Jundishapur Scientific Medical Journal
Year:2005 | Volume:4 | Issue:4 (46)|Papers Count:16

Central vein catheterization for providing an efficient access for haemodialysis, is a known procedure with many complications. In order to constructing a good circulatory access, temporary or long lasting one, we would be able to use trans jugular, subclavian or femoral vein roots. Inserting the catheter through these ways to access the central circulation necessitates passing through the vital anatomical elements as arteries, nerves, lymphatics and relative vessels that contain possibility of predisposing to complications such as bleeding, hematoma, arterio-venous fstula, pseudoaneurysm, nerve bandle injury, hemo-pneumothorax, cardio-conductive disability or air embolism. Most of these complications are directly related to the capability of introducers. Today, calculation with the guide of radiologic facilities or ultrasonography could be able to eliminate the complications. Progressive hematoma due to arterial puncture and bleeding are the most common early complications and so common carotid artery and its branches, subclavian artery and neighboring branches are the most involved elements. Pseudoaneurysms, arterio-venous fistulas and also nerve injuries are rarely reported as late complications. The most dangerous is pseudoaneurysm that potentially endangers the patient because of compressing effect on vital organs. This paper reports a rare primary nerve injury which was accompanied by a rare positional pseudoaneurysm in the proximal base of common carotid artery produced by indwelling central vein catheter for hemozdialysis via right internal jugular vein.

Objective: Hypertrophic pyloric stenosis with signs and symptoms of gastric outlet obstruction (for example projectile non-bilious vomiting) occur in late neonatal and early infantile periods and if not treated can lead to other complications such as weight loss and death.Methods: Data for this cross-sectional retrospective study were collected from files of 40 patients (aged between 3 to 5 weeks) who were operated on by pyloromyotomy procedure in Emam Khomeiny and Abouzar hospitals (Ahwaz) during 1373-1379 . Results: In most patients symptoms occur in the third week of life and hospitalised in the third to fifth week of their lives. All these patients were presented with projectile non bilious vomiting (100%), other symptoms included acid-base abnormality (50 %), electrolyte abnormality (40 %), dehydration (35%), constipation (20%), respiratory problem (15%) and weight loss (15%). Sensitivity of sonography and contrast study in detection of the abnormality was almost 100%. Most of the patients were hospitalised 1 to 2 days before operation and discharged 3days after operation. Most common post-operative complication was vomiting in 30% of cases which were treated by conservative management. Conclusion: Early diagnosis and treatment of hypertrophic pyloric stenosis can prevent the development of serious complications.

Objective: Although nausea and vomiting are the most common disorders that start in the early weeks of pregnancy. Despite the fact that various physical and drug interventions have been attempted, non has proved to be universally accepted as the standard treatment. The aim of this study was, therefore, to compare the effectiveness of acupressure with vitamin B6 (pyridoxine) in reducing the severity of nausea and vomiting among pregnant women. Methods: In this clinical intervention study 100 primigravida women with nausea and vomiting and gestation age of 10-16 weeks were randomly selected and divided in two groups. Age, BMI, profession, education, severity of nausea was matched both groups. Treatment with acupressure or pyridoxine was carried out for four days. In the acupressure group, sea bands were placed on Nigan (p6) point on hands. While in the pyridoxine group 40 mg B6 tablet was administered daily. Results: Nausea scores and frequency of vomiting decreased significantly (p<0.001) after treatment in both groups. Acupressure was more effective in reducing the frequency of vomiting (p<0.05). However, there was no significant difference in the severity of vomiting between treatment groups.Conclusion: Both acupressure and vitamin B6 are effective in reducing in reducing pregnancy-induced nausea and vomiting. However, because sea-bands are more economical, are free of side effects and more efficient in reducing the frequency of vomiting therefore are preferable in controlling nausea and vomiting during pregnancy.

