Razi Journal of Medical Sciences
Year:2003 | Volume:9 | Issue:31|Papers Count:26

Violence against women is one of the social difficulties all over the world. This social difficulty; in addition to, physical and mental problems it causes, has social consequences. There fore, researchers decided to investigate on physical injuries reffered to forensic centers to have a useful effect or removing this anti-social phenomenon in society. This cross-sectional study studied partner mis treatment, frequency of types and effectors on it in Autumn 2000. Data is collected from all women reffered to women’s ward of forensic center of Tehran in order to admit violence of spove. Each of them filled a check list consisted of demographic characteristics, type, frequency, history of violence, the causes of disagreement in the family & partner’s demographic data. 87.2% of studied women were diploma or under. The average age was 28.9 (28-29.8) years and was 20.2.(19.6-20.8) 68.7% of them were hort. By injuring instroments, 58.7% of theirchildren were beated and 40.1% were alcohol users and 42.41% drug-abusers respectedly. In a overall view, causes sochas young being, low educational status of each partner, being houskeeper, alcohol using and drug-abusing by the partners are the most inportant related causes of partner mistreatment. There fore general & special education are recommended to stay against this social problem, also reporting of these cases by physician & psychiatrist is recommended to avoid worse complications.

The purpose of the present study was to depict the condition of chronic schizophrenic patients and their carers after discharge regarding functions and quality of life of patients as well as carers burden. To this end a series of questionairs including family experiences interview scale (FEIS), Morningside rehabilitation status scale (MRSS) and Wisconsin quality of life (WQL) were administered on 260 schizophrenic palients and 261 carers. Finding revealed that tensions (70%) and negative emotions (94%) were prevalent in the majority of the carers. The function of caring for the ill member of the family had intrupted the routine life of most carers, more than half of the patients were moderately dependent on others, they were redundent/jobless and had limited social interactions. As for avocation 72% of patients, listened to radio or audio cassettes and did walking. Over half of the patients experienced difficulties for conducting their different functions. This group have perceived their mental health status at undesirable level. However, the patients were content with their quality of life except for inadequate recreation and feeling lonely. These findings imply the necessity for the provision of psycho-social services for patients and their carers. An emphasized component of such programme should include teaching the nature of illness as well as life skills to both groups.

This study is done to compare the long term outcome in two group of patient withsystemic sclerosis (SSc), diffuse cutaneous type (dcSSc) versus limited type (lcSSc) and determine predictive factors for specific organ involvement. Patient had to meet American College of Rheumathology (ACR) criteria for clacification of SSC eligible to study. In this study only clinically detectable antemortem evidence of organ system involvement attributable to SSc was considered. Two groups compared with regard global and local outcome and any organ system involvement and survival rate. Predictive factors for any organ system involvement analyzed. Group means were compare using 2-Tailed T-test. Dictomous variable analyzed by using chi-square test. Logestic regretion for prediction of factors on any organ involvement. Life table method was used for survival study. 38 patient entered the study. 9 patients with dcSSc and 29 patient with lcSSc type. Mean age of patient in two groups was 40.8 year. Sex ratio(F/M) was 8:1. Mean duration of disease from first symptom onset was 8.3 year for two groups. There was no difference in long term study in 6 organ system involvement, or local and global outcome variables. Survival was not significantly different (P>0.05). There was no predictive role for any variable to specific organ involvement by logestic regretion (P>0.05). No difference in long term between outcome variables and survival. No predictive factor for organ system involvement was found.

