Researcher Bulletin of Medical Sciences
Year:2001 | Volume:6 | Issue:3 (23)|Papers Count:27

Background: Regarding the widely usage of stent PTCA and controversies about efficacy and safety of ticlopidine for prevention of thrombosis, the present study had compared two different regimens of ticlopidine after stent PTCA in patients referring to Shahid Modarres hospital since 1998 till 2000. Materials and methods: 145 individuals with symptomatic coronary artery disease, candidated for stent PTCA according to the angiographic studies, had entered this clinical trial. Those with acute coronary syndrome including AMI and unstable angina or those who were not received aspirin or ticlopidine 48 hours prior to the operation have been excluded. Patients were randomly distributed in two groups of case and control. Control group was given ticlopidine 500mg/d for 4 weeks after stent PTCA, whereas, the case group was received ticlopidine at the dosage of 500mg/d for one week followed by 250mg/d for 3 weeks. Efficacy of both regimens was assessed considering the newly progressed chest pain or ST-T changes in ECG and definite angiographic diagnosis of stent-induced thrombosis. Results: 60 patients were in the control group and the remaining 85 were studied in the case group. Groups were matched according to the following criteria: age, sex, type of lesion, size of vessel, type of target vessel; size, type, number and place of the stent, severity of primary stenosis and initial and final TIMI. No complication was recorded in the case group; however, acute stent-induced thrombosis was seen in two patients of the control group. These patients had primary stenosis severity of more than 90%, vessel size of less than 3 mm, comptex lesions, and initial TIMI Flow 11. Wiktor stent was used that was 15-20mm. Both patients were male. Conclusion: Minor dosage of ticlopidine (250 mg daily) is as effective as the dosage of 500mg/d for prevention of stent-induced thrombosis. Further multicentric studies with greater samples are highly recommended. We also suggest a study to determine the side effects of ticlopidine when prescribed at the dosage of 250 mg/d.

Background: Nowadays, pulseoximetery is one the best and most available methods of detecting patient's arterial blood oxygen saturation; so its normal function is of great importance. Hypothermia, hypotension arid peripheral vasoconstriction can lead to pulseoximeter abnormal function. The present study was carried out over the patients referring to Shahid Modarres hospital since 2000 till 2001 to determine the effect of digit nerve block on pulseoximetery. Materials and methods: 50 patients over 10 years old, underwent operation longer than 3 hours, had entered this double-blinded sequential clinical trial study. One finger was blocked using 3 cc of marcain 0.5%, where the other finger was just injected saline. Then, both fingers' tip temperature, central temperature, systemic blood pressure, and both fingers' SpO2 were all determined by a person being unaware of the blocked finger. T-test was used for statistical analysis. Results: 50 patients, including 35 males and 15 females, with mean age of 51±17.6 yrs were studied. Favorable functional period of pulseoximetery was 5.8±1.22 and 4.56±1.85 hrs in the case and control group, respectively (p<0.001). In the mean time, mean digit temperature was recorded 29.31±1.57 and 27.68±1.26 °c in the case and control group, respectively (p<0.001). Conclusion: Digit nerve block seems to be a suitable approach for maintaining normal function in pulseoximetery. Further studies with different drug dosage and greater samples are recommended.

