Razi Journal of Medical Sciences
Year:2005 | Volume:12 | Issue:48 (SPECIAL ISSUE)|Papers Count:31

Background & Aim: A high prevalence of gastroesophageal reflux(GER) in asthmatic children has been reported in several reports, however, no research has been done in Iran in this regard. The goal of the present study was to evaluate the prevalence of gastroesophageal reflax in asthmatic children between 2 to 16 years of age.Patients & Methods: This cross-sectional retrospective study was conducted on 2 to 6-year-old asthmatic children who were hospitalized in Rasoul-e-Akram Hospital in Iran during 1993-2003.Results: Forty out of 70 asthmatic patients(57.4%) had GER in the Barium X-ray(15 females, 25 males). Asthmatic patients, with GER(40 patients) were divided into three groups according to their age: group I: ranging from 2-5 years of age, group II: 5-10 years of age and group III: 10-16 years of age. In groups 1, 2, 3, 75%, 44% and 38.44% of patients had GER respectively. A statistical difference was found between the age of asthmatic patients and GER(P=0.01). GER symptoms were present in only 11 out of 40 asthmatic patients with reflux(27/5%). Abnormal GER seems not to be a clinically significant problem in many patients with asthma in this study.Conclusion: Barium X-ray should be performed even on asthmatic patients who do not have any symptoms of GER especially in younger ages.

The most common cause of airway stenosis is prolonged intubation. Postintubation stenosis may be a delayed onset and may progress gradually. Endoscopic assessment and deciding to do a tracheostomy after 7 days is advised in adults. Segmented resection and primary anastomosis is the most effective modality of treatment for complete or near-complete tracheal stenosis. Surgeon’s ability for releasing trachea depends on multiple factors including neck extension. The patient of the present case report was a 19-year-old man who had complete tracheal stenosis because of prolonged endotracheal intubution(40 days). He had a severe blunt trauma, 2nd and 3rd cervical vertebra fractures and dislocation and spinal injury. Neck fixation was a great jeopardy for lanryngotracheal anastomosis. However, one year after surgery, the patient was decannulated successfully with normal laryngotracheal functions.

Background & Aim: Major histocompatibility complex(MHC) class one and intercellular adhesion molecule-I(ICAM-I) play important roles in immune response. It is well known that the expression level of the MHC class I and ICAM-I is frequently altered in accordance with tumor progression and is significantly related to tumorigenesis, tumor progression, and/or metastatic potential(e.g.kidney and prostate cancers). The aim of this study was based on the hypothesis that decreased or absent expression of MHC class I and ICAM-I surface antigens or costimulatory molecules on tumor cells might be responsible, in part, for the progression of breast cancer.Patients & Methods: To investigate the expression level of above molecules, 25 breast cancer and 25 breast hyperplasia cells samples from women aged between 35-65 years were obtained. Then, biopsy specimens from samples were prepared. Indirect immunofluorescence technique and H&E staining were used.Results: Immunohistochemical and pathological analysis in this study revealed a negative correlation between the expression of MHC-I and ICAM-I surface antigens and grade (differentiation) of breast cancer was compared with breast benign hyperplasia cell samples. Results were expressed as the mean±SD. Student’s t-test and SPSS program were used to assess the differences, and a significant level of P<0.00 was found.Conclusion: In general, tumor with higher grade(cell differentiation) expressed MHC class I and ICAM-I sufraceantigens on breast cancer cell less frequently and intensely. The absence or decreased level of MHC and ICAM-I surface antigen expression on women breast cancer cells is responsible for tumor progression.

Background & Aim: Beta thalassemia major is a severe transfusion dependent anemia that causes infertility due to iron deposition to endocrine organs after overtransfusion. Very few pregnancies were reported among such patients in the past. However, after modern therapies, patients who have been receiving a prolong intensive treatment with hyper transfusion and iron chelation become spontaneously pregnants.Patients & Methods: The present study was conducted on 32 thalassemia women who were  admitted to Ali Asghar children’s Hospital and the Thalassemia Clinic, and were concepted spontaneously. The objective of this cross-sectional study was to estimate the frequency of fertility (spontaneous ovulation or ovulation induction) and complications for mother and newborn including: cardiac failure, endocrinological and hepatic parameters monitored at the beginning, throughout and after pregnancy, viral infection, term and preterm deliveries and complication of pregnancy.Results: All the files were studied and data was a nalyzed with SPSS software. The checklists were gathered and the findings showed that 12 babies were delivered by elective cesarean section and the others were vaginally delivered. The mean brithweight of the newborns was 2678gr. All babies were normal, 45 cases were mature, 5 of them were preterm, and 12 cases were spontaneous abortion. 27 of mothers had no cardiac problem and 5 of them had cardiac failure.Conclusion: Pregnancy can be safe for mothers and babies, if the women with thalassemia start early intensive treatment.

