JOURNAL OF MEDICAL RESEARCH (JMR)
Year:2003 | Volume:1 | Issue:4|Papers Count:9

Background: Communication and adaptation in our world and the understanding of stimulation as well as sending optimum responses and its detection are all entities that demonstrate the need for nerve cells. The knowledge of the developmental stages of these cells can help to solve many problems in life. Materials and Methods: In this study, Nissl bodies in the perikaryon of motor neurons of the spinal cord were studied from fetal period to adult age in male cats. These changes were evaluated microscopically in 2 prenatal groups of mid-stage fetus (day 37) and late-stage fetus (day 52) and in 3 postnatal groups of newborn stage (day 1), sexually adult stage (at 6 months) and adult age (more than 1 year). Each group consisted of 3 cats. From all 5 groups, tissue sections of 5 micrometers thickness of C1, C4, C8, T4, T7, T13, L4, L7, S2 and Co1 were prepared and stained with thionine method. In all age groups, the motor neurons in IXth lamina (according to Rexed classification) were used to compare the changes in Nissl bodies. Cytoplasmic and nuclear changes of motor neurons within the ventral horns in C8, T4, L7 and S2 spinal cord segments were studied by electron microscopy (EM). The results of both methods were compared. Results: An increase in density and number of Nissl bodies in the cytoplasm of motor neurons of cats was seen with an increase in age. Lipofuscin granules and degenerated axons were also seen in 6-month-old and adult group segments by EM technique. Conclusion: It can be concluded that with an increase in the growth of animals, the size of motor neurons and Nissl bodies are increased to facilitate communication with the surrounding environment.

Background: Pain, nausea and vomiting are among the most disturbing problems after general anesthesia. Pain is the main problem following major surgeries, whereas nausea and vomiting are considered to be the most disturbing complications following strabismus surgery. Antiemetic drugs may lead to unexpected side effects such as extra pyramidal syndromes, drowsiness and hypotension. Therefore, studies are being undertaken to evaluate acupuncture for the control of nausea and vomiting. Patients and Methods: In a clinical trial, 60 patients with an age range of 5-14 years, who were scheduled for elective outpatient strabismus surgery were randomly divided into two groups of 30 patients; the case and control groups. After induction of general anesthesia with thiopental and atracurium, Pc6 (Neiguan) points of both forearms were pierced and stimulated with special needles by rotating clockwise for 15 seconds, after which the needles were removed. In the control group, patients received no antiemetic therapy or acupuncture. Maintenance of anesthesia was similar in all patients of both groups. The incidence of nausea and vomiting in the recovery room (first 2 post-operative hours) and the first day (2-24 hours after operation) were recorded. Results: In the recovery room, the incidence of nausea in the control group was 30% while this figure was 10% in the study group (p<0.05). The incidence of vomiting in the control and study groups was 20% and 10%, respectively (p=0.47). The incidence of nausea in the first post-operative day was 35.7% and 29.6% in the control and the study groups, respectively. For the same period, 25% of the control and 26% of the study group suffered from vomiting. The incidence of nausea and vomiting Oh the first day had no statistical difference between the control and the study groups and the beneficial effect of acupuncture had been disappeared. Conclusion: After the induction of anesthesia, acupuncture of Pc6 (Neiguan) points in children scheduled for strabismus surgery, effectively reduced the incidence of nausea during the patients stay in the recovery room. Repeated acupuncture or acupressure of Pc6 points are recommended in order to continue and potentate this beneficial effect in the first day following strabismus surgery.

