Researcher Bulletin of Medical Sciences
Year:2002 | Volume:7 | Issue:2 (28)|Papers Count:19

Background: Tracheal and laryngeal tumoral or nontumoral lesions could lead to severe tracheal stenosis. This is stenosis which is exacerbated with time, is asymptomatic at the beginning. The present study was conducted to determine the therapeutic approach in the affected individuals in two academic centers in Shaheed Beheshti University of Medical Sciences. Materials and methods: One hundred fifty one patients with severe tracheal or tracheolaryngeal stenosis underwent rigid bronchoscopy and dilatation of the airway stenosis and/or biopsy of tumoral lesions. Inhalational anesthesia by halothane with or without the aid of regional block of the superior laryngeal nerves was used. Rigid bronchoscopy with occasional supplemental fiberoptic bronchoscopy was used for dilatation and biopsy of the tumors. Results: In all patients brochoscopic evaluation of the lesions were satisfactory. Eighty patients had severe respiratory distress before the procedure, of whom 77 had successfully undergone brochoscopic dilatation. Eight patients who had some degree of dyspnea in the recovery room were intubated for 1-4 days without any problem after extubation. Thee patients became hypoxemic severely during brochoscopic procedure. We had to do emergency surgery to relieve airway obstruction in these 3 cases but one died due to brain hypoxemic injury, and other two recovered completely. The remaining 71 patients had mild to moderate dyspnea who had undergone brochoscopic dilatation successfully. There was no cardiac complication, however, 5 patients had increased tracheobronchial secretions after dilatation, which were treated by antibiotics. Conclusion: Brochoscopic procedure in patients with severe stenosis of trachea or tracheolaryngeal area requires specific brochoscopic and anesthesiologic techniques. With the use of appropriate techniques in these critical patients brochoscopic dilatation of stenosis and diagnostic evaluation of lesions is safe. Irreversible hypoxemic complications may occur if appropriate techniques are not used.

Background: There has been no accurate report of mortality rate and malpractice in our surgery departments, however, these reports may lead to increased mortality probability, further stress on physicians and patients, and also distrust on physicians. Autopsy is the most reliable diagnostic technique, and its educational value is noticeable, too. We have evaluated the autopsy and mortality rate in department of surgery, Modarres General Hospital, between 1990 and 1999. Materials and methods: It was an existing data study. The cause of death was classified in accordance to Gordon Guidelines to five subdirectories: Error in Judgement (EJ), Error in Diagnosis (EO), Error in Technique (ET), Error in Management (EM), and Patient's Disease (PO). Results: During the study period, a total of 14041 patients were hospitalized, of whom 12441 (88.6%) underwent operation. The overall mortality rate was 3.9% (488 patients). Autopsy was performed on 390 cases. The cause of death was as below: EM (14.5%), EJ (11.6%), ET (10.6%), and EO (7.1 %). 59.6% of the patients were died due to their own disease (PO). Error in Diagnosis has shown significantly lower probability (p<0.0266). Conclusion: Our findings are comparable to the western societies, which demonstrate a unique educational performance. Having the same studies performed in other surgery departments, we could promote the educational level of residency training program.

Background: Due to the lack of reports in our country, risk factors influencing mortality in patients undergoing cardiac surgery are usually referred to, on the basis of western academic papers. In Iran this has been associated with different facilities and equipment s in different groups of populations. Thus, we have attempted to evaluate the above mentioned risk factors and their effects on mortality. Materials and methods: All of the patients admitted for adult cardiac surgery in our center during a IS-month period (January 1999 to April 2000) were enrolled in a prospective study. Those undergoing surgery without the use of cardiopulmonary bypass (CPB) were excluded. Results: The study population included 472 males and 273 females with the mean age of 53±14.4 years (range, 16-82 years). The mortality rate was 5.2%. Factors associated with mortality were age, emergency surgery, ejection fraction, the individual surgeon operating, and the duration of CPB time. Sex, weight, body surface area, history of diabetes or hypertension, and the aortic cross clamp time didn't affect the mortality. Conclusion: The overall success rate of cardiac surgery in our center is comparable to that of western societies. Emergency surgery, the individual operating surgeon, and CPB time are the associated risk factors statistically significant in mortality. Diabetes mellitus, hypertension, and duration of cross clamp time had no effect on mortality.

