JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2005 | Volume:10 | Issue:2|Papers Count:18

Background: Dry cough is the most common adverse effect and limiting factor of all angiotensin converting-enzyme inhibitors (ACEIs). Prostaglandins have been pinpointed as playing an important role in the genesis of this problem. This double blind clinical trial desinged to study the efficacy of 500 milligram (mg) of aspirin comparing with placebo in controlling Enalapril-induced cough. Methods: The subjects were 32 patients who had developed Enalapril-induced cough. They were randomized into two groups: a group of daily dose of aspirin, 500 mg and a group of placebo for a treatment period of 4 weeks. Mean of cough severity was compared between two groups before treatment and weekly, until 4 weeks. Results: Mean of cough severity in aspirin and placebo groups before and at the end of first week of treatment did not show any significant difference. After the second, third, and fourth weeks, cough severity scores were significantly reduced in aspirin group (p<0.001). Conclusion: 500mg aspirin, once daily, can suppress or abolish Enalapril-induced cough and this finding proposes alternative therapeutic approach for ACEIs-induced related cough.        

Background: The aim of this study was to study the influence of depth of anesthesia (awake or deep anesthesia) and choice of anesthetic drug (halothane or propofol) on the incidence and severity of airway hyperreactivity associated with Laryngeal Mask Airway (LMA) removal. Methods: A prospective, randomized, double blind study was done in 156 ASA physical status I and II patients, aged 18-65 years, who had under gone short time elective surgery (<1 hour). Patients were randomly assigned in one of the four subgroups: Hal-Aw (anesthesia maintenance with halothane and LMA removal in awaked state), Hal-Deep (anesthesia maintenance with halothane and LMA removal in deep anesthesia), Pro-Aw (anesthesia maintenance with propofol and LMA removal in awaked state), and Pro-Deep (anesthesia maintenance with propofol and LMA removal in deep anesthesia). The incidence of cough and straining, bronchospasm, laryngospasm, breathholding, vomiting, oxygen desaturation, and severity of airway hyperreactivity (mild, moderate, severe) with LMA removal were evaluated. Results: There were no significant differences in bronchospasm, larynchospasm, oxygen desaturation among four subgroups. Significant differences were in cough and straining, breath holding, vomiting, and finally severity of airway hyperreactivity among four subgroups. Depth of anesthesia didn’t have any effect on incidence and severity of airway hyperreactivity but in those with propofol, they were lower than those with halothane. Conclusion: In short time surgery and with use of LMA, anesthesia with propofol is associated with lower incidence and severity of airway hyperreactivity than halothane.    

Background: Preemptive analgesia is based on the idea that analgesia which initiates before a nociceptive even will be more effective than the analgesia commenced afterwards. This clinical trial compared postoperative analgesia and comfort in patients with general anesthesia combined with preoperative or postoperative local anesthesia. Methods: 90 patients who had been scheduled for phacoemulcification in Farabi Eye Hospital, 2002-3, were enrolled in the study. Sixty patients received general anesthesia: 15 received preoperative local anesthesia (GA+LA+OP), 15 received postoperative local anesthesia (GA+OP+LA), and 30 did not get local anesthesia (only GA). Thirty patients only received local anesthesia (LA). Subjective postoperative pain was determined by a visual analogue scale. Frequency of oculocardiac reflex, postoperative nausea and vomiting (PONV), and patient's comfort were assessed. Results: Postoperative pain was less in local anesthesia (LA) compared to general anesthesia (GA) (p < 0.0001). Additional preoperative application of local anesthesia (GA+LA+OP) resulted in less pain than additional postoperative application (GA+OP+LA) (p <0.05). Additional postoperative peribulbar block did not differ from general anesthesia (Only GA). The incidence of intraoperative oculocardiac reflex and postoperative nausea and vomiting was significantly less in patients with peribulbar block (P = .0001) and in GA+LA+OP group, as compared with others (P= 0.001). Conclusion: We conclude that preoperative local anesthesia (Only LA ) or in combination with general anesthesia provides the best comfort for the patient in eye surgery.  

