BACKGROUND: Intracranial epidermoid tumors account for approximately 1% of the intracranial tumors. These tumors are thought to arise from displaced epithelial remnants after the neural tube closure. These tumors are usually benign intradural but extracerebral lesions and are rarely found within the substance of the brain. Even more rare location for epidermoid tumors is fronto-ethmoidal. To the best of our knowledge, only 28 cases have been reported in this location so far.

 CASES: Here we report two cases of middle-aged men presenting with recurrent headaches, which were associated with behavioral changes and seizures. Both men were diagnosed with fronto-ethmoidal epidermoid cysts, which were surgically excised. Surgical excision was easily established due to the avascular nature of the tumor. However, the tumor capsules had to be left behind due to adhesions with vital structures. On follow-up visits, the patients were asymptomatic and were living without any residual symptoms.

CONCLUSION: Surgical resection appears to be the mainstay of treatment; however, the extent of resection is dictated by adherence of the tumor capsule to the surrounding vital structures. The advantages of aggressive neurosurgical intervention must be weighed against an acceptable risk of neurological complications.  Given the indolent growth pattern, subtotal resection is also acceptable.

A 49-year-old woman with a 2-year history of right upper quadrant pain was referred to our clinic for management. Sonography revealed a cystic lesion with suspicion of hydatid cyst. Pathological section after surgical exploration revealed eosinophilic abscesses of the liver secondary to Enterobius vermicularis. Only a few reported cases of hepatic oxyuriasis exist in the current literature.

INTRODUCTION: Surgical bypass for the treatment of lower extremity peripheral arterial disease is a suboptimal option in high-risk surgical patients or patients with limited life expectancy. Percutaneous transluminal angioplasty (PTA) is an alternative in such patients; however, the results of this approach have not been well-studied in our region. This study evaluated the results of infrapopliteal percutaneous transluminal angioplasty and/or stenting for critical limb ischemia (CLI) due to peripheral arterial disease of lower limbs in surgically high-risk patients.

METHODS: We conducted a retrospective study in four medical centers in Iran, from May 2006 to September 2009. Patients with CLI (Rutherford category 4-6), multiple two-vessel lesions, ankle-brachial index (ABI) of less than 0.05, high surgical risk category, and a follow-up of > 1 year after percutaneous transluminal angioplasty were included. Patients with restenosis of graft lesions, a life expectancy of less than 1 year, or those who were thienopyridine intolerant were excluded. “Limb salvage” was defined as a reduction in stenosis or occlusion to less than 30%. The primary endpoint was limb salvage rate. Survival and patency were evaluated with the 

Kaplan-Meier method. 

RESULTS: Sixty patients met the inclusion criteria. Mean age was 60.5±8.4 years (men 73.3%, diabetes mellitus 83.3%, current smoker 33.3%, hypertension 70%) and baseline ABI was 0.51±0.08. Anterior tibial artery (47%) was the most frequently involved blood vessel. A total of 22 stents and 122 balloon angioplasties were used in 98 limbs. “Limb salvage” was achieved in 58 (96.6%) patients immediately after the procedure. One-year salvage rate was 88.3%. Complete ulcer healing was achieved in 64.3% patients, and partial healing was obtained in 26.4%. Only one major procedure-related complication was reported; perforation with post-operative compartment syndrome. Major arterial access site complications (n=3, 5%) included two hematomas and a pseudoaneurysm. One-year survival rate was 96.6%. One-year major amputation rate was 11.7%.

CONCLUSIONS: Infrapopliteal angioplasty alone or with stenting is a valuable treatment option for the prevention of amputations in patients with CLI for whom surgical bypass is not an option and in whom the risk of amputation is high.

BACKGROUND: Trauma secondary to road traffic accidents (RTA) constitutes a major cause of head injury. Every trauma victim with altered level of consciousness must be evaluated for brain injury. Radiological evaluation has undergone dramatic changes with the advent of computed tomography (CT) as it can precisely define the nature and location of the culprit lesion(s).

METHOD: This cross-sectional study includes 382 patients, admitted to the emergency department of our hospital, from September 2008 to September 2010. We present results of evaluation by CT on the nature and location of the identified lesion(s).

RESULTS: CT scans revealed skull fractures.

(62.04%), intra-cerebral hematoma (46.33%), epidural hematoma (30.36%), subdural hematoma (19.37%), subarachnoid hematoma (28.79%), diffuse axonal injury, brain swelling and edema (63.35%), midline shift (24.34%), pneumocranium (12.04%) and intra-ventricular hemorrhage (10.73%) in our study. We also found that young males between the ages of 20 and 40 years were predominantly involved with head trauma due to road traffic accidents.

CONCLUSION: CT scan has detected and precisely localized the parenchymal damage of brain and effectively predicted the functional outcome.

BACKGROUND: The hormones ghrelin and leptin play central roles in the regulation of appetite, energy expenditure and body weight. Changes in ghrelin and leptin, at least to some degree, are thought to underpin metabolic diseases such as the metabolic syndrome. This regulation is particularly highlighted in the response of a small mammal to a state of starvation in which ghrelin and leptin are modulated in order to increase survivability. The aim of this study was to examine the relationship between ghrelin, leptin, and plasma FFAs after fasting in mice.

 METHODS: Ten male mice were subjected to a controlled 18-hour fast. After 18 hours, a terminal blood sample was obtained for the analysis of hormone and plasma FFA levels. These levels were compared to control mice that received a normal diet and to baseline levels prior to fast.

RESULTS: We found that the plasma ghrelin levels in the fasting mice were significantly higher than in control (1106 ± 72.57 vs. 282.3 ± 28.07 pg/ml; P<0.0001, STD err). In an antagonist manner, plasma leptin was significantly lower in fasting mice (3.2 [IQR 2.66-4.653] vs. 0.64 [IQR 0.458-1.105] ng/ml; P<0.0001). Plasma FFA doubled from control values of 4.438 ± 0.094 to a fasting average of 7.276 ± 0.413 μEq/L.

CONCLUSION: The levels of plasma ghrelin, which is an appetite inducer, are significantly increased during a fast. Plasma leptin, which produces satiety, is reduced. Plasma FFAs are increased approximately two-fold, probably as a result of mobilization of fat stores. These changes may help to prolong survival of the animal under harsh conditions.