Razi Journal of Medical Sciences
Year:2005 | Volume:11 | Issue:44 (SPECIAL ISSUE 2)|Papers Count:34

Secondary Malignant Neoplasm (SMN) is one of the late effects of childhood cancer. Among secondary malignancies, acute myeloid leukemia (AML) is the most common and life-threatening neoplasm. Secondary acute lymphoblastic leukemia (ALL) is rare and only 10% of SMN is ALL. Patients with Wilm's tumor are not protected from the secondary cancers after the primary diagnosis.Among patients with this tumor the most common SMN is AML and ALL is very rare. In this paper, we report a case of ALL, four years after diagnosis of Wilm's tumor. The patient died nineteen months after the beginning of leukemia treatment due to multiple relapse arid resistance to treatment. With advances in the treatment of childhood cancer, more children are surviving long periods of time; therefore, careful follow-up and other examination sequels are necessary for early diagnosis of SMN.

Traditionally, surgeons believe that patients should receive a physician-dieted regimen for gradual expansion of their diets following major gynecologic surgeries including cesarean section and hysterectomy. Nowadays, based on clinical trials, this belife is under serious questions. Some studies have specially shown that early oral feeding is safe and additionally reduces cost and hospital stay in gastrointestinal and colorectal surgeries. However, there is upset about the probable ileus after early oral feeding. The objective of the present study was to compare gastrointestinal symptoms and tolerance to early oral feeding after cesarean section and hysterectomy. By a randomized controlled trial, 122 women under cesarean section and/or hysterectomy were studied in gynecology department of Firoozgar Hospital during 7 months. They were randomly allocated to two groups of early (60 subject), and late (62 subject) oral feeding. Subjects in early oral feeding group received clear liquid diet within 6 hours of delivery or operation. Once 500cc was tolerated, a regular diet was given. The same protocol during 12 to 24 hours after surgery was given to late group. Exclusion criteria were: history of malignancy, bowel obstruction or inflammatory bowel disease and current or previous surgeries with extensive lysis or adhesion of the bowel. Patients were evaluated on a daily basis for bowel sounds, flatus, bowel movement, hunger, nausea, and vomiting. Two groups were compared in terms of hospital stay, nausea and vomiting and post surgery complications. T-test, chisquare, and Fisher's exact tests were used for analyzing data. The demographic characteristics of two groups were similar statistically. There was not any significant difference between groups with regard to hospital stay, and mild ileus incidence. There was more nausea and vomiting proportion in early oral feeding group than that of late group (40% versus 19%). On average, regular regimen is tolerated 4 hours earlier in early oral feeding group than late group (20.9 versus 24 hour), and this difference was statistically significant. Early oral feeding group were earlier in first bowel movement, first post operation flatus and defecation, although these differences were not statistically significant.In conclusion, early oral feeding after cesarean delivery and abdominal hysterectomy is tolerated earlier with a more rapid return to a normal diet and bowel habit.

Hearing loss is an important complication in chronic renal failure. The etiology of hearing loss is various in these patients, but uremia is the most important cause (uremic neuropathy). Other etiologies include electrolyte disorders (hyperkalemia- hyponatremia), vascular disorders, susceptibility to infections, antibiotics (e.g. aminoglycosides) and antihypertensive drugs. Studies on the effects of renal replacement therapy on hearing disorders are various and occasionally contradictory. Most studies have demonstrated that hemodialysis reduces uremia, but it is an ineffective or even intensifying treatment for hearing loss.On the contrary, renal transplantation is more remarkable in treatment of hearing disorders especially in early phase in most assessments However, it was also seen that hearing loss rebounds in later phases (as much as previous degree or even more). Although hearing is an important sense in pediatric group, a few numbers of studies have been conducted on it in this group and the assessments in adults have also had various results. Therefore, it was decided to assess and compare hearing loss and its treatment in children with chronic renal failure undergoing dialysis or transplantation in order to be able to recognize the proper treatment for hearing loss in these children. 35 patients with chronic renal failure and hearing disorder who were treated by conservative hemodialysis or transplantation were assessed from 2002 to 2003 in Ali Asghar Hospital. Audiometry was performed in low, moderate and high frequency by an experienced person. The mean age was 12 years old. 20% of patients were treated by conservative therapy, 34% by hemodialysis and 46% of patients by transplantation. Hearing loss was prominent with high frequency and no significant difference was found between these groups regarding hearing disorder.

