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Background: The present study aims at evaluating the safety and efficacy of ureteral reimplantation and its influence on quality of life in the complete ureteral obstruction due to prostate cancer. Methods: In a prospective randomized study, 86 patients with complete ureteral obstruction were randomized into 2 groups: group 1 (ureteral reimplantation) and group 2 (nephrostomy). Biochemical values, complications, and survival of patients were recorded. Results: The mean age of patients were 72.20 ± 7.77 and 74.26 ± 7.56 years in group 1 and group 2, respectively (P ₌ 0.21). The mean decrease in Creatinine values were not significant between 2 groups (P = 0.639). The mean survival of patients after intervention were 22.42 ± 0.87 months in group1 and 20.48 ± 0.65 in group 2 (P = 0.0001). No major complications were happened in group 1. Main delayed complications in group 1 were ureteral stricture at the anastomosis point 20% (n = 8), UTI 27.5% (n = 11), and permanent pain at the operation site 15% (n = 6). In group 2, 100% of patients had experienced complications, including: febrile UTI 65.2% (n = 30), perirenal abscess 10.8% (n = 5), dislodgement of nephrostomy tube 30.4% (n = 14), local inflammation and dermatitis of nephrostomy tract 54.3% (n = 25), and hemorrhage during nephrostomy placement 4.3 (n = 2). Likewise, all of them (100%) had social inconvenience, local pain and discomfort in tract and sutures of tube, urine leakage and odor, and need to regular replacement of tube. Conclusions: Reimplantation is a safe and effective option in the management of complete ureteral obstruction due to advanced prostate cancer with significant benefits in overall survival and patient satisfaction.

Introduction: Renal rhabdomyosarcoma is a rare malignant mesenchymal tumor, representing 1% - 3% of all renal malignant tumors. Case Presentation: In the present study, we discussed about a 33-year-old woman with a botryoid type embryonal rhabdomyosarcoma of the left kidney presented with gross hematuria. Conclusions: This very rare tumor in adults should be considered in differential diagnosis among undifferentiated malignant tumors.

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.

Objective: To evaluate whether the use of vascular endothelial growth factor (VEGF) with alginate increases oocyte maturation following in vitro maturation. Methods: This experimental study was performed on 150 immature oocytes (germinal vesicle oocytes) from females who were candidates for assisted reproductive technology. The germinal vesicle oocytes were randomly placed in the control, alginate, and VEGF plus alginate groups. The basic culture medium for oocytes culture (tissue culture medium 199, follicle-stimulating hormone 0.075 IU/mL, and fetal bovine serum 10%) was used in the control, alginate, and VEGF plus alginate groups. For the treatment groups (alginate, and VEGF plus alginate groups), alginate (8%) and VEGF (5 ng/mL) were added to the basic culture medium. After culture, immature oocytes were considered as oocytes unchanged in the nucleus whereas oocytes with a polar body were considered as mature oocytes (metaphase II stage). The mature oocytes in each group were fertilized by intracytoplasmic sperm injection and formed embryos were evaluated by reverse microscope. Results: The oocyte maturation rate (metaphase II) significantly (P < 0.05) increased in the alginate plus VEGF group as compared with the alginate alone and control groups during in vitro maturation. On day 2, the cleavage rates were significantly different in the matured oocytes between the treatment groups and the control group. The percentage of the two-cell stage, four-cell stage and eight-cell embryos was significantly higher in the treatment groups compared with the control group (P

Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January 2001 and January 2011. We classified the severity of SE in five grades including the (1) base of the neck, (2) all of the neck area, (3) subpectoralis major area, (4) chest wall and all of the neck area, and (5) chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum. We excluded all patients in grades 1 and 2, because the symptoms and signs were not significant. Statistical analysis was carried out with SPSS 18. We collected 35 cases of SE with the mean age of 53 ± 14.83 (71 % men). The most common cause of SE was pneumothorax with background of COPD and surgery in grade 5, trauma due to rib fracture in grade 4, and iatrogenicity in grade 3. We performed two bilateral 2-cm infraclavicular incisions. In our patients with infraclavicular incisions, expansion of the lung was better, and the patients’ appearance improved. Infraclavicular incisions as a simple method for the management of SE can decrease the severity of SE with no cosmetic problem.

Gossipyboma is a mass which is made around a cotton sponge or abdominal compress retained in a patient during surgery accidentally. Patients manifest with either acute or chronic symptoms due to complications. Here in wereported an 89-year-old man case of transvesical migration of gossipyboma who presented with gross hematuria with a history of transvesical prostatectomy 6 years ago. Patient underwent exploratory laparotomy with repairing of the bladder and peritoneum. He had no complications during surgery and was subsequently discharged.