Background & Aim: Mebudipine is a calcium antagonist drug which is used to treat blood pressure. A new high performance liquid chromatography(HPLC) system for the determination of a new 1, 4-dihydropyridine, mebudipine, in rat plasma and other biological fluids was developed in this study for the first time.Materials & Methods: To 1 ml of rat plasma and/or other biological fluids, 0.5 ml of internal standard(dibudipine) and 0.5 ml of 1 M NaOH was added. Mebudipine and internal standard were extracted to 5 ml ethyl acetate, evaporated under slow stream of nitrogen. The residue was reconstituted in 200μl mobile phase and 20μl of aliquots was injected into a HPLC system equipped with 4.6×250mm i.d.C18 analytical column. Mobile phase consisted of methanol(70%), water(25%) and acetonitril(5%) and its flow rate was 1 ml/min.Results: There were no interfering peaks from endogenous components in blank plasma chromatograms. Standard curves were linear(r(2)>0.99) over 10 to 500ng/ml. The extraction efficiency was above 90% and the minimum quantifiable concentration was 10ng/ml(CV<10%) which reveals that it is a suitable, convenient and simple HPLC assay for pharmacokinetic study of mebudipine in rat.Conclusion: By using this method, it was found out that while the oral bioavailability of mebudipine was low(<2%), it had a marked first-pass effect. The distribution of mebudipine into some tissues such as brain, heart, liver and kidney following intravenous administration(0.5 mg/kg) was studied and a rapid distribution of mebudipine into these tissues was found. It was concluded that brain, heart, liver and kidney are in the same compartment as plasma(central).

Background & Aim: Therapeutic drug monitoring(TDM) is a very important function of a modern clinical laboratory. Chromatographic techniques have been the gold standard method for quantitative monitoring of drugs from the long time ago. Immunoassay methods are very useful today due to their ability to be installed on automation systems, their high speed and independence from expert personnel. The present study was undertaken to compare high performance liquid chromatography(HPLC) method with fluorescent polarization immunoassay(FPIA) for analysis of carbamazepine(CBZ) and phenobarbital (PHE) level in human blood. Patients & Methods: In this cross-sectional research 100 patients on PHE and 103 patients on CBZ regimen admitted to TDM center of Iran Reference Laboratories were sampled. Levels of drug in blood were measured. Data were recorded and then analysed by statistical tests of Pearson correlation coefficent(r), linear regression analysis and T-Test.Results: For PHE and CBZ, r was respectively 0.971 and 0.953, which indicated a good correlation between two methods. Linear analysis of regression and T-Test showed that data sets of FPIA method are a little higher than HPLC.Conclusion: Both HPLC and FPIA may be applied to determine PHE & CBZ in TDM. HPLC can be more useful in special cases who need high precision and TDM related research.

Background & Aim: Intra-aortic ballon pump(IABP) is a mechanical device that has become an accepted treatment modality for patients with severely compromised hemodynamics. The present retrospective study was undertaken to identify the major survival and nonsurvival determinants of patients who were in need of intra-aortic ballon pump support after cardiac surgery .Patients & Methods: This study was conducted on 46 out of 2200 patients who underwent coronary artery bypass grafting(CABG) during one year in Tehran Shahid Rajaie Hospital and required IABP support. The patients were divided into survival(n=33) and nonsurvival(n=13) groups. Nonsurvival group was divided into 2 subgroups; weaned and not weaned from IABP. Variables compared between 2 groups were: sex, age, body surface, smoking, acute myocardial infarction(AMI), diabetes mellitus, previous cardiac surgery, ejection fraction(EF), functional class according to Canadian Cardiovascular Society(CCS), duration of cardiopulmonary bypass(CPB), aortic occlusion, IABP support, mechanical ventilation and intensive care unit(ICU) stay. Differences between 2 groups were analysed via student’s t-test, chi-square test, and frequency analysis. A Pvalue of <0.05 was regarded a significant level. Results: Overall survival and nonsurvival rate was 71.17% and 28.3% respectively. Nonsurvival group had higher rate of Canadian Cardiovascular Society functional class III, IV(P=0.03) and depressed left ventricular ejection fraction(P=0.13). This group had longer duration of cardiopulmonary bypass(P=0.01) and aortic occlusion(P=0.02). No significant difference was seen with other variables. In nonsurvival group, 6 patients weaned and 7 patients were not weaned from IABP, but all died from heart failure(P=0.009), renal failure(P=0.059), or respiratory failure(P=0.3) .Conclusion: This data suggest that heart failure was the major cause of death in patients not weaned from IABP, and patients with EF<30% had a poorer outcome. In patients weaned from IABP, renal failure, heart failure and respiratory failure were causes of death.