Seizure due to fever is very common during childhood. It can simply be associated with fever without a focus for infection or can be the presenting sign of localized infections, including central nervous system infections. It is difficult to exclude meningitis merely on the basis of physical findings in children with febrile seizure under the age of 18 months. So, performing a lumbar puncture (LP) is a valuable diagnostic procedure in this group. However, despite many clinical studies in this regard, there is still controversy over doing LP. This cross-sectional retrospective study was undertaken to evaluate files of 245 patients. with febrile seizure who were between 5 months and 6 years of age and were admitted to the pediatric ward of Hazrat Rasoul Hospital over a period of 5 years (1997- 2002). The objective was to study children with febrile seizure to determine the necessity of performing LP in this group. Of 254 patients with mean age of 28.5±18.3 months, 206 (84%) had simple febrile seizures, while 39 (16%) presented with complex febrile seizure. Analysis of CSF in 9 (3.6%) patients were compatible with meningitis. 4 out of 9 patients had bacterial meningitis. Mean age of children with meningitis was 13±4 months. All children with febrile seizure and underlying meningitis were under the age of 18 months and this was their first episode of febrile seizure and none of them had clinical signs of meningitis. In those with meningitis 56.6% had complex febrile seizure. 3 (75%) children with bacterial meningitis and 2(40%) of those with aseptic meningitis had complex febrile seizures. Chi2 test results showed a significant relation (Pvalue<0.05) either between type of seizure and incidence of meningitis or type of seizure and incidence of bacterial meningitis. According to this study, meningitis was not a common finding in children with febrile seizure.However, we recommend performing LP in all children with febrile seizure under the age of 18 months. Meningitis should especially be excluded in children with complex febrile seizure.

This study was a comparative evaluation conducted to assess the effectiveness of cognitive-behavioral religious-cultural therapy in addition to medication treatment versus medication treatment alone and cognitive behavioral therapy in addition to medication treatment in improvement of anxiety disorder (obsessive compulsive). 15 obsessive-compulsive patients (5 males & 10 females) with religious background were randomly assigned into three groups: 1) Cognitive-behavioral religious-cultural therapy in addition to medication treatment (CBRCT, add. M), 2) Medication treatment alone (clomipramine or Fluoxetine), 3) Cognitive behavioral therapy in addition to medication treatment (CBT, add. M). the subjects' religious affiliation was determined by religious attitude questionnaire. All patients were evaluated before the commencement of treatment and, once again, eight weeks after the treatment by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Yale-Brown Obsessive-Compulsive Scales, a checklist of obsessive behaviors, religious beliefs questionnaire and dysfunctional attitude questionnaire. The results were analyzed and further interpreted by chi-squared test (X2) and one-way analysis of variance (ANOVA). The results showed that both cognitivebehavioral religious-cultural therapy in addition to medication treatment and cognitive-behavioral therapy in addition to medication treatment were effective in reducing the severity of anxiety symptoms, depression, obsession, and dysfunctional beliefs and attitudes. Medication treatment alone was only effective in reducing symptoms of depression and obsession, while it was not effective in reducing anxiety or dysfunctional beliefs and attitudes. Cognitive-behavioral religious-cultural therapy in addition to medication treatment was more effective than medication treatment alone, but in comparison with cognitive-behavioral therapy in addition to medication treatment was less effective. Based on the statistical analysis of findings, the addition of religious cultural components to cognitive-behavioral therapy was not necessarily effective in improvement of religious patients with symptoms of obsessive- compulsive disorder; however, the raw scores of improvement indices were higher in subjects receiving cognitive-behavioral religious-cultural therapy in addition to medication treatment than the other groups.

