Researcher Bulletin of Medical Sciences
Year:2003 | Volume:8 | Issue:2 (32)|Papers Count:21

Background: Carpal Tunnel Syndrome (CTS) is a prevalent problem among hemodialyzed patients. Regarding the prevalence of CTS and its known complications, the present study was conducted to determine the association between CTS and arteriovenous (A-V) fistula among patients undergoing hemodialysis.Materials and methods: For this historical cohort study, wrist of hemodialyzed patients who had A-V fistula for at least 6 months was served as the case group and the other intact wrist of the same patient served as the control group. CTS were diagnosed clinically. Meanwhile, 116 random patients have undergone electrodiagnostic studies the day after hemodialysis. Patients' age, sex, duration of fistula, and type of fistula were all recorded. Finally, the association between A-V fistula and CTS was determined.Results: Of 806 patients, 279 have met our inclusion criteria. The mean (±SD) age was 51.9±14.8 years. 61.6% were males and 38.4% were females. Duration of hemodialysis was 58.7±5 1.3 months. Clinical diagnosis of CTS was made in 12.2% and 32.3% of the control and case group, respectively (p<0.000). The relative risk was 4.Conclusion: We have found an association between A-V fistula and CTS. With respect to its severe complications, routine examination, i.e. at 3-month intervals, is highly recommended.

Background: Lipid abnormalities and oxidative stress are the two major risk factors for atherosclerosis in hemodialyzed patients. Therefore the present study was designed to determine the effects of vitamin E supplement on serum lipids and apoproteins in hypertriglyceridemic hemodialyzed patients.Materials and methods: It was a double-blind randomized clinical trial. Twenty-six hemodialyzed patients from dialysis centers in Tehran with fasting triglyceride range of 230 to 500 mg/dl were randomly assigned to placebo or vitamin E (receiving 600 mg/d alpha-tocopherol acetate) groups. All patients received their supplements for 13 weeks. Venous blood (5ml) was drawn after a 12 to 14- hour fast at the beginning of the study and at the end of sixth and thirteenth weeks. Then, serum lipids and apoproteins were measured.Results: During the study, two patients of the vitamin E group and one patient of placebo group were excluded. The results showed mean serum vitamin E concentration was significantly increased in vitamin E group compared to placebo group at the end of sixth and thirteenth weeks (P<0.01I). During 13 weeks, mean serum triglyceride was, reduced 62 mg/dl in vitamin E group but increased 84 mg/dl in placebo group (P<0.01). Also, mean serum total cholesterol, LDL-C/HDL-C ratio and apoB100 were significantly reduced in vitamin E group compared to placebo group (P< 0.05). There were no significant differences between mean serum HDL-C, LDL-C, apoAI and Lp(a) of the two groups. Conclusion: Pharmacological doses of vitamin E have beneficial effects on serum lipids and apoproteins in hypertriglyceridemic hemodialyzed patients. It is suggested that future investigations be done with larger sample sizes and on various types of lipid abnormalities.

Background: Many body organs, particularly heart and thyroid, are involved in Down syndrome. Regarding various reports of prevalence rate of congenital heart disease and thyroid gland dysfunction in this syndrome, as well as lack of informative data in Iran, and in order to determine the prevalence rate of congenital heart disease and thyroid dysfunction in Down patients, the present study was conducted on 120 Down patients invited from Iranian Down Syndrome society as well as exceptional schools throughout city of Tehran in year 2001. Materials and methods: For this descriptive study patients aged between 2 months and 20 years were studied. Diagnosis of Down syndrome was made in accordance to karyotype or apparent symptoms of this syndrome. Then, they were examined for goiter. Congenital heart diseases were identified by echocardiography, and thyroid dysfunction was assessed by blood tests including TSH, T4 and T3. Results: The study population included 50 boys and 70 girls with the mean age of 10.1±5 years. The prevalence rate of goiter was estimated 5%. Subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism were revealed in 8.8, 11.5, 2.6, and 2.6%, respectively.Congenital heart diseases (CHD) were observed in 55 individuals (46%), among which 36.4% had pulmonary hypertension. The most frequent congenital heart disease was VSD (17.5%). Also it was found that the age of mother plays a role in developing congenital heart diseases in these patients.Conclusion: The prevalence rate of congenital heart disease is very close to other studies, however, the prevalence rate of thyroid dysfunction is either close to or higher than other studies. Moreover, these disorders are more commonly seen in Down patients than the normal population. Therefore, concerning the high prevalence rate of CHD and thyroid disorders in patients with Down syndrome, and with respect to the complications associated with these diseases, we strongly recommend that patients with Down syndrome should be evaluated for CHD and thyroid problems during the neonatal period.