Background: Cardiovascular damage after Radiotherapy of left chest wall for left breast cancer is a potential fear, therefore studing both the possible causes of radiation-induced heart damage and preventive measures are crucial issues in radiation therapy of breast cancer. The present study investigates noninvasively the possible acute and chronic ECG changes and their incidences after Radiotherapy in patients with left sided breast cancer who have received 6-8 courses of Anthracycline based chemotherapy following mastectomy. Methods: 56 patients with breast cancer (invasive ductal carcinoma) who had been undergone modified radical mastectomy, adjuvant Anthracycline based chemotherapy, and left sided chest wall electron therapy with direct field, have been evaluated. All patients investigated with physical examination and standard 12 leads ECG before, and immediately after completion of radiation therapy, and 6 months afterward. Results: New electrocardiographic changes after therapy were seen in 3 patients (5.35%) and reduced to 2 cases (3.57%) after 6 months. there was no significant difference in T wave findings before and after radiation therapy(P=0.521).Also there wasn’t any correlation between stage of cancer and any changes in ECG findings after radiation therapy (P=0.56). Conclusion: There were no clinical cardiac symptoms or signs after Radiotherapy. Most affected leads in ECG were V1-V4 and the main abnormality was Inverted T wave. This findings suggest that the most acute and chronic electrocardiographic effect of irradiation on heart is repolarization abnormality. This study suggests that there are no significant ECG changes after Radiotherapy of left chest wall by electron beam in patients with left sided breast cancer who has received Anthracycline based chemotherapy following mastectomy. Also Radiotherapy by electron doesn't induce any clinical cardiac symptoms and signs in these patients. Therefore, we recommend using electron beam for Radiotherapy of patients with left sided breast cancer after radical mastectomy if Anthracycline based chemotherapy, has been administered.    

Background: Kidney's functional and anatomical changes reversibility of after treatment of partial ureteropelvic junction obstruction (UPJO) is not defined well. Therefore, in this clinical trial study, we've evaluated these changes. Methods: In a clinical trial study with non randomized-simple sampling, 32 patients with chronic partial obstruction of urinary tract due to unilateral UPJO were studied. In each patient, IVU, DMSA, DTPA, and bilateral kidney sonography were down pre and post operatively. Paired t-test, Wilcoxon, and McNemar tests analyzed data. P-value less than 0.05 was considered significant. Results: Mean age of the patients was 5.44 ± 0.47 years old and 40.6 % of the patients were male. Split function mean in DMSA had significant difference, comparing pre and post operatively (P<0.05). There also was a significant difference in mean of retention time and T1/2 of DTPA (P<0.05), comparing pre and post operatively (P<0.05). Mean of kidney pelvis diameter had significant difference, comparing pre and post operatively (P<0.05). Conclusion: Our study showed that operation of chronic partial obstruction of kidney, could improve kidney function. We also showed that sonographic evaluation of kidneys could help to evaluate kidney function in these patients.  

Background: Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. Methods: A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5 % bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. Results: There were no differences in postoperative pain scores on the visual analog scale (VAS): In groups 1and 2, VAS at hour 4 were 6.37±1.13 versus 6.29±1.19; At hour 8 were 5.54 ± 1.17 versus 5.37±1.09; and at hour 12 were 4.5 ± 1.31 versus 4.45 ± 1.1 respectively (P-value was not significant). There was not any difference between the main of morphine consumption between the two groups: at 12 hours, they were 11 ±3.5 versus 11.5 ±3.63; and at 24 hours, they were 17.87±5.88 versus 18.29 ±5.85 (P-value was not significant). Conclusions: The administration of local anesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing lower abdominal surgery.

