Researcher Bulletin of Medical Sciences
Year:2004 | Volume:9 | Issue:2 (38)|Papers Count:15

Background: According to concerns about the amount of lung irradiated in breast cancer patients treated with tangential fields, and due to lack of any information about its status in Iran, this study has been carried out to determine the percentage of irradiated lung volume, in breast cancer patients referring to Imam Hossein Hospital during years 2002-3. Materials and methods: Cross Sectional study was performed in 50 women. The percent of irradiated lung volume was calculated, using tangential simulation. Presumed values greater than 20% were considered as unacceptable. The correlation of apparent chest wall size and also wide surgical incision or extensive remaining breast tissue (within tangential fields) was also assessed with the above-mentioned volume. Results: Mean age of studied patients was 44±9.1 years, without routine simulation control, in 72% of patients percent age of lung irradiated was unacceptable. The Pearson Correlation between tangential field length, sternum length, hemi thorax width, hemi thorax thickness and multiplied of 3 later parameters, were: 0.1 (NS), -0.1 (NS), -0.4(NS), -0.11(NS), -0.1(NS) respectively. %78.6 of patients with wide surgical incision or extensive breast tissue and %63.6 without this status had unacceptable irradiated lung volume (NS). Conclusion: Without routine simulation, percent of irradiated lung volume in tangential fields radiotherapy is unacceptably high, and it seems that apparent parameters of chest wall and also surgical incision or remaining breast tissue, solely and without simulation, are not useful for estimating irradiated lung volume. Therefore, pretreatment routine simulation control is recommended.

Background: To evaluate early and late results of carotid endarterectomy (CEA) and the rate of recurrent carotid stenosis after the surgery, this study was done on the patients admitted at the Iran-Mehr hospital between 1991 and 2001. Materials and methods: In a cross sectional study, data of all the patients who underwent CEA, including indication, age, sex, preoperative angiogram and duplex scans, underlying medical illness, technique of carotid closure and immediate postoperative complications, were collected. The long-term follow-up results and the recurrence of the stenosis assessed by duplex scan were recorded and the impacts of various risk factors on the development of recurrent stenosis were assessed statistically. Results: During the study a single surgical team on 197 patients performed 212 consecutive CEA. The mean age of the patients was 66.2±8.5 years and 132 (67%) were male. Indication for surgery were Transient Ischemic Attack (TIA) 139 (65.6%); Reversible Ischemic Neurological deficit (RIND) 35 (16.5%); recovered stroke 26(12.3%); Amaurosis fugax 10 (4.7%); and symptom free high-grade stenosis 3 (1.9%) respectively. The technique emphasized routine general anesthesia and routine use of intra-operative shunt. The artery was closed primarily in 61(35.8%) cases and with a patch in 136 (64.2%). Complications include 3 (1.4%) death, 3 (1.4%) strokes, 3 (1.4%) wound hematoma and one recovered phonation disturbance. At long-term clinical follow-up one TIA and one carotid artery psuedoaneurysm was observed. Duplex scan follow-up were performed on 67 patients who 11(10.9%) of them identified with recurrent symptom free stenosis above 50%. Only coronary artery diseases were associated with an increased risk of restenosis (odds ratio, 8.2; 95% confidence interval, 1 to 73). None of the other factors including sex, diabetes mellitus, and chronic renal failure and using patch graft or simple closure influenced on restenosis. Conclusion: Surgical management of symptomatic carotid stenosis is safe on the hand of experienced surgeon using the above techniques. Recurrent stenosis was seen with more frequency in patients with CAD. This may reflect the rapid progression of arterial occlusive disease in this group of patients.

