Razi Journal of Medical Sciences
Year:2006 | Volume:13 | Issue:50|Papers Count:34

Background & Aim: Apart from poor cosmetic appearance, the most important potential consequence of spinal deformities is cardiorespiratory function. However, one of the reasons that patients discontinue wearing orthosis seems to be an increase in energy expenditure during activity apart from its cosmetic problem. The purpose of this study was to assess the effect of Milwaukee brace on energy expenditure indices of male adolescents with flexible thoracic kyphosis.Patients & Methods: In this semi-experimental study with repeated measurement manner, nineteen male adolescents with flexible thoracic kyphosis aged between 13-17 years were selected by non-probability method. They had worn the orthoses for at least 3 months and did not have any limitation in physical activity or any history of cardiovascular or respiratory disease. After recording anthropometric data and information, based on clinical examinations, Bruce test was performed for evaluation of them on treadmill in 3 distinct sessions. After doing the test, heart rate, VO2max, speed, incline and the duration of activity was recorded from monitor.Results: Statistical analysis showed that means of heart rate, VO2max, speed, incline and the duration of activity on treadmill had significant difference with patient condition(with and without brace). That means all of these parameters increased when the test was performed while the individuals did not have their braces on during the activity. Conclusion: Greater amount of energy expenditure indices of subjects during activity on treadmill without brace is probably because of being less limited and having no load on them. Subjects could spend more stages of the test and involved with more difficulties with speed or incline of the treadmill. Comparing the means of heart rate in every minute of subjects’ activity with and without brace revealed that recorded heart rate was higher in every minute while the subjects’ performance with brace indicated that brace acts as a load or a limiting factor during activity. Therefore it is concluded that the use of Milwaukee brace increases the total energy expenditure of adolescents with kyphosis deformity during physical activity.

Background & Aim: Enterococci comprise an important and diverse group of bacteria that cause disease in human and animals. They reside in the gastrointestinal tract of human and animal, soil, water, foods, and can persist in elevated salt contents and various pH values. They can readily acquire antibiotic resistance and various other virulence factors. In this study, the prevalence of various virulence factors among different clinical isolates versus those isolated from healthy individuals was compared.Material & Methods: In this analytic cross-sectional study, enterococcal strains isolated from clinical and healthy cases were tested for various virulence related properties such as hemolysin, gelatinase, hemoglutinin, DNase, and fremone(aggregative substance) production. T-test and chi-square test were used for analysis of the data and their antibiotic resistance patterns were also determined. The ability to exchange resident plasmids via conjugation was tested by two different mating protocols.Results: The frequency of gelatinase, aggregation substance, and hemolysin production was higher in E.faecalis relative to those in E.faecium. However, no statistically significant difference was detected in the other trains. Fremone-responsive plasmids were common in most isolates and had the ability to transfer between strains with high frequency (10-4-10-7). Most isolates contained one or more plasmids in the 3-98 MDa range. Two isolates showed total resistance to all of the antibiotics tested. Antibiotic resistance genes had the ability for conjugational inter-strain transfer. The prevalence of aggregative substance in the strains isolated from clinical cases was much higher than those obtained from the control group (P<0.001).Conclusion: Since no known protein ecotoxin was identified in enterococci, their pathogenic potential may be attributed to a variety of extracellular enzymes, antibiotic resistance, aggregative substance, and other factors. Their importance in medicine is related to their ability to acquire antibiotic resistance and cause nosocomial infections in hospitalized and debilitated patients. The statistically significant higher proportion of aggregative substance in enterococci spp, isolated from sick people in comparison with those obtained from healthy cases, points to the pivotal role conjugational gene transfer may play in the acquisition of pathogenic potential.

Background & Aim: Gastric ulcer is the result of imbalance between the effect of protective and destructive factors on gastric mucosal layer. There are so many proposed destructive factors including acid, bile, nonsteroidal anti-inflammatory drugs(NSAIDS) and increased gastric motility. In this study we examined the time course effect of water immersion stress on gastric motility.Material & Methods: Male wistar rats were immersed in 20-25°C water for 2 hours. After water immersion the rats were sacrificed at 30 min, 1 h, 6 h, 12 h and 24 h intervals and the stomaches were excised. Transverse strips of the fundus region were prepared and placed in organ bath containing modified Krebs solution perfused with carbogen gas (95% O2, 5% CO2) at 37°C. The contractile activity of the strip was recorded using an isotonic transducer (preload 2g) on NarcoBioSystem physiograph. The amplitude and frequency of the spontaneous contractions were compared to their relevant control groups using student t-test (Pvalue<0.05).Results: No significant change was noticed between the water immersion stress groups and their relevant controls except in 24 h group. The amplitude of spontaneous contractions increased by 161%. Conclusion: In previous studies it has been shown that shortly after water immersion stress, gastric mortility increases in live rats. In the isolated fundus strip model, it was noticed that the increase in contractile activity of the stomach occurred only 24 hours after water immersion stress. This may lead us to the conclusion that there are gastric as well as nongastric factors involved in water immersion induced gastric hypermotility. Nongastric factors (e.g. vagus nerve, systemic hormones and …) act rapidly and their effect can be seen shortly after the stress in live animal models. However, in isolated fundus strip model, which is free from nongastric factors, a late increase in gastric motility can be seen. This may be due to the synthesis of cell made products like Immediately Early Genes (IEGs), Heat Shock Proteins (HSPs) and so on. Further work is needed to prove this theory.