Background: Psoriasis is a common chronic papulosquamous skin disease. Cardiovascular diseases have been reported with greater frequency in affected individuals. This is mainly due to higher plasma lipid level. This study was conducted with the aim of determining lipid profile in psoriatic patients referring to Booali and Loghman hospitals in 2001. Materials and methods: It was a case-control study. Our exclusion criteria were familial hyperlipidemia, hypothyroidism, nephrotic syndrome, chronic renal failure, connective tissue disease, and users of the following drugs: antilipidemic agents, oral steroids, cyclosporine, and B-blockers. The control group was matched according to the sex, age, body mass index, blood pressure, daily physical activity, and smoking. Blood samples were obtained following 14-hour fasting status, and serum level of triglyceride, cholesterol, HDL, LDL, and VLDL were all determined. Statistical analysis was done by Hest. Results: 67 individuals were studied in each group. The study population included 38 males and 29 females with the mean (±SD) age of 37±17 years. For the case group, mean serum level of TG, cholesterol, LDL HDL, and VLDL were 177±188, 201±44, 126±33, 43±11, and 3l±21 mg/dl, respectively. These figures were 99±29, 183±42, 103±41, 6l±11, and 20±6 mg/dl for the control group, respectively. Significant differences were noted between the groups. Conclusion: Results have revealed higher plasma level of TG, cholesterol, LDL, and VLDL and lower level of HDL in psoriatic patients. This could be a contributing factor in cardiovascular diseases. Thus, psoriatic patients should be informed of cardiovascular risk factors and their serum lipid level should be monitored periodically.

Background: Female genital malignancies have comprised 12.7% of all female malignancies. The present study was conducted in Jorjani Hospital to determine the female genital malignancies and their related risk factors. Materials and methods: Reports of female malignancies for a 26-year period (between 1972-98) were reviewed in our center. Results: Results have shown that female genital malignancies have comprised 20.25% of all female malignancies, of these, carcinoma of cervix, ovary, and uterine were reported in 12.2%, 4.85%, and 2.54%, respectively. Breast cancer was the most common finding (23.54%). Our findings have revealed epidemiological and regional differences. Conclusion: With respect to the different pattern of female genital malignancies, as compared to the western pattern, further studies could be helpful.

Background: Lipid disorders have an increasing prevalence with known complications. Anethum was revealed to be useful in animal models, thus, the present study was conducted to determine the effects of Anethum on plasma lipid disorders in Shahrekord clinics in 1999. Materials and methods: One hundred one hyperlipidemic patients have enrolled in this clinical trial. Triglyceride, cholesterol, LDL and HDL were determined and patients were randomly distributed in two groups of Anethum and placebo. The first group received Anethum (Baridj Essence, Iran) for 21 days, whereas the second group was given placebo with the same dosage and duration. Following the trial, plasma lipid determinants were evaluated and analyzed. Results: Of 101 patients, 52 were studied in the Anethum group and the remaining 49 were in the placebo group. Groups were matched according to the sex, age, and primary lipid profile. In the Anethum group cholesterol was reduced from 193±37 to 171±36mg/dl (p<0.001), but in the control group it was changed from 184±36 to 186±32mg/dl (NS). Meanwhile, Anethum group has shown a significant reduction in TG level (266±85 to 226±134mg/dl, p<0.05) and LDL-C (101±34 to 79±35mg/dl, p<0.001). Conclusion: Anethum is an effective agent on plasma lipid disorders. Since it is an available drug with least side effects and expenses, it is highly recommended.

Background: With respect to the high prevalence of UTI and its established risk in kidney scar formation and also the importance of urinary reflux, the present study was conducted on infected children referring to Taleghani and Labafinezhad hospitals in 1997-98. Materials and methods: Thirty six kidneys were studied. Kidney infection was diagnosed based on clinical manifestation, positive urine culture, and abnormal scan using Tc99DSMA. Children with urinary system anomalies or previous scar formation were excluded. Reflux was detected by VCUG (standard VCUG in boys and isotopic VCUG in girls). Patients were followed up for at least 6 months. Finally, scar formation and the role of urinary reflux were determined. Results: Of 36 kidneys, 5 (13.2%) revealed scar formation. We have considered 11 kidneys without reflux as the control group and 25 kidneys with reflux as the case group, among which, 9.1 % of the control group and 16% of the case group developed scar. The difference was not statistically significant. Meanwhile, scar formation was more frequent in younger children. Conclusion: Since scar formation is strongly correlated with UTI and hypertension and end stage renal disease are late complications of kidney scar, prevention, early diagnosis, optimal treatment and follow up are highly recommended in children suffering from UTI.