Background: Astrocytoma is a CNS tumor for which pathologists could not make diagnosis easily, especially if it is in early stage, due to close pathologic similarity with reactive gliosis. Prior investigators have introduced immunohistochemistry of P53 as a diagnostic modality for astrocytoma, thus, the present study was conducted to determine the immunohistochemical pattern of P53 in low grade human astrocytoma. Materials and methods: For this descriptive study, all samples with definite diagnosis of astrocytoma were included. Paraffin-embedded blocks were selected and stained for P53 immunohistochemistry. Finally, zeiss microscope was used and samples with brown pigments in astrocyte nucleus were considered positive. Results: We have studied 55 samples with astrocytoma, of these 37 were males and 18 were females with the mean age of 31±16 years. Immunohistochemical pattern of P53 was positive in 20 samples (36.4%). Conclusion: Immunohistochemistry of P53 could not be used solely for definite diagnosis of low grade astrocytoma. Thus, we suggest a combination of diagnostic modalities.

Background: The cultivation of medicinal plants in difference geographical areas may be affect on their chemical composition and therapeutic activity. The present study was conducted to determine microscopic and macroscopic identification (microghraphy) of cultivated herb hyssop (Hyssopus officinalis L.) and study the chemical composition of essential oil.Material and Methods: In this explorative study carried out in 1999, the herb sample was collected from research farms of Medicinal Plants and Natural Products Research Center in Karaj. Samples were dried and hydrodistillated. The essential oil was analyzed by gas chromatography coupled by mass spectrometry (GC/MS). The compounds micrographical survey and analysis of oil were performed and compared by standard.Results: The essential oil obtained was 0.5%. The major compounds identified were pinocamphone, iso-pinocamphone and β-pinene. In micrographical study, stomata diacytic, glandular trichomes and parenchymous cells were characterized.Conclusion: The quantity of the oil, its constituents and percentages were similar to reference hyssops. Geographic area of Karaj seemed to be suitable for cultivating the herb. Study on other chemical constituents and also its cultivation in other areas to perform the same analysis is strongly recommended to complete our information regarding the Iranian hyssop.

Backgrounds: Regarding the prevalence of upper extremity injuries and soft tissue defects and problems occurred following reconstruction through conventional methods such as skin graft, local flaps, and distant flaps, the present study was conducted to determine the efficacy of extended groin-thoracolumbar flap in reconstruction of upper extremity soft tissue defects in patients referring to 15 Khordad Hospital, during the academic years of 1996-2001.Materials and methods: This clinical trial of quasiexperimental type has been carried out on 6 patients suffering from extensive upper extremity soft tissue defect. Flap length was within the 25-41 cm range. We have surveyed the efficacy of flap in covering the extensive defect, appearance of the tissue, duration of surgery, patient's hospitalization and complications.Results: The study population included 2 females and 4 males with the mean age of 25.8±8.6 years. The mean flap size was 388.7±80.4 cm2. Lesions were caused by trauma in 3 cases and burning in the remaining 3 cases. The mean operation time was 80 minutes for the first stage and 35 minutes for the second stage. For all cases the operation was successfully achieved and flap necrosis was not present in any case.Conclusion: Extended groin-thoracolumbar flap is a useful alternative for upper limb coverage. Flaps of 12×41cm size could be successfully used for this procedure. This flap can cover very large defects, meanwhile, the operation is safe and simple, and less time-consuming. Donor site morbidity is minimal.

Background: With regard to thyroid dysfunction in patients treated by radiotherapy and this concern that radiotherapy of head and neck cancers employing Cobalt 60 machine that is still in use in our country might have adverse effects on thyroidal function of patients treated by radiotherapy the present study was performed in order to determine the relationship between radiotherapy of non-thyroidal cancers of head and neck and thyroid dysfunction in patients and the control group referring to radiotherapy clinic of Imam Hossein Hospital in 2001-2.Material and methods: The study was performed using historical cohort on 60 patients consisting of 30 patients suffering from non-thyroidal cancers of head and neck as the case group and 30 patient with cancers except those of head and neck, brain and thyroid as control group. Patients were matched according to the age, sex and minimum radiation dose. Thyroid function was assessed according to a standard procedure using TSH and T4.Results: The control group included 19 females and 11 males with the mean age (±SD) of 54.5±14.2 years and the case group included 12 females and 18 males with the mean age of 45.8±15.1 years (NS). TSH disorder was reported in 6.7% and 46.7% of the control and case group, respectively. Radiotherapy has increased the possibility of TSH disorder in nonthyroidal head and neck cancer 7 times. T4 disorder was revealed in 6.7% of the control and 13.3% of the case group.Conclusion: Radiotherapy of non-thyroidal cancer of head and neck has led to disordered TSH.