The effect of ultrasound waves with low intensity on reducing the time of repair and healing of bone fracture has been known. The present research was undertaken to investigate the effect of ultrasound waves on acceleration of bone growth and, finally, on repair and healing of surgical area using in-vivo animal experiment. In this study, 20 titanium implants with proper dimensions were designed and implanted in the femur bone of 20 female rabbits. They were then divided into two groups: control group (4 groups each with 2 rabbits) and experimental group (4 groups each with 3 rabbits). In the experimental group, each rabbit, after surgery and receiving implant, was irradiated for twenty minutes per day with ultrasound waves (1 MHz, 0.1 mw/cm2). The results obtained in this research, after statistical analysis, are suggestive of the fact that ultrasound waves have influences on acceleration of bone growth towards interior of titanium implants with the most rate of influence at the end of the second week of therapy. During this time, calcium distribution rate-percentage was found 66.4:H.9 in experimental group, and 52.1±4.2 in control group. Phosphorus distribution percentage was measured 32.1±1.1 and 23.2±4.6 in experimental and control group respectively (P<0.05).

Liposuction and tumescent fluid injection at the time of abdominoplasty accompanied by hazards of ischemia, flap necrosis or wound dehiscence have been reported in many recent articles. The problems that cause patients' complaint and dissatisfaction in tummy tuck operation are: fullness of flanks and epigastric areas, lack of posterior lumbar curve, hanging skin over the incision line and visible scars over the flanks and beyond the swimming suit coverage. The purpose of the present article was to introduce modalities to do proper liposuctioning of whole abdomen without confronting any ischemia or flap necrosis danger. Wide lipoaspiration at the time of abdominoplasty resulted in shortening of the incision line and removing the flanks and epigastric fullness. This study also attempted to introduce authors' experience in using a new method to omit the complications of classic abdominoplasty operation in 56 cases, operated in three-year period (2000-2003).

Blood over ordering is a common practice in elective surgeries which can be corrected by a simple mean of changing the blood ordering pattern. Nowadays, the use of Maximum Surgical Blood Ordering Schedule (MSBOS) is the accepted standard of practice for hospital blood banking almost throughout the world. Therefore, a retrospective study was carried out for the first time in Firoozgar Hospital for a period of one year (2002) to study the ordering strategies in this hospital. Blood ordering and transfusion practices were evaluated in 364 elective surgical patients including 6 common major procedures: cesarean section (C/S), thyroidectomy, total hysterectomy, laminectomy, cholecystectomy and modified radical mastectomy (MRM) with the help of different indices such as cross-match to transfusion ratio (C/T ratio) transfusion probability (TI) and transfusion index (TI). Transfusion guidelines for these 6 procedures were proposed. Due to existence of a high total C/T ratio (21.5) (accepted standard value=2.5 times) and very low utilisation percenage of cross-matched units (only 4.7%), it is concluded that change of blood ordering pattern in this hospital is necessary. Also, type and screen (T&S) procedure can be introduced in these 6 procedures as a guideline for preoperative blood ordering.

Kaposi's sarcoma is a malignant neoplasm of lymphatic and blood vessels endothelial cells. The disease is classified into four clinical subtypes, all of which are associated with human herpes virus 8(HHV-8). We report a 71-year-old man who was treated for six months with prednisolone and azathioprine for bullous pemphigoid and presented with multiple purple papules and plaques on ear, nose and fingers. Pathology of the lesions revealed Kaposi's sarcoma. Subsequently, the dose of azathioprine was lowered. There are few reported cases of Kaposi's sarcoma after immunosuppressive therapy for bullous pemphigoid and in some of these cases the pathogenic role of HHV-8 has been documented.