Propofol is a IV anesthetic which produces hypnosis and bispectral index (BIS), a parameter derived from the electroencephalograph (EEG), target of this study is comparing wake up time after termiation of surgery at control group which received constant dose of propofol with study group which received variable dose of propofol within BIS monitoring. This study performed on fifty patient which candidated for vertebral column surgury according to a randomed clinical trial study those receiving a propofol sufentanil anesthetic were studied in a general hospital center. Patient randomly divided to townty five persons in every group. BIS was recorded for all patients. In the BIS group, propofol were adjusted to achieve a target BIS between 40-50 in another group propofol was constant (150µg/kg). Drug use intraoperative responses and patient recovery parameter were recorded. Monitoring consist of BIS index, vital sign (HR, BP) and time of wake up was measured.Compared with the first group (BIS group), patients in the second group required propofol infusion rate (150µg/kg/min), were waked up sooner 549 vs 480 second, p<0.05, had a higher percentage of patients oriented on arrival to PACU (45%vs 19% p<0.05). total dose of propofol which consumed within surgery that last about 120±30 minutes for all patients for first group was about 980mg and for second group was 1240mg.Titrating propofol with BIS monitoring during TIVA anesthesia decreased propofol use and significantly improved recovery. Intraoperative course was not changed. These findings indicate that the use of BIS maybe valuable in guiding the administration of propofol.

DMPA ampoules have such benefits as easy usage, high effectiveness, increasing the Level of Hemoglobin in the blood of persons who use it. And it lacks increasing the risk of Termbolism toward compound drugs. But despite of the advantages mentioned above, After one or two times of injecting the ampoule many women referred to Health center and asked for discontinuing ampoule. This matter needs study and research to clarify the reasons of discontinuing ampoule, an focusing on the probable effects of this prevention method. Research was conducted with the aim of specifying the reasons for stopping the injection of ampoule in 900 women who refer to Health and Treatment centers of Iran University of Medical sciences. The data was collected during 10 months through questionare and interview with the women who stoped injecting the ampoule. Results indicated that %61 of cases discontinued injecting the ampoule after 1-2 times and %40 of cases had delayed menstruation after discontinuing it. The most important reasons of stoping the injection were disorder in menstruation (%53.6), Amenoreha (50.6), headache (%33.5) and decrease of sexual tendency (20.3). Therefor most important task of clinic staff working at family planning units, is selecting women for DMPA with notice and follow them up regularly in the case of choosing ampoule as preventive method. Then they should perform regular and periodical examinations so that they could be able to take timely appropriate action in case of occuring any problem.

This observative study was aimed to assess the frequency of knee chondrocalcinosis in patients (pt.s) with knee osteoarthritis (OA), older than 40 years, came to rheumatology clinics. 65 pt.s with mean age of 59.3 years (SD=9.1206) and range of ages 42-81 years were collected. 56 of then female and rest (9) male. 9.23% [confidence Interval (CI) 3.46.19.01] had chondrocalcinosis and grade 4 OA according to kellgren classification, all older than 60 years. It showed a prevalence of 19.35% (CI: 7.45-37.47) for chondrocalcinosis above 60 years old, suggesting the increase of its incidence with advanced age and severity of OA. Among all pt.s (65) that 84.6% (CI: 73.5-92.36) of them had advanced OA. There were only 7.69%(CI: 2.5-17) of pt.s with bone cyst. The female to male ratio of OA was 6.2 to 1, showing the higher frequency in females, the same ratio of chondrocalcinosis was 2 to 1 showing the higher frequency in males. Only 10.77% (CI: 4.4-20.9) of all pt.s were smoke and nobody of pt.s with chondrocalcinosis were smoke.87.7% (CI: 77.2-94.5) of pt.s with OA were overweight or obese. In pt.s with chondrocalcinosis (6), 1/3 of them were normal weight, 1/3 were overweight, and 1/3 were obese 61.5% (CI 48.6-73.3) of pt.s had buchard’s node or Heberden’s node or both, that showed the higher frequency of them primary OA. Most of the pt.s (66.15%) had isolated decreasing of articular space in medial tibiofemoral joint.

