Researcher Bulletin of Medical Sciences
Year:2004 | Volume:9 | Issue:3 (39)|Papers Count:18

Background: Performing chronic hemodialysis in patients suffering from end stage renal disease needs a suitable vascular access like A-V fistula in upper limbs, bridge fistula in upper or lower limbs, and use of permanent or temporary catheters. The purpose of this study was to compare the saphenous vein loop fistula as a venous autograft versus the synthetic Gortex vascular graft for creating loop A-V fistula in the thigh for hemodialysis. Using on autologue vein instead of costly synthetic materials and technical feasibility because of one vascular anastomosis in lieu of two in the other method, are the features of our proposed method. Materials and methods: In a single blind, randomized and matched controlled clinical trial, sixty petients who need a bridge fistula for dialysis access were randomly divided in two groups. The groups were matched for the underlying diseases including diabetes melitus and HTN. The loop saphenous A-V fistula was performed in the test group and the Gortex loop bridge fistula in the control group. Then the function criteriae (fistula thrill and murmur) and complications in planned intervals were assessed. At the end of a year of follow up, the flow rate of all fistula were assessed by means of Doppler sonography. The data were compared with each other. Results: The function criteriae of the loop saphenous A-V fistula and the Gortex method had not significant differences (p<0.8). Also a significant difference concerning thrombosis of the fistula between the two groups were not observed (p<0.8). But, the infection rate of the Gortex method was significantly higher than the saphenous method (p<0.05). The flow rate of the fistula showed no significant difference in two groups (p<0.8). Conclusion: Thigh loop A-V fistula provides a satisfactory vascular access for hemodialysis with similar function criteria and lower infection rate in comparison with Gortex loop A-V bridge fistula in thigh. Concerning the cost and facility of its use, thigh saphenous loop A-V fistula could be a good substitude for the routine use of synthetic grafts in dialysis access surgery.

Background: Previous studies have shown major differences between age, sex and anatomical distribution of colon cancer in different colorectal regions that can be resulted from different etiologic factors in these regions. This study was performed to assess the epidemiological indices of colorectal cancer in a large series of Iranian patients. Materials and methods: In this existing data type study all patients with the definite diagnosis of colorectal cancer in twelve hospitals during 10-year was presented. Results: Totally, 2107 patients were assessed, 1177 (%55/9) were men and 930 (44/1%) were women Mean age located in fifth decade of life. %20/4 of patients was under 40 year old. %13/9 of tumors was located in right side of colon (cecum, ascending and transverse colon) and others in left side (descending colon sigmoid and rectum). In different location, sex distribution varied; 60% of rectal tumors were observed in males while, in descending and sigmoid, %47 of patients were male (p<0.001). Rectal tumors in men were %10 higher than women. In Patients under 40 years olds, occurrence of rectal involvement were higher than others (10%). Conclusion: In this study, involvement of patients was significantly greater than other countries. Also, in contrast with other studies in recent decades that have shown a shift of cancer from distal to proximal site of colon, left side involvement of colorectal cancer is a prominent feature of disease in this study. Assessing of reasons needs additional studies on epidemiology of this kind of cancer and approving of these results may necessitate screening programs in lower ages for early diagnosis.

Background: According to high prevalence of inguinal hernia, recurrence and known complication due to it's repair, It is necessary to use the favorable procedure to repair the hernia with less side effect. There are some reports about successful use of mesh in repairing the inguinal hernia. This study was performed in patients with inguinal hernia hospitalized in Ayatollah Taleghani & Mehr hospitals to compare the two procedure of inguinal hernia surgery with using mesh and without it between 1376-1381. Materials and methods: This is a prospective cohort study. Case group were the patients whom were operated using mesh and control group were operated using tissue repair technique (without) mesh. Two groups were matched by age and sex. The results of treatment regarding recurrence, infection, hematoma formation and hosoitalization days were evaluated statistically using fisher and t-test respectively. Results: From 129 patients who were studied, 52 operations was performed without using mesh (control group) and 72 operations with using mesh (case group). In control group, infection was occurred in only one case (1.9%) but; no infection was observed in case group. Hematoma formation occurred in 7.7% of control patients but not in case group. The differences between two groups were not statistically significant. Mean days of hospitalization of patients were 2.1±1 day in control and 2.7 ±1 in case groups. Conclusion: The type of operation (using mesh or without mesh) had no effect on treatment’s outcome, but according to the results of other studies in foreign medical center, we recommend more studies for accepting the effect of mesh in preventing recurrence of inguinal hernia after surgical treatment.