Concepts are the subject matter of theory. Precise development of concepts criteria and properties is crucial to the construction of a grounded theory. Theory is tentative and requires creative and imaginative judgment of the theorist. Applying analytical tools facilitates the processes essential to theory construction. For this reason, the present study was conducted with the aim of discovering the properties and dimensions of the concept to reach conceptual density, make a tentative definition of the concept, understand the meanings of the concept in different contexts and conditions to apply it in the construct of the grounded theory and, ultimately, validate the constructing elements of the theory. In this article, the concept of "perfunctory care" was developed using an integrative method which is a combination of the approaches to developing conceptual meaning proposed by Chinn & Kramer (1999) and the analytical tools of Strausse & Corbin (1998). Criteria and properties of the concept and the structure and intervening variables were identified and a definition of this concept was .presented. With accurate use of the approaches of concept analysis and application of analytical tools, analysts became confident of the reliability and validity of the developed concepts.

Self-induced injury in upper limbs is a well-known problem. Patient usually has one of these presentations: 1-wound and limb injury 2-edema 3-finger and hand deformity. In the present case report two cases of self-induced upper limb injury are presented. They were two young women with severe edema and same presenting signs and symptoms but different outcomes. Both of them underwent numerous surgical operations. Since self-induced injury can result in irreparable conditions, it is believed that self-induced injury should be suspected in the presence of prolonged edema, numerous medical consultations and operations, no established diagnosis and especially the presence of constriction type circular scars in proximal arm.

Fucosidosis is a rare hereditary metabolic disease that is resulted from a deficiency in a-fucosidase enzyme activity. This deficiency produces accumulation of fucose-containing glycosphingolipids, glycoproteins and oligosaccharides in lysosomes of liver, brain and other organs. Phenotypes of this disease are various. Most of the cases have severe form or infantile type that begins in the first year of life with psychomotor retardation, coarse facial features and macroglossia (similar to mucopolysaccharidoses), hepatosplenomegaly and skeletal disorders (dysostosis multiplex). In milder types, clinical signs begin in the second year of life. The first sign is angiokeratomas (similar to Fabry disease). After that, thick skin, puffy eyelids, spastic gait and positive Babinski appear gradually. The case of the present report was a 13-month-old girl who referred due to motor developmental delay. In physical examination, there were developmental delay, growth retardation (weight, height and head circumference<5 percentile of normal), coarse facies, macroglossia, puffy eyelids, skeletal deformities and myelomeningocele in thoracic region. Laboratory studies revealed a deficient enzymatic activity of fucosidase and nomucopolysaccha riduria.

The mainstay of pharmacologic therapy in patients with inflammatory myositis is corticosteroid and sometimes immunosuppressive drugs. However, because patients sometimes become refractory to these drugs and since these drugs have potential short and long-term toxicities, an alternate therapy is highly desirable. Therefore, a pilot study was initiated using intravenous gammaglobulin (IVIG) in the treatment of inflammatory myositis. Five adult patients (4 female, 1 male), with mean age of 49 years and chronic refractory myositis (3 polymyositis, 2 dermatomyositis) were treated with high dose of IVIG after the patients had received the following traditional treatments: Prednisolone (n=5), Methotrexate (n=2), Azathioprine (n=3), and Hydroxychloroquine (n=l). Patients received 2gr/kg IVIG 4 days per month. The clinical assessment involved the evaluation of proximal muscle power, esophageal disorder and muscle enzyme level (CPK-LDH). Mean muscle power was estimated before and after IVIG therapy and was found to be significanlty improved. Side effect was absent. One patient died due to colon cancer, and one patient with polymyositis relapsed two years after the discontinuation of IVIG. The present study showed the effectiveness of IVIG in the treatment of polymyositis and dermatomyositis, replacing or reducing steroid and immunosuppressive medication.