Enterococcus fecalis is responsible for majority of enterococci infections and can cause clinical disorders in adult and pediatrics. In order to adverse effects of synthetic drugs, it has made a positive attitude toward alternative and complementary medicine. Ruta graveolens has a wide therapeutic application for various diseases. Aim of this study was to see the effect of this herb on Enterococcus fecalis growth. In this investigation we used standard Enterococcus fecalis. Effect of hydro-alcoholic, aqueous and methanolic extracts of Ruta graveolens on growth of bacteria has been evaluated by disc diffusion and serial dilution method and compared with eight prevalent antibiotics. None of disks with different extracts in the range of 50 to 400μ/ μl show any non-growth hallo. Disks with 500μg of all type extracts in comparison with antibiotic disks did not avoid from growth of bacteria. Third test showed the growth of bacteria and ineffectiveness of various amount of extracts. It seems that this ineffectiveness is because of low antibacterial substance against the bacteria in extracts of the herb and high resistant nature of Enterococcus fecalis to antibiotics and it needs more studies.

To compare monotherapy with tadalafil or tamsulosin and their combination therapy in men with benignprostatic hyperplasia and erectile dysfunction by comparing IPSS score, prostate volume and Qmax and someother outcomes.This randomized, single-blind, paralleled group clinical trial was done in 2013 on patientswho had referred to our hospital in Tehran. All patients with lower urinary tract symptoms, benign prostatichyperplasia and any grade of erectile dysfunction were recruited. They were randomly divided into three groups(61 participants in each group): Group A received 20 mg/daily tadalafil; Group B received 0.4 mg/daily tamsulosin;Group C receieved a combination of 0.4 mg/daily tamsulosin and 20 mg/daily tadalafil. Primary outcomeswere prostate volume, prostate specific antigen, post-void residual volume, IPSS score, LUTS severity, Qmax,IIEF and erectile dysfunction severity and secondary outcome was complications.The mean ± SD of ultrasonographic prostate volume was 61.4 ± 15.1 mL and prostate specific antigenlevel was 2.4 ± 1.9 ng/dl. Post-void residual level was significantly different before and after the treatment, exceptfor group A. Also, this group had no meaningful difference compared to the other groups in this regard (P0.05).There were significant differences between pre- and post-treatment international prostate symptom scores in eachgroup (P0.05).Combination of tamsulosin and tadalafil can improve international prostate symptom scores, internationalindex of erectile function questionnaire scores and Qmax in patients with lower urinary tract symptoms andbenign prostatic hyperplasia to more degrees than their separate use. This combination is recommended becauseof its synergistic effects, well toleration and safety.

This figure shows the hexadactyly of feet and severe inflammation of the lower limbs of a 32-year-old Iranian female patient with Bardet–Biedl syndrome (BBS) who was referred to us with uraemic symptoms and metabolic acidosis. She had suffered from insulin-resistant type 2 diabetes mellitus for 2 years and moderate hypertension for 6 months. Her parents had noticed progressive decline in her vision and hearing since the age of 7 years. She had mild mental retardation. She had irregular menstrual periods but her secondary sex characteristics were normal. Her parents were not consanguineous. On physical examination, the patient was markedly obese with a body mass index of 31.4 Kg/cm2. She was dyspnoeic and often unwell. The blood pressure was 190/100 mmHg, axillary temperature 39°C, respiratory rate 22 beats/min, and heart rate 78 beats/min. Fundus examination revealed pigmentary retinopathy. Both lungs had coarse crackle in the basal field. Cardiac, abdominal and genital examinations were normal. On admission, her blood glucose level was 482 mg/dL, blood urea nitrogen 190 mg/dL and serum creatinine 12.6 mg/dL. Blood revealed metabolic acidosis. Ultrasonography also showed bilateral small-sized high echogenic kidneys without cyst and hydronephrosis. BBS is a rare autosomal recessive disease characterized by the abdominal obesity, mental retardation, pigmentary retinopathy, polydactyly and hypogenitalism. The degree of polydactyly, a prominent feature of this syndrome, varies from patient to patient, ranging from a wide fifth metatarsal or metacarpal to a complete sixth digit.