Background: Waist circumference (WC) cut-points were derived by identifying WC values corresponding to BMI cutoffs for overweight and obesity and not on the basis of their relation to risk factors. This study was conducted to evaluate the WC cutoff points to predict CVD risk factors in overweight Tehranian population. Materials and methods: From the 15005 participants of TLGS, 10837 subjects were aged 18-74 years. Subjects taking medications affecting serum lipoproteins, blood pressure or carbohydrate methobolism were excluded from the study and finally, 3065 subjects (1406 males and 1659 females) with BMI=25-29.9 were enrolled in this study. Weight, height and WC were measured and BMI was calculated. Blood pressure was evaluated using standard methods. Biochemical analyses were conducted on a fasting serum sample. Abdominal obesity was defined as WC≥102 cm for men and ≥88cm for women. Hypertension and lipid disorders were defined based on JNC VI and ATP II, respectively. Diabetes was considered as FBS≥126 mg/dl. Results: Dyslipidemia, "hypertension or dyslipidemia" and "one or more risk factor" were more prevalent categories of risk factors in both genders. WC≥102cm for men had very low sensitivity to detect cardiovascular risk factors. The specificity of this cut-point was relatively high. WC≥88cm had low sensitivity for identifying cardiovascular risk factors in women aged 18-34 years. Sensitivity tended to increase with age and specificity tended to decrease with age in both genders. These cut-off points had the highest positive predictive value for more prevalent risk factors in both genders. The negative predictive value was different for various risk factors among age groups. Conclusion: These cut-points failed to provide adequate evidence for the use of WC in detecting CVD risk factors. Further studies should be conducted to determine optimal WC cut-points for Iranians.

Background: Therapeutic measures for acute hepatitis B patients are mainly conservative and the most prognostic factors are natural course of the disease and host immune system effectiveness. Recently, the use of PG compounds for acceleration of recovery and improvement has been favored. Therefore, this study performed to determine the effectiveness of misoprostol (PGE analogoue) on acute hepatitis B. Materials and methods: This study was a randomized controlled clinical trial with observation & interview technique. 30 patients with acute hepatitis B (i.e. serum HBsAg & Anti HBc IgM positive) with total bilirubin >10mg% and negative Anti HCV, were selected. Patients were divided in two matched groups (based on Bilirubin, Transaminases, PT, PTT levels and also age). Case group received misoprostol 200mg/qid for 14 days and controls received placebo daily for 14 days. The level of above mentioned variables were measured before & after intervention. Thereafter, statistical analysis was performed based on c2 method and t-test P value<0.05 was considered significant. Results: Mean age of case group was 42.9±16 years and control group 47.1±17 .The meaningful differences between two groups was obvious after 14 days of initiating the treatment, so that at the end of second week of treatment, levels of Bil, SGPT, PTT and at the end of third week, amount of all mentioned variables except SGOT, were lower in case group than controls. In fourth week, decreasing in Bil, SGPT, ALP, PTT levels in case group were meaningful yet, and finally at the end of fifth week, this trend was constant. Conclusion: Using misoprostol in acute hepatitis B accelerates the trend of recovery and the levels of Bil and liver enzymes return to normal state.

Background: radiotherapy has a very important role in treatment of breast cancer but causes some complications, inducing secondary tumor in contralateal breast due to scatter dose. This study has done to measure scatter dose range in breast cancer radiotherapy in Imam Hossein hospital in 1382. Materials and methods: In a cross sectional study, the received dose to the contralateral breast with thermoluminescence dosimetry was measured in 30 patients with breast cancer The patients had undergone surgery by MRM technique and had indication for radiation therapy (two TLD chips in 5cm And two in 9cm at the level of the central ray of the medial tangenital fields). The association between different field type treatment and received dose to the breast was also evaluated. Results: On the basis of results the scattered radiation dose to the contralateral breast was in rang of 100-300 cGy in Imam Hossein hospital (142.9±19.2) in 5cm and (121.3±7.5) in 9cm. There was no meaningful association between the number of therapeutic fields and received radiation dose to the contralateral breast. Conclusion: It appears that the scatter dose in Imam Hossein Hospital is in range of reference books and doesn't increase the received dose to contralateral breast. Therefore, the risk of secondary cancer in controlateral breast is very low.