Background: Postoperative infection especially in case of orthopedic surgery is one of the most severe complications. Controversies about antibiotic prophylaxis had made us conducting the present study over the patients referring to Taleghani hospital since 1997 till 1999 to compare two doses of cephradin for prevention of postoperative infection. Materials and methods: This sequential double-blinded clinical trial was carried out over 200 patients. Predisposing factors such as open wound, active infection, artificial heart valve, advanced underlying disease, using immunosuppressive drugs and malnutrition were all exclusion criteria in this study. Patients were randomly divided in two groups of case and control. Primary antibiotic dosage was administered intravenously 30 minutes prior to the operation; however, postoperative dosages of antibiotic were administered in 6-hour intervals. Control group was received 9 dosages of cephradin postoperatively, whereas the case group was given just 3 dosage of cephradin and the remaining 6 dosages were placebo. Clinical criteria, ESR, and culture were used for infection assessment. Results: 200 patients, including 132 males and 68 females, with mean age of 33.1±19.2 years had been studied. Groups were matched according to the age, sex, level of albumin, period of preoperatively hospitalization, and the duration of surgery. Meanwhile, difference between the types of the surgeries was seen. Infection rate of 5% and 6% was rep0l1ed for the case and control group, respectively (N.S). Meanwhile, no significant statistically difference was seen between the superficial and deep infection. Conclusion: Changes in dosage of prophylactic cephradin seems to be ineffective for prevention of postoperative infection, so with respect to the known side effects of cephradin lower dosage of cephradin is recommended.

Background: Meralgia paresthetica is a sensory neuropathy caused by involvement of lateral cutaneous nerve of thigh (LCT) that is originated from L2 and L3 spinal segments. Neurological examination is noticeable only for distributed sensation in the involved territory. The present study was carried out over the patients with definite diagnosis of meralgia paresthetica (MP) referring to Shohada Tajrish and Loghman Hakim hospitals since 1999 till 2000, to determine whether the latency of P35 and P55 waves are increased or not. Materials and methods: 20 patients with unilateral MP had entered this case-control study. The control group was consisted of the unaffected lower limbs of the same patients' group. Then, latencies of P35 and P55 waves (msec) were compared between the two groups. Delayed latencies of greater than 10% were considered abnormal. Results: 20 patients, including 9 males and 11 females, with mean height of 166 cm and age of 42.7 years were studied. The P35 latency in the unaffected limb was 33.9±1.4 ms and in the affected limb was 42.7±2.7 ms (p<0.0001). These figures for P55 latency was reported 54±1.3 ms and 63.1±2.9 ms, respectively (p<0.0001). Conclusion: We have observed statistically significant delay in the appearance of P35 and P55 waves in MP disease. So, SSEP could be a reliable and sensitive method in the diagnosis of MP disease.

Background: The high prevalence of urinary stress incontinence and the controversies brought up about the relationship between this entity with the rout of delivery had made us studying the relationship between the rout of delivery and urinary stress incontinence in patients referring to Shohada Tajrish hospital and two other private clinics in Tehran during the academic year 1998. Materials and methods: This case-control study was carried out over 258 candidates. Patients were labeled as having "urinary stress incontinence" when their chief complaint was urinary incontinence with coughing, sneezing, laughing, or physical activity. Meanwhile, positive Q-tip or Cough test should accompany these symptoms. Normal individuals with either negative test, matched with our cases, have compromised the control group. Route of delivery was determined in both groups. Results: 86 patients with urinary stress incontinence were compared with 172 normal individuals. Vaginal delivery was reported 93% and 91.3% in the case and control group, respectively. (N.S) Coughing, sneezing, and laughing had caused urinary stress incontinence in 98.8% of the cases; whereas physical activity-induced urinary stress incontinence was recorded in 87.2%. Q-tip and Cough test were positive in 95.9% and 60.9% of the cases, respectively. Conclusion: Route of delivery has shown no significant correlation with the urinary stress incontinence. A cohort study and also other studies with greater samples seem to be useful.