Background & Aim: Occlusion of organs artery results in ischemia and the opening of occluded artery leads to tissue lesion identified as reperfusion injury(RI). Oxygen-derived free radicals seem to be involved in the reperfusion injury. In this experimental study the effects of 5-aminosalicylic acid(5-ASA), a prescribed drug for ulcerative colitis, was assessed. 5-ASA is a potent scavenger of oxygen-derived free radicals in the RI of the kidney in a uninephrectomized rat model. Materials & Methods: Male Wistar rats of 200-250g were pretreated with 5-ASA(300mg/kg). Ischemiareperfusion(IR) injury was induced by left renal artery clipping for 45 min plus 24 or 48h reperfusion, while the right kidney was being removed. After 24 or 48h of IR injury, creatinine and nitric oxide(NO) levels in serum and urine, as the main parameters for evaluating of renal function, were determined. Results: After 24h of IR injury, 5-ASA(300mg/kg) not only obviously increased the levels of serum creatinine but also decreased the content of urinary creatinine and serum nitric oxide compard with the control group(P<0.05-0.0001). Whereas after 48h of IR injury, 5-ASA(300mg/kg) had no obvious effects on these parameters.Conclusion: 5-ASA(300mg/kg) used I.P 24h prior to the initiation of RI, in a time-depend ent  manner, induced nephrotoxicity. Further studies on renal biopsy, laboratory findings and immunofluorescence microscopy for assessment of mechanisms involved in 5-ASA renal toxicity is suggested.

Background & Aim: Invasive fungal sinusitis is an opportunistic infection by aspergilosis and mucoracae, but mucoracae is more common than aspergilosis. Mucormycosis is an acute opportunistic fungal infection mostly seen with an underlying disease. It has different clinical presentations such as rhinocerebral and orbital involvement, which are very aggressive and with high mortality rate. There is no obvious protocol for treatment of invasive fungal sinustis. Due to having lots of these patients it was decided to write a protocol for management and treatment. Patients & Methods: In this retrospective case series study, 21 patients who directly came or referred to this center were studied. As soon as taking a biopsy and after documentation and confirmation of pathology proper protocol was selected. Results: The most common site of involvement is nasal and orbit(52.4%) and then involvement of nasal cavity orbit and brain(38.1%) and involvement of nasal cavity alone(9.5%). There were 14 male(66.7%) & 7 female(33.3%). Out of these patients 19 had underlying disease including diabetes(10 cases), diabetes & renal failure(4 cases), ALL(2), end stage renal failure(1 case), SLE with ESRD(1 case) and CML in one case. Twelve patients were alive and 9 patients died. Those with nasal involvement alone were all alive. Of patients with sinonasal involvement only one patient died and those with sinonasal and brain involvement were dead. Conclusion: Treatment consists of early diagnosis, treatment of the underlying disease, debridement and medical therapy. Surgical protocol based on extension of disease consists of 3 groups: A: Surgical management in patients with sinonasal involvement is complete debridment of nasal and sinus. B: In patients with orbit involvement orbital exenteration is added. C: With involvement of brain, prognosis is poor and surgical and medical therapy can not affect the survival.

