Researcher Bulletin of Medical Sciences
Year:2003 | Volume:8 | Issue:1 (31)|Papers Count:17

Background: Reduced bone density is a well-known complication of thalassemia major. This problem has been manifested more commonly due to longer life of affected individuals. The present study was conducted to determine the prevalence of reduced bone mineral density in 10-20 year old patients with thalassemia major and its related factors, Tehran, 2001. Materials and methods: For this cross sectional study, 208 patients with thalassemia major undergoing blood transfusion in Tehran were included. Bone mineral density of lumbar and femoral bones was determined by dual X-ray absorptiometery technique. Those who have Z score of-1 to -2.5 (compared with age-and sex-matched controls) were considered as osteopenic; however those with Z score of less than-2.5 were osteoporotic. Results: Osteoporosis of lumbar and femoral bones was reported in 50.2 and 11% of subjects. Mean age of patients with osteoporotic lumber bones was significantly higher than others (P<0.001). Testis size in boys and breast size in girls was significantly correlated with Z score. Growth percentiles of weight for age, weight for age and height for weight were significantly correlated with lumbar bone density. Conclusion: The association between age and bone density reveals the effective factors influencing the mineral contents over a period. Meanwhile, delay in puberty could be an influential the mineral contents over a period. Meanwhile, delay in puberty could be an influential factor. Preventing methods (hormone therapy and modified diet) as well as early diagnosis and treatment are strongly recommended.

Background: The influence of HER-2 on prognosis of breast cancer is a matter of controversy. The purpose of this study was to investigate the long-term prognostic significance of HER-2 oncoprotein expression in breast cancer. Material and methods: 103 premenopausal node positive breast cancer patients who received adjuvant treatment between 1004 and 1997 were enrolled in this study. The immunostaining for HER-2 was performed on formaldehyde solution fixed paraffin embedded sections of patients. HER-2 positive subjects were considered as the case group, whereas those negative for HER-2 compromised the control group. Prognosis was determined according to the overall survival (OS) and disease free surveillance (DFS). Results: Groups were similar according to the age, pathology, stage of the disease, type of surgery, and adjuvant. 30 patients (29.3%) revealed a positive staining for HER-2 oncoprotein. Positive staining correlated with absence of estrogen receptor content (P<0.009). The difference in survival between two groups was significant for overall and disease free survival (P<0.004). HER-2 positive patients who underwent oophorectomy revealed better HER-2 negative patients. In a multivariate analysis, HER-2 expression was an independent prognostic factor. Conclusion: This study supports the association of HER-2 oncoprotein expression with poor prognosis in node-positive premenopausal breast cancer. Oopherrctomy must be considered as an adjuvant treatment for HER 2+patients. Further multicentric studies would precisely clarify the association.

Background: Hearing loss is one of the manifestations of multiple sclerosis. BAER test shows abnormality in many patients, however, few patients complain of hearing loss. This study has been designed to assess hearing state of MS patients with BAER impairments without hearing symptoms by performing PTA test during one year, 2000-2001, in Loghman Hakim Hospital. Materials and methods: This case-control study was performed on 20 MS patients with BAER impaired test as case group and 20 other non-neurologic patients with normal BAER test. Groups were matched according to the age, sex and socioeconomic status. There was no history of any hearing symptoms in both groups. The data regarding clinical manifestations and impairment of specific BAER components were obtained from the case group. Both groups performed PTA test. The interpretation of BAER and PTA test was done based on the normal and abnormal values in the related laboratories in Loghman Hakim Hospital. Results: In each group 5 patients showed hearing loss. In the case group four patients had hearing loss in frequencies above and below 4000 Hz and only one had exclusive high tone hearing loss. In contrast 4 patients in the control group had exclusive high tone hearing loss, however, it is known that low tone haring loss is clinically more valuable. The Fishers exact test revealed no significant difference regarding the hearing loss pattern. Conclusion: Hearing loss is well-defined is MS but we could only consider a modest probability of relationship between BAER impairment and hearing loss in asymptomatic patients in some limited frequencies. Thus we recommend similar-large multicentric studies to settle the issue.

