Jundishapur Scientific Medical Journal
Year:2008 | Volume:7 | Issue:1 (56)|Papers Count:26

Medical science has been one of the important aspects of the Iranian civilization. The climax point of the history of medicine in ancient Iran is the establishment and development of the Gondi-Shapour (GS) University. GS was a city located in the North of Khouzestan Province between Shooshtar and Shush. In 271 AD. the city was built by the decree of Sassanian King Shapour I (241- 272), in the memory of the celebration of his victory over Valerian, the Roman Emperor, by using the Roman and Greek prisoners of war.After half a century, King Shapour II (309- 379) chose the city as his capital, creating grounds for further development in all fields. When the Roman Emperor (Zeno) closed down the important scientific centers of the Nestorians in Raha City, he gave shelter to the Nestorians and embraced their physicians into GS. The transference of the Greek heritage into GS by these physicians played an important role in advancement of this science in Iran. In 531 AD., Khosrow-Anoshirvan (531- 579) acceded to Sassanian throne in Iran. He was an educated man interested in sciences and scientists and intended to make his court more glorious by inviting the learned men of that age. So, he paid a special attention to developing the medical hospital and School of SG. He invited some Greek and Roman physicians to teach and conduct research in SG and dispatched some physicians such as Borzuye to India to learn medical tradition of that land. Also when the Attenian Schools were closed down in the age of Justinian, he welcomed the scientists of these schools. In fact, he established a link between the scientific heritage of the east and west of that time within the format of this university. He also established some well-disciplined regulations to administrate the physicians' affairs. He created a well-planned organization to test the physicians and grant their academic degrees.In 651 AD at the end of the Sassanian dynasty, the GS city was captured by the Arabs and then gradually declined toward the end of the century. The head of the GS hospital, a Christian by the name of Goargis-Bakhtisho was called to Baghdad by the Caliph, Mansour Abbasi (136-158 AH.) and this resulted in the gradual closure of the hospital to patients. In 1955, after the lapse of twelve centuries, the new GS University was established in Ahvaz city, the capital of Khouzestan Province, where the College of Agriculture had already been created and then the college of medicine was initiated (1956). In 1968, the university hospital of Jundi-Shapour started to teach medical students. In 1986, this university was divided in two branches: Ahvaz University of Medical Sciences (AUMS) (having 8 colleges) and Shahid Chamran University of Ahvaz (having 13 colleges). Both of them share the same university campus. In 2004, the name of AUMS was changed into Ahvaz Jundi-Shapour University of Medical Sciences (AJUMS).

Objective: The causes of abortion are numerous and is performs in different ways all over world and sometimes is associated with irreversible damages and even death. Abortion is indicated only in life threatening cases for mother and before fetus is viable and when the fetus begins to move in the uterus that which usually in forth month of pregnancy. In spite of the importance of this phenomenon, no sufficient data on abortion status, its causes and complications is available in Ahwaz. The aim of this study was to address the phenomena in our city.Subjective and Methods: In this one year (2004) descriptive cross-sectional study, 85 females who referred to imam Khomainey and Razy Ahwaz University hospitals and have undergone abortion were the subjects of this study. The required data were collected by completing a questionnaire.Results: The most common age (29.4 %.) of abortion was 21-25 years old. The most common cause of abortion (37.64%) was accidental or spontaneous abortion. The most common criminal abortion (30.58 %) was due to unwanted pregnancies and the common which was self inflected induction method was administration of drugs in 46.7 % of these cases. The common complication after abortion was hemorrhage which occurred 20% of cases. Among the studied population, 44.7% had intermediate economic status. The most common place for abortion was in hospital; however, 18% of abortions were carried out in private clinics and were not prosecuted. Forty seven percent of persons had strong religious beliefs.Conclusion: The results from this study demonstrated that the most common underlying cause of abortion was unwanted pregnancies and the most implicated group was in the 21-25 years old. It seems that lack of knowledge among this group of mothers on contraception methods, dangers associated abortion and prosecutions that may follow criminal abortion are important aspects that need to be considered for reduction of this undesirable act.

