We also did not find any correlation between blood lead concentration and haemoglobin, ferritin, iron, TIBC, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cells (WBC) and platelets.
Conclusion:
Based on these results, no correlation was found between blood lead concentration and iron deficiency in the children. Because all children had lead intoxication, further studies in highly polluted and a comparison with a low polluted area are necessary to make a general conclusion.
doi:10.4103/0300-1652.122353
PMCID: PMC3883233  PMID: 24403711
Anaemia; iron deficiency; lead
6.  Association of Helicobacter pylori infection with the Lewis and ABO blood groups in dyspeptic patients 
Background:
Helicobacter pylori infection is a basic risk factor for chronic gastritis, and gastric carcinoma. Based on some studies, the reason is binding of H. pylori to H and Leb antigens in gastric mucosa. However, some other findings have not determined any association between the infection and these antigens. Because of this controversy and the fact that H. pylori infection and gastric adenocarcinoma are common diseases in Iran, the assessment of the association of H. pylori infection with these blood groups could be valuable.
Materials and Methods:
In a cross sectional study on 135 adult dyspeptic patients in Mashhad, Iran, from 2009 to 2010, H. pylori infection was evaluated by using the Heliprobe 14C-urea breath test and the ABO and Lewis blood group antigens were determined by the tube method. Association between the Lewis and ABO phenotypes with H. pylori infection were analysed by Fisher's exact test. A P ≤ 0.05 was considered to be significant.
Results:
68 (50.4%) patients were positive for H. pylori infection. The frequencies of the ABO, Lewis and secretion phenotypes were not significant in the infected and non-infected patients. We also did not find a significant association between Lea and Leb antigens and this infection.
Conclusion:
We could not establish a significant association between the Lewis, ABO and secretion phenotypes with H. pylori infection. Diversity of sequences of blood group antigen b-binding adhesion (babA gene) of H. pylori may be a reason why our findings are different from other studies in other geographic areas.
doi:10.4103/0300-1652.114583
PMCID: PMC3719247  PMID: 23901182
ABO blood groups; gastritis; Helicobacter pylori; Lewis blood group; secretor blood group
7.  Is there any relationship between Chlamydophila pneumoniae and coronary atherosclerosis among Iranians? 
Background:
Atherosclerosis is a coronary heart disease, andis the most common cause of death in the industrialized world. Some studies suggested that atherosclerosis may be triggered by infectious agents, mostly Chlamydophila pneumoniae. However, the role of C. pneumoniae in the pathogenesis of coronary atherosclerosis is still controversial.
Objectives:
This study was performed to evaluate whether there is a significant association between coronary artery atherosclerosis and C. pneumoniae by the polymerase chain reaction (PCR) method.
Materials and Methods:
This case-control study was carried out on formalin-fixed paraffin-embedded tissue biopsies of the coronary arteries obtained from 30 patients with coronary atherosclerosis and 30 subjects without atherosclerosis living in Northeast of Iran. All subjects' weight and height were determined, and the body mass index was calculated. We also reviewed the medical history and previous laboratory reports of patients. Deoxyribonucleic acid (DNA) was extracted, and C. pneumonia DNA was amplified and detected using PCR assay.
Results:
The age of the patients in the study group was from 18 to 50 years, and the male to female ratio was 5:1. Only oneout of the 30 coronary tissue samples had positive PCR for C. pneumoniae (3.3%), while it was negative for patients in the control group.
Conclusions:
This study showed that C. pneumoniae infection is not strongly associated with coronary artery atherosclerosis in Northeast of Iran.
doi:10.4103/0300-1652.108894
PMCID: PMC3644743  PMID: 23661898
Atherosclerosis; Chlamydophila pneumonia; coronary artery; Iran
8.  Entrapment of an air gun pellet between the thyroid cartilage and the lining mucosa in a patient with a penetrating neck injury: a case report 
Introduction
Air guns, either modern or traditional models, are powerful weapons that are capable of causing serious or life-threatening injuries.