Introduction: Aneurysmal bone cyst (ABC) is a benign lesion with variable and expansile growth that can occur in any part of the skeletal, mainly in long bones and vertebra. ABC in paranasal sinuses is rare with only 7 previous cases having been describes in the ethmoid, sphenoid and frontal sinuses. Case Report: We present a case of ethmoidal sinus ABC in a 15-year-old female presenting nasal obstruction, epistaxis, proptosis and lateral displacement of left orbit.Conclusion: PNS-CT revealed an expansile mass centred over the left ethmoidal sinus extending to left orbit and anterior cranial fossa with destroying the fovea ethmoidalis. MRI revealed the presence of a large cystic expansile mass and presence of multiple fluid levels within. Complete en-bloc excision was performed by using left frontal craniotomy approach, followed by immediate reconstruction of the nasal vault by using a split calvarial bone graft in combination with left ethmoidectomy and partial maxillectomy using left lateral rhinotomy approach.

Background & Aim: Clonidine, an alpha 2 agonist, attenuates sympathetic responses during general anesthesia and improves the intra-operative hemodynamic stability. In this randomized double blinded clinical trial study, we report the effects of 300 μg oral clonidine premedication (n=22) or placebo (n=22) on hemodynamic alteration during gynecologic laparoscopic surgery, under general anesthesia. Previous works have reported the effectiveness of clonidine on blunting the sympathetic responses during open surgeries.Patients & Methods: Anesthesia consisted of isoflurane/O2 and remifentanil. Muscle relaxation was maintained by cisatracurium. Hemodynamic data were obtained at 5 epochs: base, after induction of anesthesia, insufflation (after peumoperitoneum, supine position), trendelenburg 30 degrees, and end (after supine extubation.Results: There was a significant increase in systolic blood pressure during peritoneal insufflation and trendelenburg position in patients in the control group (129±23, 115±29 mmhg) compared with patients in the clonidine group(126±34, 116±25 mmhg), P<0.05. Peritoneal insufflation and trendelenburg positioning resulted in significant increase in systolic blood pressure compared with base, in patients in both groups (control 127±15 mmhg to 129±23 & 126±34 mmhg; clonidine 109±19mmhg to 115±29 & 116±25 mmhg, P<0.05). After extubation, there was significant increase in diastolic BP in clonidine group: (98±32 mmhg vs 86±8mmhg in control group). During laparoscopy, there was a significant increase in diastolic BP in the control group (89±16 mmhg vs 75±18 mmhg in clonidine group; P<0.05). There was a significant increase in diastolic BP in the patients in clonidine group (98±32) compared with the patients in control group (86±8) P<0.05. There was significant slower HR during the procedure in both groups (71±29 bpm, 63±22 vs base 85±22bpm, 85±39).Conclusion: It seems that clonidine can not blunt the hemodynamic responses in hyperdynamic phases after gynecologic laparoscopy in spite of its effectiveness during the procedure.

Introduction: Extracranial meningioma is a rare tumor which is located in middle ear, temporal bone, sinonasal cavity, oral cavity, parotid gland and soft tissue of head and neck.Case Report: The case of the present study was a 67-year-old male patient who referred with pain complaint during flexion of neck from 5 years ago and palpable mass in posterior neck triangle from 2 years ago.Conclusion: Fine needle aspiration was performed and epithelial lesion was reported. Finally excision of the mass was performed and the diagnosis of meningioma was made. This diagnosis was confirmed by immunohistochemical staining which were vimentin, EMA positive and GFAP negative.

