Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture

<p>Abstract</p> <p>Background</p> <p>Spontaneous splenic rupture considered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture.</p> <p>Case presentation</p> <p>A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlarged spleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is also presented.</p> <p>Conclusion</p> <p>Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.</p

Enamel Surface Roughness after Orthodontic Bracket Debonding and Composite Resin Removal by Two Types of Burs

Objective: Increased enamel surface roughness following orthodontic bracket debonding leads to increased plaque accumulation and enamel decalcification. Therefore, different methods are employed to achieve smoother enamel surfaces after bracket debonding. This study  compared enamel surface roughness following orthodontic bracket debonding and composite resin removal using white stone and tungsten carbide burs.Methods: In this in-vitro, experimental study, 20 first and second premolars of 10-20 year-olds were collected and their crowns were mounted in acrylic blocks. Roughness of the buccal surfaces of teeth was determined by atomic force microscopy (AFM) and the brackets were bonded to the teeth. After bracket debonding, composite remnants were removed using white stone and tungsten carbide burs. Parameters of enamel surface roughness were determined by AFM and time required for composite removal was also calculated. Repeated measures ANOVA was used to assess the changes in parameters based on the time of measurement, type of bur and their interaction effect. Time required for composite resin removal by bur was analyzed using one-way ANOVA and Tukey’s multiple comparisons.Results: Resin removal increased enamel surface roughness compared to the baseline values in all groups. However, no significant differences were noted between the two types of burs regarding arithmetic average of the roughness profile (Ra), the root mean square roughness (Rq) and the maximum peak-to-valley height in the sampling length (Rt) after resin removal. Time required for resin removal with tungsten carbide bur (34.2 seconds) was significantly shorter than with white stone bur (56.6 seconds)(both ps&lt;0.0001).Conclusion: Considering the similar enamel surface roughness values achieved by the two burs, tungsten carbide burs are recommended for resin removal following orthodontic bracket debonding

Analgesic Effects of Ketamine Nebulizer vs. Intravenous Morphine in Limb Trauma Patients in Pre-Hospital Emergency Setting; A Randomized Double-Blinded Clinical Trial

Background: Limb trauma is one the main causes of emergency room (ER) referrals and patients often complain of pain from the very moment of arrival. Objective: We decided to compare the analgesic effect of ketamine nebulizer with intravenous (IV) morphine in trauma patients referred to ER.&nbsp;Methods: In this clinical trial study trauma patients referred to ER of Alzahra and Kashani hospitals in Isfahan, Iran were selected. All trauma patients older than 18 years with limb pain who had a pain score ≥ 7 based on visual analogue scale (VAS) criteria were included. During pre-hospital management, patients were divided into two groups of receiving ketamine nebulizer with a dose of 1.6 mg/kg and receiving IV morphine with a dose of 0.1 mg/kg. Pain score, vital signs and complications were recorded 5 and 15 minutes after receiving the first dose of drug and also at the time of arrival to ER.&nbsp;Results: Finally, the records of 391 patients were analysed. There was no significant difference between the two groups in terms of pain intensity, vital signs before intervention, the first 5 and 15 minutes after and the time of arrival in ER (P&gt;0.05). But the changing of VAS scores in different times was significant in both groups (P&lt;0.001). There was a significant difference between the two groups in complications including nausea and vomiting (P&lt;0.001), and also delirium (P=0.010).&nbsp;Conclusion: Using ketamine nebulizer can produce similar analgesic effects as IV morphine in trauma patients referred to ER

The Effect of Everolimus on Subependymal Giant Cell Astrocytoma (SEGA) in Children with Tuberous Sclerosis Complex

Objective: Subependymal Giant Cell Astrocytomas (SEGAs) are slow-growing glioneuronal tumors typically found around the ventricles of the brain, particularly near the foramen of Monro in 15%-20% of patients with tuberous sclerosis complex (TSC). Surgical resection is the standard treatment for these symptomatic tumors. The mTOR inhibitor everolimus can be regarded as an alternative treatment of SEGAs due to the complications of surgery.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Materials &amp; Methods: This pre- and post-treatment clinical trial was performed on 14 children (eight females and six males with a mean age of 10 years) previously diagnosed with TSC based on the diagnostic criteria. The subjects received oral everolimus at a dose of 3 mg/m2 for at least six months. The present study primarily aimed to specify the effect of this medication on SEGA volume change before and after treatment. Secondary objectives were to determine the effect of this drug on renal angiomyolipoma (AML), skin lesions, and seizures in TSC patients.&nbsp; Results: Half of &nbsp;the patients &nbsp;had more than 30% of volume loss in SEGA; in 28.5% of them the response rate of ≥ 50% reduction in SEGA volume was achieved (P=0.01). Moreover, 92.9% of the patients had ≥ 50% decrease in the frequency of seizures (P=0.000). The response rates in AML and skin lesion were 14.2% and 50%, respectively. &nbsp;&nbsp; Conclusion: Everolimus significantly reduced the seizure frequency and SEGA volume in the subjects, hence, a potential alternative treatment for symptomatic SEGA in TSC patients

Involvement of heparanase in the pathogenesis of acute kidney injury: Nephroprotective effect of PG545