Background: Scintigraphy remains the gold standard to study gastric emptying. We used this method to demonstrate the impact of delayed gastric emptying on gastroesophageal reflux disease (GERD), one of the most common gastrointestinal disorders. Materials and methods: For this case-control study, Scintigraphy was performed on 16 patients with documented GERD and 16 asymptomatic normal volunteers. The test meal was composed of two labeled fried eggs with two slices of bread, and 150 ml of unlabeled water. Images were obtained in anterior and posterior projections in 30-minute intervals for a total period of two hours. Gastric emptying curves T1/2 (the estimated time required for the stomach to empty one-half of its original meal (and RA120 (gastric retention activity at 120 minute) were used for gastric emptying evaluation. Results - Seven (43.75%) of patients had deviation in their gastric emptying curves compared to normal limits. Mean T1/2 and RA120 of the patient group were 95.8±54.0 minutes and 33.0 ± 15.9 percent compared to 64.9±14.5 minute and 20.3 ±8.4 percent of asymptomatic control group respectively ,demonstrating a significant different (p<0.04 for T1/2 and p<0.01 for RA120). Conclusion: There is a significant relationship between delayed gastric emptying and GERD, particularly related to distal gastric function.

Background: Color Doppler ultrasound revealed to be one the most important diagnostic modalities, however, diagnosing portal venous disorders requires comparative normal values for portal diameter, peak blood velocity and volume flow. Materials and methods: Forty-three normal adults referring to our sonography center entered this cross sectional study. They were fasted for at least 8 hours. Sonography was achieved on supine position using Gary scale B-mode and also color and pulsed wave Doppler ultrasonography. Having measured the main portal vein and its branches diameter and peak velocity, the volume flow was estimated, then, their association was determined by gender, sex, height, weight, body surface area, and body mass index. Results: In the main portal vein, the mean (±SD) diameter, peal velocity, and volume flow were 9.57±1.89mm, 17.59±3.57, and 583±179 ml/min, respectively. The main portal vein and its braches diameter were significantly differed among males and females (P<0.01). Meanwhile, there was a significant association between the main portal vein diameter and height (P<0.05), and weight (P<0.01), however, this correlation was absent for body surface height (P<0.05), and weight (P<0.01), however, this correlation was absent for body surface and body mass index, and age. Moreover, we could not find any significant correlation between the right and left portal vein branches diameter and peak velocity and these independent variables, however a significant relation was revealed between the main portal vein and its branches diameter and peal velocity (P<0.05). Conclusion: To compare the main portal vein diameter between healthy subjects and patients, sex difference should be taken into account. Meanwhile, volume flow of main portal vein is highly correlated with body surface area.

Background: Focal hyperhydrosis is a common disease with unknown etiology. There are some therapeutic approaches, all of which are relatively ineffective of even accompany side effects. Botulinum toxin A was introduced as an effective therapy some years age, however we lack any informative data in our country, thus the present study was conducted in Loghman Hakim Hospital in 2001.Materials and methods: For this clinical trial, 32 patients with focal hyperhydrosis were included. Palm, sole and auxiliary regions were affected in 20, 5, and 7 patients, respectively. Botulinum toxin A was injected intradermally. Results: of 32 patients, 31 (96.9%) have responded to our intervention. Transient weakness of hand was reported in 9 patients. Conclusion: Intradermal Botulinum toxin A is an effective, stable therapeutic approach for patients with focal hyperhydrosis. Further studies are highly recommended.

Background: Diarrheal diseases are the most important health problems in developing countries. In our country, the shigellosis has been recognized as a common cause of acute diarrheal disease, particularly during summer season. Since the true profile of antibiotic sensitivity is not available, physicians prescribe wide range of antibiotics for shigellosis. This may lead to antibiotic resistance and also impose large expenses on patients and society as well. The present study was conducted to determine the antibiotic resistance among shigella serotypes isolated from shigellosis cases in Booali hospital. Materials and methods: It was a descriptive study. All cases of shigellosis who were diagnosed according to their clinical picture and culture were included. Having the shigella serotype defined, qualitative (disk perfusion) and quantitative (MIC) antibiotic sensitivity tests were achieved. Results: Patients age ranged 12 to 89 years 55.9% were males and the remaining 44.1% were females. Of 89 positive cultures, shigella sonnei was revealed in 40.25 were shigella flexenery, 21 were s. dysentery, and 3 were s. boydii. More than 95% of the isolates were sensitive to ciprofloxacin, ceftriaxon and ceftizoxim, 70% to Nalidixic acid and less than 50% to co-trimaxazol, tetracycline, ampicillin and fourazolidon. Conclusion: Shigellosis is best treated with Nalidixic acid fro mild cases and out patients and fluoroquinolones and third generation of cephalosporines for more acute cases.