Background: With respect to the increasing rate of using arteriovenous fistulas (AVF), current attitude and controversies in different references about constructing A VF in different anatomic sites such as snuff box and radial region; the present study was pyrformed on the CRF patients referring to Shohada Tajrish hospital since 1998 till 2000 to determine the effect of the anatomic site of the AVF on its efficacy and complications. Materials and methods: In this clinical trial, AVF of the case group was constructed in the snuffbox; however, the control group had AVF being constructed in the radial site of the wrist. Fistulas were managed according to the standard side-to-side criteria. The efficacy of fistula was determined through sufficient blood flow and acceptable engorgement ofthe veins of the limb in periods of one (short term) and six months (long term). Meanwhile, complications such as thrombosis, venous hypertension, paresthesia, wound infection, and steal syndrome were all recorded. Finally, statistical analysis was done. Results: 110 individuals, including 80 as the case and 30 as the control group, had entered our study. Groups were matched according to the affecting factors. Short-term efficacy of the fistula was reported 90.5% and 89.7% in the case and control group, respectively, however, long-term efficacy was 94.5% and 95.8%, respectively. (N.S) In the control group thrombosis was recorded in 13.3%, venous hypertension and absence of venous engorgement, each in 3.3%, and paresthesia in 1.8% of the patients, however, in the case group these figures were 13.7%, 2.5%, 1.2%, and 2.5%, respectively. So no significant statistically difference was revealed. In the mean time no cases of wound infection and steal syndrome was reported. Conclusion: The anatomic site of the rasiocephalic AVF in the wrist had no effect on efficacy and complications of the fistula. AV fistulas of the wrist region with acceptable efficacy and few complications are strongly recommended as a favorable vascular access in hemodialytic patients. Further studies "with the aim of comparing this method with other endogenous and exogenous methods would be useful.

Background: Gastroesophageal reflux is among the most common GI disorders during infancy that has known complications in case of leaving untreated. Cisapride is an effective drug but controversies about its cardiac complications and genetic predisposing factors still exist. So the present study was designed with the aim of determining the cardiac complications of cisapride in infants with GER referring to a private clinic in Tehran, 2000. Materials and methods: The before and after clinical trial strategy of this research was achieved over 54 infants with normal ECG. Cisapride was given in dose of 1 mg/kg/day, and then 24-72 hours later the second ECG was observed. Cardiac complication was defined as prolonged QTc intervals (>450 ms). Statistical analysis was performed using Mcnemar and paired Hest. Results: 54 infants, including 3] males and 23 females, with mean age of 3.5 months had entered our study. Cardiac complication was reported in 2 (3.7%) infants (N.S). QTc intervals were increased from 403±35 to 420±34.5 ms (p<0.001). Other indices such as pulse rate, PR and QRS intervals were intact. Conclusion: Gastroesophageal reflux is a common disorder and drug side effects are usually seen, so cisapride could be safely prescribed according to the Y van recommendation.

Background: Maximum exercise capacity is the best predictor factor of future cardiac events, so the present study was designed with the aim of determining the effect of PTCA (Percutaneous Transluminal Coronary Angioplasty) on exercise capacity in different special subgroups, candidated for PTCA, in Shahid Modarres hospital during the academic year 2000. Materials and methods: The before and after clinical trial strategy of this study was performed on 70 patients using conventional anti-ischemic drugs. Patients had undergone symptom limited exercise test (Bruce protocol) using Marquette Electronics Treadmill Max-I model, before, one-month, and three-month after the PTCA. Exercise time, workload and rate pressure product were all measured and statistical analysis was managed using paired Hest and t-student tests. Results: 70 patients (69% male and 31 % female) with mean age of 53.9±10.1 yrs had entered this study. In a one-month follow up 70 and in a 3-month follow up 28 patients had undergone exercise test. Exercise time was increased from 7.8±2.6 minutes to 9±2 and 9.1±2.2 minutes in the one-month and 3-month follow up, respectively (p<0.01). However, workload was increased from 9.4±2.7 METS to 10.6±2.2 and 10.7±2.3 METS in the one month and 3-month follow up, respectively (p<0.01). Rate pressure product (RPP) has diminished from 24348±5354 units during the later months (N.S). Type of revascularization and PTCA on LAD had no significant effect on exercise capacity. Conclusion: PTCA is accompanied by increased exercise test capacity, where, type of revascularization and PTCA on LAD had no significant effect. A true experimental study seems helpful.