Case presentation
Here, we present a case of an air gun pellet injury, with the pellet trapped between the thyroid cartilage and the lining mucosa of a 58-year-old Iranian man.
Conclusion
Entrapment of air gun pellet between thyroid cartilage and the lining mucosa, as presented in our case, may cause diagnostic challenges through the clinical presentation of slight odynophagia.
doi:10.1186/1752-1947-6-184
PMCID: PMC3517344  PMID: 22759623
9.  Role of the Lewis and ABO Blood Group Antigens in Helicobacter pylori Infection 
Background:
Helicobacter pylori infection is a major risk factor for chronic gastritis and gastric cancer. Some findings show increased frequencies of these diseases in individuals with type O blood and in secretors (expressing Leb antigen), but other studies have not found any relationship between blood groups and this infection. Given that H. pylori infection and gastric cancer are common in Iran, the assessment of the pathogenesis of this infection in relation to these blood groups could be valuable.
Methods:
In a cross-sectional study, we determined the ABO and Lewis blood groups of participants using the tube method and evaluated the level of anti-H. pylori immunoglobulin G using an enzyme-linked immunosorbent assay. This study included 171 Iranian blood donors from Mashhad, Iran, during 2010. The significance of the differences in the frequencies of the Lewis and ABO phenotypes between individuals infected with and without H. Pylori infection were tested using the Chi-square test. A P-value < 0.05 was considered significant.
Results:
H. pylori infection was found in 76.6% of the study subjects (n = 131). The most common ABO blood group was O (33.9%), and the most common Lewis blood group was Le(a-b+) (54.7%). The frequencies of the ABO, Lewis, and secretion phenotypes were not significantly different between the infected and uninfected subjects.
Conclusion:
We did not find any significant relationship between the Lewis, ABO, and secretion phenotypes and H. pylori infection.
PMCID: PMC3629660  PMID: 23610545
ABO blood groups; blood group antigens; Helicobacter pylori; Lewis blood group; secretor blood group
10.  Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients 
Background/Aims
Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not.
Methods
This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used.
Results
A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 ± 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 ± 1.67 vs 1.37 ± 1.50, P = 0.009).
Conclusions
We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.
doi:10.5056/jnm.2012.18.1.70
PMCID: PMC3271257  PMID: 22323990
Gender identity; Irritable bowel syndrome; Questionnaire; ROME III
11.  Pulsatility Index in Aortic Coarctation: A Possible Way to Evaluate Factors Affecting Stenting Outcome 
Background:
The pulsatility index (PI) shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment of stenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices.
Methods:
Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice (before and after stenting). The patients were divided into two groups based on the percentage of increase in the PI after stenting (< 50% or ≥ 50%). The relation between the post-stenting PI and the baseline echocardiographic indices was assessed.
Results:
The PI was increased from 0.89 (SD = 0.30) to 1.75 (SD = 0.51) after stenting (p value < 0.001). Baseline diastolic/systolic velocity (D/S velocity) ratio of the abdominal aorta (p value = 0.013), mean velocity (p value = 0.033), and peak gradient of the descending aorta (p value = 0.033) were significantly higher in the patients with ≥ 50% increase in the PI after stenting.
Conclusion:
Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict ≥ 50% increase in the PI in our patients.
PMCID: PMC3466886  PMID: 23074630
Aortic coarctation; Stents; Echocardiography, Doppler
12.  Gross hematuria as the presentation of an inguinoscrotal hernia: a case report 
Introduction
Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations.
Case presentation
A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms.