Background: With respect to the importance of meat preservation and various reports on different types of packaging and to compare the effects of Modified Atmosphere Packaging (MAP) and Vacuum Packaging (VP) on shelf-life of fresh bull meat, the present study was conducted in National Research Institute of Food Science (NRIFS) in 1997. Materials and methods: It was an experimental study. 96 samples were randomly packed in two groups of MAP and VP, then transported in chilled condition to NRIFS. Chemical and microbial tests were carried out. These included PH, TVN, TBA, total coliform, lactic acid bacteria, and pseudomonas count and looking for clostridiums. Sensory evaluation consisted of color, odor and weep tests. Results: Results have revealed that total microbial count was in standard range within the first 6 weeks for VP and the first 5 weeks for MAP technique. Other microbial factors including coliforms, lactic acid bacteria, pseudomonas were similar to total count, however, clostridiums were not seen. Deterioration was defined as the presence of 24 milligrams of volatile nitrogen in 100 gram of sample and was occurred at 6th week for VP and 5th week for MAP technique. TBA and PH were always in normal limits. There was no significant difference in TBA except in the second week (p<0.05). Sensory evaluation showed that VP offered better condition in odor and color, however, it had a bit more weep.Conclusion: The results showed that according to our existing facilities, VP is recommended for meat packaging.

Background: Pemphigus vulgaris is a skin disease with mucocutaneous involvement. Although it is a rare disorder in some areas of the world, it's not considered to be so uncommon in Iran. Several etiologies have been proposed such as environmental factors, but there is no consensus on genetic factors. The present study was conducted in Loghman Hakim Hospital to determine the association between kinship and pemphigus vulgaris. Materials and methods: For this case-control study, 100 subjects including a case group of 50 first relatives of patients with definite diagnosis of pemphigus vulgaris and 50 normal controls who had no previous history of bullous diseases even within their first relatives. Indirect immunofluorescence was used to measure antibodies against pemphigus vulgaris, meanwhile, clinical studies were achieved. T test and chi square were used for data analysis. Results: The case group consisted of 18 males and 32 females with the mean age of 28.6± 17.4 years, and the control group included 19 males and 31 females with the mean age of 29.3±1.1. (NS). We could not detect any antibody against pemphigus vulgaris. Conclusion: Negativity of antibody to pemphigus vulgaris in close relatives may be due to a technical shortage. Surveying this with other techniques such as immunoblotting, DIF, and HLA Typing on greater samples is highly recommended.

Background: Painful neuropathy is one of the side effects of diabetes mellitus, the treatment and etiology of which is still unknown. With respect to the importance of pain management, the present study was conducted to determine the effect of continued diabetes on the formalin-induced pain and baclofen analgesia in Rat. Moreover effect of Baclofen as a non opiate, analgesic drug on the increased pains in the quiescent phase as the model of diabetic pain was investigated.Materials and methods: Seventy rats were included in this experimental study. The first group was assigned to control (injection normal saline) and diabetic (injection aloxan 100 mg/kg) which were tested, following the observation of the routines signals of diabetes, after one to four weeks from the beginning of diabetes, the second group was divided to a new control and diabetic group and before performing formalin test, they received baclofen (10mg/kg). The third group was divided to two diabetic groups that received baclofen and normal saline and then the pain of the quiescent phase was compared between them.Results: The results indicated that diabetes increases formalin-induced pain (P<0.05) and remained with continued diabetes. It also indicated that diabetes established increased pain in the quiescent phase (P<0.05). Diabetes had no ii1fluence on the baclofen analgesic effect, on the first phase of formalin test and increased it on the second phase and also baclofen could quiet the increased pain in quiescent phase (P<0.05).Conclusion: Diabetes mellitus could increase the formalin-induced pain in the first and second phases and also during the quiescent phase, via changes in the central and peripheral pathways. Baclofen could eliminate increased pain of quiescent phase, thus, we strongly recommend baclofen as an effective drug to comfort painful diabetic neuropathy.