Background: Regional anesthesia is an alternative for general anesthesia in selected case. Paoravertebral block as a regional anesthesia technique was compare with general anesthesia for elective breast surgeries regarding postoperative pain. Materials and methods: In a randomized clinical trial, 60 patients were assigned randomly in the case and control groups. Having fulfilled our inclusion and exclusion criteria, patients underwent anesthesia and surgery. Postoperative visual analogue scale scores as well as postoperative hospital stay and morphine requirement were compared at hours 1, 3 and 6 following the operation. Data analysis was done with SPSS (Ver.9.0) software. Results: There was no statistically significant difference between the groups regarding the demographic variables; however VAS (visual analogue scale) scores, morphine requirement and days of hospital stay were significantly lower in the Para vertebral group. Conclusion: The study suggests Para vertebral block as a suitable alternative for general anesthesia in elective breast surgical procedure.

Background: Hysterectomy is the most common intraabdominal operation after cesarean section. The closure of peritoneum in abdominal hysterectomy is traditional despite published data that indicate re-approximating peritoneum is not necessary and may promote adhesion formation. This study was undertaken to compare postoperative short-term morbidity between closure and non-closure of peritoneum in abdominal hysterectomy. Materials and methods: A parallel-group, double blind randomized controlled trial was their peritoneum (both parietal and visceral) closed and 60 patients (open-group) did not have any peritoneal re-approximation. Initial data including period of operation, bowel performance, postoperative pain, and postoperative were all determined and compared between the two groups. Results: Groups were similar according to the age, surgery indications, preoperative hemoglobin concentration, and type of anesthesia. Postoperative pain (visual analog scale) was lesser in the open-group (P-0.0073). The mean period of operation was shorter in open group (P=0.005). There was no significant difference in postoperative bowel performance, liquid diet, laxative usage, antibiotic administration, analgesic usage and fever. Conclusion: Non-closure of visceral and parietal peritoneum in abdominal hysterectomy seems to have better outcomes. Shorter period of surgery and anesthesia may lead to lesser postoperative pain.

Background: According to high incidence of Poly Cystic Ovarian Syndrome (PCOS) in our population, the question is if transvginal can help the diagnosis of this disease. To answer this question, this study was performed on patients referred to Mahdieh hospital between 1999.2001. Materials and methods: It was a descriptive study. 60 PCOS patients were included and their ovarian volume, number and size of small follicles in each ovary, ovarian asymmetry and stromal hyperechogenicity were determined by transvaginal ultrasound, and then compared to Takahachi and Vander's criteria. Results: Of 60 patients, 93.3% had infertility, 53.3% oligomenorrhea, 67% amenorrhea, and 36.7% regular cycles. Hyrsutism and acne were revealed in 43.3% and 10% respectively. Mean (±SD) ovarian volume was 11.1±6.7 cc. Mean follicular number was 13±4.4 and follicular size was 6.7±1.5 mm. Increased ovarian hyperechogenicity was seen in 83.3% and ovarian asymmetry was seen in 50% of patients. Conclusion: Ultrasound indices were reliable for our population, but with respect to the lack of gold standard, it is better to study the role of transvaginal ultrasound, clinical and hormonal evaluations.

Background: Outpatient surgery is practiced worldwide. The shortage of nursing and limitations of bed spaces, as well as the popularity of outpatient surgery with patients has encouraged the growth of outpatient surgery and the emphasis on its efficacy. Complications like nausea, vomiting, dizziness, drowsiness may delay ambulating of patients and cause prolonged hospitalization. The present study was conducted with the aim of determining the efficacy of intravenous fluid therapy on adverse events of outpatient surgeries. Materials and methods: We studied 70 patients ASA class I, II who had been candidated for D&C. They were randomized in two groups to receive 20 cc/kg (case group) or 2cc/kh (control group) of ringer solution intraoperatively. A standardized balance anesthesia (fentanyl 1 µg/kg, thiopental sodium 4mg/kg and maintenance of (Halothane 1%, O2, N2O 5%) was used for all patients. The incidence of drowsiness, dizziness, fatigues, nausea, vomiting, and recovery time, obeying orders and obeying exact order were recorded. Finally data were analyzed by SPSS software. Results: Incidence of nausea, vomiting, and drowsiness had significantly decreased in case group (P<0.05), meanwhile, mean time of recovery, obeying orders and obeying exact orders were decreased significantly in case group (P<0.0001). Mean time of eye opening has shown no significant difference between the groups. Conclusion: Intraoperative fluid replacement seems to be associated with reduced postoperative complications. Thus, this approach is highly recommended on outpatient surgeries.