Background & Aim: The object of the present research was to study the prevalence of Trichomonas vaginalis(T.V) and Candida albicant(C.A) and to compare the two stains of Loffler(L) and Diluted carbol-Fuchsin(DC-F) for rapid diagnosis of T.V in 500 vaginal discharges referred to Medical Center of Robat Karim City. Patients & Methods: In this study, comparative diagnostic techniques including direct smears, staining methods and culture media were used. Results: Our results indicated that the prevalence rates of Trichomonas vaginalis and Candida albicans in our defined society were 7(1.4%) and 67(13.4%) respectively. According to our study there were no significant relations between Trichomonas vaginalis infection and the patients’ age, level of education number of childbirth, use of contraceptive devices, vaginalis itch, pruritus and painful intercourse(P>0.05). However, there was a statistically significant difference between vaginal pH, vaginal discharges, WBC number in each microscopic field and Trichomonas vaginalis infection(P<0.05). No significant difference was found with regard to Candida albicans infection and women’s age, education level and the number of parturitions(P>0.05). However, contraceptive devices, vaginal discharges, itches and burning, painful intercourse, vaginal pH, number of WBC in every microscopic field were statistically significant(P<0.05). Conclusion: Using Loffler and Diluted Carbol Fuchsin for rapid diagnosis of Candida albicans was quite statisfying but not suitable for Trichomonas vaginalis.

Background & Aim: Premature rupture of membrane is one of the most common problems in obstetrics, and successful labor induction, especially in cases with low bishop score(BS), is an important factor in decreasing maternal and fetal complications. The object of this study was to assess the efficacy and safety of vaginal misoprostol on duration of labor in preterm premature rupture of membrane(PPROM) cases with low BS.Patients & Methods: In this randomized controlled trial, 108 pregnant women with PPROM, gestational age of 29-37 weeks, BS≤4 and indication of pregnancy termination were randomly assigned into two groups to receive oxytocin(control) or 25μg misoprostol and then oxytocin(case). Results: The mean induction to delivery interval was significantly shorter in the misoprostol group than oxytocin group(507.68±248.01min vs 596.66±246.38min) (P=0.005). Cesarean section rate was similar in two groups but cesarean rate due to failed induction was lower in misoprostol group than oxytocin group(9%vs19%)(P=0.004). There was no difference between two groups with regard to birthweight and 1 and 5 min apgar scores. Tachy systol was not seen in two groups. There were 2(3.7%) cases of headache (which responded to analgesic) and 3(5.5%) cases of nausea(which needed no treatment) in misoprostol group. Conclusion: It can be concluded that vaginal misoprostol is effective, safe, and economic in PPROM cases with low BS.

Background & Aim: Due to the importance of assessing outcome evaluation in traumatic patients, the present study was undertaken to correct the therapeutic managements. Patients & Methods: Between 23 July 2003 and 23 May 2004 traumatic patients in Hazrat Rasoul Hospital were studied prospectively. Demographic variables of patients including age, sex, type of trauma, mechanism of injury,RTS(Revised Trauma Score) and ISS(Injury Severity Score) were compared with standard studies. Length of stay(LOS) and mortality rate were used for outcome evaluation. Results: It was found out that trauma had high frequency in young men with motorcycle accident. The mean length of stay for these patients was 8.5 days versus 9.7 days in MTOS(Major Trauma Outcome Study). The mortality rate(P<0.005) was apparently less than the mortality rate in MTOS study(4.1 versus 9) that can be due to low ISS in the patients and dysfunction of prehospital system in transferring traumatic patients. Conclusion: Outcome evaluation with W and Z score was 2.9 which means that out of each 100 patients in this study 2.9 people died above the MTOS standard.

Background & Aim: Preparation of safe and enough blood products which can solve the physiologic needs during surgery is a big and old problem. The anesthetist must have adequate knowledge about indications and complications of transfusion. The method used in this study was acute normovolemic hemodilution which is a recommended procedure in reference books. The goals of this study were to determine the effects, benefits and side effects of this method. Patients & Methods: In a randomized clinical trial(RCT), 60 patients were evaluated in two groups of 30. All of them were ASA 1, 2 and between 15-45 years old who were candidates for elective orthopedic surgery. The induction and maintenance routs of anesthesia and used solutions were similar in two groups and all patients were intubated with one person. Blood bags were achieved from arterial line. Heart rates, mean arterial pressure, SPO2, ETCO2 and cardiac output(non invasive with NICO) were measured and recorded before induction, 1 hour later, 2 hours later and at the end of the surgery. Volume of blood loss was calculated at the end of surgery. The number of used blood bags in two groups was recorded. Results: Number of heart rates 2 hours later and at the end of operation was statistically significant and was higher in autologous group(P=0.001, 0.00). Mean arterial pressure 2 hrs later and at the end of the surgery was statistically significant and different in two groups and were higher in autologous group(P=0.02, 0.005). ETCO2 was significantly different 1, 2 hrs later and at the end of the surgery and was lower in autologous group(P=0.005, 0.004, 0.00). Blood loss volume was statistically different in two groups and was lower in autologous group(P=0.00). Cardiac output was not statistically different in two groups. Conclusion: These results show that increase in heart rates after blood donation is probably due to induced stress in autologous group, but no change in cardiac output occurred. Also, mean arterial pressure and ETCO2 were different in two groups and were more satisfactory in autologous group. Furthermore, volume of blood loss was significantly lower in autologous group than hemologous group. It seems that autologous blood transfusion is a better method with more adequate hemodynamic control than hemologous transfusion.