Background: Because of head trauma is frequent in our country and needs to rapid diagnosis, this assessment was done for survey of epidemiological and important factors in prognosis of the disease. Materials and methods: This existing data study was done on 304 patients with traumatic epidural hematoma that undergoing surgery. The clinical, imaging and operative characteristics of patients were assessed and prognisis was evaluated in discharge and 6 months later. Results: 261 (%85.9) of patients were male. Mean age was 26.3±15.1 years old. The most trauma mechanism was car accident. (%32.2) mean GCS at admission was 12. The most common site of the hematoma was temporoparietal (%28.3). The overall morality was %10.9. There was relation between age and preoperative awareness with mortality. The mortality was greater in car accident. There were relation between hematoma volume and preoperative GCS with disability but not with mortality. There was relation between closing of basal cistern in CT scan, coma and mortality. Conclusion: The overall mortality was similar to other studies. The prognostic factors on mortality and morbidity were similar to other reports. Attension to brain CT scan and clinical findings can be effective in final outcome.

Background: Neoplasms especially the malignant types are important health problems in all communities. Gastrointestinal malignancies are amongst the leading causes of malignancy-related mortality and morbidity. This study was performed to determine one-year prevalence of gastrointestinal neoplasms by type, location of involvement and demographic factors. Materials and methods: In this existing data study medical records of all patients receiving the diagnosis of a gastrointestinal neoplasm in public and private hospitals in East Azerbaijan province, Iran were evaluated from Mehr 1378 to Mehr 1379. Results: 1822 cases of gastrointestinal neoplasms were recorded. The mean±s.e. of the subject’s age was 60.2±13.4 years and 63% of them were male. The highest frequency of malignant neoplasms was found in the 7th decade. Gastric, esophageal and colorectal malignancies comprised 36%, 23% and 16% of the total gastrointestinal malignant tumors, respectively. The most common type of gastric malignancies was adenocarcinoma (94%) while the most common esophageal malignancy was found to be squamous cell carcinoma (82%). Conclusion: Considering the remarkable increase in the prevalence of gastrointestinal neoplasms in the province during 5 years, investigations on the etiological factors and especially the food content and dietary habits of people seems necessary. Such investigations can be facilitated and fortified by more meticulous registration of cancers and developing specialized information and data registry centers for cancer patients.

Background: It was attempted to evaluate the differences between Echocardiographic pulmonary indices and the newly proposed "myocardial performance index (Tei Index)" defined as sum of isovolumic contraction and isovolumic relaxation time divided by ejection time (IVRT+IVCT/ET). Materials and methods: A historical cohort study was designed. Total of 134 patients with pulmonary, cardiac disease and normal volunteers were enrolled in this study (19 cardiac, 78 pulmonary and 37 normal adults). All groups were matched by age, sex and EF. Echocardiography was performed for all of them. All variables were reported in Mean + S.D. Data was analyzed using ANOVA and multiple comparison tests. Results: Left Tei index in control, Pulmonary and cardicac groups were 0.41±0.16, 0.46±0.20 and 0.52±0.25 respectively (p<0.05). Right Tei index in control, Pulmonary and cardicac groups were 0.38±0.16, 0.47±0.25 and 0.52±0.19 respectively (p<0.05). Conclusion: The Tei Index is a reliable noninvasive index for evaluating global cardiac function but no correlation was noted between this index and PA pressure or other right side indices.

Background: With respect to importance of benign breast masses (risk of transformation of malignancy) and lack of precise information about epidemiology of these tumors in Iran, we have evaluated clinical, pathological and epidemiologic aspects of these tumors in patients referred to surgical department of Modarres hospital during 1987-2002. Materials and methods: In an existing data study, all data including age, sex, type of masses (benign or malignant), Symptoms and compliances, pathologic findings and familial history of patients were recorded. Data were evaluated by the descriptive-analytical statistical method. Results: From 265 patients reffered in this center by reason of breast mass, 59% had benign tumors. The most common pathological types of tumors were: fibrocystic changes 28/7%, fibroadenoma 28%, Sclerosing adenosis 10/9% and chronic nonspesific mastitis 6%. The most common symptom were: pain (60/9%), change in tumor size (48/5%), bloody nipple dyscharge (15%), positive history of breast cancer in first or second degree families in 19/8%. On physical examination of these tumors there was: Auxillary lymphadenopathy in 45/2%, undefined border in 35/6%, adhesion to skin or chest wall in 32% and dimpling in 18/4%. Conclusion: There are some malignant chracteristics in benign bearst masses. So, for exact determination or recognizing of the breast masses, both of history and physical examination with histological study are necessary and recommended.