Background & Aim: Evidence has revealed that opioids can produce antinociceptive effects by interacting with opioid receptors in peripheral tissues. The present research was undertaken to compare the effects of morphine with bupivacaine and with mixture of two drugs intra-articularly upon post-operative pain following arthroscopic knee surgery. The objective of this study was to find out whether intra-articular injection of morphine or local anesthetic (bupivacaine) has an analgesic effect on relief of pain after arthroscopic knee surgery and which of these drugs or mixture of them are more effective for the relief of pain.Patients & Methods: This double-blind study was done on 40 ASA I patients with 20-50 years of age. Patients were divided into four groups. At the end of arthroscopic surgery group A received 10mg morphine, group B 50mg bupivacaine (0.25%), and group C received 10mg morphine with 50mg bupivacaine (0.25%) intra-articularly. Group D was the control group. Anesthesia protocol was similar in all patients. Post-operative pain was controlled in 2, 4, 6, 8 and 24 hours after surgery with VAS (visual analouge scale). Data was analysized via t-test & SSEP Software.Results: Findings showed that intra-articular morphine produced an analgesic effect with delayed onset and long duration, but intra-articular bupivacaine produced an analgesic effect with fast onset but short duration.Conclusion: Intra-articular morphine and bupivacaine together produce a fast, long and desired analgesic effect after arthroscopic knee surgery.

Background & Aim: When inner ear is disturbed, both hearing sensitivity and selective property decrease. Early rehabilitation for proper progression of speech and language appropriate to age is mandatory. Several studies were performed to compare factors that affect the results of cochlear implantations to select the best candidates on the basis of different criteria. This study was undertaken to compare speech perception and intelligibility between two groups of hereditary and non-hereditary deaf patients.Patients & Methods: In this descriptive-comparative study, prelingual patients (below the age of 7) who had profound deafness (unable to identify sounds with severity of>90 dB) and admitted to Rasoul-e-Akram Hospital(1992-2004) were assessed by census method. For determination of speech perception a standard CAP test as well as a standard 2-syllable words test was used and for determination of speech intelligibility a standard SIR test was used after 2 years of cochlear implantation. Relationship between parents and the existence of another deaf person in the family, with absence of definite cause for deafness, were considered as a hereditary deafness while other cases were considered as non-hereditary deafness.Results: The mean age of patients was 71.47 months with SD=35.51. 42.5% of cases had hereditary and 57.5% of them had non-hereditary deafness. The mean perception scores of 2-syllable words were 45.78% (SD=34.73) and 46.28% (SD=33.85) in hereditary and non-hereditary deaf children respectively. Between two groups of hereditary and non-hereditary deaf children there was no significant difference in terms of frequency of different levels of speech perecption and mean percentage of two-syllable-word perception(the median of speech perception level in both hereditary and non-hereditary deaf children was the discrimination of some speech sounds without lip-reading). Also, the frequency of different levels of speech intelligibility (the median of speech intelligibility level) in both hereditary and non-hereditary deaf children was intelligible speech if someone concentrates. There was not any significant difference between speech perception or intelligibility and the mean perception scores of 2-syllable words in hereditary and non-hereditary deaf prelingual profound patients.Conclusion: Being hereditary or non-hereditary subject is not a helping factor to choose candidates for cochlear implantations.

Background & Aim: Ethnicity and location are among the factors that affect the time of puberty onset. There are few studies concerning the age of puberty in Iranian children. The aim of the present study was to evaluate the age at the onset of puberty in Iranian schoolgirls and schoolboys living in Tehran. Patients & Methods: This cross-sectional study was conducted between 2001 and 2004 on 2212 children consisting of 1420 6-17-year-old healthy schoolgirls and 792 6-15–year-old healthy school boys living in Tehran, Iran. Samples were collected on the basis of a multistage probability sampling. All the samples, examined by a physician, were evaluated with regard to the secondary pubertal characteristics, and asked about the presence of menarche. All pubertal characteristics were evaluated by inspection, while budding breast was by palpation. General additive logistic modeling method was used for the analysis of data and the estimation of the probability of pubertal stages.Results: The median age (percentile 10, percentile 90) of G2 and P2 in boys were 9.01(90=11.84) and 10.34(6.84- 13.10) years and the median age of B2 and P2 among 1136 girls were 9.74(8.23-11.94) years and 10.49(8.86-12.17) years, respectively. There were 399 girls who had experienced menarche with the median age of 12.68(11.27-15.96) years.Conclusion: The time of the onset of secondary pubertal characteristics among Iranian girls is similar to other white girls but the onset of puberty seems to be earlier among Iranian boys in comparison with reports from the other countries.