Angiotensin-converting enzyme (ACE) (EC: 3.4.15.1) is a peptidyl dipeptide hydrolase that removes the carboxyl terminal (His-Leu) from angiotensin I to produce the octapeptide angiotensin n. Due to the importance of ACE and its active site-directed inhibitors in the pathogenesis and treatment of cardiovascular disorders such as hypertension and heart failure, ACE purification and assay are of clinical and commercial as well as scientific interest. In the present study it was attempted to purify ACE faster and simpler. Purification procedure was finally performed in three steps. After homogenization and centrifugation, ACE was solubilized from pellet using Nonidet-P40, a non-ionic detergent. The supernatant solution brought to 50% and 70% saturation concentration of ammonium sulfate. After ammonium sulfate precipitation, the supernatant solution was used to purify ACE by Q-Sepharose HP as a strong anion exchanger and then by Sephacryl HR S200 (gel filtration). After these steps, ACE purification was confirmed by PAGEand SOS-PAGE. The molecular weight found for ACE was 175 KO. Final specific activity was 39.1 units/mg which was achieved through 651 fold purification and the activity' recovered was 5.2%. After purification, Km of ACE for Hippuryl-Histidyl-Leucine, a synthetic substrate, was 2.17 mM. Concentrations between 0.001- 0.1 mM of Captopril, a competitive inhibitor, inhibited ACE almost completely. Optimal pH determined for ACE activity was 8.3. Incubation temperature above 37oc decreased ACE activity remarkably. ACE purification in three steps (previously often in 5 steps), a decrease in purification steps, procedure time and expenditure and also acceptable activity and yield, were all due to using resins with high resolution and also FPLC (Fast Protein Liquid Chromatography) system which, finally, facilitated the chromatographic procedures.

Nowadays, many drug groups are available for prophylaxis and treatment of post-operative nausea and vomiting (PONV). These drugs can have different effects on individual patients and surgical procedures. Additionally, some of these drugs are expensive and this can be a limiting factor in their selection. Moreover, no exact protocol exists for the use of these drugs. Due to the involvement of different neurotransmitters in these phenomena (nausea and vomiting), multiple drug therapy can be more effective. Therefore, in this double-blind randomized clinical trail (RCT) study, 140 patients with intra-abdominal operation (in which PONV could be seen with high incidence) were selected and randomly divided into two groups. Later, different prophylactic measures were used in these groups and their effects were then compared. In the first group the combination of granisetron and dexamethasone was used while the combination of dexamethasone and droperidol was used in the second group in order to determine and compare the incidence of PONV24h after operation in these two groups. The- range of age was 15-50. Alcohol and drug abuse, the use of neurologic drugs, operations more than 4 hours and women in their first 10 days of menstrual period were exclusion criteria. The incidence of PONV in granisetron/ dexamethasone group was 1.4% and 23% in the other group (P=0.0001). According to this study the great efficacy of granisetron is in favor of its routine use with dexamethasone as a prophylactic measure.

The present study was undertaken to compare the gleason score and histologic grade of needle biopsy specimens to those of radical prostatectomy (RP) specimen to examine how accurately biopsy specimens reflect the corresponding excised specimens. In this comparative-descriptive study, gleason scoring was made on the needle biopsy specimens from 57 patients with prostate cancer and then on the RP specimens from the same patients, who underwent radical prostatectomy between midyear of 1998 to midyear of 2003 in two main urological hospitals of Tehran. The gleason scores of the two sets of matched specimens were compared. Then, the specimens were grouped into four main histologic grades (well: 2-4, moderate: 5-6, moderately-poor: 7 and poor: 8-10) and then were compared again. Interobserver reproducibility between the two pathologists of two centers was examined. The most common gleason score by needle biopsy and prostatectomy was 6 and 7 respectively. 43.86% of all patients had no change in score assignment, while 21.05% were overgraded and 35.09% undergraded by needle biopsy. When grouped into four histologic grades, the correlation improved, with 56.14% of patients remaining in the same group after RP, 12.2% overgraded and 31.58% undergraded. The most common histologic grade by both needle biopsy and RP was moderately differentiated. 72.73% of poorly differentiated cancer category showed the same grade after surgery and most undergrading was in the well differentiated group (50%). Positive predictive values (PPV) were almost 50% for each well, moderately and moderately-poor differentiated groups, but 72.8% for poorly differentiated tumors. Kappa value was used for the evaluation of interobserver reproducibility and there was relatively good overall agreement (kappa: 0.371, Pv=0.000).A high gleason score on needle biopsy usually indicates a poorly differentiated tumor on RP specimens; however, well differentiated tumors on needle biopsy does not correlate with final pathology grade in the majority of cases.

