Search

In conjunction with traditional modular bifurcated aortic endografts, bilateral iliac branch endoprostheses have been safely and effectively used for treatment of bilateral iliac artery aneurysms. However, anatomic constraints, such as inadequate renal artery to iliac bifurcation lengths and unfavorable aortic anatomy, can preclude deployment in certain configurations and limit use in many patients. We present an innovative technique to overcome such anatomic constraints and to extend the reach of iliac branch endoprosthesis technology in patients with iliac artery aneurysms.

Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist. Locoregional therapies, such as thermal ablation or chemoembolization, can be efficacious in patients with HCC and pre-existing TIPS; however there is a risk for increased adverse events in patients receiving these therapies who have TIPS compared to those who do not. In summary, TIPS is a safe, effective treatment that can be used to ameliorate the complications that are sequelae of portal hypertension. While it does not appear to improve survival post-transplant, TIPS placement pre-transplant may increase survival time to transplant, thus improving overall survival as well as quality of life., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. The objective of this study was to develop a method to predict response to intra-arterial treatment prior to intervention. The method provides a general framework for predicting outcomes prior to intra-arterial therapy. It involves pooling clinical, demographic and imaging data across a cohort of patients and using these data to train a machine learning model. The trained model is applied to new patients in order to predict their likelihood of response to intra-arterial therapy. The method entails the acquisition and parsing of clinical, demographic and imaging data from N patients who have already undergone trans-arterial therapies. These data are parsed into discrete features (age, sex, cirrhosis, degree of tumor enhancement, etc.) and binarized into true/false values (e.g., age over 60, male gender, tumor enhancement beyond a set threshold, etc.). Low-variance features and features with low univariate associations with the outcome are removed. Each treated patient is labeled according to whether they responded or did not respond to treatment. Each training patient is thus represented by a set of binary features and an outcome label. Machine learning models are trained using N - 1 patients with testing on the left-out patient. This process is repeated for each of the N patients. The N models are averaged to arrive at a final model. The technique is extensible and enables inclusion of additional features in the future. It is also a generalizable process that may be applied to clinical research questions outside of interventional radiology. The main limitation is the need to derive features manually from each patient. A popular modern form of machine learning called deep learning does not suffer from this limitation, but requires larger datasets.

In this project, our goal is to classify different types of liver tissue on 3D multi-parameter magnetic resonance images in patients with hepatocellular carcinoma. In these cases, 3D fully annotated segmentation masks from experts are expensive to acquire, thus the dataset available for training a predictive model is usually small. To achieve the goal, we designed a novel deep convolutional neural network that incorporates auto-context elements directly into a U-net-like architecture. We used a patch-based strategy with a weighted sampling procedure in order to train on a sufficient number of samples. Furthermore, we designed a multi-resolution and multi-phase training framework to reduce the learning space and to increase the regularization of the model. Our method was tested on images from 20 patients and yielded promising results, outperforming standard neural network approaches as well as a benchmark method for liver tissue classification.

Purpose: To use magnetic resonance (MR) imaging and clinical patient data to create an artificial intelligence (AI) framework for the prediction of therapeutic outcomes of transarterial chemoembolization by applying machine learning (ML) techniques., Materials and Methods: This study included 36 patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization. The cohort (age 62 ± 8.9 years; 31 men; 13 white; 24 Eastern Cooperative Oncology Group performance status 0, 10 status 1, 2 status 2; 31 Child-Pugh stage A, 4 stage B, 1 stage C; 1 Barcelona Clinic Liver Cancer stage 0, 12 stage A, 10 stage B, 13 stage C; tumor size 5.2 ± 3.0 cm; number of tumors 2.6 ± 1.1; and 30 conventional transarterial chemoembolization, 6 with drug-eluting embolic agents). MR imaging was obtained before and 1 month after transarterial chemoembolization. Image-based tumor response to transarterial chemoembolization was assessed with the use of the 3D quantitative European Association for the Study of the Liver (qEASL) criterion. Clinical information, baseline imaging, and therapeutic features were used to train logistic regression (LR) and random forest (RF) models to predict patients as treatment responders or nonresponders under the qEASL response criterion. The performance of each model was validated using leave-one-out cross-validation., Results: Both LR and RF models predicted transarterial chemoembolization treatment response with an overall accuracy of 78% (sensitivity 62.5%, specificity 82.1%, positive predictive value 50.0%, negative predictive value 88.5%). The strongest predictors of treatment response included a clinical variable (presence of cirrhosis) and an imaging variable (relative tumor signal intensity >27.0)., Conclusions: Transarterial chemoembolization outcomes in patients with HCC may be predicted before procedures by combining clinical patient data and baseline MR imaging with the use of AI and ML techniques., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To determine if the attenuation of contrast material in the excluded stomach compared with the gastric pouch is helpful in diagnosing gastrogastric (GG) fistula., Materials and Methods: In a retrospective study, 13 CT scans in 12 patients (age 43.2 ± 9.2, 10 females) who had undergone Roux-en-Y gastric bypass and who had oral contrast in both the gastric pouch and excluded stomach were qualitatively and quantitatively evaluated for GG fistula by two radiologists, using upper GI series (UGI) as the gold standard. Quantitative analysis was performed by computing the relative attenuation (RA) ratio (HU in excluded stomach/HU in gastric pouch). Statistical analysis was performed to determine if the RA ratio values correlated with the UGI findings of GG fistula., Results: 46.2% (6/13) of UGI studies demonstrated a GG fistula. Statistical analysis demonstrated a significant difference in RA ratio (P < 0.05) between the fistula group (1.12 ± 0.29) and the reflux group (0.56 ± 0.19). A receiver operating characteristic analysis identified an RA ratio of 0.8 that maximized sensitivity (100%), at the expense of specificity (78.6%), for diagnosing GG fistula. In contrast, the initial qualitative evaluation for GG fistula yielded a lower sensitivity (45.8%) and a higher specificity (89.2%). After taking RA ratios into account, radiologists' final conclusions achieved higher sensitivity (58.3%) and specificity (100%)., Conclusion: The relative attenuation ratio of oral contrast in the excluded stomach versus the gastric pouch can be a reliable tool in differentiating GG fistula from oral contrast reflux up the biliopancreatic limb on CT.