Fibrodysplasia (Myositis) ossificans progressiva is rare herditary connective tissue characterized by widespread soft tissue ossification and bilateral hypoplastic hallux valgus (short big toe). Onset is typically in childhood and progressive involvement of the spine and proximal extermities leades to immobility and articular dysfunction. No effective treatment is known but it is important to avoid exacerbating factors such as biopsy, operations and intramuscular injection. We present here 16 years old man with severe restriction in pripheral and axial articular movement, bilatral hallux valgus, foci of ectopic ossification in the different site of body and conductive hearing loss in right ear.

The crow-fukas, Takatsuki or POEMS syndrome (The acronym of Polyneuropathy, Organomegaly, endocrinopathy, M component and skin changes), a rare, multisystem disorder associated with osteosclerotic myeloma, is characterize by the combination of plasma cell discrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal (M) protein, skin changes, as well as various other sign, such as cachexia, fever, pleural effusion, anasarca, and thrombocytosis. Elevated level of serum interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-ل) is frequently seen POEMS syndrome is rare in caucasians population and seen more frequently in Japanese persons Treatment is the same as multiple myeloma and symptoms improve with resolution of myeloma. Prognosis is better than multiple myeloma We report interesting case from IRAN with POEMS syndrome and Rheumatoid Factor (RF) elevation. He presents with polyneuropathy, and we find out splenomegaly, adenopathy, clubbing and hyperpigmentation of skin. More evaluation showed plasmacytoma, thyroid dysfunction and elevated level of rheumatoid factor.

We reported a case of primary centeral nervous system lymphoma (PCNSL) following Behcet’s syndrome. A 24-years-old man with a past history of muco-cutaneous lesions including oral and genital aphthosis, facial acen, feet ulcer, and anterior uveitis since May 1999 visited the Behcet’s clinic and full work-up was performed. During this time. Patient showed abnormal behavior, aggressiveness and agitation. Brain CT scanning and laboratory data were compatible with Behcet’s syndrome and ite CNS vasculitis. Treatment started and continued in several stages with colchicine, prednisolone, chlorambucil and pentoxyphiline with resultant partial response. On December 2001, patient came in emergency ward with symptoms and signs of increased intracranial pressure. Brain CT scanning was done and an emergency craniotomy was performed that revealed a posterior-fossa tumor. Tumor resection done and pathological examination showed non-Hodgkin’s lymphoma (NHL), diffuse large cell type. Staging procedures was performed and showed no sign of other organ involvement. So, with impression of PCNSL, patient received radiation therapy and chemotherapy with good response. He is now under supervision of out-patient clinic. This is the second case of PCNSL associated with Behcet’s syndrome reported on the basis of literature review at the end of 2001. It seems that occurrence of NHL in Behcet’s syndrome is related to immunosuppressive state induced by therapeutic agents such as colchicine, etc. or the disease as a premalignant state. Therefore, Behcet’s patients should be under special supervision inpoint of view of developing malignancies.

In this study incidence of H.G. Prostatic intraepithelial neoplasia and concurrent Prostatic cancer is evaluated. We reviewed the slides of 137 cases of prostatic specimens (1999-2000) in hashemi nejad Hospital, that consists of needle biopsy, total prostatectomy and transurethral resection for H.G. prostatic intraepithelial neoplasia and concurrent cancer. Based on the pathologic reports, H.G. PIN was present in 50 (%36.5) of the cases, concurrent cancer observed in 31 (%62) this patients. Considering this point may help pathologists for exact follow up and early detection of prostatic cancer in patient with this lesion.