Background: Satisfaction of orgasm is a necessary physiologic demand. With respect to lack of informative data, the present study was conducted in females referring to primary health care centers in Shaheed Beheshti University of Medical Sciences in 2000, to determine the attitude and satisfaction towards sexual relation.Materials and methods: For this cross sectional study, 406 subjects were selected through a randomized sampling. Initial data including age, level of education, family size, parity, breast feeding following the delivery, private bed room, availability to bathroom, socioeconomic status, stimulation and orgasm phases, and attitude towards sexual satisfaction were all recorded. Satisfaction was defined based on the orgasm phase including the culmination of the sexual excitement. Finally, attitude towards sexual relation, excitement phase and orgasm were determined among samples.Results: The mean (± SD) age of the participants was 29.1± 6.8 and the mean marriage duration was 9.1± 7.1 years. They belonged to the moderate socioeconomic class. 63.5% of the participants were not satisfied with their sexual relation. Positive attitude towards sexual relation was found in 85.2%. Reaching an orgasm was increased by age till 30 years, however, it was decreased after that time. The time of marriage has shown no correlation with attitude but a reverse association with satisfaction (p<0.05). Higher socioeconomic status was significantly associated with orgasm and attitude (p<0.05).Conclusion: To be unsatisfied with sexual relation is a serious problem that seeks further attention. Developing educational programs before and after the marriage is highly recommended.

Background: Small intestine perforation is common problem with unspecific presenting signs and symptoms. With respect to the lack of informative data in Iran, the present study was conducted in Taleghani Hospital to determine the prevalence of small intestine perforation during a 13-year period, 1988-2001. Materials and methods: For this existing data type study all patients with the definite diagnosis of small intestine perforation were included. Then patients" clinical manifestations, diagnostic modalities, and site of perforation were recorded. Results: Of 1329 cases of laparotomy, 58 (4.4%) had small intestine perforation. There were 48 males and 10 females, their ages ranged 19-75 years. Site of perforation was ileum in 37.9%, duodenum in 32.8%, and jejunum in 29.3% of the cases. In 15 cases of 19 duodenal perforation, free air under diaphragm was visible in CXR or plain abdominal X-Ray.Conclusion: In patients with typical manifestations of acute abdomen, the most important factors for laparotomy are generalized tenderness with garding or rebound tenderness, however, in case of nondiagnostic manifestations, DPL sonography and CT scan should be kept in mind, since CBC count and plain X-ray are not helpful. Totally, laparotomy may be indicated in case of progressive symptoms & physical examination.

Background: Intussusception was defined as the prolapse of one part of the intestine into the lumen of an immediately adjoining part. In case of delay in diagnosis, invagination may progress and complications worsened.Materials and methods: A retrospective study of the clinical features and surgical management of 95 cases of pediatric intussusception treated in Taleghani and Mofid hospitals during a 10-year in presented.Results: The study population included 62 males and 33 females, with their ages ranged between 2 days and 132 months. The classic triad of abdominal colic pain, abdominal mass and rectal currant jelly stool occurred in only 15.8 percent of patients. Barium enema examination was used in 19 patients but successful reduction was achieved in only 7. Surgical treatment was performed in 47 patients. 15 cases required bowel resection.Conclusion: Clinical manifestations of abdominal distension, abdominal mass and rectal mass have differed with previous studies. We have mainly applied surgery, however, barium enema is more commonly used by other surgeons. We had three cases of mortality due to post operative or post barium enema in the hospitals. Needless to say, earlier diagnosis is the single factor most likely to reduce morbidity.

Background: Glucose is a vital element that is necessary for brain function. Unfortunately, there is no unique definition for low glucose level, thus, the present study was conducted to determine the glucose level of mature and immature neonates in Arya hospital.Materials and methods: For this descriptive study, all neonates who have been delivered via cesarean section or normal vaginal delivery were included. Blood samples were gathered from cubital vein 3 hours following the delivery. Glucose level was measured by enzymatic technique. Results: 237 neonates were included, of which 222 were mature and 15 (6.3%) were immature. 110 were girls and 127 were boys. The mean glucose level was 58.86± 14.19 and 57.46± 13.6 mg/dl in matured girls and boys, respectively. We could not find any significant difference regarding the sex and type of delivery. Of 222 mature neonates, 5 had glucose level of less than 35 mg/dl. Conclusion: Based on our results, there is no need to screen for glucose level.