Introduction: There are two different types of 90 Y Microspheres, glass and resin, in the market for 90 Y radioembolization ( 90 Y-RE). This study aimed to investigate the dose of radiation delivered through glass vs. resin-based 90 Y-RE to intrahepatic cholangiocarcinoma (ICC)., Methods: In this retrospective study, 10 patients with ICC underwent 90 Y-RE, five underwent glass (Glass group) and other 5 resin (Resin group) microspheres. Technetium-99m macro-aggregated albumin (Tc-99m MAA) shunt study was performed two weeks before 90 Y-RE. Within 2 h from 90 Y-RE, Bremsstrahlung SPECT/CT was obtained. Regions of interest (ROIs) were segmented around the targeted tumor and the liver. Tumor and liver volumes, corresponding radioactive counts, and tumor to liver count ratio were calculated using MIM software and compared between Glass and Resin groups., Results: Mean hepatopulmonary shunt fraction was 7.1 vs. 6.2% for the Glass and Resin groups (p = 0.83), with no extrahepatic activity. There was no difference in the activity and tumor uptake of administered Tc-99m MAA between both groups (p = 0.71 and p = 0.63). Mean administered activity of 90 Y in the Glass group was higher than the Resin group (73.2 ± 24.3 vs. 44.5 ± 18.2 mCi, p < 0.001). The tumor 90 Y uptake was significantly higher in the Glass group compared to the Resin group (41.3% vs. 33.5%, p < 0.001), corresponding to the mean tumor dose of 205.7 ± 19.7 vs. 128.9 ± 10.6 Gy, respectively (p < 0.001). The tumor to normal liver parenchyma 90 Y dose ratio was significantly higher in the Glass group compared to the Resin group, 4.9 ± 0.7 versus 2.4 ± 0.3 respectably (p < 0.001)., Conclusions: Both 90 Y glass and resin-based microsphere 90 Y-RE are feasible and safe in patients with ICC, while 90 Y glass microsphere delivers higher dose of 90 Y to the targeted tumors., Advances in Knowledge: While both 90 Y glass and resin-based microsphere yttrium-90 radioembolization are feasible and safe treatment options for in patients with intrahepatic cholangiocarcinoma, 90 Y glass microsphere delivers higher dose of 90 Y to the targeted tumors., Implications for Patient Care: Both of 90 Y glass and resin-based microsphere can be safely and feasibly used for treatment of intrahepatic cholangiocarcinoma, difference in dose of 90 Y delivered to the targeted tumors should be clinically considered while choosing the microsphere type., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background/aims: Variability in the grade of atherosclerosis among patients with chronic kidney disease (CKD) could affect the ultrasound measurements of intima media thickness (IMT). We sought to investigate IMTs of carotid (cIMT) and femoral (fIMT) arteries in CKD patients and assess the degree of their correlation with histopathological atherosclerosis., Methods: Eighty-nine out of 99 enrolled subjects completed this study. The subjects were divided into 3 groups: 34 patients with CKD (Case group), 31 with coronary artery disease undergoing coronary artery bypass graft (CABG, positive control group), and 24 healthy kidney donors (negative control group). For histopathological assessment of atherosclerosis, arterial tissue samples were obtained from the patients in each study group. The cIMT and fIMTs were measured by ultrasonography., Results: Histopathological atherosclerosis was present in 82.3, 100, and 20.8% of CKD, CABG, and donor groups respectively (p < 0.001). CKD patients had higher values of cIMT and fIMT than the donor group (p = 0.01 and 0.004, respectively). cIMT was positively correlated with the grade of atherosclerosis in the CKD group only (p < 0.001), while fIMT was correlated with the grade of atherosclerosis in both CKD and donor groups (p < 0.001 and p = 0.009 respectively). In CKD patients, cIMT >0.65 mm and femoral values >0.57 mm predicted the presence of histopathological atherosclerosis with sensitivities of 96 and 92% respectively., Conclusion: Higher values of cIMT and fIMT in CKD patients are associated with higher rates and degrees of histopathological atherosclerosis. Additionally, when compared to fIMT, cIMT has a higher sensitivity for detecting atherosclerosis in CKD patients., (© 2018 S. Karger AG, Basel.)

Objective: The study objective was to describe our initial experience performing a V-shaped single sinus remodeling procedure in patients with ascending aortic aneurysm and moderate aortic root ectasia., Methods: Twelve consecutive patients underwent supracoronary ascending aortic replacement with V-shaped noncoronary sinus remodeling (median age, 63 years [range, 56-77]; 10 patients [83%] were male). All patients had an ascending aortic aneurysm (median diameter 48 mm [range, 42-53]) and aortic root ectasia (median root diameter, 43 mm [range, 38-49.7 mm]). A deep V-shaped (triangular) portion of the noncoronary sinus was excised, and the wall was directly reapproximated in 2 layers, 1 everting mattress suture layer followed by a running over-and-over layer., Results: No technical complication due to root remodeling was observed. All patients survived the initial hospitalization. Only 1 patient required reexploration for bleeding, unrelated to the V-shaped repair. On postoperative computed tomography, every patient showed reduction in maximal aortic root diameter and cross-sectional area. Mean aortic root diameter was reduced from 4.30 cm (range, 3.82-4.97) to 3.81 cm (range, 3.58-3.96) (P < .0006). Mean aortic root cross-sectional area was reduced from 1452 mm 2 (range, 1327-1615) to 1180 mm 2 (range, 961-1328) (P < .0002). Mean wall tension decreased postoperatively by 12%., Conclusions: The V-shaped resection of the noncoronary sinus is a viable option for patients with moderate aortic root enlargement. This technique reduces aortic root diameter, cross-sectional area, and wall tension. We offer this technique as another option in the surgeon's armamentarium., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose To implement a magnetic resonance (MR) imaging protocol to measure intracranial atherosclerotic disease (ICAD) in a population-based multicenter study and report examination and reader reliability of these MR imaging measurements and descriptive statistics representative of the general population. Materials and Methods This prospective study was approved by the institutional review boards and compliant with HIPAA. Atherosclerosis Risk in Communities (ARIC) study participants (n = 1980) underwent brain MR imaging from 2011 to 2013 at four ARIC sites. Imaging included three-dimensional black-blood MR imaging and time-of-flight MR angiography. One hundred two participants returned for repeat MR imaging to estimate examination and reader variability. Plaque presence according to vessel segment was recorded. Quantitative measurements included lumen size and degree of stenosis, wall and/or plaque thickness, area and volume, and normalized wall index for each vessel segment. Reliability was assessed with percentage agreement, κ statistics, and intraclass correlation coefficients. Results Of the 1980 participants, 1755 (mean age, 77.6 years; 1026 women [59%]; 1234 white [70%]) completed examinations with adequate to excellent image quality. The weighted ICAD prevalence was 34.4% (637 of 1755 participants) and was higher in men than women (38.5% [302 of 729 participants] vs 31.7% [335 of 1026 participants], respectively; P = .012) and in African Americans compared with whites (41.1% [215 of 518 participants] vs 32.4% [422 of 1234 participants], respectively; P = .002). Percentage agreement of plaque identification per participant was 87.0% (interreader estimate), 89.2% (intrareader estimate), and 89.9% (examination estimate). Examination and reader reliability ranged from fair to good (κ, 0.50-0.78) for plaque presence and from good to excellent (intraclass correlation coefficient, 0.69-0.99) for quantitative vessel wall measurements. Conclusion Vessel wall MR imaging is a reliable tool for identifying and measuring ICAD and provided insight into ICAD distribution across a U.S. community-based population. (©) RSNA, 2016 Online supplemental material is available for this article.