The worldwide prevalence of dyspepsia is %7-41 that less than 50% of them visit a doctor. Many sources of medical and costs servises are spend for this problem. Decision about treatment against H.Pylori is contraversy that may due to different prevalence of H.Pylori in ulcer like with non ulcer like patients who have non ulcer dyspepsia. We want assess the prevalence of H.Pylori between UL and NUL patients. This analytic cross-sectional study is done on 120 patients with NUD. Patients were symptomatic more than 3 months and were examined clinicaly and paraclinicaly(CBC, serum amylase, T3, T4, TSH, LFT, Sex3, abdominal sonograghy, ECG, endoscopy), by rule out of other diagnoses, type of dyspepsia was determined. H.Pylori was determined according to culture or urease test. T-test, Chi2, corelation coefficient were used for analysis. 68.3% of patients had H.Pylori. percent of patients with H.Pylori in subgroups of patients with NUD were significantly different (P=0.00001) but mean of age was the same. Correlation between type of dyspepsia and H.Pylori was nonsignificant. According to this study; H.Pylori or age are not efficient for a specific type of NUD. Eradiction of H.Pylori were alwayes unable forreducing of symptoms of patients in long term. H.Pylori is not a suitable cause for NUD and eradication of H.Pylori isn’t advised in all of these patients, yet.

This research was conducted to examine the effect of adding forward and backward running in a wobble training program on some of functional static balance tests. In this research 30 young male(15-35 years) with sprain of lateral ligaments (grade I,II) of ankle joint were selected by non-probability sampling and assigned randomly into three groups: Group 1 included 10 subjects that performed 15 minutes forward running training and then 15 minutes wobble board training. Group 2 included 10 subject that performed 15 minutes backward running training and then 15 minutes wobble board training. Group 3 included 10 subjects that performed just 15 minutes wobble board training. The functional static balance tests included the most possible time of standing on the injured leg in the straight posture on the surface by eye open(A), and eyes closed (B) and non-injured leg in the straight posture on surface by eyes open and eyes closed. The testing period lasted 6 weeks with 3 sessions per week. Measurments were taken at the beginning and every two weeks hence forward at 4 stages. At the end of 6 th week, the difference between 3 groups (A) statistically was not significant but there was significant difference of mean data between 2 and 4 weekstraining in 3 group (B). That is, backward running for 4 weeks has a good effect on the staticbalance by wobble board training.

In this case report we introduce 9 years old boy who had suffered recurrent bone infections including the sternum, clavicles, navicular bone, distal radius and proximal tibia since the age of 5. In every instance the diagnosis of infectious ostemyelitis was made and antibiotic therapy was instituted to which the patient did not respond. More over all the cultures taken from the affected sites were negative for bacteria, fungi and mycobacteria, and all the immunological tests which were based on the probable diagnosis of chronic granulomatous disease or other immune deficiencies proved to be negative. After being diagnosed as a case of CRMO treatment with NSAIDs successfully controlled the disease process. In 7 months follow up no new exacerbation was noted.

It has been reported that chromaffin cells secrete some neuroactive substances particularly opioid peptides and catecholamines which reduce pain. Adrenal medullary implant, have been used in other injury models to provide an endogenous source of catecholamines. The goal of the present study was to determine whether adrenal medullary implants in the spinal space could repair sensory and motor function following peripheral nerve injury. For this reason 32 male Sprague Dawley rats weighing 250-300 g were allocated to 4 groups. Unilateral chronic constriction nerve injury inuced by 4 loose ligature around sciatic nerve according to Bennett and Xie model. One week after nerve surgery some animals were implanted with either adrenal medullary tissue or control tissue. Implanted tissue were obtained from adult male rats. For implantation laminectomy at L1-L2 level has been done and graft tissue was implanted under dura. Behavioral test for sensory and motor function were done prior to nerve injury (day 0) as control and 2, 4, 7, 10, 14, 21, 28, 42, 56 days after injury. Motor function was assessed using grasping and placing reflexes. Sensory behavior was determined by passive observation of animal, mechanical, paw immersion and acetone tests. Results of this study demonstrated that chronic constriction injury produce disturbance of sensory and motor function which begins after 2 days and reaches to maximum after 10 days and adrenal medullary implants into the spinal subarachnoid space can attenuate motor and sensory dysfunction in rats with peripheral neve injury.