Objective: Non-ulcer-dyspepsia (NUD) is the fullness of abdomen after meals, early satiety, bloating but nausea or burning sensation, heart bum or pyrosis without epigastric pain. The aim of the present study was to evaluate the role of Helicobacter pylori H pylori the pathogenesis of NUD and assess the effectiveness of eradication of HP in its improvement.Subjects and Methods: This clinical trial study including 90 patients of NUD and positive for HP. Upper GI endoscopy and rapid urease test were carried out. These patients were divided into two groups. Treatment group received omeprazole 20mg BID, furazolidone 100mg TDS, amoxicillin 1000mg BID and bismuth subcitrate 120 mg QID) for 14 days and followed by two weeks of omeprazole 20 mg BID. The eradication of HP was confirmed by upper GI endoscopy and antral and body biopsy for pathology six weeks after the end of treatment. The controlled group was treated with omeprazole 20 mg BID for four weeks. Both groups were treated with H2 antagonist for a further one year period. The patients were followed up at three month, six and twelve months. The data were analyzed with per protocol analysis. Results: During follow up of three, six and twelve months, the incidence of improvement in symptom in control group was greater, especially during the twelve months follow up. The improvement was statistically significant. Satisfactory improvement was seen in 28 patients (70%), unsatisfactory improvement were seen in 12 patients (30%) in treatment group, in comparison with them control group in which satisfactory improvement was seen in 16 (41%) and, unsatisfactory improvement in 21 (59%) patients (P=0.01). The rate of improvement in clinical symptom in both group had no relationship with sex, education, psychiatric medications, occupation, cigarette smoking and the number of family members. But significant improvement in symptoms was seen in control group patients aged less than 39 years old) P<0.01). Side effects associated with drugs was higher in the treatment group (P<0.05). Conclusion: The findings from this study suggest that eradication of H pylori in treatment of NUD is a useful measure in the treatment of patients suffering NUD with positive H pylori.

Objective: During labor every woman is likely to be apprehensive about some aspect of labor. Patient's morale is important in progress and outcome of labor. Mother's anxiety can cause release of catecholamine’s and decrease uterine contraction, A Supportive companion is a great source of strength to the woman. This study evaluates the effect of labor support from a supportive companion on labor process.Subjects and Methods: This clinical trial was conducted on 150 prim gravid women who randomly assigned into either a supported group (n=75) or a control group (n=75). In additional to the routine care, the women in the supported group received continuous support from a female companion, who was from the patients' family or a friend and has experienced at least a successful vaginal delivery). The companion person accompanied the patients from the time of admission to postpartum ward. The support provided were: encouragement, appeasement, touch, patting and reassurance.Results: Continuous labor support by a companion significantly reduced length of active phase (P<0.01), need for oxytocin augmentation (P<0.01), pain intensity (P<0.05), cesarean section (P<0.05) and increased mother's satisfaction of childbirth experience (P<0.001), but length of the second stage of labor was not significantly affected.Conclusion: Labor support from a companion person is an inexpensive and uncomplicated method that has significant positive effects on labor process.

Objective: The most common presentation of severe hemophilia is the hemarthrosis that can lead to severe and permanent morbidities. This study was performed to assess the condition of joints of Hemophilic patients who routinely refer to our Shafa's hospital and to determine the amount of factor 8 consumption over one year in relation to age, severity of their disease and degree of joint involvement. In addition, to compare of these findings with similar studies in other countries.Subjects and Methods: In this study, hemophilic patients were visited and examined for the number of involved joints and their severity of arthropaty on Gilbert's scale. The amount of factor 8 consumption for each patient was computed from their record. Clinical findings from patients' examination and their records were processed for obtaining the frequency tables for their age, type and severity of hemophilia and also for number and severity of joints involvement and mean annual factor consumption.Results: A total of 138 cases were assessed in this study (mean age 21.8 years), 112 of these cases (81 %) had type A, 26 cases (19%) type B hemophilia. In terms of severity of the disease 97 case (70%) were severe, 26 cases (19%) moderate and 15 cases (11%) had mild form of the disease. The mean of the number of joint involvement was 3.43 and the mean of physical examination of joints on Gilbert's scale was 14.6, and for severe form this was 17.9.Knee was the most involved joint (113 case). The mean of factor 8 consumed over one year for type A was 38770 ID and for type B was 23562 ID.Conclusion: The mean Gilbert's scale was higher than reported in similar studies in France and Spain. However, the mean factor consumption over year was lower. The finding of this study suggests that the control of Hemarthrosis as well as its outcome in our patients is not good. Lacking a proper prophylactic or curative policy for these patients can lead to a huge economic burden for our health system.