Background: Transcranial Doppler (TCD) with agitated saline has been shown to be an alternative for the detection of right-to-left shunts (RLS) with similar diagnostic accuracies as transesophageal echocardiography (TEE). It is hypothesized that the addition of blood to agitated saline increases the sensitivity of TCD for the detection of RLS. The aim of this meta-analysis was to determine whether agitated saline with blood increases the sensitivity of TCD for the detection of RLS compared to agitated saline alone and other contrast agents., Method: A systematic review of Medline, Cochrane, and Embase was performed to look for all prospective studies assessing intracardiac RLS using TCD compared with TEE as the reference; both tests were performed with a contrast agent and a maneuver to provoke RLS in all studies., Results: A total of 27 studies (29 comparisons) with 1,968 patients met the inclusion criteria. Of 29 comparisons, 10 (35%) used echovist contrast during TCD, 4 (14%) used a gelatin-based solution, 12 (41%) used agitated saline, and 3 (10%) utilized 2 different contrast agents. The addition of blood to agitated saline improved the sensitivity of TCD to 100% compared to agitated saline alone (96% sensitivity, P = 0.161), echovist (94% sensitivity, P = 0.044), and gelatin-based solutions (93% sensitivity, P = 0.041)., Conclusion: The addition of blood to agitated saline improves the sensitivity of TCD for the detection of RLS to 100% when compared to other conventional contrast agents; these findings support the addition of blood to agitated saline during TCD bubble studies., (© 2016, Wiley Periodicals, Inc.)

Objectives: To evaluate the accuracy of triple-bolus computed tomography urography (CTU) as a surrogate of intravenous pyelography (IVP) for determining the anatomy of the urinary collecting system in living kidney donors., Materials and Methods: In an analytic descriptive cross-sectional study, 36 healthy kidney donors were recruited during 12 months. Preoperative IVP and CTU were utilized to evaluate kidneys' anatomy; major and minor calyces and variation were used as anatomical indices to compare the accuracy of CTU and IVP; the images were then compared to surgical findings., Results: Thirty-six kidney donors (92% male; mean age: 28 ± 6 years) were enrolled in this study. The kappa coefficient value was significant and almost perfect for the CTU and IVP findings in detecting the pattern of calyces (kappa coefficient 0.92, asymptotic 95% confidence interval 0.86-0.97). Anatomic variations or anomalies of the urinary collecting system included the bifid pelvis (5.6%), duplication (8.3%), and extra-renal pelvis (2.8%). Both the sensitivity and specificity of CTU in the detection of the anatomy and variations were 100%; the sensitivity and specificity of IVP were 83.3% and 100%, respectively., Conclusions: The triple-bolus preoperative CTU can be considered an alternative to IVP for assessing the anatomy of the urinary collecting system.

The foramen ovale is a remnant of the fetal circulation that remains patent in 20-25% of the adult population. Although long overlooked as a potential pathway that could produce pathologic conditions, the presence of a patent foramen ovale (PFO) has been associated with a higher than expected frequency in a variety of clinical syndromes including cryptogenic stroke, migraines, sleep apnea, platypnea-orthodeoxia, deep sea diving associated decompression illness, and high altitude pulmonary edema. A unifying hypothesis is that a chemical or particulate matter from the venous circulation crosses the PFO conduit between the right and left atria to produce a variety of clinical syndromes. Although observational studies suggest a therapeutic benefit of PFO closure compared to medical therapy alone in patients with cryptogenic stroke, 3 randomized controlled trials (RCTs) did not confirm the superiority of PFO closure for the secondary prevention of stroke. However, meta-analyses of these RCTs demonstrate a significant benefit of PFO closure over medical therapy alone. Similarly, observational studies provide support for PFO closure for symptomatic relief of migraines. But one controversial randomized study failed to replicate the results of the observational studies while another two demonstrated a partial benefit. The goal of this review is to discuss the clinical conditions associated with PFO and provide internists and primary care physicians with current data on PFO trials, and clinical insight to help guide their patients who are found to have a PFO on echocardiographic testing., (Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Background: Pericardial effusion (PE) volume is often assessed semiqualitatively by echocardiography and categorized into minimal, small, moderate, or large. Several methods of echocardiographic quantification have been proposed, but their application is limited either by complexity or inaccuracy. We evaluated the accuracy of PE volume quantification by two-dimensional transthoracic echocardiogram (2DTTE) and commercially available volume quantification software in patients undergoing pericardiocentesis., Methods: In a retrospective case series, immediate preprocedure echocardiograms of 33 patients for pericardiocentesis were analyzed. 2DTTE using the Simpson's method was adopted for volume measurement in the apical two- and four-chamber views. Pericardial fluid volume was calculated by taking the difference between volumes obtained by tracing the epicardial border of the heart and the pericardium. Postprocedure echocardiograms were performed to verify adequate pericardiocentesis., Results: The mean pericardiocentesis fluid volume was 725.1 ± 299.5 mL (range, 250-1420 mL). The average volume estimated echocardiographically by the Simpson's method was 657.5 ± 276.9 mL (range, 205.7-1193.2 mL). There was strong direct linear correlation between echocardiographic and pericardiocentesis-derived volumes (P < 0.001, r = +0.823). Echocardiography underestimated PE volume by a mean of 9.3%., Conclusion: Two-dimensional transthoracic echocardiography using biplane Simpson's method of disks can simply and accurately estimate PE volume., (© 2014, Wiley Periodicals, Inc.)

Aim: We aimed to study the relationship of peripheral arteries' atherosclerosis with serum and tissue endothelin-1 in chronic kidney disease patients., Methods: Ninety patients were enrolled, including 35 patients with chronic kidney disease (case group), 31 patients with coronary artery diseases who were candidates for coronary artery bypass grafting (positive control group), and 24 living kidney donors (negative control group). Intima-media thickness of the common carotid and femoral arteries was determined by ultrasonography. Serum and tissue endothelin-1 were measured by ELISA method., Results: The mean serum and tissue endothelin-1 levels in the donor group were significantly lower than other groups (p < 0.001 for both). The coronary artery bypass grafting group had higher carotid and femoral intima-media thickness than other groups (p < 0.001), and the chronic kidney disease group had higher carotid and femoral intima-media thickness than the donor group (p < 0.001). Regression analysis in all groups did not reveal any correlation between the carotid intima-media thickness/femoral intima-media thickness and the serum/tissue endothelin-1. There was a direct linear correlation between the carotid and femoral intima-media thickness (p < 0.001) in all groups., Conclusions: Endothelin-1 level and intima-media thickness were higher in the chronic kidney disease patients and coronary artery bypass grafting candidates, without any correlation between endothelin-1 and peripheral arteries' intima-media thickness of both groups. Perhaps endothelin-1 rises and remains high upon endothelial damage and initiation of atherosclerosis., (© The Author(s) 2014.)