Post cataract operation visual acuity affected by the astigmatism which it is influenced by several factors including the suture material. This study compares 8-0 vicryl (V) and 10-0 Nylon (N) suture material for induced astigmatism and its decay in time in cataract operation. This is retrospective study of consequetive case series that underwent cataract extraction and intraocular lens implantation by one surgeon with scleral flap incision and horizontal suturing. Exclusion criteria included history of pre and postop ocular surgery topical or systemic steroid use, diabetes and less than 40 years old age. From the file of the patient age, sex, visual acuity and Keratometry of pre-op and one week, one month, 3 months and 6 months post op datas kind of sature and computer transferred to a computure. According to the type and number of suture material patients divided into V. and N. groups, and according to induced astigmatism divided into No, with the rule (WTR) AND AGAINST THE RULE (ATR) astigmatism and underwent statistical analysis by X2 tests. From 345 eyes that has complete 6-70 (Mean 18±3.2) month fallowup, 162 has been sutured by V and 183 by N. Age range was 41 to 85 (Mean 62.56±4.2) years and 47% were male. At one week post op 89.5% of V and 91.2% of N group had WTRA and no ATRA. At one month post op 38.2% of V and 33.8% of N had WTRA while 35.8% of V and 36.6% of N developed ATRA. After 3 months 3.7% of V and 4.9% of N had WTRA while 81.4% of V and 83.5% of N had ATRA. After 6 months and on final, visit 2.4% of V and 3.2% of N had WTRA and 80.8% of V and 83.6% of N group were ATRA. For each period of time there was no significant statistical differences between V and N (P>0.05) but there was statistically significant differences between preop and one week, one week and one month, one month and 3 months (P<0.05) but not between 3 months and 6 months astigmatism. There is no differences in induced astigmatism and it decay in cataract extration by scleral flap incisionn and8-0 VICRYL VS NYLON 10-0 horizontal suturing between V. and N.

The determination of birth parameters is one of the first and main works in every newborn and composed of height, weight, head and chest circumference measurements. Because of the impression of social, economical, cultural differences in fetal growth and birth parameters, the determination of these parameters seems necessary in different groups of people. In this study in 1000 health newborns, these parameters was measured and matched by the standard NCHS. This is a cross-sectional study in 1000 healthy Iranian newborn that were born at Firoozabadi hospital in Tehran. The parameters of height, weight, head and chest circumference were measured by one pediatrician and by unique tools. Multiple longitudinal regression models has been used for the prediction anthropometric characteristics. Male/Female was 1/1. The boys’ means of weight and height were meaningfully higher than the girls’ (P=0.009, P=0.003). The means of weight and head circumference were meaningfully different by the NCHS reports and were less than those. The mean of girls’ height was meaningfully more than the NCHS, but the mean of boy’s height had no significant difference by the NCHS. For prediction of height, weight and head circumference by the results of this paper and by the regression methods, some models are offered. In this study we have meaningful difference between height, weight, head circumference of both newborn sexes by the NCHS standards, which are not clinically significant, but the role of some social, economical, maternal and placental factors are important in this difference and so more researches in our country and between different groups of people is necessary.

A 68 year old lady visited a surgeon due to swelling of her right thigh for about three months. A mass was detected on examining the thigh. She had developed a mass in her right groin about three years ago, which was reported as a necrotizing lymph node. Her thigh mass was biopsid surgically, and subsequent histopathologic study supplemented by immunohistochemistry confirmed the presence of diffuse mexed small and large cell lymphoma of B cell origin. Soft tissue involvement by lymphoma is a rare manifestation of the disease, which can occur in various morphologic types and is either primary or secondary. The majority of patients are above 50 years. Althoug different anatomical locations may be involved, most reported caseshas developed in lower limbs. Other soft tissue lesions, which are more common than lymphoma, are included in the differential diagnosis, and due to different therapeutic approaches, proper differentiationand clear diagnosis of lymphoma is necessary for correct management of patients.