Background: The role of solid dispersion system in enhancement of dissolution rate of drugs was first explained in 1961. We have studied the dissolution rate, physical stability, and distribution of Indomethacin (Ind) in coprecipitation with povidone. Materials and methods: During this experimental study, to determine the kind of dispersion and causes of enhanced dissolution rate of Ind. in coprecipitation with povidone, the following tests were carried out: 1) dissolution rates" studies of mechanical mixes as well as coprecipitation mixtures with the same percentage of Ind. 2) simultaneous dissolution rate of povidone and Ind. 3) microscopic photography of dissolution process, 4) solubility of pure Ind. in different concentrations of povidone, and 5) electron scanning micrography of coprecipitate. Results: We have found that the dissolution rate of Ind. in coprecipitate is a function of povidone molecular weight and percentage of drug. Thus, dissolution rate of drug in low molecular weight of povidone was about 10 fold faster than that of high molecular weight povidone. Meanwhile, dissolution rate in low fraction weight of drug was about 110 times greater than that of high fraction weight. Conclusion: Our findings have provided the formation of colloidal or molecular dispersion of Ind. in povidone in fraction weight under 13.5% of Ind. Stability of coprecipitate in different relative humidity was varied. At relative humidity of 60%, stability of sample was too low due to salting-out phenomenon, however, at relative humidity of 70% and higher, the dissolution rate is increased mainly because of reduced glass transition temperature, viscosity of polymer and plasticizing effects of water.

Background: This study is an attempt to evaluate the cardiovascular effects of Adult Cold and Antihistamine Decongestant tablets, both of which containing sympathomimetic agents, through comparing them with each other and also with placebo. Materials and methods: Thirty hypertensive patients with the mean age of 57.1±5.7 years received single oral dose of Adult Cold and Antihistamine Decongestant tablets or placebo, in a single blind, crossover trial with a wash out period of two weeks. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were measured before and 10, 20, 30, 60, 120, and 240 minutes after administration of drugs and placebo. Results: With Antihistamine Decongestant tablets, significant increases in SBP (at minute-3°, -60, -120, and -240), DBP (at minute-30 and -120), and MAP (at minute-3° and -60) were obtained in comparison to placebo following the drug administration. Heart rate was significantly decreased 60 minutes after Antihistamine Decongestant administration. With Adult Cold tablets, no significant change was observed in SBP, DBP, and MAP in comparison to placebo. The heart rate, however, showed a significant decrease 120 minutes after the drug administration. Conclusion: Sex has no effect on the aforementioned parameters. The results are considered as an alarm for the medical society as well as hypertensive patients regarding certain drugs which for long have been consumed as safe OTC drugs. For common cold, an effective drug such as Adult Cold can be recommended, which has no considerable effects on blood pressure.

Background: COPD is a prevalent problem with well-known complications. Rehabilitation techniques have been reported to be effective in affected patients. The present study was conducted to determine the effects of rehabilitation techniques on the improvement of clinical status of COPD patients. Materials and methods: This clinical trial was carried out on 30 COPD patients on the basis of before and after experimental designing. Those who have used drugs, aged 40 or above, and had other pulmonary diseases were excluded. Dyspnea intensity, ABG and PFT parameters were determined Rehabilitation techniques were performed for 10 days, then the aforementioned parameters were determined and analyzed by paired t-test and McNemar. Results: The study population included 12 males and 18 females. Following the rehabilitation techniques, the dyspnea intensity during walking, stair climbing, bending, resting and clothing was decreased significantly (p<0.05). FYC and FEV1 differences were 0.44±0.27/L and 0.l8±0.l5L/s. The differences were statistically significant. ABG results have shown significant differences in Pa02 (p<0.002). Conclusion: Results have revealed that rehabilitation techniques had satisfactory effects on dyspnea intensity, Pao2, FYC, and FEV1.

Background: Anxiety is a common problem during GI endoscopy. Fearing has different effects on endoscopy procedure and midazolam has been revealed to be an effective agent to reduce this fcar. Thus, the present study was conducted to determine the effects of midazolam on arterial oxygen saturation during upper gastrointestinal endoscopy in Booali hospital in 2001. Materials and methods: 60 patients had entered this double-blinded sequential clinical trial. Patients had no previous history of cardiopulmonary, liver or kidney disease and were nonsmoker. They have been randomly distributed in either the case or control group. One minute before the endoscopy the case group was received 0.07mg/kg midazolam intravenously and the control group was given 5cc normal saline intravenously. Arterial oxygen saturation was determined one minute before the endoscopy till one minute following the procedure, each a minute. Results: Groups were matched according to the sex, age, duration of endoscopy, and one-minute preoperative Sao2. So02 before the procedure was 95.7±1.48 and 95.9±1.47 per cent in the control and case group, respectively. Following the endoscopy it was changed to 95.5±1.5 and 95.6±1.58 per cent in the control and case group, respectively. The difference was not statistically significant. Conclusion: Midazolam does not reduce arterial oxygen saturation, though, monitoring the susceptible patients during the procedure is highly recommended.