Background: The nasal tip is an important esthetic feature of the face and surgery on it is the most challenging part of a rhinoplasty. In the present study, we evaluated the effects of modification of the depressor septi nasi muscle on nasal tip rotation and projection., Methods: Eighty primary rhinoplasty patients who required nasal tip modifications were enrolled in a randomized clinical trial from October 2008 to March 2012. A study group composed of 40 patients underwent rhinoplasty including cutting and repositioning of the depressor septi nasi muscle and another group of 40 patients (control) underwent rhinoplasty without manipulation of the depressor septi nasi muscle. Nasal tip rotation and projection, and patient satisfaction were evaluated before and 6 months after the operation., Results: Following rhinoplasty including cutting of the depressor septi nasi muscle, nasal tip rotation and projection, and patient satisfaction were improved in 70, 57.5, and 85 % of the patients, respectively; and in the control group, they were improved in 82.5, 55, and 67.5 %, respectively (P = 0.089, 0.607, and 0.069)., Conclusion: Cutting and repositioning of the depressor septi nasi muscle as an adjunct to rhinoplasty is not associated with any additional advantage in terms of nasal tip rotation and projection, or patient satisfaction., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tuberous sclerosis or Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant and progressive neurocutaneous disorder involves multiple organs mainly brain, heart, kidney, lung, liver, skin and eye. The diagnosis is typically made clinically. Here, we are reporting a case of TSC presented mainly with dermatologic findings and only neurologic manifestations on MRI. A 15-year-old female with intellectual disability is followed up at neurology clinic for history of seizure. Intelligence evaluation showed that she has intellectual disability. She had wart like lesions distributed in form of butterfly over the face especially involving nose. She did not have any sign and symptom of heart, kidney, lung, bone and eye involvement. Also, her laboratory tests were normal. Despite the physical examination showed absolutely intact neurologic examination, but brain MRI and CT scan revealed several cortical and subcortical tubers, and subependymal glial nodules; no evidence of giant cell astrocytomas and aneurysm. Hypesignal foci are seen at subcortical white matter on long TR images. Fibers are involved. In this case, there is no evidence of giant cell astrocytomas and aneurysm. It seems that TSC could be the prevalent disorder and referring intellectual disability patients in birth with normal organs could be diagnosed as TSC. Therefore, there is necessary need to design genetic natal and post natal tests for diagnosis of TSC cases. Also, there is pivotal that similar cases must be reported; perhaps TSC is more prevalent than to be considered.

Introduction: Diabetes is one of the common causes of renal insufficiency and is responsible for about one third of cases requiring renal transplantation. Conventional sonography provides limited information regarding the severity and prognosis of disease. The present study was carried out to evaluate the renal vascular Doppler indices role in determining renal dysfunction and carotid artery atherosclerosis., Methods: Fifty five patients with diabetic nephropathy (albuminuria more than 300mg/24 hours) were enrolled into this cross-sectional study. Renal interlobar arterioles were studied using resistive (RI) and pulsatility (PI) indices of Doppler ultrasonography, in addition to conventional kidney length and renal parenchyma thickness. Intima-media thickness of common carotid artery (CCIMT) was also assessed just before the bifurcation. Serum creatinine (sCr), urine albumin and lipid profile were measured using standard methods. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula., Results: The renal interlobar arterioles' RI was positively and linearly correlated with the sCr and albuminuria levels (P<0.039 r= +0.320 and P=0.047, r= +0.287). There were negative linear correlations between eGFR and the renal interlobar arterioles' RI (P<0.001, r=-0.539) and PI (P<0.045, r= -0.328). The mean CCIMT was more than 0.7 mm in 90% of the studied patients. No correlation was found between CCIMT and renal ultrasonographic and Doppler findings., Conclusion: Although Doppler ultrasonographic indices of renal interlobar arteriols show the severity of renal dysfunction in patients with diabetic nephropathy, these indices do not have any advantage over the simple and cost effective biochemical parameters.

Background & Objectives: After menopause in women, loss of bone density increases rapidly with estrogen deficiency. Evidence has revealed that this deficiency may be directly correlated with growth hormone (GH) level declining with age. The present study was designed to evaluate the age dependant patterns of GH, insulin-like growth factor-1 (IGF1-1) and insulin-like growth factor binding protein-3 (IGFBP-3) endogenous secretion in postmenopausal women., Methods: During this prospective study in a 12-month period, 150 postmenopausal women were enrolled who were referred to the densitometry unit of bone research centre of Tabriz University of Medical Sciences for assessing bone mineral density. Serum levels of basal and clonidine stimulated GH were measured using radioimmunoassay while IGF-1 and IGFBP-3 were measured by ELISA. Post stimulation over 3 to 6 fold increase in GH over the baseline level was considered normal response and less increase was considered abnormal., Results: There were no significant differences in the mean levels of GH0, GH60 and GH90 in different age groups of postmenopausal women. No significant difference in the mean IGFBP-3 and IGF-1 levels was seen in different age groups of postmenopausal women. The number of postmenopausal women with abnormal response to stimulation by clonidine in 61-70 and > 70 yr age groups was higher than in other groups (P< 0.05)., Interpretation & Conclusions: Despite the higher rate of abnormal response to stimulation by clonidine in women aged more than 60 yr, the current study showed no significant correlation between age, and the basal and stimulated GH secretion rate and serum levels of IGF-1 and IGFBP-3 in postmenopausal women.

Patient: Male, 5 Primary Diagnosis: Rule-out appendicitis Co-existing Diseases: Acute lymphoblastic leukemia (ALL) Medication: Chemiotherapy Clinical Procedure: Chest CT • flow cytometry Specialty: Pediatrics' oncology • infection diseases., Objective: Rare disease., Background: Leukemias are among the most common childhood malignancies. Acute lymphoblastic leukemia (ALL) accounts for 77% of all leukemias. In rare cases, ALL patients may present with eosinophilia., Case Report: Here, a 5-year old boy was admitted to our hospital with a possible diagnosis of appendicitis. This patient's complete blood cell count demonstrated leukocytosis with severe eosinophilia. Following a 1-month clinical investigation, 2 bone marrow aspirations, and flow cytometry analysis, a diagnosis of acute lymphoblastic leukemia was proposed. Finally, the patient was transferred to the oncology ward to receive standard therapeutic protocol, which resulted in disease remission. After chemotherapy for 2 years, patient is successfully treated., Conclusions: ALL is diagnosed by eosinophilia in rare cases. These patients need immediate diagnosis and intensive therapy due to worsened prognosis of ALL presenting as hypereosinophilia.