Background & Aim: Patients admitted to intensive care units require sedation. The usual drugs for this issue include benzodiazepines, opioids, barbiturates, and hypnotics. This study was conducted to compare the sedative and hemodynamic effects of morphine and remifentanil in traumatized patients requiring intubation and mechanical ventilation in intensive care unit during the years 2003-4.Patients & Methods: This study was performed as a randomized controlled clinical trial at the surgical intensive care unit. 60 patients with an age range of 18-80 were enrolled in this study. The patients were randomly categorized into morphine and remifentanil groups. The first group was given a 5 mg bolus dose of morphine and the second group received an infusion of remifentanil starting with 0.05μg/kg and the doses were sequentially increased to reach a sedation state of 3-4 according to Ramsey scale. The regimen was continued as maintenance for 24 hours, during which blood pressure, heart rate, and respiratory rate was monitored every 4 hours. Data was analyzed using SPSS software.Results: A total number of 60 patients aged 18-80 yrs (mean age of 42.53±18.5 yrs) consisting of 37(61.7%) male and 23(38.3%) female were equally categorized into two groups. The mean blood pressure of the morphine group was 109.12±1.68mmHg and that for the remifentanil group was 90.01±6.66 (P<0.00). The mean heart rate of the aforementioned groups were 101.89±2.31 and 95.06±10.15 (P<0.00) and the mean respiratory rate was 19.95±2.49 and 19.24±4.37 (P<0.4) respectively.Conclusion: Although remifentanil induced an initial decline of blood pressure, it maintained the pressure in a rather steady state during the period of infusion (24 hours) compared with that of morphine. Therefore, in situations in which an initial decline of blood pressure is not considered a threat, remifentanil provides a more stable condition for the patients.

Background & Aim: Chronic hepatitis is a common liver disease which can be caused by various viral and non-viral agents. The chronic hepatitis prevalence is high in Iran. After 50 years of introducing this disease, yet there is unknown etiology in some cases. The aim of the present study was to determine the frequency of pathology findings regarding Ishak system in chronic cirrhosis patients in order to have an accurate diagnosis and more appropriate clinical decision making.Patients & Methods: This observational cross-sectional study was performed on biopsy samples related to 40 chronic hepatitis and cirrhosis patients admitted to Rasoul-e-Akram Hospital from 1997 to 2002. These samples were scored according to modified Ishak system. Chi-square test, one way ANOVA and K.S were used for analyzing the data. Results: Patients’ mean age was 51.1± 3.3 (42.1% female and 57.9% male). Grading and staging of biopsy samples regarding Ishak system were as follows: 7 patients (pts.) (17.5%) minimal chronic hepatitis (grades 0, 1), 15 pts., (37.5%) mild chronic hepatitis (grades 2-6), 7 pts., (17.5%) moderate chronic hepatitis (grades 7-11), 10 pts., (25%) severe chronic hepatitis (grades 12-16), 1 pt., (2.5%) active cirrhosis (grades 17, 18), 8 pts., (20%) stage 0, 8 pts., (20%) stage1, 5 pts., (12.5%) stage 2, 9 pts., (2.5%) stage 3, 4 pts., (10%) stage 4, 5 pts. (12.5%) stage 5 and 1 pt., (2.5%) stage 6. In analytic assessment there was significant statistical association between staging and grading of disease (P=0.000). Also, staging and grading of disease had statistical relation with hepatic encephalopathy, history of ascitis and increasing age of patients (P<0.05).Conclusion: Clinical importance of scoring system reveals itself when physicians and specialists face problem in diagnosing some diseases. The use of Ishak scoring system is suggested for evaluating chronic hepatitis in order to have appropriate diagnosis and monitoring treatment.

Background & Aim: Nasal polyp is a common finding in patients referring to ENT specialists. Also, some specialists believe that there are patients with nasal polyp and some evidence of fungi. The present study was undertaken to describe coincidence of nasal polyp and fungi in patients referred to ENT ward of Rasoul-e-Akram Hospital in Tehran. Patients & Methods: 118 patients with nasal polyp (62.7% male and 37.3% female; mean age 35 years, ranged 12- 70) were investigated in a cross-sectional study.Results: 52.5% of the patients had high total serum IgE level. Direct examination and culture for fungi was positive in 32.5% and negative 36.4% of the patients. The most common isolated fungus was aspergillus (50.9%). Other fungi were candida (34.5%), penicillium (7.3%), alternaria (5.5%) and curvularia (1.8%). Mean age of patients with fungal infection was higher than patients with negative fungal culture result (40y vs. 35y; P=0.06). Patients with high serum IgE level were more infected with fungi (49% vs. 14%; P<0.001).Conclusion: Results showed that in nasal polyposis, a special attention must be paid to patients with high serum IgE and fungal infection.However, most of our patients had chronic sinusitis as well as polyps in their medical history which may affect our results. Therefore, further studies on patients suffering from nasal polyps and those cases with fungal sinusitis are suggested.