Background: The overall mortality in civilians sustaining hepatic injuries remains in the vicinity of 10%. As 70-90 percent of all hepatic injuries are minor, complex hepatic injuries remain formidable challenges even for the most experienced trauma surgeons. Until recently, these complex hepatic injuries were associated with mortality rates often in excess of 50%. However, in the last decade a number of major changes have occurred in the way complex hepatic injuries are managed. These changing approaches have been responsible for reducing the mortality of grade III and IV hepatic injuries to less than 10%. Materials and Methods: This study was performed on 20 white young rabbits with a mean weight of 2.1 kilograms. The rabbits were randomly divided into two equal groups: A and B. Under general anesthesia with intra-venous diazepam, intra-peritoneal ketamine and ether inhalation, a midline laparatomy was performed. Liver was evaluated and a 22 cm wound was made on the right lobe. In group A, control of bleeding was done by wrapping a penrose drain on the injured site while it was filled with normal saline. Two limbs of the penrose drain were exteriorized from the lateral abdominal wall and a 3- way foly catheter was connected to one limb to measure the pressure and fill the penrose cavity. Intra-peritoneal pressure (IPP) was measured by an intra-vesicular catheter. In group B, control of hepatic bleeding was performed by perihepatic gauze packing. In both groups IPP, duration of operation, bile leakage and infection rate were recorded. Results: Operation time was 20 minutes and 40 minutes in groups A and B, respectively. Post-operation time needed for full control of hepatic bleeding was 24-36 hours and 72-96 hours in group A and B, respectively. In group A, there was no raised intra-abdominal pressure while an increase was observed in 20 percent of group B. Spontaneous displacement of penrose balloon was seen in 10 percent of group A, while no collection and bile leakage was detected. In group B, 30 percent bile leakage and subhepatic collection was seen. Mortality in group A and B was, zero and 30 percent, respectively. Severe postoperation perihepatic adhesion band was detected only in groupB (30 percent). Histopathologic study of group A showed no reaction to the penrose drain. Conclusion: This study showed that perihepatic balloon is effective in the control of hepatic bleeding due to trauma. Control of intra-balloonic pressure from outside and its removal without need for re-laparatomy eliminates most post-operation complications of peri-hepatic packing such as sepsis, increase of intra-abdominal pressure and subsequent abdominal compartment syndrome. Perihepatic balloon tamponade is an easy, safe, effective, and rapid method for control of hepatic bleeding due to trauma.

Background: Neuroblastoma is the third childhood malignant tumor and is the most common extracranial solid tumor in children, accounting for 10% of childhood cancers. It has a prevalence of ten per million. Patients and Methods: There is an attempt, in this study, to evaluate the patients (less than 18 years of age) with histopathologically-proven diagnosis of neurobalstoma who were referred to hospitals affiliated to the Shiraz University of Medical Sciences over a period of ten years (1991-2001). Results: During this time, 65 patients were admitted with this diagnosis, out of them 38 (58%) were males and 27 (42%) were females. The male to female ratio was 1.4:1. The mean age was 3.5 years with a range of 15 days to 18 years. The most common symptoms of patients at the time admission were fever (48%), anorexia (35%) and abdominal mass (26%). The common signs on admission were fever (42%), hepatomegaly (20%), respiratory distress (17%), diarrhea (15%), convulsion (6%) and proposes (6%). Forty-five percent of the patients had hemoglobin less than 10 mg/dL. Eleven per cent had a WBC count less than 4500. None of the cases were in Stage I, 10 (19.5%) were in Stage TI, 10 (19.5%) in Stage III, 29 (57%) in Stage IV and 2 (4%) in Stage IVs. The primary sites for the tumor were: abdomen (68%), chest (22%) and the neck (5%). Conclusion: In this study, male to female ratio was 1.4:1. Only 18% patients had an age of less than 1 year, 34% were less than 2 years at the time of diagnosis, which showed a delayed diagnosis. The majority of patients (81%) were diagnosed in advanced stages (III, IV and IVs) much more than in similar studies.

Background: As the expenses of patient hospitalization are high, most surgeons prefer to perform operations in out-patient departments. Many researchers have tried to find practical and scientific ways to shorten the recovery stay time in order to prevent an abundance of patients in recovery rooms after operations. Previous studies have shown that corticosteroids are useful in the control of nausea and vomiting as well as pain, which are all important factors in increasing recovery staying time after operations. Patients and Methods: In this prospective double-blind study, the effect of a single dose of dexamethasone on recovery staying time in a group of 80 patients who had undergone an anorectal surgery was studied. The patients who were in ASA class I or II were randomly divided into two equal groups. The case group (Group A) consisting of 40 patients and the control group (Group B) had the same number of patients. All the patients received 0.03 mg/kg of midazolam and 0.1 mg/kg of morphine intravenously as premeditation (preanesthetics), after which 4 mg/kg of thiopental was used to induce anesthesia. After injection of preanesthetic drugs, the cases (Group A), received 8 mg of dexamethasone (2 ml) and controls (Group B) 2 ml of normal saline, intravenously. The maintenance of anesthesia was achieved using 50% of 02, 50% of N20 and 1% halothane via a mask. The recovery staying time was regarded as the time from termination of anesthetic gases, until the patient could walk and drink. A recovery nurse, who was blind to the study, recorded nausea, vomiting and pain. Results: The results showed that the injection of 8 mg of dexamethasone intravenously could effectively reduce nausea (p=0.007), vomiting and pain (p=0.002) after out-patient anorectal surgeries and could also significantly decrease the recovery staying time of patients postoperatively (p=0.001). Conclusion: It can be concluded that a single dose of intravenous dexamethasone during induction of anesthesia could shorten the recovery staying time of patients postoperatively.