Objective: Patellar maltracking is one of the main causes of patellofemoral joint pain. This tracking dysfunction is mainly due to lock of a precise neuromuscular control between two parts of quadriceps muscle vastus medialis oblique (VMO) and vastus lateralis (VL). The ratio between electrical activity VMONL muscles is considered as an index for comparison between normal subjects and with those with patellofemoral pain. The purposes of this study are to compare the VMONL activity ratio in active and reactive movement patterns.Methods: This quasi-experimental study was conducted on a group of 30 healthy men as a control group and 30 patients with patellofemoral pain as an experimental group. These two groups were non-probably assigned, conveniently sampled and randomly asked to perform movement patterns test. During these tests, electromyographic activity of the muscles were normalized and integrated to absolute values. Movement pattern tests include maximum isometric contraction of quadriceps muscle at 60 degree of knee flexion; active movement patterns consist of forward step up (FSU) and lateral step up (LSD), and reactive movement patterns that consist of angular perturbation of ankle and perturbation of waist.Results: in healthy subjects VMONL ratio in active and reactive movement patterns was significantly greater than isometric contraction (P<0.05). Also this ratio was significantly greater in upward phase of FSU and LSU compared to downward phase. There was no precise and clear relationship between muscle activity ratios in different movement patterns. Comparison between control and experimental groups revealed the greatest significant difference only in active and isometric movement patterns. Conclusion: results indicate that VMONL activity ratio in normal patients has no relationship with the direction and location of perturbation but conversely is task-dependent to direction and location of perturbation in patients with patellofemoral pain.

Objective: Otitis media is the most frequent illness resulting in office visits to physicians who care for children. After every episode of the acute infection, effusion persists in the middle ear for weeks to months. The pathophysiology of otitis media has been linked with abnormalities of Eustachian tube function. If left untreated, otitis media with effusion can predispose to hearing loss, adversely affects cognitive linguistic and auditory development as well as reduces the communicative skills. The aim of the present study was to estimate the prevalence of otitis media among primary school students in Ahwaz schools. Methods: A one-year study (1996 -1997) was conducted on 27791 primary school students, who were randomly selected from all areas of Ahwaz schools, and were examined by otoscopic and audiometric methods.Results: The incidence of otitis media with effusion was 11.1%. The risk factor was male gender and occurred predominantly during Winter months. Conclusion: The adverse effects of otitis media with effusion on hearing and on the development of cognitive, linguistic, auditive and communicative skills are of concern to parents and physicians alike.

Objective: Over the next decade approximately 40 million women will experience menopause. Menopause and many reproductive events can play essential roles in women's life. Although the timing of menopause affects on long-term disease risk, little is known about factors that affect this timing. The aim of the study was to identify the mean age of menopause and determinant factors. Methods: In this cross-sectional study, 1612 cases of menopausal women in the age range of 40-60 years were the subjects of this study house by house from 2001 to 2002 in Ahwaz (centre of Khozestan province of Iran). The instruments for data collection were by selfreport, interview and filling a questionnaire by trained personnel. Approximately 20 thousand families were searched for allocation of women at menopausal age. Based on statistic centre report Ahwaz City is divided into 30 clusters. Finally 60 cases (totally 1612 cases) from each cluster were selected. The data were analysed by Chi-square, means comparison tests (Hest, ANOVA) and correlation tests.Results: Overall median age at natural menopause was 48±4.17 years. The results of the present study showed that smoking was associated with earlier age at menopause. Life events, irregular menstrual cycles in reproductive ages, history of pelvic surgery were associated with earlier natural menopause (p<0.02). While prior use of HD (high dose ocp), lactation, BMI>20 were associated with later age at natural menopause (p<0.04). There were no significant associations among age at menarche, marital status, kind of delivery (normal delivery or C/S) and age at menopause after adjustment for multiple factors.Conclusion: Mean age at menopause in Ahwaz is less than some international reports. This study showed that life events, irregular menstural cycle ,prior use of HD, BMI and history of pelvic surgery significantly influence the natural age of menopause.