Background: Botulism is caused by a neurotoxin produced from the anaerobic, sporeforming Bacterium clostridium. Food-borne botulism is one of the dangerous forms offood poisoning in the world. The purpose of this study was to survey some clinicalpresentations and laboratory findings in patients suspected with botulism toxicity thathad received anti-botulism.Methods: This descriptive-retrospective study was done on food-borne botulismpoisoning cases admitted to the emergency ward and received anti-botulism at RaziHospital of Rasht (north of Iran) during 2001-6. Completion of the questionnaire whichincluded such variables as gender, age, clinical presentations, and laboratory data wasbased on the information available on the patients.Results: Of the 31 patients that had taken anti botulism, 20 cases (64.5%) were male.Subjects were in age range of 19-55 and the mean of age was 34.5 years. Conservedfoods (38.7%), salted caviar (32.3%), and fish (16.3%) were the main causes ofbotulism, respectively. The most common clinical symptom was vomiting (77.4%) andthe most common neurological presentations were visual abnormalities (48.4%).Azotemia, leukocytosis, and leukopenia were seen in 3 cases (9.7%), in 2 cases(6.5%), and in 4 cases (12.9%), respectively.Conclusion: Marine products (salted caviar and fish) have an important role in theincidence of botulism in Guilan. Botulism is seen in males more than females and itsmost common clinical manifestation is vomiting.

Objective The aim of this study is to further compare the efficacy of PGE2 suppository, the intracervical foley catheter and extra-amniotic saline infusion in nulliparous women referred for labor induction. Materials and methods Totally 368 nulliparous women with a Bishop score ≤ 4 with singleton gestation, vertex presentation and intact membrane referred for labor induction were randomly assigned to 3 groups; Foley catheter alone, Extra-amniotic saline infusion (EASI) and PGE2 suppository. All women received concurrent dilute oxytocine infusion. The change in the Bishop Score, labor progress, various labor endpoints and outcomes of labor were assessed. Results From 363 women studied after exclusion of 5, 119 were assigned to EASI, 121 to Foley and 118 to PGE2. Patients’ demographics did not differ significantly between three groups nor did indication for induction (P = 0.0001). The EASI group had a significant improvement in Bishop Score 6 hours after induction. The mean time to active phase was 357±135min for EASI,457±178 for Foley and 609±238 min for PGE2 group respectively (P < 0.05).rate of spontaneous rupture of membranes was higher in the EASI group (P = 0.0001) and the mean time from the start of induction up to spontaneous rupture of membranes in the EASI group was shorter than other group(P < 0.05). The mean time to vaginal delivery was 14.8±6.1 in EASI group,11.4±4.8 in Foley and 18.9±6.4 in PGE2 group(P < 0.05).there were no differences in Apgar scores, mean neonatal birth weight and neonatal morbidity. Conclusion Our study showed that pre-induction cervical ripening by EASI with concurrent oxytocin is better than Foley and PGE2 in Bishop score and various labor end point and outcomes.

Sarcoidosis is a chronic multiorgan autoimmune disorder that affects all racial and ethnic groups and occurs at all ages.The aim of this study was to assess the clinical and epidemiological features of sarcoidosis patients in a referral clinic of pulmonary disease in city of Rasht (Guilan-Iran).This retrospective study was done by reviewing sarcoidosis patient's records containing demographic, sign and symptom and clinical data in a pulmonary clinic in Rasht from 2001-09. All statistical analyses were achieved using SPSS.most common signs and symptoms were respiratory, systemic and musculoskeletal complaints. According to Chest X-Ray, 61.3% had bilateral hilar lymphadenopathy (BHL) alone (stage 1), and 24.2% had BHL plus parenchymal involvment (stage 2). The most common abnormal finding in spirometry was small airway disease (20.3%).The follow-up data showed that 178 patients (45.2%) had significant improvement clinically, radiologically or both.It seems many clinical and radiological aspects of sarcoidosis in our patients are similar to other series. However, presentation with Lofgren's syndrome is a common feature and skin (n=48, 12.3%) and eye (n=19, 4.8%) involvement are less frequent. There is significant difference between west and east of Guilan in relation to referred patients (12.9 % vs 78.5% respectively).Of course this may be due to referral issues of patients and medical teamwork connections

Exchange transfusion is the standard method for treatment of severe hyperbilirubinemia. Our goal was to determine the indications for exchange transfusion (ECT) and the rates of ECT-related adverse events. A retrospective descriptive investigation was performed in newborns that underwent ECT at 17 Shahrivar Pediatric Hospital, Rasht, Guilan province during the period April 2008 to April 2011. Of the 69 patients, 2 (2.9%) required more than one ECT. The mean total serum bilirubin before ECT was 21.55 ± 5.12 mg/dl. The most common cause of ECT was ABO incompatibility (26.1%). ECT complications occurred in 9 neonates (13.0%), the most common being sepsis (7.4%). No case of ECT related mortality was observed. All the adverse events resolved completely before discharge. ABO isoimmunization was the most common cause of ECT in this study. The majority of adverse events associated with ECT are asymptomatic and reversible.