Background: Hospital wastes, contain a large quantity of dangerous wastes, which are hazardous to the health of man, animal, plant and environment. The daily increasing production of these wastes, has changed the collection, keeping and disposal of wastes to a bio-health problem which needs urgent attention. In Iran, like many other developing countries, enough attention is not paid to this matter. The present information about production and disposal of wastes in our hospitals is little and incomplete, making it difficult to plan a system for hospital waste management. In this study, the results of a survey on hospital waste management system in Fars province university hospitals, which serves as medical referral center for the southern part of the country will be presented. Materials and Methods: In this cross-sectional study, all 35 university hospitals (12 educational and 23 noneducational) in Fars province were assessed from November 2001 to March 2002 using a specific data collection form. Results: Waste generation rate in these hospitals was 3.93±3.44 kg/bed/day which included domestic waste (51.5%), infectious waste (45.6%) and sharp objects (2.9%). Lack of complete regulations for collection and on-site transport of wastes, the unsuitable treatment of hazardous wastes, disposal of hospital wastes along with house garbage (in 91.4% of hospitals), insufficient training of personnel (in 46% of hospitals), insufficient personal protective equipment (in 85% of hospitals) and lack of knowledge about their importance and use were the most important results. Conclusion: In order to improve the present situation, performing more research in the hospitals of the country on this matter as well as compilation of necessary rules and effective training of medical staff in this matter is recommended.

Background: Determination of gestational age by physical examination is possible because there is a predictable pattern of physical changes that occurs throughout gestation. This estimation is more important for infants whose gestational age is unknown or discrepant with their growth. This study compares the clinical methods as well as preclinical methods of gestational age determination. Patients and Methods: This prospective, cross-sectional study was done on 1000 neonates, born in hospitals affiliated to the Shiraz University of Medical Sciences during the first 48 hours of life. Gestational age using clinical methods (Ballard and Dubowitz), was determined and compared with the age of pregnancy evaluated by ultrasound findings and the first day of the last menstrual period (LMP). Finally these data were compared using statistical methods. Results: Determination of gestational age with clinical methods (Dubowitz and Ballard) and LMP showed a good correlation (p<0.05). Also, LMP, Dubowitz and Ballard methods had a statistically significant correlation with perinatal sonographic findings (p=0.05) Conclusion: Clinical assessment of gestational age using Ballard and Dubowitz methods, have the same predictive value as LMP and determination of gestational age by sonography.

Background: Antrochoanal polyp (ACP) is one of the rarest nasal polyps with an unknown etiology and without relation to allergy, sinusitis or lower respiratory tract diseases. Unilateral nasal stuffiness is the most common symptom and opacification of the antrum may be seen radiographically. Patients and Methods: In this retrospective study, patients with nasal polyps who underwent operation at Khalili hospital, Shiraz, during a three-year period (1995-1997) were selected. Data were collected and analyzed statistically for age, sex, clinical and pathological findings. Results: Antrochoanal polyps were present in 13 out of 122 patients with polyps which comprises 10.65% of the patients. The mean age of patients with antrochoanal polyps was 15±11 years and 34±15 years in patients with simple polyps. Both forms of polyp were more common in men. Antrochoanal polyps were unilateral in 93 percent and were on the right side in 69.5 percent, while simple polyps were bilateral in 78 percent (p<0.001).The most common symptom in ACP was unilateral nasal stuffiness (84%). There was no association between ACP and asthma or aspirin hypersensitivity. Histopathologic studies of ACP showed inflammatory polyps in most of the cases. Conclusion: Antrochoanal polyps have a higher prevalence in our region. This type of polyp has some differences from simple polyps especially regarding prevalence, pathology, pathogenesis and clinical presentation and should therefore be regarded as a separate entity.