Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to
facility and good view, its physiologic effects are most relevant to the surgeons. CO2
pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP) and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases) using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and
CO2 consumption in the group using mechanical wall elevator as compared to conventional
laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group). We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus (DM) that can cause annoying symptoms. To address this condition, several treatment approaches have been proposed, including static magnetic field (SMF) therapy, which has shown promise in treating neurological conditions. Therefore, this study aimed to investigate the effects of SMF therapy on symptomatic DPN and the quality of life (QoL) in patients with type 2 diabetes.A double-blind, randomized, placebo-controlled trial was conducted from April to October 2021. Sixty-four DPN patients (20 males, 44 females) were recruited for the study via invitation. The participants were divided into two groups: the magnet group, which used magnetic ankle bracelets (155 mT) for 12 weeks, and the sham group, which used non-magnetic ankle bracelets for the same duration. Neuropathy Symptom Score (NSS), Neuropathic Disability Score (NDS), and Visual Analogue Scale (VAS) were used to assess neuropathy symptoms and pain. In addition, the Neuropathy Specific Quality of Life Questionnaire (Neuro-QoL) tool was used to measure the patients' quality of life.Before treatment, there were no significant differences between the magnet and sham groups in terms of the NSS scores (P = 0.50), NDS scores (P = 0.74), VAS scores (P = 0.17), and Neuro-QoL scores (P = 0.82). However, after 12 weeks of treatment, the SMF exposure group showed a significant reduction in NSS scores (P < 0.001), NDS scores (P < 0.001), VAS scores (P < 0.001), and Neuro-QoL scores (P < 0.001) compared to the baseline. The changes in the sham group, on the other hand, were not significant.According to obtained data, SMF therapy is recommended as an easy-to-use and drug-free method for reducing DPN symptoms and improving QoL in diabetic type-2 patients. Trial registration Registered at Iranian Registry of Clinical Trials: IRCT20210315050706N1, 2021/03/16.
Background. Oxidative balance and inflammatory processes affect wound healing phases, and their disruption is connected with delayed wound healing. The present study aimed to assess the association between serum hs-CRP, prooxidant-antioxidant Balance (PAB), and vitamin D with anthropometric and biochemical parameters in patients with diabetic foot ulcers (DFU). Methods. Thirty-two patients with DFU were included in this study. The Spearman correlation coefficient was used to evaluate the bivariate relationship between serum hs-CRP, PAB, and vitamin D with anthropometric characteristics, glycemic status, lipid profiles, homocysteine level, liver, and kidney function tests. Results. Our data showed a significant positive association between serum hs-CRP and insulin (r = 0.417, P = 0.027), uric acid (r = 0.629, P = 0.001), creatinine (r = 0.431, P = 0.022), erythema (r = 0.36, P = 0.049), and ESR (r = 0.560, P = 0.002). Moreover, hs-CRP negatively correlated with FBS (r = –0.427, P = 0.023), total bilirubin (r = –0.639, P = 0.001), direct bilirubin (r = –0.445, P = 0.033), LDL-cholesterol (r = –0.405, P = –0.032), BMI (r = –0.398, P = 0.033) and HTN (r = –0.450, P = 0.014). Serum PAB value negatively correlated with patients age (r = –0.460, P = 0.027), and BMI (r = –0.442, P = 0.035), and positively associated with insulin level (r = 0.431, P = 0.040). A significant positive association between serum vitamin D with patient sex (r = 0.379, P = 0.047), and QUICKI (r = 0.456, P = 0.029), and negative correlation with HbA1c (r = –0.381, P = 0.045) were also determined. Conclusions. This study demonstrated that serum hs- CRP, PAB, and vitamin D are significantly associated with some anthropometric and biochemical parameters with important clinical value in patients with DFU. Low levels of vitamin D and high levels of hs-CRP and PAB may have an important role in the pathogenesis of DFU.
To evaluate the existing prehospital trauma care system in Tehran, Iran.This was a cross-sectional study in which all trauma-related dispatches of Tehran's emergency medical services (EMS) system were evaluated-during 18 randomly selected days from September 22,1997, to March 17,1998. Emergency medical technicians completed a checklist for all trauma cases, and the criteria for this performance evaluation were different partial time intervals in each dispatch and different procedures that had been done for the patients.The means of the "dispatch-beginning-to-scene-arrival interval" and "scene-arrival-to-scene-leaving interval" were 10 and 18 minutes, respectively (median: 10 minutes, range 0-55 minutes for the first; and median: 15 minutes, range 1-165 minutes for the second time interval). The mean of the "dispatch-beginning-to-hospital-arrival interval" was 45 minutes (median: 42 minutes, range: 5-170 minutes). Among advanced life support (ALS) procedures that include cardiac monitoring, intratracheal intubation, intravenous fluid therapy, nasogastric tube insertion, defibrillation, and tracheostomy, only intravenous fluid therapy had been administered for the patients. The patients, however, had received different kinds of basic life support (BLS) that include initial evaluation, bleeding control, oxygen administration, splinting, suction use, and cardiopulmonary resuscitation.The prolonged response, scene, and dispatch-beginning-to-hospital-arrival intervals compared with those for a developed EMS system indicate one potential area for improvement. Furthermore, significant differences in the field of prehospital care (conducting no ALS procedure) showed that ambulance equipment and training of EMS personnel are two other potential sites for improvement.