Despite the high prevalence of acute kidney injury (AKI) and its association with increased morbidity and mortality, therapeutic approaches for AKI are disappointing. This is largely attributed to poor understanding of the pathogenesis of AKI. Heparanase, an endoglycosidase that cleaves heparan sulfate, is involved in extracellular matrix turnover, inflammation, kidney dysfunction, diabetes, fibrosis, angiogenesis and cancer progression. The current study examined the involvement of heparanase in the pathogenesis of ischemic reperfusion (I/R) AKI in a mouse model and the protective effect of PG545, a potent heparanase inhibitor. I/R induced tubular damage and elevation in serum creatinine and blood urea nitrogen to a higher extent in heparanase over-expressing transgenic mice vs. wild type mice. Moreover, TGF-\u3b2, vimentin, fibronectin and \u3b1-smooth muscle actin, biomarkers of fibrosis, and TNF\u3b1, IL6 and endothelin-1, biomarkers of inflammation, were upregulated in I/R induced AKI, primarily in heparanase transgenic mice, suggesting an adverse role of heparanase in the pathogenesis of AKI. Remarkably, pretreatment of mice with PG545 abolished kidney dysfunction and the up-regulation of heparanase, pro-inflammatory (i.e., IL-6) and pro-fibrotic (i.e., TGF-\u3b2) genes induced by I/R. The present study provides new insights into the involvement of heparanase in the pathogenesis of ischemic AKI.Our results demonstrate that heparanase plays a deleterious role in the development of renal injury and kidney dysfunction,attesting heparanase inhibition as a promising therapeutic approach for AKI

Medication Errors in an Emergency Department in a Large Teaching Hospital in Tehran

Medication errors have important effects on increased length of hospitalization, increased mortality and costs. We assessed the incidence of medication errors and characterize the error types in an emergency department in a large teaching hospital in Tehran. We also investigated the effect of Emergency Department pharmacists on patient safety with regard to recovery of potentially harmful medication errors. The study was conducted in the 24 bed emergency department from February to March, 2010 at a 600-bed teaching hospital. Two hospital pharmacists and two clinical pharmacy residents observed care provision and collected data on medication errors. Demographic data, type of medication error, the recorded stage of error, date and time of occurrence and report, who made the error, probability of error were recorded from medical records. We used chi-squared and independent sample t- tests for analyzing the data. We recorded 203 medication errors during 180 hours. The incidence of medication errors was 50.5% at various levels in the emergency department. Significant difference in age means was seen between the patients with and without medication errors. Seventy four point nine percent of errors were recorded as definitely an error. Most recorded errors were made by nurses (44.5%) and occurred in administrating stage (63.6%). Given that the rate of the errors was relatively high, it seems that the presence of clinical pharmacist can be beneficial

Arsenic in Soils and Forages from Poultry Litter-Amended Pastures

In regions of concentrated poultry production, poultry litter (PL) that contains significant quantities of trace elements is commonly surface-applied to pastures at high levels over multiple years. This study examined the effect of long-term applications of PL on soil concentrations of arsenic (As), copper (Cu), Zinc (Zn), and the uptake of these elements by bermuda grass grown on Cecil (well-drained) and Sedgefield (somewhat poorly-drained) soils. The results showed that concentrations of As, Cu, and Zn in soils that had received surface-applied PL over a 14-year period were significantly greater than untreated soil at 0–2.5 and 2.5–7.5 cm depths. However, the levels were well below the USEPA loading limits established for municipal biosolids. Arsenic fractionation showed that concentrations of all As fractions were significantly greater in PL-amended soils compared to untreated soils at 0–2.5 and 2.5–7.5 cm depths. The residual fraction was the predominant form of As in all soils. The water-soluble and NaHCO3-associated As were only 2% of the total As. Significant differences were found in concentrations of these trace elements and phosphorus (P) in forage from PL-amended soils compared to that in untreated plots. The concentrations of Cu, Zn, As, and P were significantly greater in forage from Sedgefield amended soil compared to Cecil soil, but were in all cases below levels of environmental concern

Prevalence of Metabolic Syndrome in Iranian Professional Drivers: Results from a Population Based Study of 12,138 Men

It is evident that professional driving is associated with substantial changes in lifestyle habits. Professional drivers are prone to metabolic syndrome (MetS) and its complications because their working environment is characterized by numerous stress factors such as lack of physical activity due to working in a fixed position, disruption in diet, and irregular sleep habits. The aim of the present study was to estimate the prevalence of MetS among long distance drivers residing in West Azerbaijan province in Iran.To assess the prevalence of metabolic syndrome among professional long distance drivers, 12138 participants were enrolled in this cross sectional study. The MetS was defined using International Diabetes Federation criteria.Among12138 participants, 3697 subjects found to be MetS. The crude and age-adjusted rates of MetS were 30.5% and 32.4% respectively. Based on Body mass index (BMI), 5027 subjects (41.4%) were overweight (BMI ≥25.01–30 kg/m2), and 2592 (21.3%) were obese (BMI ≥30.01 kg/m2). The presence of central obesity was more common than other components. The associations of MetS with BMI, pack-year smoking, age, weekly driving duration and driving experiences were significant in the logistic regression. By increasing BMI, pack-year smoking, age, weekly driving duration and driving experiences, odds ratio of MetS was increased.The study suggests that MetS has become a noteworthy health problem among Iranian long distance drivers. This might be due to the following facts: sitting in a fixed position for long hours while working, cigarette smoking, job stress, unhealthy diet and lack of physical activity. Educational programs should be established for promoting healthy lifestyle and also for early detection and appropriate intervention