Introduction: We report a case of sarcomatoid transitional cell carcinoma of urachus in a 53-year-old man with unusual and very rare pathology. Case Report: The patient was operated for BPH a year before his admission. He complained from abdominal pain and palpable tumoral mass in left rectus muscle for five months. At follow-up, abdominal ultrasonography showed one semi echo mass in left rectus muscle. Then, abdominal and pelvic CT scan with double contrast study revealed asymmetric enlargement of the left rectus muscle. The density of the muscle was in homogeneous central hypodensity region. Suggestive of chronic resorbing hematoma, abscess or rare tumoral lesion, cystescopy showed no space occupying lesion in mucosa of bladder, but external pressure was identified in dome of bladder. The patient was operated with possibility of soft tissue tumor of abdominal wall and with high probability suspect for sarcoma or desmoids tumor. Post-operative pathological diagnosis was sarcomatoid transitional cell carcinoma of urachus.Conclusion: In review of the literature we found only one case with TCC of urachus, and to our knowledge no case of sarcomatoid TCC of urachus has been reported before.

Background & Aim: A total number of 1760 renal transplantations (Tx) have been performed at Hashemi Nejad Hospital since 1986. The results of the first 1350 consecutive renal Txs were previously reported in Clinical Transplants (2000). During the recent years (1996-2005), the ratio of renal Tx from living unrelated donor (LURD) to living related donor (LRD) has markedly increased and majority of renal Tx recipients have received Mycophenolate Mofetil (MMF) instead of Azathioprine (Aza) in their immunosuppressive regimen. This study was carried out to evaluate the short and long- term results of kidney transplantation in Hashemi Nejad Hospital 1996-2005 (group B) and compare them with the results during 1986-1996 (group A).Patients & Methods: On the basis of transplantation date, patients were divided into two groups: Group A(1986-1996) consisted of 863 renal Tx recipients. 572(66.3%) were male and 291 (33.7%) were female with mean age of 33.4±10.9 years. 365 (42.4%) of the renal allografts were from LRDs and the rest were from LURDs. The majority of patients were on Cyclosporine (CsA), Aza and Prednisolone. Group B (1996-2005) consisted of 878 renal Tx recipients. 527(60%) were male and 351(40%) were female with mean age of 38±12 years. 66 (7.5%) of renal allografts were from LRDs and remaining 812 (92.5%) were from LURDs.613 recipients received MMF. The statistical analysis was done via SPSS 9.1. t-test, chi-square and logistic regression analysis were used to compare the groups. Patient and graft survival and their risk factors were estimated by Kaplan- Meier method and Log rank test. Results: The findings showed that the patient survival rates were not significantly different in two groups (P=0.28). The overall graft survival rates were 90.76%, 74.7% and 61.6% at one, 5 and 8 years after Tx respectively. These data showed a statistically significant improvement in graft survival rates in comparison with similar data of years 1986-1996 (85.02%, 65.32% and 54.6% P<0.001). Among risk factors of age and gender of donor and recipient, date of Tx, related vs. unrelated Tx, HLA and immunosuppressive regimen, graft survival rates in patients who were on MMF were significantly better compared to patients who were on Aza (P<0.05).Conclusion: Improvement of graft survival rates in 1996-2005 in comparison with 1986-1996 report showed the beneficial effect of MMF, which compensated for the adverse effect of HLA mismatching (higher percent of LURD) in kidney graft survival.

Background & Aim: Secondary amyloidosis (reactive) is an important late complication in chronic imflammatory disorder such as rheumatoid arthritis. The present study was undertaken to determine the prevalence of secondary amyloidosis in rheumatology patients with rheumatoid arthritis (RA) and assess associated clinical and laboratory characteristics.Patients & Methods: In this cross-sectional study, 220 consecutive patients (167 female/53 male) with a history of minimal 5 years of RA were selected from 2 rheumatology clinics during 2001-2003. Abdominal subcutaneous fat pad aspiration (ASFA) was performed and specimens were stained with congo-red and observed under polarized light microscopy. Clinical and laboratory characteristic were then assessed via t-test, chi-square test & SPSS software.Results: Amyloid was positive in 11 patients (5%) by ASFA and all had 1+ deposit. 7 (64%) patients had constipation and 6 (55%) of them had proteinuria.Conclusion: These Iranian patients with RA had a low prevalence of amyloid deposition, about half of them were subclinical. Follow-up studies are needed to investigate whether this subclinical amyloidosis will progress into clinically significant amyloidosis or not.

