JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2005 | Volume:10 | Issue:4|Papers Count:19

Background: Although long-term mammography is the standard means of evaluation for the probably benign lesions of breast, some times we feel obliged to know about the benignity and the extent of lesions earlier. Therefore we evaluated the diagnostic value of stereotaxic fine-needle aspiration (SFNA) in low suspicion breast lesions as an alternative to the routine modality. Methods: The study included 150 low-suspicion or probably benign breast lesions detected on mammography. All cases underwent SFNA and followed by exciosional biopsy or follow-up mammography based on SFNA findings. Results: Fibroadenoma and normal tissue lesions were diagnosed in 57% of patients, in whom no evidence of malignancy was found in the follow-up period. In 48 patients with cytologic findings suggestive of proliferative fibrocystic disease, three cases of malignancy were detected by excisional biopsy. Conclusion: A SFNA result suggesting benignity allows safe clinical follow-up, whereas a suspicious or equivocal diagnosis needs more invasive modalities for further investigations.      

Background: Iron deficiency and its resulting anemia is a common problem among Iranian pregnant women. In spite of iron supplementation program, yet, this problem has not resolved in many parts of the country. Zinc deficiency also is very common in Iran. This study evaluated the efficiency of concomitant zinc and iron therapy in the treatment of anemic pregnant Iranian women. Methods: A total of 118 anemic women were registered in this randomized controlled trial. Both groups received 100 mg elemental iron daily. The intervention group received an additional dose of 15mg zinc every day for a period of 12 weeks while the control group received placebo. Serum hemoglobin was measured at the beginig of study, after 12 weeks of treatment and at the end of 8 weeks follow-up. Collected data were analyzed with %95 significance level by ANOVA test for comparing baseline characteristics in the two groups and t-test was applied to assess hemoglobin changes in the intervention group. Results: After 12 weeks of therapy, desirable response was obtained in 78.35% and 93.1% (CI=95%) of anemic women in control and intervention group, respectively which showed a significant difference (P<0.05). Increase in serum hemoglobin just after 12 weeks of treatment was 2.22 ± 0.77 and 1.5 ± 0.66 (gr/dl) in intervention and control group respectively, (P<0.001). Serum hemoglobin differences in the two groups 8 weeks later (step2) when iron alone was administered to both groups were 2.24 ± 0.77 and 1.49 ± 0.66 (gr/dl) respectively. (P<001) Conclusion: this study clearly demonstrated the efficacy of this inexpensive and simple intervention in the treatment of anemia and prevention of its recurrence in anemic pregnant women.  

Back ground: In major thalassaemia patients who need blood transfusion, iron overload is a major therapeutic disadvantage that leads to heart failure which is the major cause of death in such patients. Desferrioxamine (DFO) is the most efficient factor for iron chelation, but it carries adverse effects such sensory-neural hearing loss. Methods: The study began in March 2002 and continued untill March 2003, on 160 cases of thalassaemia to determine the incidence of sensory – neural hearing loss and its risk factors in patients who received Desferrioxamine (DFO). All cases underwent audiometric tests. Retrospectively, other needed information were either obtained through interview or extracted from the medical files. Results were analyzed with ANOVA, t-test and Chi-square tests. Results: Seventy-six patients of the total 156 patients showed impairment in PTA (48.7%) with 24 of them suffering significant involvement (15.4%). These abnormalities generally affected high frequencies including, 4000 and 8000 Hz. Male gender, increased serum billirubin level and fasting blood sugar were statistically correlated with hearing loss (p.v = 0.038, p.v = 0.38, p.v = 0.002 respectively). There was no significant correlation between hearing loss and other factors. Mean DFO administration in patients, was 29.69 mg/kg/day and mean therapeutic index of DFO was 0.01 mg/kg/day/mg/lit. Both of them were below the critical level (<40mg/kg/day and <0.025mg/kg/day/mg/lit respectively), however hearing loss had developed. Conclusion: Controlling DFO dosage per se does not seem to be enough for decreasing ototoxicity rate. Periodic audiometric tests are highly recommended to detect hearing loss as soon as possible. There are some other factors such as male gender, increased billirubin and FBS, which contribute to DFO ototoxicity. Looking for these risk factors and controlling them, would help identifying susceptible patients and preventing this complication.  

Background: Etiologic overlaps may occur in patients with ischemic stroke depending on the diagnostic investigations and classification criteria. Methods: Consecutive ischemic stroke patients admitted in Mackenzie hospital, Canada from August 2003 to August 2004 underwent a standard battery of diagnostic investigations by stroke neurologists. Stroke mechanism was defined based on the Toast criteria. Stroke topography subtypes were small and large artery territory infarcts. Results: A total of 302 stroke patients (159 female, 143 male) were registered. Small and large artery territory infarcts consisted 25.5% and 74.5% of our topography respectively. Etiologic overlaps were found in 17.5% of the patients. Cardiac source of embolism was significantly more frequent in patients with large artery territory infarcts (p= 0.002) but frequency difference of corresponing large artery atherosclerotic stenosis was not significant in these topographies (p= 0.378). Etiologic overlaps were more frequent in patients with small artery territory infarcts (p= 0.004). Conclusion: Etiologic overlaps are frequent and should be considered for optimal management of the ischemic stroke patients.  