Objective: Musculoskeletal disorders (MSDs) represent one of the leading causes of occupational injury and disability in the developed and industrially developing countries. For this reason, many researches have been conducted on MSDs and risk factor evaluation techniques. This study was conducted among workers of a rubber factory in Shiraz with the objectives of a) determination of WMSDs prevalence and b) evaluation of level of exposure to WMSDs risk factors. The results of this study can be used to develop WMSDs preventive strategies in the workplace and improve workers' health.Subjects and Methods: In this descriptive cross-sectional study, all 16 production units of the factory were studied. In each unit, 50% of the workers were randomly selected and included in the study. Totally, 454 workers participated. Nordic Musculoskeletal Questionnaire (NMQ) was used to study prevalence of WMSDs and QEC technique was applied to evaluate physical exposure to the risk factors. Photography technique was used to collect required data from each worker and each workstation. In all, 56 workstations were photographed. Data was analyzed using SPSS (VersionI3).Results: Means of age and job tenure were 29.8±7.3 and 6.6±6.1 years, respectively. 73.6% of the workers suffered from some kind of symptoms during the last 12 months. The highest prevalence was reported in lower back (50.2%), knees (48.5%) and upper back (38.1%). Statistical analyses showed that there was an association between the QEC level of risk and MSDs symptoms (P<0.001).Conclusion: This study demonstrated that WMSDs occurred at a high rate in the study population. Major ergonomic problems were found to be awkward postures, manual material handling and back rotation and bending. Furthermore, based on the results, QEC was found to be an appropriate and reliable technique for evaluating level of exposure to WMSDs risk factors Implementation of interventional corrective measures to reduce level of workers' exposure to WMSDs risk factors was essential.

Objective: Growth and development are the characteristic features of childhood. Growth is the increase of height and weight along the time. Intrauterine growth retardation (IUGR) is defined by a birth body weight deviation greater than two standard deviations from the population mean, and is presented in two forms: symmetric and asymmetric. The aim of this study was to evaluate the prevalence of intrauterine growth retardation and its pattern among neonates born in Imam Khomeini university hospital in Ahwaz.Subjects and methods: In this cross-sectional study, all neonates borne in the first 6 months of 1384 (2005) in Emam Khomeini university hospital of Ahwaz were studied. Gestational Age (according to LMP & Ballard criteria), body birth weight, length and ponderal index (PI) were measured among IUGR neonates. Calculation of PI was made by use of the following relationship: PI= [weight in g x 100 /(height in cm)3]. Correlation of PI with sex, gestational age, parity, maternal education and age were also assessed.Results: The prevalence of IUGR in our study was 4.03%. Where 80% of these cases were asymmetric and 20% symmetric, with 60% males and 40% females. There was a direct correlation between PI and sex (higher in females), maternal age, gestational age to 40th week and parity. But there was no significant statistical correlation between PI and maternal education.Conclusion: The prevalence of IUGR among our study population was high and it seems that determination of PI is a simple and appropriate method for assessment of proportion ofIUGR neonates. Promotion of knowledge of family and society, and attention to daughters' health from early childhood is recommended.