Background & Aim: Measuring the length of kidneys is an important issue in diagnosis and treatment of renal diseases. In various diseases, kidneys become larger or smaller than normal. Ultrasonography is a suitable method for measuring renal length because it is accurate, noninvasive, available and with low cost. Nowadays, multislice spiral CT scanners are widely used for evaluation of renal diseases and are capable of making different reconstructions on images including multiplanar reconstruction (MPR) and in many situations, measurements like measuring renal length are done on these reconstructed images. Hence, knowing the accuracy of measurements on reconstructed images is very important. This research was done to evaluate the accuracy of renal length measurement on multiplanar reconstructed images of spiral CT scan.Patients & Methods: In a cross-sectional study, spiral CT scan was performed on all of the patients referred to CT scan department of Hashemi Nejad Hospital for abdominal CT scan during July and August 2004. Multiplanar reconstruction was carried out on all of the images and the maximum length of kidneys was measured. Then ultrasonography was done for all of the patients and the maximum length of kidneys was measured as gold standard. The lengths of kidneys obtained from these two methods were compared with each other.Results: 40 patients (80 kidneys) with the mean age of 42 years were evaluated. Analysis with SPSS and paired t-test revealed that the mean renal length at ultrasonography was 107.1 mm with standard deviation of 12.08 and the mean renal length at spiral CT scan was 110.18 mm with standard deviation of 11.93. The mean length of kidneys resulted from ultrasonography was 3.08 mm less than the mean length of kidneys resulted from multiplanar reconstructed images of spiral CT scan, and considering P<0.05, the difference was considered significant. Conclusion: Measuring the renal length on reconstructed images doesn’t have enough accuracy. Therefore, in situations when knowing the exact size of the kidney is important, measurements should be done on the basic CT images(without reconstruction) or on other methods like ultrasonography.

Background & Aim: Dietary isomeric trans fatty acids are suspected to increase the risk of coronary artery disease. The fatty acid composition of human adipose tissue is a useful biomarker of the long-term average of dietary fat. In this population-based case-control study the association between trans fatty acids intake and the risk of coronary artery disease was investigated.Patients & Methods: Adipose tissue samples were obtained from 112 patients aged between 20-75 with angiographically proved coronary stenosis who referred to Tehran Rajaee Cardiovascular Center. The healthy control subjects included 70 individuals without any history of heart disease. Adipose tissue fatty acids were determined by gasliquid chromatography technique.Results: There were no differences between patients and controls in any of the adipose tissue trans fatty acids measurements. Patients had lower levels of linoleic acid (18:2). Odds ratios (OR) were calculated from logistic regression analysis. Adipose tissue t-18:2 were positively associated with risk of coronary artery disease. An association between t- 16:1 and t-18:1 was not detected. Adipose tissue trans fatty acids was positively correlated with LDL-C/HDL-C (r=0.11, P=0.049). Adipose tissue t-18:2 was positively correlated with LDL-C (r=0.15, P=0.04). The results also showed that Iranian subjects had higher proportion of adipose trans fatty acids than subjects from other countries.Conclusion: These findings suggest that dietry intake of total trans fatty acids is associated with increase in the risk of coronary artery disease and trans isomers of linoleic acid is even more associated with increase in the risk of coronary artery disease. These associations need to be confirmed by further studies.

Background & Aim: The effect of food and drink consumption and their variation on acute myocardial infarction incidence has been investigated in several studies. The objective of the present study was to investigate correlation between nutritional risk factors and acute myocardial infarction.Patients & Methods: This case-control study involved 250 patients with acute myocardial infarction as the case group and 250 ones without acute myocardial infarction as the control group. Paired matching was done in terms of sex and age. All subjects were those referred to Imam Khomeini Hospital in 2003. The method of sampling was non-random sequential and data was gathered through interviews. Statistical analysis was done via t-test, chi-square test and odds ratio. Type one error was 0.05.Results: The mean age was calculated to be 54.8 (±11.9) years. The most common type of oil for cooking in both groups was vegetable oil. In the case group, beer drinking was more common than the other group (P=0.009, OR=1.1). The consumption of tea and meat was significantly more in the case group (tea: P=0.005, meat: P=0.003). Fresh fruit and dairy products were mostly used by the control group (P=0.000). Eating fish, eggs, grains, salty foods, vegetables and sugar were equal in both groups.Conclusion: A perfect dietary regimen plays an important role in the prevention of coronary artery diseases and people should be informed about it so that they can use an alternative dietary regimen.

Background & Aim: The indications for fine needle aspiration (FNA) cytology of ovarian cysts are controversial. Some authors contend that the procedure is never justified since diagnostic accuracy of the method is low. The others contend that FNA of the ovarial lesion has a useful role in the evaluation of persistant ovarian lesion in the premenopausal women who wish to preserve fertility. The aim of this study was the assessment of diagnostic value of aspiration cytology in ovarian mass lesion.Patients & Methods: In this analytic cross-sectional study, during a 2-year period, the cytology of 79 aspirates from women between 20-56 years of age was examined. Ovaries submitted for pathologic examination were then grossly examined. Fluid was removed by needle aspiration and prepared for cytologic examination. The cytologic findings categorized as non-neoplastic (follicular & non follicular cyst) and neoplastic (malignant & benign) were then correlated with histologic findings. SPSS software and chi-square test were used for data analysis.Results: Thirteen out of 15 (86%) malignant lesions were correctly diagnosed as malignant by cytology & there were 4 false positive results. On the other hand, 15 out of 25 (60%) follicular cysts were correctly diagnosed by cytology and there were 8 false positive results. In malignant lesions sensitivity was 86% and specificity was 91%. In follicular cyst, sensitivity and specificity were 60 & 81% respectively.Conclusion: Aspiration cytology is an accurate predictor of malignancy in ovarian lesion but one should not rely on cytology alone. It is difficult to distinguish between follicular and non follicular lesion by cytology alone and ancillary study such as hormonal study (estradiol) must be used for improvement of diagnostic accuracy of the procedure.