Objectives: Hypertension is one of the most prevalent chronic diseases. Previous studies showed that non-compliance to medications is the most important reason for poor controlled hypertension. The objective of this study was to determine the factors which associated with non-compliance among hypertensive patients registered in our out-patient clinic.Method: This study was undertaken among selected patients from a total of 532 hypertensive patients attending the health care centre of Shaheed Motahari in Shiraz.A standard interview was conducted with 250 patients who met our study inclusion criteria. The data collection included information about sociodemographic variables, variables related to disease and treatment, and patients' knowledge and attitudes.Results: The result showed that 60.4% of the patients had less than 90 % compliance. Medication compliance was better among patients who were above 50 years old, had insurance coverage, had a good knowledge about hypertension and had positive attitude toward antihypertensive drugs, have taken drugs more than 5 years and interval between their visit to physician was less than 3 months (p<0.05). Multiple logistic regression analysis showed that positive attitude toward antihypertensive drugs and interval between visits to the physician of less than 3 months were two independent predictors of compliance (p<0.01).Conclusion: Patient medication compliance is a multi-factoral behaviour, in which the role of patients' attitude is very important. For assessment the other factors, it is necessary to conduct further researches on patients -physician relationship and the way of providing health care to patients.

Objective: L-carnitine plays an important role in fatty acids and glucose metabolism. On the other hand, hyperglycaemia and hyper-lipidemia are two independent risk factors in development of diabetes complications such as atherosclerosis, nephropathy, neuropathy and retinopathy. The aim of the present study was to compare the serum free L-carnitine level in diabetic women with and without diabetes complications. Methods: In this case-control study, 17diabetic women with complications (cases) and 17 control diabetic women without any complications were the subjects of this study. Assessment of free L-carnitine level was made using enzymatic kit and uv/vis spectrophotometer.Results: The results showed that although the serum free carnitine levels was within the normal range in both groups and carnitine deficiency was not seen in any of these groups, the overall mean serum free L-carnitine concentration in the case group was significantly lower than that in the control group (41.76±2.85vs. 53.89±3.55µmol/L, respectively (p<0.001).Conclusion: The finding from this study suggest that the lower serum L-carnitine level measured in the complicated group might be due to increased L-carnitine acylation, increased acyl-carnitine excretion, or its decreased renal re-absorption. This difference may be the result of rising in the L-carnitine requirement in diabetic patients with diabetic complications. Based on these results, carnitine supplementation might be useful in diabetic patients, especially in those with diabetes complications.

Objective: Disturbances in sciatic nerves following gluteal injection can lead to varim complications Identification of these disturbances are important in planning treatments and prevention of complications The aim of this study was therefore to evaluate the sensitivity and usefulness of H. reflex as method for disturbance in sciatic nerve injection palsies following gluteal injections.Methods: during a prospective critical study in 4 years, fifteen patients whom suffered from lower extremity paralysis following gluteal injection underwent electrodiagnostic evaluation. After a full-history taking, physical examination and investigation in order to exclude other causes of lower extremity weakness, complete blood count, erythrocyte sedimentation rate and fasting blood sugar, and MRI study of lumbosacral spine were assessed and patients who suffered from lower extremity paralysis three weeks after a gluteal injection were selected for our study. For this purpose, tibial and deep peroneal NCV and tibial H reflexes of both lower extremities at room temprature were recorded .Patients underwent electromyographic examination of extensor digitorum brevis, tibialis anterior and posterior, gastrocnemus, gluteus maximus and paraspinal muscles in L4, L5 and S1 levels to exclude lumbosacrol radiculopathies..Result: The results showed that peroneal nerve conduction velocity less than 40 m/s were recorded in eleven patients. But, only three patients had tibial nerve conduction decrement less than 40 m/s. Seven patients had H. reflex disturbances (absent or increased H reflex latency)Conclusion: Measurement of H reflexes disturbances is a more sensitive method in meeting of electrodiagnostic criteria than tibial NCV method for detection of disturbances in sciatic nerve palsies following gluteal injection.