Objectives: This study was designed to determine the effects of zinc supplementation on oxidative stress in hemodialysis (HD) patients through evaluating total antioxidant capacity (TAC), whole blood glutathione peroxidase (GSH) level, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) level., Design and Setting: Double-blinded randomized controlled trialfrom October 2006 to December 2007 at Tabriz Imam Khomeini Hospital., Subjects: Sixty-five HD patients were randomly enrolled into 2 groups., Intervention: Patients received placebo in group A and zinc (100 mg/day) in group B for 2 months. After a washout period for 2 months, the groups were crossed over and the study was continued for an additional 2 months., Main Outcome Measures: Serum zinc concentration was measured using atomic absorption spectrophotometry. TAC, GSH level, and SOD activity were determined by commercial enzyme-linked immunosorbent assay kits. MDA level was measured using a thiobarbituric acid method., Results: The levels of serum zinc, TAC, GSH (P < .001 for all), and SOD activity (P < .001 for group A and P = .003 for group B) significantly increased after zinc supplementation whereas the serum level of MDA decreased after the same period (P = .003 for group A and P < .001 for group B)., Conclusions: Zinc supplementation for 2 months improved the serum levels of zinc, antioxidant status, and lipid peroxidation in HD patients., (Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background and Aims: The goal of this study was to evaluate the efficacy of platelet dressing in the treatment of burn wounds and compare its results with silver sulfadiazine dressing., Material and Methods: Between 21 march 2011 to 21 September, 50 patients with burn injuries were selected by a randomized double-blind controlled trial. In order to eliminate the biological and personal variables among the various treated burn wounds, in the same patient, distal or proximal, lateral or medial part of burn wound were selected for dressing with platelet or silver sulfadiazine. All patients were designated for homologous component use. The dressing was repeated every day up to complete healing., Results: The results indicated that treatment with platelet enhanced epithelialization and accelerate epithelialization and granulation tissue formation. Platelet dressing to be most significant in this respect compared with silver sulfadiazine dressing., Conclusion: It is concluded that topical application of platelet enhanced the wound healing process in burn patients.

Background: The purpose of the present study is to determine the accuracy of magnetic resonance voiding cystourethrography (MRVCUG) for diagnosis of vesicoureteral reflux (VUR) in children and adolescents with recurrent urinary tract infection (UTI)., Materials and Methods: During the cross-sectional study from May 2009 to June 2011, 30 patients' (60 kidney-ureter units) MRVCUG findings by 1.5 T magnetic resonance imaging (MRI) were compared with voiding cystourethrography (VCUG) findings in patients with urinary tract infection. The sensitivity, specificity, positive and negative predictive values for MRVCUG were calculated., Findings: The sensitivity, specificity, positive and negative predictive values and accuracy for MRVCUG for detecting VUR were respectively 92.68% (95% CI: 80.57-97.48%), 68.42% (95% CI: 46.01-84.64%), 86.36% (95% CI: 71.95-94.33%), 81.25% (95% CI: 53.69-95.02%), and 85% (95% CI: 80.40-89.60%. The level of agreement between MRVCUG and VCUG findings for diagnosis VUR was very good (P < 0.001, according to Cohen's kappa value = 0.638). Studying correlation of low grade VUR (grade I and II) and high grade VUR (grade III-V) showed a very good agreement between MRVCUG and VCUG findings (P < 0.001, Cohen's kappa value = 0.754)., Conclusion: MRVCUG could accurately reveal the presence and severity of VUR, especially in cases with high-grade (grade III-V) VUR in both children and adolescents.

Objectives: Extracorporeal shock wave lithotripsy (ESWL) is mainly an alternative for other therapeutic methods such as surgery and endourology to treat urinary tract calculus. Although it is safe and effective, it has undesirable effects on renal function. Diagnostic techniques such as color Doppler ultrasonography create a new attitude toward renal function. The aim of this study was to evaluate renal vascular resistance change before and after extracorporeal shock wave lithotripsy., Methods: During the present study, vascular resistive index (RI) of renal intralobar artery was measured before, 30 min, and 1 week after ESWL using Doppler ultrasonography., Results: Thirty minutes after ESWL, RI was significantly increased from primary value of 0.62 ± 0.05 to 0.66 ± 0.06 (p = 0.0001). There was no correlation between increase of RI and patients' age. Following up the patients revealed that mean RI did not return to pretreatment level after 1 week (p < 0.05). The RI level in the old patients (3 patients who were 60 years or older) was higher than that of the younger ones (19 patients who were younger than 60 years) after 1 week (0.76 ± 0.05 vs. 0.64 ± 0.06). There was no meaningful relationship between ESWL voltage or number of shocks and RI variation before and after ESWL., Conclusion: Following ESWL, patients are at risk of renal tissue damage due to increase of primary RI level. Measuring RI variations using ultrasound techniques after ESWL may provide helpful information to clinical detection of renal tissue damage.

BACKGROUND/AIMS: There are controversial data about renal function following off-pump coronary artery bypass grafting (CABG). The present study aimed to evaluate renal function changes 24 h after on- and off-pump CABG, as well as renal function correlated with high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α). METHODS: Ninety patients with coronary artery disease referred to our center for CABG from July 2006 to November 2007 were enrolled in the study. Patients were equally and randomly divided in two groups, on- and off-pump. Serum levels of creatinine (Cr), blood urea nitrogen, creatinine clearance (CrCl), hs-CRP, and TNF-α were determined immediately before and 24 h after surgery. RESULTS: Cr and CrCl changes after surgery were not significantly different between the two groups; however, blood urea nitrogen levels after surgery were significantly higher in the on-pump group (p = 0.035). No statistically significant difference was noted between the two groups in terms of changes in levels of hs-CRP and TNF-α (p = 0.350 and 0.805, respectively). The changes in CrCl levels had no significant correlation with hs-CRP and TNF-α. CONCLUSIONS: The early Cr and CrCl levels after surgery are not significantly different in on- and off-pump groups. The early renal function after on- or off-pump CABG is not correlated with the levels of inflammatory markers including hs-CRP and TNF-α.