Background & Aim: AMI is a major coronary disease that causes a high degree of death and disability. Worldwide death rate from AMI is declining and a significant cause of this decline is due to diagnosis and treatment. However, results indicate that many patients are deprived of proper treatment. In the present study AMI quality improvement program in Yazd Afshar Hospital was implemented to improve the quality of in-hospital AMI care.Patients & Methods: This study had 3 stages: 1- baseline assessment, 2-feedback and intervention and 3- remeasurement. To quantify baseline situation, 143 AMI patients who were admitted to Afshar Hospital during one year (2003) were studied. Later, a group discussion and baseline results feedback were arranged and then the group selected an educational plan to improve the quality. Booklets and posters were prepared based on hospital AMI guidelines and then distributed. After intervention, AMI patients admitted to hospital were assessed for 4 months (during 2004) again.Results: In baseline assessment, aspirin and b-blocker administration at admission for eligible patients was 86.1% and 79% respectively. Among patients who received thrombolytic, only 50.5% received it in less than 30 minutes from hospital arrival and mean time to thrombolysis was 44.38 minutes. No patient during hospital stay took advice/counseling for smoke cessation and echocardiography was performed for 44.3% of patients. Aspirin and b-blocker in discharge were administred for 41.9% and 36.6% eligible patients respectively and 20% of heart failure patients were administerd ACE (inh) at discharge. In-hospital deaths were a little more than expected (relative hospital mortality=1.12). Remeasuring and comparing the results showed significant improvements in smoke cessation advice/counseling, performing echocardiography during hospital stay and in administration of aspirin, b-blocker, and ACE (inh) at discharge. Improvement caused by aspirin and b-blocker at hospital admission was not statistically significant.Conclusion: There are many opportunities for care improvement in this hospital and quality improvement program can be effective. In short, continuation and development of this program in Afshar Hospital and the initiation of such programs in other hospitals are suggested.

Background & Aim: Studies have shown that umbilical coiling index(UCI) can have clinical importance. The present study was undertaken to evaluate the relation between umbilical coiling index(UCI) and adverse perinatal outcome. Patients & Methods: In this prospective cross-sectional study performed in Akbar Abadi Hospital(Tehran), between March 2003-July 2004, 699 pregnant women and their umbilical cord were evaluated. All women were 37-40 weeks of gestation with singleton and cephalic fetus. Umbilical coiling index(UCI) was determined by dividing the total number of the complete vascular coilings by total umbilical cord length centimeter. UCI under the tenth percentile(less than 0.17) was defined as hypocoiled and UCI between the tenth and ninetieth percentile(0.17-0.37) was defined as normocoiled and UCI above the ninetieth percentile(more than 0.37) was defined as hypercoiled cord. Then, the relation between UCI and maternal age, parity, neonatal weight, amniotic fluid index(AFI), meconium in amniotic fluid, maternal diabetes and hypertension, Apgar score, and delivery intervention due to fetal distress were evaluated.Results: Mean UCI in cases was 0.25±0.09 coil/cm. 534 cases (76.4%) were normocoiled, 87 cases(12.4%) and 78 cases(11.1%) were hypercoiled and hypocoiled respectively. There was no statistically significant correlation between UCI and maternal age and parity. There was statistically significant correlation between UCI and neonatal weight of more than 4000gr, and less than 2500gr(mean 19.02±12.41 versus 31.32±12.76) respectively(P=0.000), Apgar score less and more than 7 in 5th minute(mean 28.04±13.58 versus 25.06±8.7 respectively)(P=0.038), AFT≤5 and AFT>5 (mean 29.1±11.44 versus 24.91±8.82 respectively)(P=0.001), meconium in amniotic fluid or no meconium (mean 28.9±9.94 versus 24.57±8.8)(P=0.000), maternal diabetes or no diabetes(mean 11±13.48 versus 25±8.6 respectively)(P=0.000), maternal hypertension and no hypertension(mean 22.96±12.62 versus 25.45±8.7 respectively)(P=0.047) and finally fetal distress or no fetal distress(mean 32.14±10.43 versus 24.43±8.6 respectively) (P=0.000).Conclusion: Abnormal UCI correlated with adverse perinatal outcome which can probably be used as a sonologic marker for finding the fetus at risk.