Objective: Advancements in fixation devices and techniques in orthopedic surgery during the recent decades have brought about an increase in operative indications of fracture fixation. However, in spite of these advances the rate of infection ranges between 0.8 to 1.2% for Total Hip Arthoplasty (T.H.A), 3.6 to 8.1% for closed fractures and 17.5-21.2% for open fractures. The aim of the present study was to evaluate the prevalence and correlate the factors affecting the development of infection among orthopedic patients requiring fracture fixations in our centre.Subjects and Methods: This study was carried out during the period of 1383-1384 in orthopedics ward of Ahwaz Razi Hospital. All patients who were admitted due to upper and lower extremity fractures and had undergone fracture fixation operations were included in this study. The patients were followed up and assessed for clinical and laboratory findings of infection. A specimen from deep tissues was taken for microbial testing and personal data regarding age, sex and predisposing factors were recorded in a questionnaire.Results: During the period of this study, 1573 patients had undergone fracture fixation which including 1239 (78.8 %) men and 334 (21.3%) women. There were 1349 closed fracture (85.8%) and 224 open fractures (14.2%). Overall 60 patients (3.7%) showed clinical and laboratory findings of wound infection. In 56 cases the fractures were in lower extremity and 4 in the upper extremity. Infection rate in closed fractures was 1.55% vs 17.41% for open fractures, the rate of infection increased with severity of fracture type I to IIIc. The most common recovered microorganisms were Pseudomoras (23.3%), Klebsiella (21.6%) and Staphylococcu aureus (11.6%). Twenty five % of patients were smoker (>= 10 cigarettes/day), 8.6% had UTI and 6.6% had history of diabetes.Conclusion: The rate of infection in closed fractures in this study corresponds to universal data. However, infection rate in open fractures and especially type II & III (a,b,c) was higher than expected. Among the predisposing factors are smoking more than or equal to 10 cigarettes/day.

Objective: Hospital observation along with repeated clinical examinations commonly use in patients with an equivocal diagnosis of appendicitis. The aim of this study was to assess the value of repeated clinical examinations in patients with non-specific abdominal pain in a university hospital in Hamedan.Subjects and Methods: Two hundred patients with equivocal diagnosis of appendicitis underwent a prospective study in Hamedan during year 2003 to 2005. We excluded patients with obvious evidence of acute appendicitis in a first clinical evaluation. From the time of admission, all the patients were examined and re-examined repeatedly every 4 and 6 hours during day and night shifts respectively for a maximum observation time of 48 hours. In patients who underwent surgery, the diagnosis was confirmed by pathological assessment. All the data were extracted manually and analyzed by SPSS 13 software with descriptive and analytic methods (Chi square and student t-test). Statistical significance was established at P<0.05.Results: The mean age was 25.03±11.53 (58 males and 142 females). There were no differences between male and female groups according to age and diagnosis. One hundred and fifty six (78%) patients were discharged without any surgical intervention and 44 patients underwent surgery. Among the operated cases, three patients had negative appendicitis and the rate of negative appendectomy was 6.82% with positive predictive value of 92.7%. Conclusion: Repeated examination is useful in accurate diagnosis and reducing unnecessary appendectomy in patients with equivocal signs and symptom of non-specific abdominal pain.

Objective: Post-operative shivering is a common complication following both general and spinal anesthesia. Tramadol is one of the drugs used for prevention and treatment of this complication. The aim of this study was to assess its effectiveness in prevention of postspinal anesthesia shivering among pregnant women undergoing elective cesarean section.Subjects and Methods: In this double blind randomized clinical trial. 90 pregnant women with ASA I & II who were referred for cesarean section under spinal anesthesia, were divided in two groups. At the end of surgery and during skin closure, tramadol 1 mg/kg (in 20 ml normal saline) was injected by slow IV in the studied group. Control group received 20 ml of normal saline. Vital signs (PR, S&D BP, SPO2) were checked at the end of injection, and 5, 10, 15 minutes after injection. Oral temperature, nausea and vomiting, and incidence of postoperative shivering and grading of shivering were recorded in both groups. The resulting data were analyzed by Chi square test.Results: Post-anesthesia shivering was detected in 39 women (86.6 %) in the control group and in 4 patients (8.8 %) in tramadol-treated group (P<0.001). Mild and moderate shivering was detected post-operatively in 6 (13.3 %) and 33 (73.3 %) of control group and 2 (4.4 %) and 2 (4.4 %) of tramadol group respectively (P<0.001). None of the patients in either group developed severe shivering. No significant differences in two groups in respect to homodynamic variables and SPO2, body temperature and nausea and vomiting were observed.Conclusion: This study showed that tramadol is an effective drug in prevention of post-spinal anesthesia shivering with no hemodynamic, SPO2, body temperature and nausea and vomiting side effect. Therefore, tramadol is recommended in prevention of post operation shivering in women undergoing post-spinal elective caesarean section.