Background: Regarding the various known and unknown complications of drugs such as marcain, and reports of similar efficacy of minidosage of marcain in spinal anbsthesia in old patients, the present study was conducted over the patients referring to Shohada Tajrish hospital in 1999 with the aim of comparing the effects of minidosage of marcain-phentanyl and routine intrathecal dosage of marcain on hemodynamic changes during TURP surgery. Materials and methods: This clinical trial was carried out over 50 patients candidated for TURP. Patients underwent standard spinal anesthesia and surgery. They have been randomly divided in two groups of control (routine dosa~e of marcain) and case (minidosage of marcain-phentanyl). The effects of these two regimens were assessed over the blood pressure and heart rate. Finally, hemodynamic changes were analyzed. Results: Groups were matched according to the age and other influencing factors on hemodynamic indices. Alteration in diastolic blood pressure was 1.26±0.3 and 1.74±0.5 mmHg in the control and case group, respectively (N.s). These changes in the systolic blood pressure were 1.26±0.3 and 1.74±0.5 mmHg, respectively. Heart rate reduction was repolied 2.59±1.3 and 3.15±0.7 beats/min in the control and case group, respectively (p<0.05), of course these differences were not statistically significant. Complications were more or less the same in both groups. Itching was not reported in the control group, whereas, 24% of the patients in the case group were suffering from itching (p<0.01). Hypertension and hypotension were the same between the groups. Level of sensory block was more than the required level in the control group (p<0.001), meanwhile, level of motor block was complete in the control group, but incomplete in the case group (p<1.0001). 18.8±9.5 mg of ephedrine was used for the control group and 12.5±6 mg for the case group (p<0.01). Conclusion: Hemodynamic reduction and its CNS and cardiovascular complications are among the most common complications of spinal anesthesia in old patients. Results have revealed no significant hemodynamic changes, so spinal anesthesia using minidosage of marcain-phentanyl is strongly recommended for lower limb and lower abdomen surgeries in patients over 65 years old.

Background: "Swimmer's shoulder" is among the most prevalent problems in swimming athletes. Shoulder dysfunction in swimmers has prevalence of 3-66% in different studies, where, no documented study was exist here in Iran. So all of the 144 swimmers participating in country's ladies championship competition in summer of 2000 were studied. Materials and methods: It was a descriptive analytic study. Personal characteristics, presence of pain, measurement of range of motion and muscle strength were all recorded in special data sheets. Results: 144 swimmers with mean age of 14.7±2.5 years have entered this study, where 16.7% had at least one kind of dysfunction in their shoulder, chiefly in the form of anterior instability (6.94%), multidirectional instability (7.63%), and bicipital tendonitis (2.08%). In addition, no significant correlation was found between swimming type and shoulder dysfunction, or between age, age of swimming onset, height, weight, and dominant hand with shoulder problem. Swimming intensity in the pain free group was 536 min/week, whereas, it was reported 449 min/week in the painful athletes, but the difference was not statistically significant. Results have revealed significant correlation between backstroke and shoulder pain, meanwhile, severe shoulder pain and bicipital tendonitis was reported in 3 members of a team who had begun their training programs just two weeks prior to the championship. Conclusion: Shoulder dysfunction is a noticeable problem in swimmers. Coaches should be taught scheduled training programs for the athletes. In addition, we strongly recommend the omission of backstroke in case of recurrent problems.

