Internal hernia traversing the lesser sac

Congenital internal hernias are a rare cause of small bowel obstruction in adults and often present with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, may lead to early surgical intervention and reduce morbidity and mortality. A 25‐year‐old man presented with colicky abdominal pain and minimal signs on abdominal examination. Computed tomography showed features of a small bowel obstruction and prompted surgery. This revealed an internal hernia traversing the lesser sac through defects in both the gastrocolic ligament and lesser omentum. A gangrenous segment of small bowel incarcerated in the lesser omentum was resected and the patient made a full recovery. The published reports relating to lesser sac hernias are reviewed and features that may lead to early diagnosis identified.      

Iranians' attitudes about possible human immunodeficiency virus transmission in dental settings.

We conducted a cross-sectional survey from October through December 2004 of 8,312 residents of Shiraz, Iran, to investigate Iranians' perceptions about undergoing dental treatment in dental offices where other patients or the dentist and/or dental assistants are infected with human immunodeficiency virus (HIV). Most survey respondents (83%) had acceptable general knowledge about the mode of transmission of HIV and about acquired immunodeficiency syndrome (AIDS); however, many misconceptions were observed. A negative association was detected between the level of concern about contracting HIV/AIDS and the intention to continue treatment in services where patients with HIV/AIDS were also treated or where the dentist and/or dental assistants had HIV/AIDS.     

Conceptualizing a Quality Plan for Healthcare

Today, health systems around the world are under pressure to create greater value for patients and society; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system's customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery.     

Can plasma D-dimer predict the result of a ventilation–perfusion scan?

The use of plasma D-dimer assay has been advocated for the exclusion of pulmonary embolism. We retrospectively looked at 840 patients in whom both ventilation–perfusion scan and D-dimer assay were performed within 48 h. The negative predictive value of a negative D-dimer assay was 96% for emergency admissions and 98% for inpatients. We present the cases of two patients with negative D-dimer assay results who had a high-probability lung scan, and we have found a further three patients with negative D-dimer assay results who had an intermediate-probability lung scan.     

Reversibility of hepatic encephalopathy after liver transplantation

Until the advent of Liver transplantation, it was widely believed that Hepatic Encephalopathy (HE) was usually reversible. The exceptions were the so called “Acquired Hepatocerebral Degeneration cases” which were considered irreversible. Paradoxically, it seems, with liver transplantation, we have seen cases that contradict these rules. Whether the “residual effects” of HE, degenerative brain injury or independent neurological insults are causing post transplant neurological deficits is not easy to discern. As more emphasis is being put on maintaining brain ‘status’ after liver transplantation, we are finding confirmation of the largely reversible nature of HE. But, enough important exceptions to this rule are occurring to make further research on this topic mandatory.     

Risk factors for rectal colonization with vancomycin-resistant enterococci in Shiraz, Iran.

OBJECTIVES: In order to determine the risk factors for rectal colonization with vancomycin-resistant enterococci (VRE) at the Shiraz Namazi Hospital, we performed a nested case-control study. METHODS: From December 2003 to July 2004 rectal swabs were taken from 700 randomly selected hospitalized patients every 5 days. RESULTS: A total of 99 of the 700 patients (14%) were colonized with VRE (cases) and 59 patients were colonized with vancomycin-sensitive strains (VSE), serving as controls. In the univariate analysis, history of antibiotic use (p=0.04), underlying disease (p=0.013), hemodialysis (p=0.03), use of third generation cephalosporins (p=0.04), use of vancomycin (p=0.04), and duration of vancomycin therapy longer than 7 days (p=0.02) were significantly associated with VRE colonization. In a multivariate analysis, underlying disease and the duration of vancomycin use longer than 7 days were independently associated with VRE colonization. CONCLUSION: Our study, the first on VRE carriage in Iran, demonstrates that VRE prevalence is high in Shiraz and confirms earlier observations in other countries. The identified risk factor 'use of vancomycin longer than 7 days' may be avoidable, indicating a feasible intervention strategy in the control of VRE.     

Preservation of biomolecules in breast cancer tissue by a formalin-free histology system

Background  

The potential problems associated with the use of formalin in histology, such as health hazards, degradation of RNA and cross-linking of proteins are well recognized. We describe the utilization of a formalin-free fixation and processing system for tissue detection of two important biopredictors in breast cancer – estrogen receptor and HER2 – at the RNA and protein levels.