Thromboangiitis obliterans (TAO) is a thrombotic-occlusive as well as an inflammatory peripheral vascular disease with unknown etiology. Recent evidence has supported the immunopathogenesis of the disease, however, the factors contributing to the altered immune function and vascular tissue inflammation are still unclear. This review was intended to collate the more current knowledge on the regulatory molecules involved in TAO from an immunoreactive perspective. The homeostasis of the immune system as well as a variety of progenitor cell populations appear to be affected during TAO and these alterations are associated with intrinsic signaling defects that are directing to an improved understanding of the crosstalk between angiogenesis and the immune system, as well as the potential of new co-targeting strategies applying both immunotherapy and angiogenic therapy.
Supplemental material, VAS910055 Supplemental Material for Humoral and cellular immune response to Buerger’s disease by Seyed Morteza Ehteshamfar, Jalil Tavakkol Afshari, Mohammad-Hadi S. Modaghegh, Mahmoud Mahmoudi, Gholam Hosein Kazemzadeh and Fatemeh Sadeghipour Kermani in Vascular
Objective The current study assesses the effects of platelet-rich plasma-fibrin glue (PRP-FG) dressing along with oral vitamin E and C on wound healing and biochemical markers in patients with non-healing diabetic foot ulcers (non-healing DFU).Methods This randomized controlled trial was performed on 25 patients with non-healing DFU. Patients were treated with PRP-FG dressing plus oral vitamin E and C (intervention group) or PRP-FG dressing plus placebo (control group) for 8 weeks.Results Eight weeks after treatment, six wounds in the intervention group and two wounds in the control group were completely closed, and also wound size significantly reduced in both intervention and control groups (p < 0.05). This reduction in wound size was significantly greater in the intervention group compared to the control group (p = 0.019). Also, a significant decrease in prooxidant–antioxidant balance (PAB) , ESR, and hs-CRP was observed in the intervention group compared to the control group (p < 0.05).Conclusion Our results showed that PRP-FG dressing along with oral vitamin E and C could be used to increase wound healing in patients with non-healing DFU by enhancing the wound healing process and reducing oxidative stress.Trial Registration This trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04315909).
Behcet disease (BD) is a chronic inflammatory disorder of unknown etiology with a clinical spectrum that has greatly expanded since it was first described in 1937 by Hulusi Behcet as a triple complex of recurrent oral and genital ulcers and uveitis [1]. Although BD has a worldwide distribution, it is mainly seen in Far East and Middle East countries [2,3]. The highest prevalence is reported from Turkey, 80–370 per 100 000, and ranges from 2 to 30 cases per 100 000 in other Asian countries (16.7 per 100 000 in the Islamic Republic of Iran) [2,3]. The age of disease onset is usually in the second or third decade of life and the male to female ratio is reported to be almost equal. However, the disease runs a more severe course in men and in those with onset before 25 years of age [2]. Since BD does not have pathognomonic symptoms or laboratory findings; diagnosis is made on the basis of the criteria proposed by the International Study Group for Behcet disease in 1990 [4]. According to the criteria, recurrent oral ulceration must be present along with at least 2 of the following: recurrent genital ulceration, eye lesions, skin lesions, a positive pathergy test [2,4,5]. Many disorders, such as cutaneous small vessel vasculitis, inflammatory eye disease, neurological disease, vascular disease, arthritis, are associated with the presence of BD [6]. Pathological features such as smallor large-vessel vasculitis lead to occlusion of the vessels or aneurysm formation [7]. Differential diagnosis of Behcet-induced vasculitis has been described by Kreuger, Hoffman and Merton [8]. More than 200 cases of BD with pulmonary involvement have been reported in the literature. The pulmonary arteries are the second most common site of arterial involvement after the aorta. Aneurysms are more common than thrombosis [2]. Aneurysms associated with BD tend to be multiple and pulmonary artery aneurysms are relatively common, with an associated rate of 1%–10% of patients with BD [9]. Haemoptysis of varying degrees (up to 500 mL) is the most common and predominant symptom [2]. Medical treatment is more beneficial when given in the early stage of the disease [10]. Surgical repair of pulmonary artery aneurysm in BD carries a high risk, with high rates of morbidity and mortality [11]. Recently, endovascular management has been attempted for treatment of vascular involvement. However, when aneurysms are multiple, endovascular treatment is still difficult and challenging. To our knowledge, there is no report on a patient with 4 or more arterial aneurysms treated solely by endovascular management [12,13].
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