Background & Aim: Crystalloids represent an attractive strategy to alleviate intravascular volume deficits. Studies have demonstrated that hemodilution with decrease antitrombin III is associated with hypercoagulability. However, there were not any researches about effect of different crystalloids on coagulation. The present study was undertaken to find out which of the used crystalloids has more effect on coagulation. Patients & Methods: In a prospective study on patients undergoing ACL reconstruction normal saline(NS), Ringer(R) and Ringer Lactate(RL)(n=25) were used for intravascular volume replacement based on standard protocol to compensate intravascular volume deficits. PT, PTT, BT, CT and platelet count were used at T0 (after induction of anesthesia), T1 (immediately after anesthesia), T2(6h after surgery) and T3(the morning after surgey), for comparing coagulability in groups.Results: Changes of coagulation at T1 in all groups were not significant. Mean (±SD) of coagulation tests at different times in all groups were statistically significant in PT(P=0.001), PTT(P=0.001), and CT(P=0.001) and not significant in BT & PLT(P>0.05).Conclusion: No differences between NS, R & RL were seen in coagulation tests and coagulability. However, hypercoagulability states were seen after hemodilution.

Background & Aim: Eighty percent of primiparous women face sexual problems after delivery and in two-thirds of them the problem remains for six months. Identifying this problem, increasing health team’s knowledge and consultation with couples about sexual problems can play an important role in decreasing these problems. The present study was undertaken to determine sexual problems resulting from delivery in primiparous women.Patients & Methods: In this cross-sectional study sexual problems of primiparous women before and after delivery were determined and compared. Data were collected through self-reporting questionnaire. 160 primiparous women were selected through consecutive sampling.Results: Findings showed that painful penetration, dyspareunia, itching after intercourse, lack of vaginal lubrication, loss of sexual desire, difficulty in reaching orgasm and anal sexual relation increased after delivery(P<0.05). There was a significant relation between decreased sexual desire and marriage duration, pain during intercourse with number of intercourse per week, pain during  intercourse with time of first intercourse, and anal sexual relation with kind of delivery(P<0.05).Conclusion: Data indicated that sexual problems increased after delivery. Therefore, it is recommended that sexual problems after delivery should be placed on the list of health teaching issues and sexual problems of men be investigated.

Background & Aim: Increased antibiotic resistance of organisms in recent years is a worrisome problem. This problem is greater in third world countries due to antibiotics misuse, cultural problems and etc. Various countries of the world report their antibiotic resistance results every year to help clinicians use appropriate treatment strategies. We have also observed dramatic increase of antibiotic resistance in our country in recent years. The most important aim of this research was to represent increased antibiotic resistance in Iran to warn medical practitioners against unnecessary application of antibiotics and make government change agricultural, husbandry, and other strategies.Patients and Methods: This study was performed on 700 aerobic micro-organisms separated from abscesses and wounds during 1999 to 2003 in Firoozgar and Hazrat Rasoul Hospitals. Micro-organisms were cultured on blood agar mac conkey media and then their antibiograms were performed with standard antibiotic disks and results were reported in the form of percent resistance percentage.Results: The most prevalent organism responsible for wounds and abscesses is staphylococcus aureus followed by gram negative organisms like E.coli and Klebsiella … Percentage of antibiotic resistance (resistance to three or more antibiotics) is 77.7 for staphylococcus aureus, 96 for pseudomonas, 100 for acineto bacter, 77 for E.coli, 90 for klebsiella and 83 for enterobacter. These results are significantly greater than reports from other countries even in third world countries like Pakistan and Saudi Arabia. Ciprofloxacin (after vancomycin) and amikacin and ciprofloxacin are the best drugs with the least resistancy for gram positives and gram negatives respectively.Conclusion: This study clarified that antibiotic resistance situation is worrisome in Iran and strategies such as avoidance of inappropriate antibiotic application, their misuse in agriculture and better hygiene and sterilization in hospitals are strongly recommended.

Introduction: Solid and cystic papillary epithelial neoplasm of pancreas is a rare neoplasm with low malignant potential which often occurs in young women. The tumor is usually large and encapsulated. Microscopic examination reveals small round cells with papillary-configuration in a delicate vascular stroma. Case Report: The cases presented in this report were 2 women at the age of 15 & 26 who were both injured by striking. Radiologic findings revealed retroperitoneal mass. Both patients have not had any problem after surgery yet.Conclusion: In this neoplasm, surgery is treatment of choice and definite diagnosis is made by histology and immunohistochemistry. Patients have excellent long-time prognosis.