Background: Following the definite diagnosis of visceral leishmaniosis in a six-year old Doberman dog and isolation of Leishmania Jnfantum in Kordan in 1995, thorough studies have been carried out to determine the visceral leishmaniosis infection in human and animal reservoirs (dog), meanwhile, sandflies were collected for determination of species, seasonal activities and anthropophilic activities in Kordan district. Materials and methods: During this cross sectional study, 925 human plasma sample and 21 dog plasma samples were tested by direct agglutination test (DAT) and latex agglutination test (LAT). Meanwhile, 2090 sandflies were collected. Results: A child with clinical features of leishmaniosis was seropositive. He was treated by Glucantime and recovered completely. Three dogs showed antileishmania antibodies against visceral leishmaniosis with >1:320 titers. Seven species of Phlebotumus genus and two species of Seregentomia genus were confirmed in this investigation. The majority species were Phlebotumus major. 356 sandflies were dissected but no promastigote was found. Conclusion: Totally, one child and three dogs were revealed to be seropositive. Thus, Kala-azar is sporadic in Kordan region.

Background: Thyroid surgery is one the most commonly performed operation involving the cervical area. Some investigators have believed that better cosmetics results could be obtained if the platysma muscle remained unsutured. We have studied the surgical scar appearance in two groups, platysma muscle sutured or not sutured. Materials and methods: Sixty patients have been distributed in two groups according to the day of operation. In 30 patients, designed as the study group, the platysma muscle was not sutured; however, in the control group the platysma muscle was sutured with interrupted 3/0 chromic catgut sutures. Results: The control group included 8 males and 22 females with the mean age of 42.3 years, however the study group included 9 males and 21 females with the mean age of 35.9 years. In the case group, good and excellent scar formation was reported 60% and 40%, respectively. For the control group these figures were 80% and 20%, respectively. The difference is not statistically significant. Conclusion: Results have revealed no statistically significant differences between the groups considering the surgical scar appearance.

Background: Malaria is the most common protozoal infection of tropical regions. In Iran it is mainly seen in south and southeast, where 80% of all malaria infections are reported. Wide usage of insecticides, development of carriers' resistance and also environmental pollution are critical issues that seek further attention. Bearing these in mind, Insect Growth Regulators (IGRs) seem to be effective altematives. Materials and methods: We have compared the larvacidal and emergence inhibition properties of two common IGRs; diphlobenzorone and methoprene (altosid). Our experiments were performed according to the WHO standards and larval death and emergence of mature anopheles were determined. ANOVA was used for statistical analysis. Results: We have found no significant difference in emergence of mature anopheles, however, there was significant difference based on larval death rate (p<0.05). Conclusion: Both tested IGRs have shown to be effective on immature anopheles, however, diphlobenzorone cause greater larval death.

Background: Hemolytic Uremic Syndrome (HUS) is known as the most common cause of acute renal failure in neonates and young children. We have studied the prevalence and clinical features of hemolytic uremic syndrome for a ten-year period (1988-99) in Shiraz University of Medical Sciences. Materials and methods: Reports of 80 children hospitalized due to HUS were reviewed. Initial data including clinical features, laboratory findings, treatment, complications and prognosis of disease were determined. Results: Children were aged 3 months to 14 years (mean, 2.29±2.38 years). They included 45 boys and 35 girls. 74 developed the classic fOffi1 of HUS (with diarrhea) and the remaining 6 had presented non-classic form of HUS. The most common signs were pallor (100%), oliguria or anuria (70%), altered level of consciousness (35%), and seizure (24%). Other clinical or laboratory findings were: petechia and purpura (11%), jaundice (4%), hypertension (16%), anemia (100%), elevated BUN and creatinine (100%), thrombocytopenia (87.5%), leukocytosis (59%), hyponatremia (52.5%), hypokalemia (65%), hyperkalemia (14%), hypoalbuminemia (70%), and elevated LFT (14%). The entire children had received FFP (1-14 times) and 70% had been dialyzed for a mean 6.4 days. Colonoscopy of 6 children with prolonged diarrhea had revealed pseudomembranous colitis. The overall mortality rate was 15%. Mortality was mainly correlated with prolonged diarrhea, anuria or oliguria, and dialysis. Conclusion: Hemolytic Uremic Syndrome (HUS) is a problem of utmost importance in pediatric disease that could lead to irreversible changes. This requires further attention.