Background: Postoperative pain is a common problem, where adding neostigmine to the local anesthetic solution has been reported to be effective in eliminating this pain. So the present study was conducted over the patients undergone lower extremity orthopedic or lower abdominal surgery through an epidural anesthetic technique, referring to Shohada Tajrish and Taleghani hospitals in 2000, to determine the efficacy of this approach. Materials and methods: This clinical trial was based on 40 patients undergone the abovementioned surgeries. Patients were randomly distributed in two groups of case and control. The control group was received lidocaine alone, whereas the case group was given neostigmine (250/lg) as well as lidocaine. Postoperative pain was assessed through the Visual Analog Scale (VAS) system. Meanwhile, drug complication and analgesic usage were determined. Finally statistical analysis was used. Results: Considering the age, sex, type of procedure and ASA classification have revealed no significant statistically difference. According to the VAS system, "after 4-hour- postoperative pain" was reported 5.7±0.38 and 3.65±0.36 in the control and case group, respectively (p<0.001). These figures were shown 7.05±0.32 and 4.75±0.28 for "after 8-hourpostoperative pain", respectively (p<0.001). First need to the analgesic drugs was occurred after 4.85±0.24 and 2.25±0.16 hours in the case and control group, respectively (p<0.001). Conclusion: Adding neostigmine to the local anesthetic solutions, used in epidural anesthesia, seems to be effective in eliminating postoperative pain. Further studies on other surgical procedures and also determining the probable side effects are highly recommended.

Background: Serous otitis media is a common disease with known effects on hearing loss and learning ability. The present study has been conducted over the patients referring to BooAli hospital since 1996 till 1998, to determine the efficacy of myringotomy and V.T. Materials and methods: 40 patients (80 ears) with bilateral serous otitis media being resistant to conventional therapy were selected through a clinical examination and tympanometery. Then, they have been randomly distributed in two groups of case and control. Patients in the case group were received oral corticosteroid one week prior to the surgery. Groups were compared considering otorrhea during the surgery, myringotomy, and VT. Results: Mucosal and serous discharge has been reported in 72.5% and 27.5% of the patients in the control group, respectively. However, in the case group mucosal discharge was recorded in 55% and serous discharge in 5%. The remaining 40% were presented without discharge (p<0.0001). Conclusion: Drug-resistant serous otitis media is a prevalent disorder in our country, where myringotomy and VT could be a helpful approach. Applying a short course of systemic steroid before the surgery seems to be accompanied with better hearing performance and operation outcome.

Background: Regarding the increasing prevalence of gastroesophageal reflux disease (GERD) during the previous decade in Iran, we have designed the present study on Tehran residents in 1999 to determine the prevalence of GERD. Materials and methods: 700 individuals (M/F=l) of different age groups had entered this descriptive study through a randomized sampling. Heartburn was considered as the cardinal symptom and its severity and frequency was determined. Meanwhile, the role of personal characteristics was observed in GERD. Results: History of heartburn was reported in 39.7%, where 10.7% had experienced daily heartburn and 6.5% had such a severe pain that made them avoid eating. Smokers were two times as likely as nonsmokers to experience GERD. Conclusion: GERD is a noticeable problem here in Iran that seeks more attention. Further studies are strongly recommended to determine the etiologic factors.

Background: Because of day to day increasing frequency of sport injuries that lead to meniscal tears and several complications of meniscectomy and open surgery, and also with respect to the successful reports of arthroscopic repair of meniscal tears seen in different journals, the present study was performed over the patients with meniscal tears, referring to Akhtar and Mehr hospitals since 1997 till 1999. Materials and methods: In this clinical trial, patients were selected according to the clinical manifestations (pain, swelling, locked knee, feeling of giving way) or physical examination (McMurray, Lachman, Pivot shift, Anterior Drawer, difference of the quadriceps muscle diameter, and joint line tenderness). Patients were left out if radial and complex meniscal tear were revealed during arthroscopic examination. Results: 24 patients, including 20 males and 4 females, with the mean age of 23.8 years had entered this study. Symptoms were averagely manifested for 4.3 months (2-7 months) and 67% of the cases had previous athletic activities. Arthroscopic measured tear was 28.9±6.4 7 mm. Tear in the red-white zonw was reported in 10 cases (41.7%), whereas, red-red and white-white zone tears were recorded in 8(33.3%) and 6(25%) cases, respectively. Longitudinal tears were seen in 16(66.7%), whereas, bucket-handle was reported in 8 cases (33.3%). Fibrin clot was used in meniscal repair of 67% of the patients and ACL reconstruction was achieved in 21 % of the cases as well as meniscal repair. Conclusion: Patients were followed for 13.2 months (12-18 months) and out side-In technique was managed for meniscal repair. 8 patients (33.3%) were pain free before the study, but after that they have increased to 19 (79.2%). The difference was statistically significant. Swelling was reported in one case after the operation and feeling of giving was persisted in 6 cases (25%). Joint line tenderness and locked knee were not seen and wasting of quadriceps was significantly occurred. Mcmurray, Anterior Drawer and Pivot shift tests were negative but Lachman test was positive in one patient undergone ACL and meniscal repair. Range of motion was normal pre- and postoperatively. Meniscal tears seek immediate management and arthroscopy seems to be useful and safe.

