Relationship between Delivery Type and Menstrual Disorders: A Case-Control Study

Background: High incidence of menstrual disorders at late ages of fertility ac-counts for 20% of clinical visits and 25% of gynecological surgeries. This study was conducted to identify the relationship between delivery type and menstrual disorders in women referring to hospitals affiliated to Medical Universities in Tehran in 2008. Methods: In this case-control study, which was conducted from April to August, 2008 in Tehran, 160 women aged 36 to 44 years, 8o women with and 80 without menstrual disorder as case and control groups were enrolled respectively. Data collection tool was a questionnaire (included questions regarding demographic and obstetrical characteristics). Higham pictorial chart (scores more than 80 denoted menorrhagia), a verbal multidimensional scoring scale (from 0 for painless to 3 for severe pain), and Holmes-Rahe scale for assessing stress were used. Results: About 93.1% of the cases and 65% of the controls had experienced dysmenorrhea at the begging of the study (P=0.009). In other words, 65% of women with dysmenorrhea had a history of C-section. Women with menstrual disorders had more caesarian sections (53.7%) than those without the disorders (27.5%) (P<0.001) with an odds ratio estimate of 3.06 [95% CI: 1.58, 5.91]. There were significant differences in the number of pads/tampons used (P=0.009) and amount of uterine bleeding based on Higham chart (P=0.009) among case and control group. Conclusion: Caesarian may be considered as a risk factor for menstrual disor-ders particularly at late ages of fertility. Therefore, pregnant women should be consulted by health providers regarding advantages versus disadvantages of caesarian before selective C-section.     

Lumbar vertebral hemangioma with extradural extension, causing neurogenic claudication: a case report

The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography (CT) scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging (MRI) showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful.     

The effect of water to ethanol feed ratio on physical properties and aerosolization behavior of spray dried cromolyn sodium particles

Cromolyn sodium (CS) was spray dried under constant operation conditions from different water to ethanol feed ratios (50:50-0:100). The spray dried CS samples were characterized for their physicochemical properties including crystallinity, particle size distribution, morphology, density, and water/ethanol content. To determine quantitatively the crystallinity of the powders, an X-ray diffraction (XRD) method was developed using samples with different crystallinity prepared by physical mixing of 100% amorphous and 100% crystalline CS materials. The aerodynamic behavior of the CS samples was determined using an Andersen Cascade Impactor (ACI) with a Spinhaler at an air flow of 60 L/min. Binary mixtures of each spray dried CS powder and Pharmatose 325, a commercial alpha-lactose monohydrate available for DPI formulations, were prepared and in vitro aerosol deposition of the drug from the mixtures was analyzed using ACI to evaluate the effect of carrier on deposition profiles of the spray dried samples. CS spray dried from absolute ethanol exhibited XRD pattern characteristic for crystalline materials and different from patterns of the other samples. The crystallinity of spray dried CS obtained in the presence of water varied from 0% to 28.37%, depending on the ratio of water to ethanol in the feed suspensions. All samples presented different particle size, water/ethanol content, and bulk density values. CS particles spray dried from absolute ethanol presented uniform elongated shape whereas the other samples consisted mainly of particles with irregular shape. Overall, fine particle fraction increased significantly (p < 0.01) with decreasing d50% and water and ethanol content of spray dried CS samples. Significant difference (p < 0.01) in deposition profiles of the drug were observed between corresponding carrier free and carrier blended formulations. The difference in deposition profiles of CS aerosolized from various spray dried samples were described according to the particle size, shape, and water/ethanol contents of the powders. The results of this study indicate that enhanced aerosol performance of CS can be obtained by spray drying of the drug from suspensions containing > or = 87.5% v/v ethanol.     

Effectiveness and residual activity comparison of granular formulations of insect growth regulators pyriproxyfen and s-methoprene against Florida mosquitoes in laboratory and outdoor conditions