Background & Aim: Protein-Energy malnutrition is one of the most important world’s health problems, especially among the children under the age of 5. Thus, this study was conducted with regard to the known complications and different reports of the prevalence and the determinants of this disorder. The goal of the present study was to determine the prevalence and determinants of protein-energy malnutrition among children under the age of 5. Patients & Methods: A descriptive cross-sectional study was conducted between Oct.2002 to Feb. 2003 in Savojbolagh. Sampling was based on 20% prevalence of malnutrition, 95% CI, design effect of 1.8, and d=0.03. By employing random cluster sampling technique, 1243 samples were chosen (632 rural samples and 603 urban samples). Data was collected by means of questionnaire, interview and observation. Results: The most important findings in this study were as follows. The prevalence of stunting among the girls was more than the boys (12.1%, 8.7% respectively). Prevalence of wasting was 4.7% in girls and 3.7% in boys. Age(P<0.043), weight(P<0.001) and height (P<0.001) of the children had significant correlation with malnutrition. There was a significant correlation between malnutrition and calorie of diet(P<0.038) in 3-4 age group. This study also showed a significant correlation between low weight for height for age and low protein in children’s diet (P<0.01)(1-2 and 2-3 age groups). Conclusion: According to the findings of this study, children were suffering from the mild malnutrition. The determinants affecting the children in this study were: mother’s lack of knowledge of appropriate time for beginning complementary food(P<0.022), use of no complementary food (P<0.045), and spending half of the household income on  food (P<0.039).

Background & Aim: Chlorine has been known as a mucus membranes and respiratory tract irritant. This gas canincrease free radicals which cause cell damage. The aim of the present study was to measure DNA content and cell cycle inwhite blood cells after chronic chlorine poisoning.Materials & Methods: A clinical experimental study was carried out on 80 male mice(40 mice as sample and 40 ascontrol). The first group was affected by chlorine during 3 weeks and then their blood samples were obtained. Cell cycleand DNA content were measured by flowcytometry.Results: The collected data showed that G0G1, G2M, S phase and DNA index changed significantly in two groups.G0G1 phase decreased and G2M and S phase increased(P<0.05).Conclusion: In conclusion chlorine can significantly affect cell cycle and DNA content and seems to act as a mitogen.

Background & Aim: Nausea and vomiting after surgery are among major side effects. Frequency of these events isreported between 40-75%. There are various ways to control these events after surgery. For many years acupuncture hasbeen used in the treatment of diseases in China and today its alternative procedure, acupressure, is used in the treatmentof some diseases. There are a number of reports of nausea and vomiting control with acupressure.Patients & Methods: The purpose of the present randomized clinical trial study was to evaluate the efficacy ofacupressure in control of postoperative nausea and vomiting. With calculating case volume, 88 women in gravidity agesundergoing laparascopy were divided into two 44 case groups. For one group acupressure was used and the other groupreceived usual therapy. Then nausea and vomiting in recovery and 6 hrs after surgery and the severity of these symptomswere recorded and then statistically analysized via chi-square test & t-test.Results: Age and weight were not statistically different between two groups. Overall frequency of nausea and vomitingwas 43.2%. In recovery this was 15.9%, and after 6 hrs 42.8% cases had mild nausea, 12 had moderate and 17 hadsevere vomiting. In acupressure group these measures were in 16, 6, 15, 6 and 5 cases. In control group these were 22,8, 22, 4, 6 and 12. Differences in cases were not statistically significant.Conclusion: Acupressure does not have any important role in the control of postoperative nausea and vomiting, butlow cost and side effect as well as free procedure make it be applicable along with other procedures.

