BACKGROUND

In true aneurysm, the wall of aneurysm is composed of the normal histological components of aorta. A false aneurysm (pseudoaneurysm) represents a rupture which does not contain the normal histological components of aorta. It is a fibrous peel that has formed from a small perforation of aorta. We describe an unusual presentation that has signs which some of them are only manifested in true aneurysm and some others only in pseudoaneurysm.

CASE REPORT

An 85-year-old man underwent elective coronary angiography for chest pain work-up. Our evaluation by invasive angiography and CT angiography showed aortic dissection. In surgery we found that dissection flap was composed of some parts of intima and media layers. These signs leaded to confusing symptoms. Localized bulging of ascending aorta had continued to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some part of intima and media layers. It was a strange case, it was not solely a perivascular hematoma and it did not have all three layers of aorta wall. Partial aorta replacement was performed. The operation and recovery was uneventful.

CONCLUSION

This unusual presentation of disease has not been mentioned in literatures. Our experience can help to manage similar cases. This case was the first unusual presentation of its type.

BACKGROUND:

Dextromethorphan (DM) is an N-methyl-D-aspartate (NMDA) receptor antagonist that may be useful during opiate addiction process, especially in reducing methadone consumption in methadone maintenance therapy (MMT). The goal of the current study was to evaluate the effects of oral administration of DM on reducing methadone dose in MMT used to treat illicit opioid drug abuse.

METHODS:

A double-blinded randomized clinical trial was designed. Seventy two opiate abusers undergoing MMT were randomly divided into two groups. Participants in the intervention group were medicated by DM while those in the control group received placebo. After a 6-week follow-up, methadone consumption dosage, quality of life (QOL) and withdrawal symptoms were assessed and compared between the two groups by repeated measure ANOVA statistical test.

RESULTS:

The mean of methadone consumption in the DM and control groups were 62.7 mg/day (52.7-72.7) and 70.4 mg/day (60.4-80.4), respectively. No statistically significant difference was found between the two groups among the four evaluations made (F = 1.192, P = 0.279). There were not any significant differences in withdrawal symptoms between the two groups (P > 0.05). Total mean scores of QOL in the intervention and control groups were 84.8 (78.7-90.8) and 77.8 (71.8-83.7) (P > 0.05), respectively.

CONCLUSIONS:

Although DM might be useful for opioid dependence treatment, results of the current study did not reveal any statistically significant differences. Therefore, further studies exploring this possibility are needed.

BACKGROUND:

Although many studies have investigated the relationship between perfectionism, anxiety, and depression among the adults, little is known about the manifestations of perfectionism among schoolage youths. This study has investigated this relationship in an Iranian sample.

METHODS:

Using multistage cluster random sampling, 793 Iranian school students in 2007 were studied. Data of demographic characteristics, children's depression inventory, revised children's manifest anxiety scale, and the positive and negative perfectionism scales were obtained using questionnaires.

RESULTS:

The results indicated that both aspects of perfectionism are associated with depression and anxiety. Negative and positive perfectionism have positive and negative associations, respectively, with depression and anxiety. The interaction of anxiety and depression with perfectionism reveals that depression is in association with lower scores of positive perfectionism, whereas in students with higher scores of negative perfectionism, the anxiety scores are also higher. Moreover, the accompaniment of anxiety with depression is in association with relatively lower levels of negative perfectionism.

CONCLUSIONS:

It was concluded that negative perfectionism is a risk factor for both depression and anxiety, while positive perfectionism is a protective factor. However, the interventions which encourage the positive aspects of perfectionism and decrease its negative aspects may be able to diminish psychopathological subsequence.

WEB SITE FEATURE

Because adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass grafting, this prospective, randomized trial was designed to evaluate the effects of ascorbic acid as an adjunct to β-blockers.

Fifty patients formed our ascorbic acid group, and another 50 patients formed our control group. All patients were older than 50 years, were scheduled to undergo coronary artery bypass grafting, and had been treated with β-blockers for at least 1 week before surgery. The mean age of the population was 60.19±7.14 years; 67% of the patients were men. Patients in the ascorbic acid group received 2 g of ascorbic acid on the night before the surgery and 1 g twice daily for 5 days after surgery. Patients in the control group received no ascorbic acid. Patients in both groups continued to receive β-blockers after surgery. Telemetry monitoring was performed in the intensive care unit, and Holter monitoring was performed for 4 days thereafter.

The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in the control group (odds ratio, 0.119; 95% confidence interval, 0.025–0.558, P = 0.002). We conclude that ascorbic acid is effective, in addition to being well-tolerated and relatively safe. Therefore, it can be prescribed as an adjunct to β-blockers for the prophylaxis of post-bypass atrial fibrillation.