Lymph leakage is a cause of prolonged fluid discharge in renal transplant patients. Lymph leakage during early post-transplantation is responsible for extracting immune substances; therefore, it may play a role in prognosis of the transplanted kidney. In this study, we aimed to investigate the effects of lymph leakage on different factors that play significant roles in renal allograft outcome. During the present case-control study, we evaluated 62 renal allograft recipients in which 31 subjects were complicated with lymph leakage and enrolled as the study group. The other 31 subjects were included in the control group who did not experience any lymph leakage during their post-transplantation period. All kidneys were transplanted from living donors. We investigated and compared the renal allograft rejection rate, hospitalization duration, serum urea, creatinine (Cr) and cyclosporine (CsA) levels, antithymoglobin (ATG) administration and treatment duration between the study and the control groups. There were no significant difference in the urea and Cr levels between the two groups (P >0.05). Early (one week) and late (one month) serum CsA levels of the study group were significantly higher than in the control group (P = 0.005 and P = 0.006). The number of days in which ATG receivers responded to therapy was significantly lower for the control group (P = 0.008). 21.93% of the study group subjects experienced allograft rejection, while this rejection probability was 28.38% for the control group (P = 0.799). Lymph leakage has no prominent role in renal function, which is estimated by Cr and urea levels in patients' serum during the days after transplantation. CsA level was higher in patients with lymph leakage, and all cases of allograft rejection were in the subjects with lymph leakage.

Background/aim: A high uric acid (UA) level is demonstrated as a major risk factor of nephropathy and cardiovascular events in people with type 2 diabetes (T2D). This study aimed to evaluate the lovastatin effect on serum UA levels in people with type 2 diabetic nephropathy (T2DN)., Methods: Thirty patients completed the study course, out of 38 adult male patients with T2DN who were initially enrolled. Lovastatin, 20 mg/d, was administered for 90 days. Afterwards, lovastatin was withdrawn for the next 30 days. Blood samples were obtained at baseline, after 45 and 90 days of intervention, and 30 days after the withdrawal of lovastatin. The serum level of UA was assessed by the uricase/PAP method. The lipid profile and high-sensitivity C-reactive protein (hs-CRP) were determined using commercial reagents and the ELISA method., Results: After 90 days of lovastatin intervention, cholesterol (Chol) and low-density lipoprotein cholesterol (LDL-C) levels significantly decreased and the high-density lipoprotein cholesterol (HDL-C) level increased significantly, despite the unchanged level of triglyceride (TG). After withdrawal, Chol, TG, and LDL-C levels were significantly increased, without any change in the HDL-C level. The baseline serum UA level was 5.94 ± 2.02 mg/dL and not changed after the intervention (5.95 ± 2.21 mg/dL; p = 0.969) and withdrawal period (5.80 ± 1.51 mg/dL; p = 0.647). The changes of serum UA levels were not correlated with the changes of serum hs-CRP levels, both after intervention and withdrawal (p = 0.963 & p = 0.835)., Conclusions: Lovastatin does not have any effect on the serum UA level in people with T2DN. There is no correlation between the anti-lipidemic and anti-inflammatory effects of lovastatin and its effect on serum UA.

Background and Aims: Patients on maintenance hemodialysis (HD) face an increased risk of atherosclerosis, a crucial problem and the leading cause of cardiovascular morbidity and mortality. This study was designed to evaluate the effects of zinc supplementation on paraoxonase (PON) enzyme activity in patients on HD., Methods: This double-blind randomized controlled trial was conducted from June 2005 to June 2007. Sixty HD patients were enrolled and divided into two groups: treatment (case) and control. The treatment and control groups were treated with 100 mg/day zinc or placebo, respectively, for 2 months. Serum zinc concentration was measured by atomic absorption spectrophotometry. PON activity was evaluated by spectrophotometric method. Lipid profile was determined using commercial kits, and apolipoprotein AI (Apo-AI) and B (Apo-B) levels were measured by commercial immunoturbidimetric kits., Results: In the case group, there was no significant change in the serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and Apo-B levels, while the serum levels of high-density lipoprotein (HDL), Apo-AI, and PON activity were significantly increased (p = 0.02). In the control group, although significant increases were observed in the serum levels of TC, TG, and Apo-B (p = 0.009, 0.019, and 0.001, respectively), the serum PON activity was significantly decreased (p = 0.025) and the serum levels of HDL, LDL, and Apo-AI were not changed. At the end of intervention period, the serum level of Apo-AI and PON activity were significantly higher in the case group., Conclusions: Zinc supplementation increased both the activity of PON and the serum level of Apo-AI in the HD patients.

Objectives: Tuberculosis remains one of the most common infectious diseases and a leading cause of mortality world wide. There is some evidence for the possible involvement of Mycobacterium tuberculosis in atherosclerosis. We aim to investigate total antioxidant capacity (TAC), red blood cell superoxide dismutase (SOD) activity, whole blood glutathione peroxidase (GPX) activity, low-density lipoprotein (LDL) susceptibility to oxidation, and malondialdehyde (MDA) levels in patients with pulmonary tuberculosis (PTB)., Methods: Forty-five males with active PTB (case group) and 45 healthy age-matched males (control group) were enrolled in the study. TAC, SOD and GPX activities were determined by commercial ELISA kits. MDA levels were measured using the thiobarbituric acid method. LDL susceptibility to oxidation was assessed by measuring lag phase duration., Results: TAC, SOD and GPX activities, and lag phase duration in the case group were significantly lower than the control group (p=.002, p=.004, p=.008, and p=.004, respectively; independent), while the MDA levels was higher in case group (p=.024)., Conclusions: Our findings suggest a higher susceptibility of LDL to oxidation and higher levels of lipid peroxidation, and therefore, a possible higher risk of atherosclerosis in patients with PTB., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture., Methods: We present our experience with outpatient management of asymptomatic chronic pilonidal disease. We prospectively studied patients presenting with pilonidal disease from Mar. 20, 2005, to Mar. 20, 2008. All were managed as outpatients. We reviewed presentation, treatment, healing, time off work and recurrences., Results: In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period. The mean age of patients was 22.1 years. The mean duration of surgery was 18.4 minutes. No general complications occurred. Local complications consisted of 3 wound infections and 4 wound hematomas. No sinus recurrence occurred. The healing rate was fast in all patients., Conclusion: Advantages of ambulatory plain lateral excision and primary repair include immediate treatment, minimal pain and a quick return to normal activities. This method is a simple and effective procedure in the treatment of uncomplicated pilonidal sinuses., (© 2011 Canadian Medical Association)