Background & Aim: Adenosine deminase(ADA) can be used in the diagnosis of tuberculous pleural effusions. In countries with high prevalence of tuberculous pleural effusions, specificity and sensitivity for ADA test is high, therefore it is an integral part of a diagnostic workup of lymphocyte-rich exudative body fluids, and it is a cheap and economically costeffective test. No study has been done on utilizing ADA test in the diagnosis of different lymphocytic pleural effusions in Iran. The present study was undertaken to determine the diagnostic value of ADA enzyme in the diagnosis of different lymphocytic pleural effusions and compare the results with pleural culture and biopsy.Patients & Methods: Sixty-five lymphocytic pleural fluid samples(lymphocyte count>50%) were analyzed which included 25 pleural effusions due to tuberculosis, 13 parapneumonic effusions, 17 malignant effusions, 5 CHF effusions, 13 effusions due to PTE and 2 post coronary artery bypass grafting(CABG) effusions. The results were analyzed by Pearson chi-square test.Results: ADA level reached a diagnostic cut-off for tuberculosis(45 u/l) in 22 cases. Also, this result was observed in 2 patients with malignancy and 2 patients with pneumonia. In other patients, this level was below 45U/L. The sensitivity and specificity of this test in the diagnosis of tuberculous pleural effusions was 88% and 90% respectively. Pearson chi-square test was utilized to demonstrate the significant difference in ADA test positivity in the tuberculous and nontuberculous pleural effusions and P<0.005 was obtained.Conclusions: ADA levels in nontuberculous lymphocytic effusions seldom exceed the diagnostic cut-off for TB(45 U/L), and according to the Pearson chi-square test, the difference in the positiveness of ADA test in the tuberculous and nontuberculous pleural effusions is significant. Therefore, this test can be valuable in the diagnosis of tuberculous pleural effusions.

Background & Aim: Doppler ultrasonography is important in diagnosis of renal diseases by demonstrating vascular anatomy and hemodynamics. There is not any fix doppler indices in all of the references and it is suggested that each center should have its own standards. Also it is proved that biologic indices are not the same in different societies. The present study was performed on normal Iranian population to measure normal limits for renal doppler indices.Patients & Methods: In this research ultrasonography was done on 256 healthy people including 126(49.2%) female and 130(50.8%) male. The mean age was 31.1 years with standard deviation of 8.64. The minimum age was 14 years and maximum age was 57 years. Doppler indices were measured in all of the cases and normal limits were calculated.Results: In main renal arteries PSV mean was 86.01(87.80, 84.25) cm/s and EDV mean was 39.01(40.40, 37.80) cm/s. In intrarenal arteries mean PSV was 75.32(77.12, 72.89) cm/s, mean EDV was 32.23(33.41, 31.45) cm/s, mean RI was 0.55(0.56, 0.54) and mean AT was 29.35(30.75, 28.35) ms.Conclusion: The obtained values are normal renal doppler indices in healthy Iranian population and we suggest that it should be used in clinical studies.

Atraumatic rupture of the spleen is an uncommon but important clinical entity. Unfortunately, the diagnosis is often missed due to the absence of any history of trauma. Atraumatic rupture of the spleen has been described in the medical literature as a clinical oddity with grave consequences, if it is unrecognised and untreated. Clinical features of splenic rupture include pain, tenderness and muscle guarding in the left upper quadrant of the abdomen along with features of haemorrhagic shock. In the absence of a trauma history, other clinical diagnoses are made on presentation and perforated peptic ulcer is the most commonly one. Occasionally, patients may have a variety of clinical features, suggesting angina pectoris, myocardial infarction, pulmonary embolism, ectopic pregnancy, acute appendicitis and acute sigmoid diverticulitis. In this case study an atraumatic rupture of the spleen in pregnant woman is reported with haemorrhagic shock. After stabilization, hemodynamic state splenectomy was performed.