Cerebral aneurysms are of clinical importance regarding their fetal outcomes. The prevalence has been estimated between 2.4% and 6.8% of outopsies. Regarding the epidemiological differences of populations, the present cross-sectional study was undertaken to assess the angiographic findings of ruptured aneurysms. 50 patients with the diagnosis of ruptured cerebral aneurysms were admitted to Haftom-e-Tir Hospital in Tehran, from 2001 to 2002. Data about sex, age, risk factors, clinical presentations and angiographic findings of DSA (site, size and number of lesions) were collected and analysed via SPSS 11.5 software (presuming 0=0.05). Mean age was 52±3.4 and 52% of the patients were women. Hypertension (65.3%) was the most prevalent risk factor. 64% of the patients suffered from headache and 58% presented with loss of consciousness. The first ranked site of aneurysms was Anterior Communicating Artery (63%). The mean size was 6.9±0.9mm (±2SE).60% of aneurysms were of 6-10mm size and 8% of patients had multiple aneurysm. The findings of this study about sex, site, size and risk factors, are in accordance with other studies. Higher prevalence of aneurysms in patients younger than 30 years old, fewer cases with multiple aneurysms and more than half of patients with loss of consciousness are the main considerable differences.

Anterior cruciate ligament (ACL) and meniscus injuries are the most common injuries in athletes.History, physical exam, MlR, arthrography and arthroscopy are used to confirm the diagnosis. In the present observational descriptive analytical study, the diagnostic value of clinical test was compared with arthroscopic findings. 68 athletes suspected of meniscus or ACL injuries, were selected by history and physical exams after completion of data sheet. McMurray test, joint line tenderness and Latchman test were performed and then diagnostic arthroscopy was done. Diagnostic value of each method was compared. Clinical results of joint line tenderness and McMurray test were positive only in 58% of the patients with concurrent ACL and meniscus injury. However, in pure meniscus injuries, joint line tenderness was positive in all of the cases. Isolated ACL injuries (29%) and concurrent ACL with medial meniscus injuries (29%) were the most common injuries in arthroscopic findings. Bucket handle tearing was the most common type of meniscus injuries and Latchman test was positive in 90% of the cases with ACL injuries. It seems that in isolated meniscus injuries, performing clinical test has high diagnostic value. However, in concurrent cruciate ligament and meniscus injuries, the clinical tests have low diagnostic value in assessment of ACL injuries.

Helicobacter pylori (HP) infection is always with active chronic gastritis, but there is no agreement on the role of HP in esophagitis. Recent articles have noted the protective role of HP in the incidence of esophagitis in patients with gastritis. The goal of the present research was to assess the relationship between HP and esophagitis incidence in patients with gastritis. This cross-sectional study was undertaken on 92 patients with gastritis who had referred for endoscopy to Firoozgar Hospital between 2002 & 2003. Urease test and endoscopy were used for diagnosis. Of 92 patients, 56(60.9%) and 36(39.1%) cases were with and without esophagitis respectively. Esophagitis frequency had significant difference in different kinds of gastritis with (Pvalue=0.003). There was not any significant difference between esophagitis frequency in patients with and without HP infection. In patients with esophagitis the HP frequency in non-infected patients was more than HP infected patients and in patients without esophagitis the HP frequency of infected patients was more than non-infected patients with HP. Based on the obtained results, esophagitis was more in cases with gastritis B. There was not any significant difference for HP infection between patients with and without gastritis and, therefore, it is concluded that there is not any relationship between HP infection and esophagitis in patients with gastritis.