Background: Postoperative pain is a significant problem in pediatrics. Preemptive administration of analgesics has recently emerged as a method to enhance pain management associated with surgery. The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative oral ibuprofen versus acetaminophen in preventing pain after lower abdominal surgery in pediatrics. Methods: In this randomized, double-blind study, following lower abdominal surgery, 75 children, aging 3 to 12 years, were assigned to receive either ibuprofen 20 mg /kg (n=25) or acetaminophen 35 mg/kg (n=25) or placebo (n=25) 2 hours before surgery. Agitation in recovery was measured and postoperative pain was quantified 3 and 24 hours after surgery by Oucher’s scale. The amount of postoperative analgesic needed in the ward was also assessed. Results: It was found that preoperative administration of ibuprofen and acetaminophen can reduce agitation in recovery but there was no difference in the agitation score between ibuprofen and acetaminophen groups (P=0.145). Agitation score was significantly lower in ibuprofen group compared to placebo (P>0.005). Similarly, patients in the acetaminophen group were considerably less agitated than those in the placebo group (P=0.002). No significant difference was observed in pain intensity 3 and 24 hours after operation between the three groups [(P=0.495) and (P=0.582) respectively]. The amount of postoperative analgesic needed during ward hospitalization was not significantly different among the three groups (P>0.005). Conclusion: These results provide evidence that preemptive acetaminophen and ibuprofen may reduce agitation during recovery but they neither improve the postoperative pain nor reduce analgesics consumption in ward.    

Systemic lupus Erythematosus (SLE) is a disease with different immunologic abnormalities affecting multiple organs and systems. We describe a case of SLE with multiple pulmonary round lesions, who was admitted due to hemoptysis, mild dyspnea, chest pain and gross hematuria. The patient favorably responded to intravenous immunoglobulin (IVIG).

Oral-Facial-Digital Syndrome (OFDS) is a general term for several apparently distinctive genetic disorders. One of these is OFDS type I (OFDS-I) which has rarely been reported in Asian countries. Here, we present an 18 year old patient with OFDS type I, who referred to Isfahan University of Medical Sciences’ Dental Clinic.    

Tuberculous pericariditis is the most common cause of chronic pericarditis, especially in developing countries. Cystic tuberculous pericarditis is an exceedingly rare type of tuberculosis. Authors discuss clinical manifestations and radiological findings in a patient with cystic tuberculous pericarditis in whom diagnosis was confirmed by pericardial biopsy.

Two infants, a boy and a girl aged 2.5 and 5 months, respectively, were admitted to Tehran's Children Hospital, for fever of unknown origin lasting for about two weeks. The boy presented with abdominal distention, diarrhea, irritability, pyuria, anemia, leukocytosis, thrombocytosis and raised titer of acute phase reactants. The girl presented with irritability, diarrhea and abdominal distention, Leukocytosis, thrombocytosis, anemia and elevated titer of acute phase reactants. All bacterial cultures and serological tests were negative. Cardiac echocardiography showed coronary artery aneurysm in both patients and confirmed the diagnosis of Kawasaki disease. These cases showed that atypical Kawasaki disease was often a late diagnosis and therefore should be quickly suspected in febrile young infants with abnormal inflammatory laboratory results without infection. Echocardiography is an important tool for diagnosis of atypical Kawasaki disease.  

Septic thrombophlebitis of a vein is a rare but life-threatening complication of an intravascular (IV) catheter placed percutaneously in the veins. Most published clinical experiences with IV catheters, mainly in the outpatient settings, have reported very low rates of catheter-related bloodstream infection compared to rates with central venous catheters placed in a subclavian or internal jugular vein. Most of the complications reported with IV catheters have been non-infectious, particularly sterile phlebitis or thrombosis. We report a case of cephalic vein suppurative thrombophlebitis from an intravascular catheter and offer guidelines for diagnosis and management of this complication.

Charles Bonnet syndrome is an entity including vivid and complex visual hallucination and has been well known in patients with visual problem. A middle-aged Afghan female refugee with the diagnosis of major depressive disorder who had episodic complex and well formed visual hallucinatory periods with open eyes will be described. She also experienced auditory and olfactory hallucinations associated with visual hallucination. Hallucinatory experiences described in Charles Bonnet syndrome may exist concurrently with psychiatric disorders such as major depressive disorder. Olfactory hallucination as a symptom of Charles Bonnet syndrome is reported for the first time in our case.

A 45-year-old woman was brought into the emergency room of Al-Zahra hospital, Isfahan, after her first generalized tonic-clonic seizure and a history of thunderclap occipital headache ten days before the first seizure. Examination revealed mild confusion and slight left hemiparesis with facial weakness and no meningeal irritation signs. CT scan showed subarachnoid hemorrhage (SAH) and MRI demanstrated left lateral, sigmoid and sagittal sinus thromboses. Angiography was normal. She was treated by anticoagulants in spite of hemorraghic parenchymal lesion.      

We would like to present the results of our study on the referral causes and mechanisms to Al-Zahra University hospital, Isfahan, Iran, from March 2001 to September 2001. In this 7 month period, a total of 900 out-patients admitted to this center were randomly registered in our survey. Patients’ information such as age, sex, occupation, being a member of University personnel or having a relation with the personnel, cause of admission and etc were filed and analyzed.