Background: Astigmatism, a type of refractive error with high prevalence. Unfortunately, there is no instrument to correct the disease completely. There are some reports that show the technolass 116 have more effective power in astigmatism correction than other instruments. This study has performed in Baghyatolla hospital by use of technolas 116 on astigmat patients in 2001. Materials and methods: 100 eyes of 60 patients were examined before and after surgery. The mean age of patients was 32±9.1 years. Their astigmatism was treated by lasik and they followed in 3 months. Date were collected during this period and then analyzed with T-test SPSS software. Results: The mean astigmatism before lasik was 1.91±0.85 diopter, but it reached after lasik to 0.34±0.14 diopter after lasik. The BCVA was 0.8±0.2. The reduction of astigmatism was 83%. No differences were observed between in male and females and also in all ages. Conclusion: It seems that effectiveness of technolas 116 in correction of astigmatism (83%) is more than other instruments.

Background: According to important of prognosis and quik decision making about treatment to patient in PICU, this study was carried to measure lactate in these patients and determines relation between serum lactate and prognosis. Lactete as the Result of the anaerobic metabolism demonstrate extent of hypoxia in ill patient. Materials and methods: In a cross-sectional study, patients who admitted to PICU irrespect of cause of admission were selected. Lactate level on admission and after 24 hours was measured. APSC score and cause of admission were also recorded after measrement of in all patients. Serum lactete in admission and after 24 hours and APSC Score with higher sensitivity and specificity that can show increase mortality in these patients were determined. Results: 68.8% of patients were male and 31.2% were female. Mortality rate was 31.2%. Serum lactate above 1.5 mmol/1 on admission and more than 1 mmol/l after 24hr and APSC>14 had correlation with mortality and increase it. Conclusion: Measurement of serum latete as a rapid and inexpensive test is recommended in pediatric patients in PICU to determine the prognosis and outcomes.

Background: Helicobacter pylori is the most microbial agent for gastroduodenal disease by increasing prevalence. There are evidences about, the occurance of disease during childhood. This study has carried out to recognize the risk factors of H. Pylori in children with gastrointestinal problems who had done endoscopy in Mofid children's hospital. Materials and methods: In this case-control study, 47 cases and the 47control were selected sequentially. The groups were matched by age and sex. Demographic variables were recorded. Positive urease test were considered as a case and negative urease test were considered as control. All of the risk factors for H. Pylori were evaluated for both groups. Odds ratio were calculated and C.I were estimated 95%. Results: The family number was 4.1±1.2 in the control and 5.7±1.2 in the case group. The attitude toward low consumption of fruits and vegetables, liquid vegetable seed oil, smoking in family, low level education of parents, blood group A and parent dyspepsia in case group were higher than control. In the all risk factors confidence was more than (1) and P Value was below 0.05. Conclusion: It appears that the consumption of fruits and vegetable, liquid vegetable seedoil and not smoking in the family are the reasons of decreasing H. Pylori infection in the children. It might be the same in adults.

Background: The aim of radiation therapy is to deliver a precisely measured dose of irradiation to a defended tumor volume. Simulation has been used instances to document the configuration of the portal and target volume to be irradiated accurately. Unfortunately, there is non-Conventional simulation in most of cancer centers in Iran. There fore in this study, it was tried to estimate pelvic inlet from inrerspinous diameter (distance between two Ant. Sup. Iliac spine) of the aforementioned patients in Radiotherapy – Oncology Department in Imam Hossein hospital. Materials and methods: Interspious diameter on the surface kin (X) and pelvic inlet (Y) on simulation in the 44 men and 61 women were determined, coefficient (r) in men and women rm=0.8841 rw=0.8141 and linear regression analysis the following equation was obtained. Y=0.525X-0.339 R2=0.7815 for men Y=0.326 X+5.18 R2=0.6626 for women Conclusion: It was concluded that in both men and women, it is possible to estimate pelvic Inlet diameter from Interspinous diameter. But the coefficient of determination (Rsq) is lower in women than men.