Object: Hyperalgesia is one of the major symptoms of diabetic neuropathy and could affect the quality of patients' lives. On the other hand, pepper has been reported to have both an antidiabetic and an analgesic property. This study was therefore carried out to evaluate its possible role in controlling pain in diabetes in an experimental model of streptozotocin-induced diabetic in rat.Methods: For this purpose, the rats were randomly divided into six groups control, peppertreated control, salicylate-treated control, diabetic, salicylate-treated diabetic (positive control), and pepper-treated diabetic groups. Pepper was administered via mixing in the normal food, and at the end of the experimental period of one month, the nociceptive responses was evaluated in both acute and chronic phases by standard formalin test.Results: The results showed that there was a significant increase in the pain scores in both acute and chronic phases in control diabetic rats,. Administration of pepper for significantly reduced the pain scores in both phases of the test. In contrast, sodium salicylate, as positive control, only reduced the chronic phase of pain scores. Conclusion: Taken together, the results form this study showed that prolonged orally administered pepper seems to attenuated nocicpetive responses through central and peripheral mechanisms in streptozotocin-induced diabetes is rats. Further studies are neede in order to assess this effect in diabetic patients.

Objective: In some part of Iran such Isfahan province some farmers tend to use the digested sludge as soil conditioner or fertilizer, and some of the mentioned sludge may content of pathogenic bacterial agents, such as Salmonella. The aim of the present study was therefore, to assess level of contamination by Salmonella products of which are used solely for agricultural purposes.Methods: Periodic sampling and counting of the level of Salmonella were according to the method presented by American Public Health Association (APHA) and the United State Environmental Protection Agency (EPA).Results: The results showed that the average number of Salmonella in the digested sludge of waste water treatment plant number 1 and Shahinshar, based of the most probable number were 24 and 11 per 4g dried sludge solids, respectively, and were higher than the standard 3 per 4g of dried sludge solids. Hence none of these two plants satisfied V.S. Government Environmental Protection Agency, for use of the sludge in agricultural works. The results taking from statistical analyese using Pearson's correlation coefficien showed that there was a meaningful relationship between the percentage of reduction of stabilized sludge (organic. materials) and Salmonella for plant number 1 (p=0.009 and r =0.9907) and Shahin-Shar digested sludge (p=0.001 and r=0.9885) .Conclusion: These results suggest the greater reduction of the volatile solids correlates with larger reduction in the level of Salmonella.

Objective: Depression is the most frequent mental disorder especially in women. Furthermore, maternal depression can affect their offspring. The aim of the present study was to assess the severity of depressive symptoms in offspring of depressed women.Methods: This analytical-descriptive study was conducted by on easy sampling. For this purpose, fifty women with major depressive disorder with 11-14 years old children were selected. CDS-A inventory was used as the tool for assessment. Fifty children completed this questionnaire.Results: The results showed the severity of symptoms in offspring of mothers with major depression was higher than general population (p<0.05). In addition, severity of depressive symptoms among children of depressed mothers was correlated positively when maternal depression was recurrent, age of onset was before 30 years and its duration was more than 10 years. There was no significant difference between male and female among severity of depressive symptoms.Conclusion: The results from this study indicate that genetic and environmental basis is basis for childhood depression. Therefore evaluation of children of depressed mothers is recommended especially in chronic, recurrent and early onset depression.

Adrenal myelolipoma is a benign tumour which has been reported very rarely in the literature. The main characteristics of this tumour is presence of bone marrow and fatty elements in the resected adrenal tissues. There is only about 100 reported cases of such tumours published in the literature and this is the first reported case in our university. In this report the clinical presentation and hospital course of a case of this tumour, together with imaging and laboratory findings and outcome of surgical intervention is reported. Our patient was a-18 year old young man with a large palpable mass in the right side of abdomen. He had a long past history of chronic anaemia which was treated as thalasemia major. After full laboratory and imaging studies, the patient was operated upon and a large mass in adrenal was resected safely. The pathological report showed adrenal myelolipoma. The patient was discharged in full recovery, good general health and behaved very well in later follow up visits.