Conclusion
Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.
doi:10.1186/1752-1947-5-561
PMCID: PMC3275640  PMID: 22136505
13.  Serum Immunoglobulins in Patients with Iron Deficiency Anemia 
Iron deficiency is a common cause of anemia worldwide. Documentation shows that these patients have impaired immunity and are prone to infections. The aim of this study was to confirm whether serum immunoglobulins change in adult nonpregnant females with iron deficiency anemia. Based on patients’ clinical history, CBC results, and serum ferritin, iron and total iron binding capacity, 45 healthy patients and 45 iron deficiency anemia (hypochrom microcytic) patients were entered into this case–control study. Serum IgG, IgA and IgM were measured in patient and control groups using the nephelometry method. Both of the groups were compared using suitable statistical test. Mean serum values of IgG, IgA and IgM in the patient group were 12.47 ± 7.67, 1.93 ± 0.92 and 1.35 ± 0.90 g/l respectively. Mean serum values for the control group were 12.51 ± 6.85, 2.14 ± 0.88 and 1.49 ± 0.73 g/l respectively. Although serum immunoglobulins were slightly lower in the patient group compared to the control group these differences were not significant with the t test. Our study showed serum immunoglobulin levels did not change in iron deficiency anemia.
doi:10.1007/s12288-010-0025-3
PMCID: PMC3002066  PMID: 21629635
Iron deficiency anemia; Humoral immunity; Immunoglobulin
14.  Non-alcoholic fatty liver disease and correlation of serum alanin aminotransferase level with histopathologic findings 
Hepatitis Monthly  2011;11(6):452-458.
Background
Non-alcoholic fatty liver disease (NAFLD) has been recognized as the most common cause of chronic liver disease worldwide. It occurs in patients who do not consume alcohol in large amounts. Alanine aminotranferase (ALT) and aspartate aminotransferase (AST) are indicators of hepatocellular injury.
Objectives
To determine correlation between histopathologic specifications of NAFLD in patients with little or no history of alcohol consumption and the serum level of ALT.
Patients and Methods
In a cross-sectional study carried out in two gastroenterology and hepatology clinics in Tehran, Iran, the medical records of those who had undergone liver biopsies between years 2005 and 2009 were reviewed. Clinical and laboratory information of biopsy-proven cases of NAFLD were obtained from 147 eligible medical records. The histopathologic, demographic, and laboratory data of the participants were also collected. Two groups of patients according to their serum ALT level (cut-point of 35 U/L) were defined. The quantitative pathologic grade of the biopsy specimens was determined based on Brunt scoring system.
Results
We studied 147 NAFLD patients including 127 men (86.4%) and 20 women (13.6%) with a mean ± SD age of 41.4 ± 11.2 years. Considering serum ALT, the mean ± SD quantitative grade of hepatosteatosis was 1.50 ± 0.67 and 1.74 ± 0.73 (p=0.136); advanced fibrosis (consisted of grade III and cirrhosis) was found in 4.5% (1/22) and 5.6% (7/125) of patients (p=0.327).
Conclusions
We found that using the cut-off value of 35 U/L for serum ALT level, it has little contribution to predict NAFLD severity.
PMCID: PMC3212791  PMID: 22087177
Non-alcoholic fatty liver disease; Serum alanine aminotranferase; Histopathology
15.  IGF-I concentration and changes in critically ill patients 
BACKGROUND:
Insulin-like growth factor 1 (IGF-I) is an anabolic growth factor that affects nitrogen balance and its changing trend is not clearly understood in critically ill patients. This study was carried out to evaluate the association between serum IGF-I levels and its changing trend in critically ill patients.
METHODS:
In this nested case-control study, all consecutive patients admitted to the medical ICU of Rasoul-e-Akram and Firuzgar hospital (Tehran, Iran) from January through October 2008 were included. IGF1 concentration was measured within the first 24h of ICU admission and the fourth, seventh and tenth day since admission. Patients were followed until discharge from ICU or expiration.
RESULTS:
The study population consisted of 90 patients (mean age: 58.01 ± 22.56), 31 (34.4%) of who died and 59 (65.6%) were discharged. On admission, 43 patients (47.7%) had low IGF-I levels, whereas 47 (52.3%) had normal or high levels. The concentration of IGF-I was not significantly different in every 4 measurements between expired and discharged patients. Significant decrease was seen between first to fourth day IGF-I concentration (p = 0.005). Changing trend was not statistically different in two groups of patients.