Objectives: : To investigate the effect of lovastatin therapy and withdrawal on paraoxonase 1 (PON1) and arylesterase (ARE) activities, and low-density lipoprotein cholesterol (LDL-C) susceptibility to oxidation in people with type 2 diabetic nephropathy (T2DN)., Design and Methods: : Lovastatin (20mg/day) was administered to 30 people with T2DN for 90days and then withdrawn for 30days. PON1 and ARE activities were measured by the spectrophotometric method. Susceptibility of LDL-C to oxidation was determined as the production of conjugated dienes., Results: : After 90days of lovastatin intervention, PON1 and ARE activities and LDL-C lag phase were significantly increased (p=0.004, 0.002, and <0.001), while after 30days of lovastatin withdrawal, PON1 and ARE activities and LDL-C lag phase had not changed significantly., Conclusion: : Lovastatin therapy improves PON1 and ARE activities, and LDL-C susceptibility to oxidation. Despite withdrawal of lovastatin, PON1 and ARE activities, and LDL-C susceptibility to oxidation remain unchanged in people with T2DN., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objectives: Osteoprotegerin (OPG), a glycoprotein, is a member of the tumor necrotizing factor alpha receptor super-family. By considering the possible role of OPG in cardiovascular disease (CVD), higher incidence of CVD in people with type 2 diabetic nephropathy (T2DN), and anti-atherosclerotic effects of statins, the present study aimed to investigate the effects of lovastatin on serum levels of OPG and soluble receptor activator of nuclear factor-κB ligand (sRANKL) in people with T2DN., Design and Methods: Thirty patients completed the study course, out of 38 adult male patients with T2DN who were initially enrolled. Lovastatin, 20mg/d, was administered for 90 days. Afterwards, lovastatin was withdrawn for the next 30 days. Serum levels of OPG and sRANKL were measured using commercial ELISA kits at baseline, after 90 days of intervention, and after 30 days of withdrawal of lovastatin., Results: Serum level of OPG was significantly increased (10.76 ± 16.44) and decreased (-7.38 ± 11.98) during 90 days of intervention and 30 days of withdrawal periods, respectively, while, sRANKL level was significantly decreased (-1192.08 ± 578.20) and increased (4418.67 ± 2124.66) during the same periods, respectively., Conclusions: Lovastatin therapy increased serum OPG level and decreased sRANKL level in people with T2DN. The withdrawal of lovastatin decreased serum OPG level, while sRANKL level was extensively increased., (Copyright © 2010 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Three to five million children from among one billion with gastroenteritis die annually worldwide. The etiologic agent in developed countries is viral in 15-60% of cases, while in developing countries, bacteria and parasites are frequently reported as the etiologic factors. Neurologic signs including convulsion are seen in some cases of diarrhea. This study aimed to investigate the etiology, risk factors and short-term prognosis of gastroenteritis with convulsion. During a case-control study, 100 patients with gastroenteritis were enrolled into the case and control groups on the basis of convulsion or no convulsion development, respectively. This study was conducted in Tabriz Children's Hospital from March 2004 to March 2007. The age of patients ranged from 2 months to 7 years, and the groups were age- and sex-matched. Body temperature (BT), severity and type of dehydration, stool exam and culture, past history of convulsion in the patient and first-degree relatives, electrolyte imbalance, and short-term prognosis were studied and compared. The mean weight of groups was not different, while the frequency of fever at the time of admission, past history of febrile convulsion in first-degree relatives and severity of dehydration were significantly higher in the case group (p < 0.001). The BT of the case group on admission was higher than in the control group (39.01+/- 0.80 vs. 37.52 +/- 0.67 degrees C; p < 0.001). Past history of febrile convulsion in the patient, shigellosis and antibiotic usage were also significantly higher in the case group (p = 0.025, p = 0.014 and p = 0.001). Convulsion mostly occurred in mild gastroenteritis accompanied with fever and positive history of febrile convulsion in first-degree relatives. History of febrile convulsion in the patient and shigellosis were associated with development of convulsion in patients with gastroenteritis. No significant electrolyte imbalance was observed in patients with gastroenteritis experiencing febrile convulsion.

Background: Low-intensity ultrasound is a biophysical intervention on a fracture repair process. However, the effect of low-intensity ultrasound therapy on fracture healing is controversial. The aim of the present study was to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) therapy on the fracture healing process, including mineral density and strength of callus using a rabbit model., Methods: A total of 30 rabbits underwent unilateral, transverse, and mid-tibia open osteotomies that were stabilized with external fixators. Then, the animals were divided into two study groups composed of 15 rabbits each: the case group (US), which were exposed to low-intensity pulsed ultrasound with 30 mW/cm(2) intensity and 1.5 MHz sine waves; and the control group (C), which underwent sham ultrasound treatment. Callus development and mineral density were evaluated using multidetector computed tomography at 2, 5, and 8 weeks, after which the animals were killed. Three-point bending tests of both healed and intact bones were assessed and compared., Results: The results demonstrated that the callus mineral density in the US group was higher than in the C group (1202.20 +/- 81.30 vs. 940.66 +/- 151.58 HU; P = 0.001) at the end of the 8th week. The mean recorded three-point bending test score of healed bones in the US group was not significantly different from that of the C group (359.35 +/- 173.39 vs. 311.02 +/- 80.58 N; P = 0.114)., Conclusions: The present study showed that low-intensity pulsed ultrasound enhanced callus mineral density with an insignificant increase in the strength of the fractured bone.

A 67-year-old man fell from an agricultural vehicle and struck his right eye on a protruding element. Eight hours later, he was brought to the emergency unit of an ophthalmology hospital where examiners could not find the right eye and believed it to have been completely destroyed. However, CT disclosed that the eye, apparently still intact, had been displaced into the anterior cranial fossa through a fracture in the orbital roof. This is the first documentation of such a phenomenon.

The aim of present study was to investigate clinical, electrodiagnostic and pedobarographic findings of non-amputee limb in chronic leprotic patients with unilateral trans-tibial amputation to determine neuropathy and plantar foot pressure in non-amputee limb. During the present prospective cross-sectional study, 10 chronic leprotic patients with unilateral trans-tibial amputation were evaluated. The study was conducted in Tabriz Bababaghi and Imam Reza Hospitals at summer of 2008. Sensory nerve conduction (SNAP) and Compound Motor Action Potentials (CMAP) studies were performed in association with pedobarographic assessment. No reliable response was detected from tested sensory and motor nerves, except a very low amplitude finding in deep preoneal nerve of one patient. In comparing with healthy group, static total plantar area, dynamic total plantar area, static rarefoot peak pressure and dynamic rarefoot peak pressure were lower in leprotic patients (p = 0.047, p = 0.004, p = 0.029 and p < 0.001), while static forefoot peak pressure and dynamic forefoot peak pressure were higher in these patients (p = 0.011 and p = 0.031). All of leprotic patients with unilateral trans-tibial amputation suffered from severe neuropathy. Also, these patients have high plantar pressure under the forefoot. Collectively, severe neuropathy and abnormal plantar foot pressure expose in non-amputee foot expose leprotic patients to the higher risk of secondary amputation.