In a randomized double blind clinical trial study with two parallel group, we assessed the analgesic effect of perioperative magnesium sulfate administration and its effect on serum norepinephrine 24h after diagnostic artheroscopic surgery in 50 ASA physical status I & II patients under general anesthesia with total intravenous anesthesia (TIVA) technique. The patients received either magnesium sulfate 50 mg/kg preoperatively and 8 mg/kg/h intraoperatively or the same volume of isotonic solution intravenously. Anesthesia was performed with midazolam (0.2mg/kg for induction, 1µg/kg /min for maintenance) and fentanyl (3µg/kg) for induction, and atracurium (0.5 mg/kg) for intubation. Intraoperative pain was defined as an increase of systolic blood preasure and heart rate of more than 20% from baseline values (systolic blood preasure and heart rate 5 min after intubation) and was treated with bolus fentanyl (1- 2µg/kg). Postoperative analgesia was achieved with fentanyl (0.5µg/kg) and evaluated using the pain visual analog scale for 4h (0, 30, 60, 90, 120, 240min). Also 24h after surgery a blood sample was taken from the patients in order to measure serum norepinephrine. During intra-and postoperative period, patients in case group required significantly less fentanyl than those in control group (control group 75+40.18µg versus case group 41+32.97µg, p=0.002 and control group 153+65.87 µg versus case group 72+52.69 µg; p=0.001 for intra and postoperative period, respectively) but there is no significant difference in serum level of norepinephrine between two groups. (case group 0.318+0.109 versus control group 0.312+0.182, p=0.9). We concluded that magnesium sulfate, although, reduce the intraoperative and postoperative pain and fentanyl requirement, but there is no significance difference in serum norepinephrine level 24h after surgery between two groups. So reduction of pain dose not have any effecton serum norepinephrine concentration.

Helicobacter pylori is motile curved shaped gram negative and microaerophilic bacilli that positive for catalase. Oxidase and urease. Fordetection of helicobacter pylori, there are different diagnostic methods with different sensivity and specifity. The best method is histological examination and search for helicobacter pylori in the specimens by specific staining. In papers be said probably, there is corrolation between helicobacter pylori and chronic cholecystitis, which predispose to gallbladder cancer. If this relationship is approved, management of chronic cholecystitis displased from surgical to medical therapy and eliminate unnecessary thousands cholecystectomy for prevention of gallbladder cancer. In this study we evaluated 100 gallbladder specimens from paitients with diagnosis of chronic cholecystitis that undergone surgery. Initially specimens exmined for existence of gallastones, then provided small sections of body-fundus and neck of gallbladder, and after special processing stained by hematoxilin-Eosin and giemsa methods. Finally, we perform microscopic examination with power of 40 and 100 for detection of helicobacter pylori, but not found helicobacter pylorilike organism. There fore, with respect of complete negative result of our study and small percentage positive result of other study, with respect of aliveness of only 3% of helicobacter pylori in billiary secration enviroments most probably, there are not meamingfull relationship between chronic cholecystitis and helicobacter pylori. But confirming of this result requires the studies in different area and counries.

Todays coronary artery bypass graft (CABG) is the most frequent among open heart surgeries. In our country some of people that are candidate for coronary artery bypass graft, are addict and they use opium daily, that cause multiple complication during intraoperative and postoperative periods. Inspite of several studies that methadone is used to anti-addiction therapy and for reducing the complications of opium, we decided to choose methadone as perioperative narcotic. Methadone is a long acting synthetic narcotic that we think it can be a good choice narcotic for coronary artery bypass graft. In a trial study, we choose 120 cases among the coronary artery bypass graft patients. Before induction of anesthesia, all of them received 0.6 mg/kg methadone intravenously and in the postoperative period they received 0.15 mg/kg methadone intravenously. 80.83% of this patients didn’t have pain during intraoperative and postoperative periodsand we didn’t see withdrawal syndrom in intensive care unit. In 7.5% of this cases we had to use oralopium in postoperative period.