Objective: Proteinuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients. Blockade of the renin-angiotensin system is an established strategy to interfere with progression of renal failure in diabetic patients. Angiotensinconverting enzyme inhibitors (ACEls) and Angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Combination of renin-angiotensin system (RAS)- inhibiting therapy provides additive benefit in type 1 diabetic patients with diabetic nephropathy. This study tested whether this dual blockade is superior to either drug alone in type 2 diabetic patients with diabetic nephropathy (DN).Subjects and Methods: To assess and compare the effects of enalapril (up to 40 mg/day), losartan (up to 100 mg/day) and combination therapy (enalapril up to 40mg/day plus losartan up to 100mg/day) on urinary protein excretion and renal failure progression. 144 type II diabetic patients with diabetic nephropathy (proteinuria>300mg/24h) and normal or slightly reduced renal function (Cr clearance = 76±42mL/min) were enrolled in a twelve months, prospective, open, randomized trial. All patients were re-evalated after 2, 6 and 12 months. Results: One hundred and forty four type 2 diabetic patients with DN (88 male and 66 female; mean age: 53±16.32 years) were recruited. Renal function, estimated by creatinine clearance, remained stable throughout the study. Hyperkalemia was more frequent in patients treated with enalapril alone or enalapril plus losartan (P<0.002) than in those on losartan alone. The blood pressure goal (<125/75 mm Hg) was achieved by week 8 in all treatment groups (P<0.005 when compared to baseline). Proteinuria decreased significantly in all patients after two months (P<0.001) and remained stable afterward. At the end of study proteinuria was reduced significantly (P<0.05). Combination therapy was statistically more effective in proteinuria reduction than treatment with losartan alone (P=0.021) and than treatment with enalapril alone (P=0.018). Conclusion: Dual blockade of the RAS with both an ACEI and ARB is associated with more reduction in proteinuria to either drug alone in type 2 diabetic patients with DN. Antiproteinuric effect during the combined therapy was not related to changes in renal function and blood pressure.

Objective: Toxoplasmosis is a zoonosis and has a worldwide distribution. It is caused by Toxoplasma gondii. The incidence of this infection depends to climates, feeding habits and contact with cats. The aim of this study was to evaluate the prevalence of sero-positivity against Toxoplasma gondii among childbearing age women in Ahwaz city.Subjects and Methods: In summer 1382, 400 blood samples accumulated randomly from women who referred to health center of 17 Shahrivar for routine examinations before marriage and these samples were evaluated by method of ELISA-IgG for presence of antitoxoplasma IgG and a questionnaire was completed answered for assessment of risk factors for acquisition of the infection.Results: Antitoxoplasma IgG was positive in 103 samples (25.8%) and this was not statistically correlated with educational status, place of living (rural or urban), eating of raw or under cooked meat, close contact with cats, and contact with soils of garden or contacts with raw meats.Conclusion: our study showed that According to this study 74.2% of these women in Ahwaz city were seronegative. This rate is high so a large percent of childbearing age women in Ahwaz city are prone to acquisition of active infection. Therefore educational programs and health recommendations should be suggested to prevent the risk of acute toxoplasmosis.