Background: Myocardial infarction is a relatively frequent disease, for its etiology, microbial pathogens were revealed to be involved. The present study was conducted to determine the role of Chlamydia pneumoniae in myocardial infarction. Materials and methods: It was a case-control study. Those who had myocardial infarction and had been hospitalized for at least one week were included as the case group. Sex-and smoking habit-matched individuals were selected among hospital staff or patients hospitalized in other wards as the control group. Blood samples were obtained and anti-Chlamydial IgA and IG were assessed by ELISA technique. Positive samples were assessed by anti chlamydia pneumoniae antibodies (ELSA). Results: The study population included 41 MI patients (27 males and 14 females) and 44 control subjects (34 males and 10 females). Of 41 MI patients, 19 (46.3%) and 9 (22%) had positive anti-chlamydial IgA and IG, respectively, theses figures were 15 (34.1%) and 8 (18.2%) for the control group (NS). Positive anti Chlamydia pneumoniae antibodies was reported in 15 MI patients and 13 control subjects (NS). Conclusion: We could not find association between chlamydia pneumoniae infection and myocardial infarction, however with respect to the current controversies, further studies are strongly suggested.

Background: Abdominal hysterectomy is one of the most prevalent gynecological surgeries with know complications such as fever. This study was conducted to evaluate the effect of vaginal usage of bethadine gel in preventing the fever-related postabdominal hysterectomy complications. Materials and methods: In a single blind randomized clinical trial, 118 women aged 30-70 years, candidated for elective abdominal hysterectomy, were sequentially selected. Those who had diabetes mellitus, malignancies and immunodeficiency disorders were excluded. Individuals were randomly assigned in two groups of case (46 females) and control (72 females). Routine surgical prep was performed for both groups. For the case group, 20 ml of bethadine gel was placed in the vaginal apex. 24 hours after the surgery body temperature was determined for all the women. Women with body temperature of>38 degrees centigrade were considered to have fever. Results: Mean (±SD) age of case and control groups were 44.9±6 and 47.3±7.3 years, respectively (NS). Post-hysterectomy fever was detected in one woman (2%) of the case group and 14 women (19%) of controls (P<0.05). Etiologies of fever in both groups were urinary tract infection, abdominal wall infection, pulmonary infection, thrombophlebitis, in order. The etiology of fever remained unknown in 67% of the patients. Mean days of hospital stay in febrile patients were significantly more than the others (P<0.05). Conclusion: Results have revealed that using bethadine gel in vaginal apex in effective in controlling the post abdominal hysterectomy complications (fever). However, we require further studies to draw a true preventive picture.

Background: In the vascular trauma, as others definite diagnosis and treatment are essential in order to again perfect results. Most of these patients are in urgent situation due to bleeding or other organ injury. For these patients, the surgeon must be concerned with basic principles of management of traumatic patients (A,B,C) as well as rapid control of hemorrhage. The purpose of this prospective study was to determine the epidemiologic and etiologic factors of vascular injuries in patients with vascular trauma admitted to Taleghani hospital during a 3-year period, 1977-2000. Materials and methods: All of the patients with arterial injuries or arterial vein as well as other organ injuries were included. Results: During the study period, 157 patients were admitted with vascular trauma. The mean age was 28.5 year and male to female ratio was 7 to 1. The most frequent type was penetrating trauma (63.69%) and the most frequent site of involvement was lower extremities (56%). In 15 cases, bone fracture was also present. Neurovascular disorders were as follows: Pulse deficit 71.4%, sensitivity deficit 33.1%, motor deficit 3.6%, and nerve cutting off 14% For treatment, 77 cases underwent interpositional graft, whereas the remaining were treated by patch angioplasty, primary closure and legations of vessels. The result of surgery was satisfactory in 88%. Unfortunately, 8 cases had died and amputation was carried out in 13 patients. Conclusion: Iatrogenic and arterial trauma are common due to IV drug abusers. We suggest educational program with respect to the approaches to vascular injuries for general practitioners as well as other physicians who are actively involved in emergence department.