Background & Aim: The aim of this study was to compare air way resistance and dynamic compliance of tracheal tube and laryngeal tube in TIVA(Total Intravenous Anesthesia). Nowadays, low airway resistance and dynamic compliance improvement during the mechanical ventilation whether in ICU or during general anesthesia, especially in patients with pulmonary diseases, is a favorable purpose to control hemodynamic condition and prevent pulmonary barotrauma in patients. Besides airway control during CPR, providing airway for ICU patients or those who need intubation during anesthesia may cause damages because of laryngoscopy, and at the same time needs experienced personnel. Therefore, this investigation was undertaken to find a method through which no experienced personnel or laryngoscopy is needed, and besides which, airway resistance and dynamic compliance can be like the common standard methods.Patients & Methods: This clinical trial study was conducted on 34 patients(22 males and 12 females) aged between 16 to 53(33.1 age±12.4) with ASA(type I and II) who were candidates for orthopaedic surgery to reduce aspiration risk and were selected based on randomized simple sampling. In anesthesia by TIVA method(Total drugs which used IV), propofol was used as anesthetic, fentanyl as analgesic and pavolon as relaxant. Pavolon was used because it has least hystamin release and, therefore, has no effect on airway resistance. Airway resistance and dynamic compliance were measured by NICOME and CO2 in expiration.Results: The results were assessed by t-test and Pvalue<0.05 was observed between mean airway resistance in tracheal tube(7.38±1.55) and laryngeal tube(34.35±3.87). There was a significant difference between airway dynamic compliance in laryngeal tube(26.08±4.54) and tracheal tube(44.55±7.06). There was also a significant difference between cardiac output in use of tracheal tube(5.37±0.207) and laryngeal tube(4.605±0.34) which showed cardiac output was lower in laryngeal tube method.Conclusion: Although laryngeal tube is a suitable alternative in difficult intubation or CPR, high airway resistance and low dynamic compliance causes decline in cardiac output and pulmonary damage; therefore, it is not a suitable alternative in all cases.

Mycobacterium tuberculosis kills about 3 million patients each year and, so, is the single most important infectious cause of death on earth. Tuberculosis is the most common cause of primary adrenal insufficiency especially in under-developed countries. In primary stage, diffused enlargement of adrenal gland is noted and in later stages, the gland shrinks. This presented case is a 3.5-year-old boy from Sanandaj who referred for abdominal mass search evaluation. Patient was involved by chronic diarrhea and iron deficiency anemia resistant to treatment for 2.5 years. In abdominal sonography no sign of para-aortic and retroperitoneal adenopathy was seen, but in upper pole of right kidney(adrenal region) hypo echo mass with well defined border without calcification was noted, therefore, neuroblastoma and Wilms’ tumor were diagnosed for the patient.

Background & Aim: Mumps infection is endemic in Iran. Due to high percentage of unvaccinated young people(<15yr old) in Iran, the incidence rate of mumps infection and its sequeles are probably higher in comparison with its incidence in developed countries before massive vaccination. The goal of the present study was to determine the role of mumps infection in children with sensory neural hearing loss.Patients & Methods: This descriptive cross-sectional study was conducted on 87 children aged up to 14 years with SNHL and 30 controls in the pediatric and ENT ward of Hazrat Rasool Hospital in Tehran from 2002-2003. The blood samples of these patients were tested for specific antibody(IgM&IgG) for mumps by Elisa method.Results: The mean age was 39.8+27.9 months(male: 60.6% and female 39.4%). The highest incidence of age was 3- 5 years(51.5%) and the lowest one was>10y(2.1%). Acute mumps infection(positive IgM) was seen in 8.3% and previous immunity to mumps(IgG) in 24.1% of all. The highest incidence of acute infection(IgM) was in 3-5-year old group, but it was not different in other age groups(P=0.11). Previous infection(IgG was also higher in 3-5-year old group and it was significantly different in other age groups(P=0.05). Acute(IgM) and previous infection(IgG), except in mean age of children(P=0.015, 0.013), was not significantly differente in terms of sex in case and control groups(P=1; 0.4). Seventyfive percent of all children had no immunity to mumps infection. Twenty-four percent of SNLH patients(like other healthychildren) had immunity to mumps infection. Acute mumps infection was seen in 8.8% of 3-5-year-old children of case compared to 6.8% of control group(P=0.11) However, previous immunity in case was lower than control group(P=0.4).Conclusion: Mumps infection in SNLH children aged between 3-5-year-old is more common and important than other age groups. Since the risk of SNHL after mumps infection will increase in older age, prevention of mumps by inexpensive and very effective mumps vaccine is helpful. Thereby, the costs of mumps infection and its sequles can be decreased with massive vaccination of Iranian young people (<20 years old).