CONCLUSIONS:
There was no relation between low IGF-I concentration on admission day and increased adverse outcome, but overall these patients had lower IGF1. No clear association was found between changing trend of IGF1 and mortality. Stress on admission time may cause decreasing pattern of IGF-I in the first 4 days of admission.
PMCID: PMC3214299  PMID: 22091227
Intensive Care Units; Critical Illness; Insulin-Like Growth Factor I; Mortality
16.  Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the “spiral” reconstruction technique 
We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upper extremity defects via resurfacing and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue expander (TE) was inserted under the LD muscle to expand the flap in a longitudinal direction thereby forming a “long” flap rather than a “wide” one. After excising the circumferential lesion, the expanded “elongated” flap was wrapped spirally around the extremity to cover the defect; the donor site was closed as usual. The 5 patients we treated via LDMC flaps in a spiral fashion were free of complications, and all were satisfied with the outcome. All the flaps survived and the spiral reconstruction allowed for a tension-free donor site closure and near complete recipient coverage. This technique is indicated for large circumferential extremity skin defects and deformities. Application of expanded LDMC flaps in a spiral fashion can be used by the reconstructive surgeon to resurface large circumferential upper extremity lesions when indicated. The idea of a long and thinned expansion flap must be in a longitudinal direction and we need this long expanded and thin flap to “spiral” it around the extremity to cover a large defect. The “spiral” flap coverage introduced here for large circumferential extremity defects enables the surgeon to cover the defect with simultaneous donor site closure and good results.
doi:10.1007/s11751-010-0090-z
PMCID: PMC2994632  PMID: 21286355
Expanded latissimus dorsi musculocutaneus flap; Circumferential defects; Reconstruction
17.  Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the “spiral” reconstruction technique 
We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upper extremity defects via resurfacing and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue expander (TE) was inserted under the LD muscle to expand the flap in a longitudinal direction thereby forming a “long” flap rather than a “wide” one. After excising the circumferential lesion, the expanded “elongated” flap was wrapped spirally around the extremity to cover the defect; the donor site was closed as usual. The 5 patients we treated via LDMC flaps in a spiral fashion were free of complications, and all were satisfied with the outcome. All the flaps survived and the spiral reconstruction allowed for a tension-free donor site closure and near complete recipient coverage. This technique is indicated for large circumferential extremity skin defects and deformities. Application of expanded LDMC flaps in a spiral fashion can be used by the reconstructive surgeon to resurface large circumferential upper extremity lesions when indicated. The idea of a long and thinned expansion flap must be in a longitudinal direction and we need this long expanded and thin flap to “spiral” it around the extremity to cover a large defect. The “spiral” flap coverage introduced here for large circumferential extremity defects enables the surgeon to cover the defect with simultaneous donor site closure and good results.
doi:10.1007/s11751-010-0090-z
PMCID: PMC2994632  PMID: 21286355
Expanded latissimus dorsi musculocutaneus flap; Circumferential defects; Reconstruction
18.  Alloimmunization among transfusion-dependent thalassemia patients 
Background:
Thalassemia is a common hemoglobin disorder in Iran and one of the major public health problems. Although blood transfusions are lifesavers for thalassemia patients, they may be associated with some complications especially erythrocyte alloimmunization. The purpose of this study was to investigate the prevalence of red blood cell alloantibodies and to determine types of these antibodies among multiple-transfused thalassemic patients.
Materials and Methods:
A total of 313 thalassemia patients in the northeast of Iran, who received regular blood transfusion, were included in this study. Screening of antibodies was performed on fresh serum of all patients and then antibodies were identified in patients’ serum that had positive antibody screening test using a panel of recognized blood group antigens.
Results:
We identified 12 alloantibodies in 9 patients (2.87%) that all were against Rhesus (Rh) blood group antigens (D, C, E). Three patients developed 2 antibodies, and others had one antibody. The most common alloantibodies were Anti-D (88.88%) and followed by Anti-C and Anti-E. Higher frequency of alloimmunization was observed in female, Rh negative and splenectomized patients.