Objective: Stroke one of the most common diseases in neurology and is the third cause of death in old age. Impairment of motor power and other neurological deficits and imposes a significant financial burden on both patients' family and health care system. The aim of the present study was to assess the effectiveness in improving the muscular power among these patients.Subjects and Methods: In this study on 100 patients (50 females and 50 males) diagnosed by history, physical examination and brain CT-scan who had experienced thrombotic CVA on superior branch of the middle cerebral artery and had a normal lipid profile on laboratory examination and did not previously receive lovastatin therapy, were allocated into lovastatin and control groups. The lovastatin group (n= 49; 22 males and 27 females) received 20 mg/day for one month. While the control group (n= 51; 28 males and 24 females). Both groups received usual standard treatment of thrombotic CVA (ASA 325mg/daily and dipyridamol 25mg/tds) and similar physiotherapy interventions. The muscle power at first, one week and 30 days after starting trial on each patient was measured with the same NIHSS scaling.Results: Both groups had some improvement at the end of trial but patients received lovastatin had a significantly better improvement (P<0.001). In the lovastatin treated group, better improvement was observed among younger patients (51-65). There was no significant statistical correlation between sex and weight with response to treatment. Conclusion: The finding of this study confirms previous clinical trials and suggests that lovastatin improved muscle power in thrombotic CVA patients.

Objective: Hypercholesterolemia is a known risk factor for erectile dysfunction (ED). Lipid lowering agents may improve ED in hypercholesterolemicmen. The aim of the present study was to evaluate the effects of lipid lowering agent atorvastatin in treatment of ED in hypercholesterolemic men.Subjects and Methods: In this prospective controlled clinical trials a total of 11 hypercholesterolemic men with ED were enrolled the study. They were treated with atorvastatin (20 mg once daily for a period 4 months). All the patients were evaluated by history, clinical interview, physical examination and laboratory analysis both at the beginning and end of the study. International index of erectile function (IIEF) questionnaire and nocturnal penile tumescence testing rigidity (NPTR) tests were also performed for each patient, prior to and after the study.Results: Eleven patient were entered the study with a mean age of 54±3 years, of whom 10 patients completed the study. Low density lipoprotein (LDL) decreased in a statistically significant manner after treatment period (mean difference= 39.1%, P< 0.005) in all of the patients. All the patient reported subjective improvement in erectile function (P<0.001), IIEF questionnaire showed significant changes in total erectile function and sexual performance (mean difference= +4.7, 95 % Cl 2-8-6.2, P< 0.001). NPTR test showed statistically significant improvement in rigidity activity units (RAU) in the basal area of penis (P<0.001). A significant statistical relation was recorded between improvement in erectile function and lipid lowering effect of atorvastatin (P< 0.005).Conclusion: The lipid lowering agent atorvastatin has a dual favourable effect in treating both hypercholesterolemia and erectile dysfunction. Better sexual performance can elevate both the sense of well being and quality of life in these men, more extended and multicentre studies need be designed to evaluate this effect.

Objective: Urinary Tract infection is the most common disease in children and its treatment is vital for prevention of subsequent complications. Currently gentamicin is used three-times a day as a common treatment for urinary infection, but this type of treatment has side effects. This study is done to determine the effect of once-a-day intravascular injection of gentamicin for urinary tract infection in children. Subjects and Methods: This study is a standard clinical trial was conducted on 66 patients with clinical symptoms of upper urinary infection aged between 3 months to 12 years who were hospitalized in Razi Hospital of Kermanshah. Both groups were completely equal with regard to age, weight and other CBC indexes. In control group (n=36) ampicillin was used and gentamicin was employed 3 times a day. In experimental group (n=30), the same amount of ampicillin was used whereas gentamicin was administered once-a-day. The treatment duration was 10-14 days. In the first 7 days, gentamicin was injected intravasculerly, while in the other days it was used orally. After receiving microbial sensitivity tests results, ampicillin was eliminated from treatment regimen. After termination treatment period, the patients were followed up for 6 months. Descriptive statistics and X2 and Fisher Exact Test were employed to analyze of the data.Results: 29 patients (80.5%) of control group and 24 patients (80%) of experimental group were less than 5 years old. The mean weight of patients in control and experimental groups were 15±8.6 and 14± 9.2 kg respectively. 25 patients (69.4%) of control group and 23 (76.7) patients of experimental group were females. In most of the cases E.Coli was the responsible organism and that the most common finding in the urinary analysis of the patients was increasing the number of neutrophills. Respond to the treatment was 97.2% in control group and 96.7% in experimental group (P>0.05). The relapse rate was 29% in control group and 33.3% in experimental group. Scar was seen 19.2% in control group and 22.2 in experimental group. In analysis with X2-test, no significant statistically difference was seen between the two groups regarding relapse and scar development (P>0.05) Conclusions: Gentamicin, administration as a once-a-day treatment is equally effective as three times a day in children with upper urinary tract infection.