Effectiveness and residual activity tests of granular formulations of 2 insect growth regulators (IGRs), s-methoprene and pyriproxyfen, against laboratory-reared larvae of 5 colonized mosquitoes, Aedes aegypti, Aedes albopictus, Aedes taeniorhynchus, Anopheles quadrimaculatus, and Culex nigripalpus, were conducted in the laboratory and outdoors in plastic tubs. Culex quinquefasciatus was exposed to these two IGRs in the laboratory only. Each IGR formulation was applied at 0.02 and 0.05 ppm active ingredient (Al) against 5 of the 6 mosquito species both in the laboratory and the outdoor evaluations, whereas Cx. quinquefasciatus was exposed to 0.2 and 0.4 ppm AI of s-methoprene, and 0.1 and 0.2 ppm AI of pyriproxyfen in the laboratory. s-Methoprene at 0.02 and 0.05 ppm AI resulted in variable levels (<39-100%) of inhibition of adult emergence in the 5 species monitored for 6 weeks after treatment under both test conditions. Aedes taeniorhynchus was the most susceptible to s-methoprene in terms of initial and residual activity. Culex quinquefasciatus and Ae. albopictus were the most tolerant to s-methopene, with maximum emergence inhibitions amounting to 84% in Cx. quinquefasciatus at 0.4 ppm and 44.3% in Ae. albopictus at 0.05 ppm during the 1st week in the laboratory. Pyriproxyfen at comparable treatment rates to s-methoprene caused very high levels (>80-100% in most cases) of initial and residual emergence inhibitions of the tested species in the laboratory as well as outdoors. In several species, pyriproxyfen induced complete inhibition of adult emergence for several weeks after treatment, even at the lower rate of 0.02 ppm. The World Health Organization has recently recommended the use of pyriproxyfen for the control of some mosquito species at specified rates in certain habitats.     

Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion

Purpose

To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute branch retinal vein occlusion (BRVO).

Methods

In this randomized clinical trial, 86 eyes with recent-onset (less than 12?weeks) BRVO were included. Participants were randomly assigned to two treatment groups: (1) IVB group (43 eyes), patients who received three monthly injections of 1.25?mg of IVB, and (2) IVT group (43 eyes), patients who received two injections of 2?mg IVT 2?months apart. Patients were examined at 1, 2, 3, 4, and 6?months after enrollment. Main outcome measure was change in best-corrected visual acuity (BCVA) at 6?months. Secondary outcome measures were central macular thickness (CMT) and intraocular pressure (IOP) changes at month 6.

Results

Mean BCVA improved significantly up to 6?months in both groups from 0.68?±?0.25 to 0.31?±?0.21 logMAR (logarithm of minimum angle of resolution) in the IVB group, and from 0.67?±?0.29 to 0.46?±?0.31 logMAR in the IVT group (P?P?=?0.013) and 6 (P?P?=?0.031) at final visit. Dividing the cases into ischemic and non-ischemic types, a significant difference was noted only in the ischemic cases regarding BCVA improvement and CMT reduction in favor of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits.

Conclusions

Both 3-times-monthly IVB injections and 2-times IVT injections with a 2-month interval could be effective for improving BCVA and CMT in cases with recent-onset BRVO up to 6?months. However, considering the better visual and anatomic outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The favorable responses were more pronounced in the ischemic types of BRVO in this trial; nevertheless, this should be confirmed in larger studies.     

Pneumothorax following feeding tube placement: precaution and treatment

Nasojejunal feeding tubes are being used at an increased frequency, but it is not without complications that could be life-threatening. We report two cases of pneumothorax following small-bore feeding tube insertion into the pleural cavity, resulting in pneumothorax. We further discuss the potential measures that can be taken to prevent and treat this serious complication.     

Comparison of the keratometric corneal astigmatism and refractive astigmatism after phacoemulsification and foldable intraocular lens implantation

Here we aimed to define keratometric and refractive astigmatism in a series of patients who underwent phacoemulsification, using small corneal incision and implantation of foldable intraocular lenses. Furthermore, we compared keratometric astigmatism and refractive astigmatism of the patients both before and after surgery. We performed a follow-up study of patients with newly diagnosed cataract before and after phacoemulsification surgery. Eighty eyes from 78 patients with a mean age of 62.9?±?12.03 (32-86) years were studied. Thirty-nine (48.8?%) were male and 41(51.2?%) were female. All subjects underwent 3.5?mm corneal incision with the temporal (75 patients; 94?%) or superior (5 patients; 6?%) approach. The patients were followed for a mean of 74.21?±?71.25 (30-400) days. Patients had higher values of keratometric measurements after surgery compared to those before surgery [45.81?±?0.11 (45.06-45.94) vs. 45.2?±?0.20 (44.6-45.41)] (p?1 D difference in these measurements.     

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility. This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine‐touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

Identification of Potential Biomarkers in the Peripheral Blood Mononuclear Cells of Relapsing–Remitting Multiple Sclerosis Patients

Inflammation - Multiple&nbsp;sclerosis&nbsp;(MS)&nbsp;is described as an immune disorder with inflammation and neurodegeneration. Relapsing–remitting MS (RRMS) is one of the most...