Background: Urinary tract infection is one of the most common diseases in neonate, infant and child and has been considered as an important risk factor for development of renal insufficiency or end stage renal disease. Quick diagnosis of acid-base and electrolyte disturbance in pyelonephritic patients and treatment of them can prevent of mentioned complications. In the Present Study the Urinary electorolyte's levels before and after treatment of urinary tract infection in Mofid children hospital were compared. Materials and methods: In this Quasi Experimental and prospective study (2002-2003), 84 patients with urinary tract infection have been investigated for changes in their serum and urinary electrolytes. Levels of sodium and Potassium in serum have been evaluated before and after treatment with ceftriaxone (75 mg/weight) and also urine random for Na and K have been measurd. Sign test was used for statistical analysis. Results: 18.8% of the patients were boys and 81.2% were girls. Sodium level in serum increased to 2.69 mEq/L (1.9%, p<0.001) and potassium level also increased to (mEq/l 8.5% p<0.001) after treatment, Random urine Na decreased to 4.2 mEq/L (23.5%, p<0.01) after treatment of pyelonephritis while. random urine postasum was increased in 52% of the patients (N.S). No differences in electrolyte were found between patients with and without obstructive uropathy. Conclusion: Hyponatraemia and hypokalaemia occurs in young infants with severe acute pyelonephritis in the absence of obstructive urophathy or vesico-ureteric reflux. The severe inflammation of the kidney, itself, may lead to the electrolyte disturbance by a transient resistance of the distal tubule to aldosterone (pseudohypoaldostronism).

Background: Regarding to importance of appropriate referral system in health system organization and Lack of data on pattern of referral of hand trauma in Iran, this study was planned to evaluate the effectiveness of referral system and pattern in hand trauma patiens. Materials and methods: In a Prospective study, 190 consecutive samples of referrals to 15 Khordad plastic surgery centre in 2001- 2002 were considered. Data gathered from oral inter view and questionnaire- based survey. Results: 90.5% of referrals were from Tehran state and 9.5% from the other states of Iran. 67.4% referred by orthopedic services, 22% by other plastic services, 10.6% by primary care centers. The mean number of orthopedic centers that the patients have gone before referral were 4.87 (range 0-12). Any care had been considered to 39% of patient before referral. 64.2% referred without any physician visit, 92% of referral had not any referral desire or request. 94.7% of patients referred without any communication by telephone or letter. Conclusion: There is not an appropriate referral system and interprofessional relation-between different specialties especially, who responsible for hand trauma management in Tehran. This results more inappropriate referral, growing health care costs, time wasting and patient unsatisfaction. The authors suggest more research into the optimum methods of dissemination and implementation of referral guidelines.

Background: Regarding to the notability environmental pollutions and high prevalence of the relevant diseases, It is important to Know whether the vegetables grown in the south of Tehran are contaminated with heavy metals or not. Materials and methods: The Present descriptive study was carried out to answer this question. Four areas in Tehran were selected randomly, and seven kinds of commonly used vegetables were collected from each area. The concentration of lead, cadmium and copper in vegetables were measured by atomic absorption. Results: 100% of examined vegetables were polluted with cadmium (0.5±0.2 ppm). 60% of vegetables were polluted with lead (5.4±2.4 ppm). There was no pollution of copper in vegetables (1.1±0.4 ppm). Conclusion: Due to high concentration of cadmium and lead in vegetables and to prevent the related diseases the vegetables should not be irrigate with waste water.

Background: The aim of this study was to determine difference of lordosis and pelvic inclination in healthy subjects and patients with CLBP. Materials and methods: 25 normal and 25 patients with CLBP (with least 6 months past history of mechanical low back pain) lumbar lordosis and pelvic inclination was measured with flexible ruler and pelvic inclinometer respectively. Results: There was not significant difference between lumbar lordosis and pelvic inclination in both normal and patient groups. Conclusion: Changes of lumbar lordosis and pelvic inclination during loading and unloading are more important than absolute amount of lumbar lordosis and pelvic inclination.