Background & Aim: Colorectal polyps are among the commonest lesions encountered by surgical pathologist. In the United States, colonoscopy and flexible sigmoidoscopy are recommended for almost all people over the age of 40 years. The development of carcinoma from adenomatous lesions is referred to as the adenoma-carcinoma sequence. Virtually, all colorectal carcinomas exhibit genetic alterations and the study of this disorder will provide deep insights into the general mechanism of carcinogenesis. APC and P53 tumor suppressor genes are the most important among them. The aim of the present study was to find out the prevalence of P53 and APC genes mutations in low grade and high grade adenomatous polyps.Patients & Methods: This study was performed on 60 cases of colonic adenomatous polyps, 30 of patients were with low grade dysplasia and other 30 exhibited prominantly high grade dysplasia.The paraffin enblock samples were selected from pathologic files of Mehr, Hazrat Rasoul and Shohada-e-Haftome Tir Hospitals. APC and P53 mutations in the samples were detected by PCR method. The results were evaluated by chi-square and t-test statistic methods.Results: The prevalence of APC mutation in low grade and high grade adenomatous polyps was detected in 36.7% and 63% respectively(P<0.05). The prevalence of P53 mutation in low and high grade polyps was seen in 10% and 43% of them(P<0.05). Both low and high grade adenomatous polyps showed significant difference. Mean age was 62.2 years.Mean diameter of polyps was 15.6mm. A direct relation was seen between polyps diameter and APC mutations(P<0.05) but this relation was not seen in P53 mutation.Conclusion: Early diagnosis of colonic adenomatous polyps and colonoscopic resection of them can prevent the malignant tumors and, therefore, diminish the morbidity and mortality.

Background & Aim: Listeria monocytogenes has potentiality to cause serious invasive disease in humans and in more than 40 animal species. L. monocytogenes is transmitted from soft cheese, milk, raw meat and sausages to human. The present study was undertaken to find the frequency of L. monocytogenes in poultry, domestic animals, sausage, cheese, milk, and also to determine ctpA(copper transport) gene among them after doing PCR on gel electrophoresis.Materials & Methods: 180 samples from brain, liver and feces of poultry(industrial hens) from 36 birderies, 166 samples of liver, brain, amniotic fluid and feces of cow, horse, sheep and goat, 80 samples of sausage, and 300 samples of dairy from shops in Karaj city were collected. L. monocytogenes was isolated by cold enrichment and standardAustralia/New Zealand method. Chromosomal DNA was prepared and used for PCR amplification of ctpA. Then, PCR products ran on agarose gel electrophoresis for detection of the ctpA band.Results: L. monocytogenes was not isolated from poultry samples. These bacteria were isolated from brain and liver of goat and sheep(12.93%), sausage(2.5%), local cheese(2.9%), and milk(2.5%). By using PCR to identify the homologus DNA in 25 L. monocytogenes isolates, 20% of them contained ctpA determinant. DNA homologus to ctpA was not detected in all isolates. Our results showed that 28.57% of cheese and 20% of domestic animal isolates, contained ctpA gene in chromosome DNA.Conclusion: Since ctpA gene was not existent in all isolated bacteria, this might indicate that all the strains do not have the same virulence. CtpA showed significant similarity to the proteins associated with copper metabolism disorders in humans, Menkes disease and Wilson disease. There might be a relationship between these two diseases and ctpA gene in L. monocytogenes. By producing ctpA protein of Listeria to make vaccines it is possible to prevent above diseases in future.

Background & Aim: The present article was a retrospective study on dysplastic hip patients treated with chiari osteotomy between 1973-2001. Our primary goal was to evaluate long-term results of this procedure and its effects on limp pain hip R.O.M and probable obstetric complications.Patients & Methods: 50 patients were treated with chiari osteotomy. Due to lack of follow-up, 4 patients were excluded, so 46 patients and a total number of 53 hips were included in the study. Mean age of the patients was 12.6 years and mean follow-up was 74 months.Results: Functional results were evaluated by Harris hip score which was excellent in 31, good in 9, fair in 4 and bad in 2 patients.Conclusion: Chiari osteotomy is a good and safe procedure for dysplastic hip in old children and adults who are not suitable for conventional osteotomies or arthroplasty.