The objective of the present study was to evaluate the frequency of ovarian tumors over a 20- year period and the age distribution of these tumors. A retrospective study was performed on ovarian tumors which were diagnosed in Shariati Hospital between 1976-1995, and had pathologic report. Frequency and age distribution of tumors were then evaluated. Of 493 evaluated ovarian neoplasia, surface epithelial tumors seen in 283 cases (57.4%) were the most frequent tumors. After that there were germ cell tumors in 152 cases (30.83%) and then sex-cord stromal tumors in 31 cases (6.28%). Metastatic tumors were in 24 cases (4.86%) and the 3 remaining cases were 2 cases of luteoma and 1 case of chondroma. The most frequent benign neoplasia of ovary was dermoid cyst (mature cystic tratoma) (39.53%) and after that scrocystadenoma (29.24%) and mucinous cyst adenoma (14.82%). The most frequent malignant neoplasia of ovary was malignant scrous tumors (53.69%) and after that there were metastatic tumors (16.1%) and mucinous cyst adenocarcinoma (14.09%). The greatest numbers of patients (111 cases) were in 21-30 age groups and after those 99 patients were in 51-60 age group and 96 patients were 31-40 years old. In our study, surface epithelial tumors were less than the other world statistics and germ cell tumors were more than other studies which was probably due to younger age of our patients (the most frequent number of patients were in 21-30 age group). Metastatic tumors were more frequent in this study and it is probably because of late diagnosis of malignancies. In sex-cord stromal tumors the most frequent number of tumors was fibrothecoma in this study, whereas in the other studies, the most prevalent sex-cord stromal tumor is granulosa-theca cell tumors. Racial factors may have a role in these differences.

Complications, specially infection after orthopedic surgery, can result in severe disability in patients. Efforts have been done to use inflammatory factors such as Erythrocyte Sedimentation Rate (ESR), C - reactive protein (CRP) and White Blood Cell Count (CBC) to predict infection after surgery and to indicate that the courses of these factors are predictable. The aim of the present study was to characterize the changes of CRP, ESR and WBC after elective orthopedic surgery. In 94 patients who underwent elective orthopedic surgery and had normal values of inflammatory factors such as ESR, WBC and CRP serial measurements of CRP, ESR and WBC were done before and 1, 3, 5, 7, 14, 28 and 59 days after surgery from December 2002 to February 2003. The results indicated a maximal count of WBC on the first day after surgery, maximal CRP values on the third day and maximal ESR rates on the fifth day after surgery. Changes of WBC were irregular, but ESR and CRP, after achieving maximal values on mentioned days, became respectively normal after 28 and 14 days following post-operation. Age and sex did not influence the pattern of changes but extensive surgeries were accompanied with higher values of ESR and CRP. Pattern of changes in CRP and ESR values are so typical that any deviation from this pattern can indicate occurance of complications such as infection. CRP was sensitive than ESR in this regard.

Cadmium (Cd) is an environmental contaminant and an important toxic chemical with teratogenic and embryotoxic effect. Chronic human exposure to Cd will result in kidney injury. The present investigation was conducted to study the effects of cadmium chloride (CdCI2) on structural changes in rat embryo and neonate glomeruli. Thirty female Sprauge-dawley rats with mean weight of 180-240 gr were used in this study. They were classified into 6 quintet groups. On the 9th day of pregnancy, 2mgjkg Cadmium Chloride was injected intra peritoneally in right lower quadrant of abdomen in groups I & III, 4mgjkg in groups IIl & IV and only 1mljkg Normal Saline in groups V &VI. Left kidneys were removed in groups I, II &V on the 21st day of pregnancy and in groups III, IV and VI 3 days after the birth. Specimens were fixed with bouin's solution and stained with H&E for microscopic changes examination including: glomeruli number, diameter and morphology. The results showed that prenatal exposure to CdC12 can induce significant changes in the histometry and differentiation of glomeruli. Such changes appear to be restricted to the late prenatal and early postnatal period and to occur in the absence of other overt signs of toxicity.