Background: The yearly incidence of AIDS continues to grow and just now no definite therapeutic approach and vaccination exist, so health educational programs are the only choice of management. First step is the awareness of the society knowledge and perception, so a study into knowledge and perception of female-high school students on AIDS was conducted in Tehran in 2000. Materials and methods: In this descriptive study, a questionnaire composed of three separate parts (demographic data, knowledge and perception assessment) was filled. Then results were analyzed. Results: Totally 646 students, including 153 students of the northern part of Tehran and 493 of the southern part of Tehran were studied. Moderate knowledge toward AIDS was reported in 52.3%, meanwhile, considering "knowledge" no statistically significant difference was found between the groups (49% of northern part vs. 45.75% of southern part). Positive perception toward AIDS was 54.5%. Perception was significantly higher in southern pail of Tehran (75% vs. 57%). Conclusion: Knowledge and perception toward AIDS has been revealed to be unsatisfactory in students, so educational programming and thorough evaluation are strongly recommended.

Background: Predisposing lesions of retinal detachment result in severe complications in case of leaving untreated, so the present study has been conducted to determine the results of prophylactic treatment of retinal detachment in patients referring to Emam Hossein hospital since 1992 till 2000. Materials and methods: This study of existing data type was performed on patients undergone prophylactic treatment (lasertherapy and cryoterapy) who had passed follow up of at least three months. Personal characteristics, variables of predisposing lesions, complications and the necessity of additional treatment were all determined. Finally, statistical analysis was done. Results: Totally, 201 patients had undergone treatment, where 76 patients with 88 lesions were studied. Overall success rate of 89.5% was achieved. The reason of further additional treatment (26%) were new breads in 14 (16%) eyes, inadequate initial treatment in 6 (7%) and retinal detachment in 7 (8%). New breads were accompanied by retinal detachment in 4 patients, so their percents were overlapped. Considering the failure of treatment, no significant difference was found between the subgroups; however, failure rate seems to be a little bit higher in aphakic, pseudoaphakic and patients with vitreous hemorrhage. Conclusion: With respect to the high success rate achieved in our study, prophylactic treatment for the predisposing lesions of retinal detachment is strongly recommended. Meanwhile, considering the necessity of additional treatment in most of the patients, longer period of follow up seems to be inevitable. We suggest another clinical trial with greater samples.

Background: Regarding the high prevalence of abnormal uterine bleeding and the probability of endometrial hyperplasia with its known complications and prognosis, an epidemiological study has been performed over the patients referring to the Mahdieh hospital with the chief complaint of abnormal uterine bleeding candidated for D&C since 1994 till 1998. Materials and methods: In this existing data study, patients with abnormal uterine bleeding candidated for D&C were studied. Pathologic report of endometrial hyperplasia was the basis of diagnosis. Results: Among 715 patients, 126 (17%) were found to have endometrial hyperplasia. The vast majority of them were in the forth decade of their life. Simple hyperplasia was established in 90.5% of the cases. Conclusion: Association of endometrial hyperplaisa with AUB seems to be a severe problem that seeks more attention and inquiry. More studies considering the etiologic factors and the role of conventional treatment in reduction the risk of endometrial carcinoma are strongly recommended.