Purpose: This study is designed to evaluate and compare follicular phase parameters during ovarian stimulation with the clomiphene citrate (CC) and letrozole (LET) in unexplained infertile patients who failed to get pregnant following frequent CC-treated cycles., Methods: A total of 64 unexplained infertile women who failed to get pregnant following frequent CC-treated cycles were studied for one CC-treated cycle (100 mg/day), 2 washout cycles, and then 1 LET-treated cycle (5 mg/day). Number of follicles over 14 mm in diameter, diameter of the largest follicles, endometrial thickness, serum estradiol (E2) and LH levels were measured when one mature follicle over 18 mm in diameter detected during transvaginal ultrasonography., Results: The mean value of the largest follicle diameter, number of developed follicles >14 mm, endometrial thickness and LH in LET-treated cycle was significantly higher than CC-treated cycle (P values were 0.007, <0.001, <0.001, and 0.004, respectively), whereas mean level of E2 showed a significantly lower level during LET-treated cycle (P < 0.001)., Conclusions: About 5 mg/day of LET is associated with better follicular phase parameters, endometrial development, serum E2 and LH levels in women with unexplained infertility who failed to get pregnant following frequent CC-treated cycles.

Introduction: We aimed to evaluate the high-sensitivity C-reactive protein (HS-CRP) level changes at the beginning and after withdrawal of lovastatin therapy in patients with diabetic nephropathy., Materials and Methods: Thirty male patients with type 2 diabetes mellitus and diabetic nephropathy were enrolled in the study. Lovastatin, 20 mg/d, was administered for 90 days. Afterwards, Lovastatin was withdrawn for the next 30 days. Blood samples were obtained before the intervention, on the 90th day, and days 1, 7, and 30 after withdrawal of Lovastatin. Serum level of HS-CRP was determined by enzyme-linked immunosorbent assay. Alterations in lipid profile was assessed, as well, and compared with that of HS-CRP., Results: Serum level of HS-CRP was significantly reduced after 90 days of lovastatin therapy (P < .001). Then, the HS-CRP reached the pretreatment baseline level on the 7th day after lovastatin withdrawal and maintained until the 30th day (P < .001). Serum HS-CRP changes showed no significant association with lipid profile except for serum total cholesterol level (r = 0.9, P = .006) after 3 months of lovastatin therapy. Their association was re-evaluated after 7 days and 1 month of treatment withdrawal and no significant correlations were found., Conclusions: Our findings suggest that lovastatin decreases serum CRP level in patients with diabetic nephropathy, and 7 days after lovastatin cessation, CRP level increases again.

Introduction: Ever since peritoneal dialysis (PD) was introduced as a form of renal replacement therapy, its efficacy and complications have been compared with that of haemodialysis (HD). The aim of this study was to determine the efficacy and outcome of PD in comparison to HD in our region., Methods: We compared 60 patients on PD with 60 matched patients on HD in Tabriz's Sina Hospital during the period 2004-2006. The technique, patients' survival and quality of life were compared by means of a health-related quality-of-life questionnaire (GHQ-28)., Results: There was no significant difference in the mean age and duration of dialysis between patients on PD and HD. Survival of diabetic patients was better with HD than PD, but in non-diabetic patients, there was no difference in the survival rates between the two groups. Among patients on PD, diabetics had a 25 percent higher mortality rate and non-diabetic patients had a three percent higher mortality rate than their corresponding counterparts on HD. In all four axes of the questionnaire, i.e. psychophysical dysfunction, stress and sleep disorders, social dysfunction and major depression, PD patients had lower scores than HD patients (p-values are less than 0.001, less than 0.001, equal to 0.002 and less than 0.001, respectively), indicating that patients on PD had a better quality of life compared to those on HD., Conclusion: In this study, technique, patients' survival and their quality of life were better on PD than on HD. However, survival and mortality of diabetic patients on HD were better than those on PD.

Background: One of the main methods for evaluation of fetal well-being is analysis of Doppler flow velocity waveform of fetal vessels. Evaluation of Doppler wave of the middle cerebral artery can predict most of the at-risk fetuses in high-risk pregnancies. In this study, we tried to determine the normal ranges and their trends during pregnancy of Doppler flow velocity indices (resistive index, pulsatility index, systolic-to-diastolic ratio, and peak systolic velocity) of middle cerebral artery in 20 - 40 weeks normal pregnancies in Iranians., Methods: In this cross-sectional study, 1037 women with normal pregnancy and gestational age of 20 to 40 weeks were investigated for fetal middle cerebral artery Doppler examination., Results: Resistive index, pulsatility index, and systolic-to-diastolic ratio values of middle cerebral artery decreased in a parabolic pattern while the peak systolic velocity value increased linearly with progression of the gestational age. These changes were statistically significant (P<0.001 for all four variables) and were more characteristic during late weeks of pregnancy. The mean fetal heart rate was also significantly (P<0.001) reduced in correlation with the gestational age., Conclusion: Doppler waveform indices of fetal middle cerebral artery are useful means for determining fetal well-being. Herewith, the normal ranges of Doppler waveform indices for an Iranian population are presented.

Background: Doppler flow velocity waveform analysis of fetal vessels is one of the main methods for evaluating fetus health before labor. Doppler waves of middle cerebral artery (MCA) can predict most of the at risk fetuses in high risk pregnancies. In this study, we tried to obtain normal values and their nomograms during pregnancy for Doppler flow velocity indices of MCA in 20-40 weeks of normal pregnancies in Iranian population and compare their pattern with other countries' nomograms., Methods: During present descriptive cross-sectional study, 1037 normal pregnant women with 20th-40th week gestational age were underwent MCA Doppler study. All cases were studied by gray scale ultrasonography initially and Doppler of MCA afterward. Resistive Index (RI), Pulsative Index (PI), Systolic/Diastolic ratio (S/D ratio), and Peak Systolic Velocity (PSV) values of MCA were determined for all of the subjects., Results: Results of present study showed that RI, PI, S/D ratio values of MCA decreased with parabolic pattern and PSV value increased with simple pattern, as gestational age progressed. These changes were statistically significant (P=0.000 for all of indices) and more characteristic during late weeks of pregnancy., Conclusion: Values of RI, PI and S/D ratio indices reduced toward the end of pregnancy, but PSV increased. Despite the trivial difference, nomograms of various Doppler indices in present study have similar pattern with other studies.

Objective: The present study evaluates the role of supplementary food and medicinal iron intake in preventing iron deficiency anemia in children aged between 4 to 6 months., Methods: During a case-control study in "Tabriz Children Hospital", nutritional and medicinal-iron intake of 60 consecutively selected patients with iron-deficiency anemia were compared with 60 non-anemic children of similar age and sex distributions., Results: The mean hemoglobin concentration, corpuscular volume and serum iron were 9.11 g/dl, 65.41 fL and 19.33 microg/dl, in case group; and 12.6 g/dl, 75.18 fL and 78.28 microg/dl, in control group, respectively. There was no statistically significant difference between age of case and control groups when complementary-semisolid foods were started (P=0.058), but the mean of received medicinal iron in case group was significantly lower than control group (P<0.001)., Conclusion: Supplementary food intake alone is not efficient to prevent iron deficiency anemia since the age of 4-6 months. So, regular administration of medicinal iron is crucial to prevent iron-deficiency anemia in children aged 4-6 months.