Maintenance of cardiac output in normal range to assure tissues and vital organ perfusion is one of the most important tasks of anesthetists. Hemodynamic and cardiac indices (e.g. cardiac output) change due to either anesthetic drugs or changes in body position during various surgical operations and they have also been important and notable problems. The goal of the present study was to determine the preference of one of volatile or intravenous anesthetic methods in patients in sitting position in terms of adequacy of perfusion to vital organs. We studied combination of two different factors: sitting position and anesthesia regimen in 38 patients undergoing the same type of surgical operation on shoulder (rotator cuff repair). Patients were anesthetized in two different methods after similar induction of anesthesia, and then they were randomly assigned into volatile (Halothane) and intravenous (Propofol) groups. Patients' cardiac output was measured in several minutes in sitting position during surgery. Finally, it was found out that there was no distinctive difference between mean cardiac output in two groups and no hypothesis was proved for preference of one of these methods of anesthesia to another.

Respiratory Syncicial Virus (RSV) is the major cause of bronchiolitis and pneumonia in children younger than one year and the most important respiratory pathogens in early childhood. The objective of the present study was to determine the frequency of respiratory syncicial virus infection and its clinical manifestations in children with acute lower respiratory infection in Rasoul-e-Akram Hospital in 2001. This descriptive cross-sectional study was carried out on 83 cases (between 2 months to 14 years of age) with acute lower respiratory infection hospitalized after taking nasal swabs and performing IFA. Positive IFA was compared in patients by SPSS9 software based on age, sex and clinical manifestations. Mean age of patients was 5.88 months. Twenty cases (23% of the patients with acute lower respiratory infection) were RSV positive. Male/female ratio was 1.8 and most of the patients were between 2 to 6 months old. The most common clinical manifestations in RSV positive, in both sexes and in all age groups were: cough, fever, rhinorrhea, wheezing and respiratory distress and 25% of cases had a history of allergy. According to statistical findings, there was not any relationship between frequency of clinical manifestations and sex. Also, there was no significant difference between the mean age of the cases with a same clinical manifestation and those without them. Therefore, unnecessary use of antibiotics can be decreased by considering clinical manifestations and performing IFA for diagnosis of RSV respiratory infection, especially, in less than 6 months infants with acute respiratory infection in cold seasons.

One of the major problems in all kinds of sports, specially bodybuilding and powerlifting, is anabolic steroids abuse. Common and sometimes life-threatening complications of these drugs have always been important among athletes. The use of these drugs was common among athletes in 1950s, and since then, there have been some reports from all over the world about their complications. Liver tumors, gynecomastia, short stature in adolescents and hair loss in athletes are some of the most common complications. Due to some reports about anabolic steroids abuse in athletes in our country, this study was undertaken to determine the frequency of using anabolic steroids and athletes awareness of them. In this cross-sectional study, 403 bodybuilding athletes from 9 clubs in Karaj were studied through a multistage random sampling method. Method of collecting data was a questionnaire with 25 demographic and specific questions about athletes' awareness of anabolic steroids complications. SPSS software (ver 11), chi-squared test, t-test, correlation and ANOVA were used for data analysis. Athletes' mean age was 22.6(±8) and most of them had education under diploma (47.1 %). Proportion of the current use of anabolic steroids among athletes was 13% and former use of these drugs was reported in 13% of the athletes. Oxymetholone was the most common anabolic steroids among athletes (16.7%) and 22.2% of them used injectable drugs. The total score of the questionnaire was 400, out of which the mean score of athletes' awareness was 66.8. The highest score belonged to Nandrolone complications. There was a significant positive correlation between athletes' awareness of anabolic steroids and their age, level of education and their experiences. On the whole, the history of at least single use of anabolic steroids in athletes' was 26% which is a high and worrying proportion. Athletes' awareness of drug complications was very low; therefore, making them aware of these complications and conducting researches on young people's attitude towards these drugs is recommended.