Conclusion:
This study showed that evaluation of the packed cells for Rh (C, E) from the start of transfusion can be helpful in decreasing the rate of alloantibody synthesis.
doi:10.4103/0973-6247.53884
PMCID: PMC2920480  PMID: 20808654
Alloantibody; thalassemia; transfusion
19.  Necrotizing fascitis: an epidemiologic study of 102 cases 
The Indian Journal of Surgery  2008;69(4):136-139.
Background
Necrotizing fascitis is a progressive, rapidly spreading, inflammatory infection located in deep fascia. It may cause necrosis of skin and subcutaneous tissues. Spreading of it may lead to shock, organ failure and even death.
Methods
In this study, we evaluated prevalence of variables including predisposing factors, clinical and paraclinical findings, distribution of tissue involvement and mortality rate in 102 patients of necrotizing fascitis at our Hospital between the years 1995 and 2005.
Results
Prevalence of this disease was higher in males than females with the rate of 2.6:1. Diabetes mellitus was the most common predisposing disease. Genital region was the most common site of involvement. Muscles were involved in 25.5% of cases. Nonspecific erythema was the main dermatological manifestation. The most common organism was Enterococcus faecalis and mortality rate was 10.8%.
Conclusion
Necrotizing fascitis is an infectious disease with high mortality rate and frequently with non-specific skin and general manifestations. High suspicion while visiting primary signs and surgical debridement can be effective in decreasing the rate of morbidity and mortality.
doi:10.1007/s12262-007-0004-6
PMCID: PMC3452458  PMID: 23132965
Necrotizing fascitis; Necrosis; Gangrene; Fascia; Infection
20.  Takayasu's arteritis associated with Crohn's disease: a case report 
Introduction
The simultaneous presence of Takayasu's arteritis and Crohn's disease in a patient seems to be rare. To our knowledge, no patient with the combination of Crohn's disease and Takayasu's arteritis has been reported from our region.
Case presentation
Herein we present the case of a 22-year-old Iranian woman previously diagnosed as Crohn's disease and who had subsequently developed Takayasu's arteritis.
Conclusion
Clinical suspicion, proper imaging, and consideration of the differential diagnosis are important for the correct diagnosis and management of patients with this coincidence.
doi:10.1186/1752-1947-2-87
PMCID: PMC2323385  PMID: 18353173
21.  Doppler echocardiographic indices in aortic coarctation: a comparison of profiles before and after stenting 
Cardiovascular Journal of Africa  2012;23(9):483-490.
Background
Diagnosis of aortic coarctation is important as it is a difficult condition to evaluate, especially in adults. A Doppler echocardiographic index could provide a simple tool to evaluate coarctation. This study was performed to compare Doppler echocardiographic profiles before and after stenting and to assess the diagnostic value of a complete list of echocardiographic indices for detecting aortic coarctation.
Methods
This prospective study was conducted on 23 patients with a diagnosis of aortic coarctation based on angiography. Echocardiographic assessment was done twice for all patients before and after stenting. Each time, two-dimensional and Doppler echocardiographic imaging modalities were performed and complete lists of indices were recorded for each case. After comparing the values of indices before and after stenting, diagnostic values of each index were calculated in order to diagnose significant coarctation.
Results
Twenty-three patients, including 16 males and seven females with a mean age of 26.14 ± 10.17 years, were enrolled in this study. Except for the mean velocity and mean pressure gradient of the abdominal aorta, the values of the other indices of the abdominal/descending aorta showed enough change after stenting to indicate significant diagnostic accuracy for detecting aortic coarctation. The velocity–time integral and the pressure half-time were among the indices with the highest accuracy rates for this purpose (all p < 0.001).
Conclusion
Post-stenting echocardiographic profiles could provide a reliable reference value of the normal aortic haemodynamics as a unique identification of each patient and it is presumed that these indices could be used as reliable indicators of response to treatment.
doi:10.5830/CVJA-2012-044
PMCID: PMC3721869  PMID: 23108515
aortic coarctation; Doppler echocardiography; index; diagnostic values

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