Objective: Poisoning represents one of the most common medical emergencies in children. Epidemiologic surveillance in each area is necessary for prevention planning program. The purpose of this study was to determine epidemiologic pattern of acute poisoning in Ahwaz during a 3-year period, from 2001 to 2004.Subjects and Methods: In this retrospective study, all children who were admitted due to acute poisoning in Abuzar and Golestan hospitals in Ahwaz during years 2001 to 2004 were included. Data were collected from medical records.Results: Of a total of 143 cases with acute poisoning, 59 (41.1%) were female and 84 patients (58.9%) were male. The age range of poisoned patients was between 40 days up to 12 years old (mean age 46.8 months). Most (71%) of poisoning occurred in the age group of 1-5 years. Accidental poisoning by child occurred in 77.8 %, in 16% the poisons were given by others and 6.2 % were due to suicide attempts. The most common ingested materials were hydrocarbons (16%), alkaloid agents (12.6%), opiates (11.9%), tricyc1ic antidepressants (8.4%), anticonvulsants (6.3%), benzodiazepines (7.7%), antihypertensive (3.5%), antipsychotic (2.8%) and pesticides (4.2%). While multi-drug poisoning occurred in 2.8% of cases. In 7 % of cases, the implicated poisons were unidentified. Opiates were the most common agents in below 6 months old. Decreased level of consciousness (67.6%) and vomiting (5%) were the most common signs. The mean days of admission were 2.6±1.67 day. There was no mortality in this study.Conclusion: Accidental ingestion was the most common cause of poisoning and 1-5 years old were the most common affected age group. Public education on safe storage of medicines and chemicals and use of child-resistant containers is necessary. To decrease the frequency of opium poisoning parents should be informed about the harms of some herbal agents containing opiates which are using traditionally for infants and children in this region.

Lipoma is one of the most common benign neoplasms with predominant occurrence in lower organs and is rarely reported in oral cavity. Pathogenesis lipoma is unclear but has a higher incidence among fat people. Metabolism of lipoma is independent of fat of body and comes as a yellow submucous mass with no signs and intact surface. In this case, 57 years woman who used complete denture was referred to oral medicine clinic of Ahwaz faculty of dentistry. After evaluation oral cavity and clinical examination, yellow exophytic mass with soft consistency and 1.5 to 2 cm in size was seen in right retromolar as pedunculated mass. After taking her medical history, it was found out that this mass had developed in her oral cavity 3 years previously and pathology report confirmed lipoma.

Torsion of spleen is a rare complication. The presence of long vascular pedicle and absence of natural suspensory ligaments attachements to peritoin and abdominal wall predispose to this complication. Therefore, the spleen may be found anywhere in the abdominal Cavity or in pelvic. The spleen may be twisted around its vascular pedicle and causes strangulation of these vescels and even infarction. Clinical presentations of wandering spleen are variable and are misleading. These presentations may be acute or chronic. Physical examination may show a tender or a non-tender mass with or without acute abodominal pain.Generally, if splenic torsion occurs, the patient presents with fever, vomiting and an acute abdomen. In face of recurrent torsion and detorsion, colicky or vague abdominal pain is presented. Early diagnosis of wandering spleen or torsion before operation without imaging studies is difficult. Treatment commonly entails splenopexy in the left subdiaphragma if the patient is young and if there is no ischemia and is splenectomy if ischemia and gangrene has occured.Our patient referred us with an acute abdominal pain. She was candidate for emergency laparatomy with primary diagnosis of ovarian torsion. Duimg the operation torsion of spleen was found and splenectomy was performed. Preoperative sonography could not help in diagnosis.