Reviews in Clinical Medicine

141-147

Authors: Kamran Aryana; Abolghasem Allahyari; Ramin Sadeghi; Farrokh Silanian Tousi; Mohammad Mahdi Kooshyar; Seyed Hosein Hashemipour; Hamideh Sadra

Introduction: This systematic review studies the prognostic value of two conventional imaging tools, sestamibi and gallium scans, for predicting how patients with Hodgkin lymphoma will respond to treatment. Methods: The PubMed database was searched for English-language articles that contained the following search terms: (Hodgkin AND [mibi OR sestamibi OR gallium OR spect] AND response). All articles that were identified during this search were included in the study, regardless of date published. The inclusion criteria were as follows: articles that described studies that were limited to Hodgkin patients and that reported the predictive value of conventional imaging tools. Articles about other types of lymphoma and/or those that focused on the diagnostic and staging accuracy of mibi and gallium scans were excluded. Result: In total, 14 articles were retrieved. Of these, the majority met the inclusion criteria of the systematic review with the exception of two, which were limited to an examination of the reliability of performing sestamibi scans to predict the response to treatment. All remaining 12 articles considered both the sestamibi scans and the gallium scintigraphy. The results of the systematic review indicate that positive gallium scan results can be proposed as a poor prognostic factor that is associated with partial or full recurrence of Hodgkin disease, a reduction in overall survival rate, and progression-free survival compared with patients with a negative scan. Discussion: Both sestamibi and gallium scans revealed high sensitivity and specificity in predicting the response to treatment including complete remission, partial remission, and recurrence of the disease. Conclusion:These imaging tools can appropriately assess how Hodgkin patients will respond to chemotherapy. As such, clinicians can use these tools to devise appropriate treatment strategies.

154-157

Authors: Atooshe Rohani

One in five adults has patent foramen ovale (PFO), which is typically without symptoms. Because of the low pressure in both atria and the anatomical position of the septum secundum, there is no left-to-right shunting and little right-to-left shunting in the general condition; however, when the right atrial pressure increases, this slit-like flap separates and allows right-to-left shunting. According to the Johnson criteria, simultaneous occurrences of arterial emboli, such as those caused by cerebrovascular accident or pulmonary embolism, demonstrate the presence of paradoxical embolism through a PFO. When a patient presents with multivascular arterial embolism, the clinician should perform a contrast transthoracic echo, a transesophageal (TEE), a real-time three-dimensional TEE, and even an intracardiac echocardiography (ICE) in order to differentiate between PFO, flat atrial septal defect (ASD) and hybrid defects. The randomized trials that have assessed therapeutic interventions for paradoxical embolism have not produced any clear guidelines as to how best to treat this condition. The classic treatment is surgical embolectomy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass. Patients with a history of ≥1 paradoxical embolism may be indicated for device PFO closure.

163-165

Authors: Niaz Mohammad Jafari Chokan; Hamidreza Reihani; Elham Pishbin

Anterior shoulder dislocation is the most common joint dislocation in human body. Many methods are traditionally described for reduction of shoulder dislocation. Most of these techniques are painful to patients and may be associated with further injury. An ideal method should be easy, effective, and less painful, not associated with iatrogenic complications and should be easy to teach and learn. Among different methods of reduction, external rotation and Milch methods are more popular. Both methods are found to be atraumatic, relatively painless and can be performed without anesthesia. In this article, we aimed to review the literatures regarding these two methods of reduction and comparing their success rate and outcome. We reviewed the literature to find articles related to reduction of anterior shoulder dislocations applying one of two techniques described above. We searched PubMed and Google Scholar. In total, 46 articles were found, of them 17 articles -which mainly focused on anterior shoulder dislocation reduction by means of two above methods-were included in this review. The results showed that both techniques were effective, safe, relatively painless, and were well tolerated with no complications, but the external rotation method was superior.

171-174

Authors: Raheleh Mirsadraee; Saba Vakili; Mohammad Reza Abbaszadegan; Rahim Vakili

Fragile X syndrome (FXS) is the most common known genetic cause of male intellectual disability. A wide variety of medical problems has been reported in FXS syndrome including seizures, facial abnormalities, macroorchidism, and autistic disorders. Here we reported a 9-year-old boy with fragile X syndrome that was confirmed through karyotyping and mental retardation. Initially, he was diagnosed as hypothyroidism when he was 15 months old. However, due to unusual clinical presentation, we re-evaluated the patient according to his history and clinical findings. Subsequently, targeted laboratory tests were performed and the results were indicative for thyroxin-binding globulin (TBG) deficiency in our patient. Therefore, levothyroxine was discontinued and one month later, laboratory tests were repeated and his diagnosis confirmed. As inherited TBG deficiency might also be X-linked, FXS and TBG deficiency may be coincidental findings in the patient.