Background: The effects of pretreatment with magnesium on cardiovascular responses associated with intubation have been studied previously. In this study we wanted to find optimal dose of magnesium that causes decreased cardiovascular responses after laryngoscopy & endotracheal intubation. Methods: In a double-blind, randomized, clinical trial, 120 ASA-1 patients with ages between 15-50 years old, who were candidates for elective surgery, were selected and classified in 6 groups (20 patients in each ). The pulse rate and arterial blood pressure were measured and recorded at 5 minutes before taking any drug then, according to different groups, patients took magnesium sulfate (10, 20, 30, 40, 50mg/kg) and lidocaine (1.5 mg/kg). The induction of anesthesia was same in all groups and the pulse rate and arterial blood pressure were measured and recorded just before intubation and also at 1, 3 , and 5 minutes after intubation (before surgical incision). Statistical analysis was performed by use of ANOVA, Post Hoc test (Duncan), Pearson correlation, and Chi square test. Results: there were no statistically significant differences in blood pressure, pulse rate, Train Of Four (TOF), and complications between groups who received magnesium but the significant differences in these parameters were seen between magnesium and lidocaine groups. Conclusion: We concluded that pretreatment with different doses of magnesium sulfate have a safe decreasing effect on cardiovascular responses that is more effective than pretreatment with lidocaine.  

Background: This study compared the efficacy of Ketotifen fumarate .025% (Zaditen) with Cromolyn sodium 4% (Opticrom) eye drops in prevention of itching, tearing, and redness in Vernal Keratoconjunctivitis (VKC). Methods: This double blind randomized single center clinical trial conducted between April and August 2004 in Yazd. One hundred eligible patients with clinical diagnosis of moderate VKC were randomly prescribed Zaditen (group A: n=50) and Cromolyn sodium (group B: n=50) eye drops for a 4 weeks period. Itching, lacrimation, redness, and photophobia were scored on a 4-points severity scale. Results: After 7 days of treatment, the response rates based on subjects assessment of global efficacy was significantly greater in Ketotifen group (61.5%) than in Cromolyn group(53%).A clear response to treatment occurred in 94.4 of Zaditen and 81.2% of Sodium Cromoglycate treated patients. The investigator,s assessment of response rates also showed that Ketotifen was superior to Cromolyn sodium (P=0.001). Ketotifen produced a significantly better outcome than Cromolyn for relief of signs and symptoms of VKC (P<0.05). Ketotifen fumarate treatment significantly reduced the total signs and symptoms score for each patients, in compare with day 0. Conclusion: Ketotifen had a faster onset of action and provided better symptom relief than Cromolyn. The rapid onset of action and symptom control, make Zaditen a valuable treatment for VKC.  

Background: The assessment of cerebral vasoreactivity can provide information regarding the reserve capacity of cerebral circulation. Reduction of this property has been found in association with situations predisposing one toward cerebrovascular disease. In this study, we defined the vasoreactivity of brain vesseles according to age and sex of the patients. Methods: In this descriptive study, 289 healthy subjects (without hypertension, diabetes mellitus, obesity, smoking, CHF, CHD,) were admitted from January 2004 to June 2004. The population was divided to four groups, according to age and sex (women and men more and less than 30). After determination of each patient’s flows velocity of middle cerebral artery (MCA) by mean of a transcranial doppler instrument (TCD), before and after 30s apnea, breath holding index (BHI) was calculated. Data was analyzed, using SPSS software. Results: BHI was significantly higher in women than men (0.918±0.40 versus 0.637±0.22; P<0.001). BHI was significantly lower in older (age > 30) women (0.812±0.31) than in younger (≤ 30 years) women (0.995±0.44; P<0.001) but there was no significant difference between older (age > 30) men (0.62±0.23) and younger (≤ 30 years) men (0.65±0.20; P > 0.05). Conclusion: The average of BHI was lower in men than in women in total and in all age subgroups. BHI was relatively constant in all age subgroups in men but there was significant decline in BHI by increasing age in women. So despite of many physiologic changes related to aging, vasomotor reactivity remains relatively constant in men but decreases in women. Findings of our study suggest that changes of cerebrovascular vasomotor reactivity in healthy subjects may be related to aging, but they are probably mainly influenced by sex.  

Background: Syncope or drop attack is a common and potentially serious condition and prompts evaluation of the affected patients should be evaluated prompting for cardiac disease, seizure, structural lesions of the brain or peripheral nerves, as well as drug induced and metabolic disturbances. This study was conducted to evaluate carotid and vertebral arteries blood flow in patients with syncope in which other etiologies had been ruled out. Methods: This one-year retrospective case-control study involved 33 patients (case group) and 33 normal individuals (control group). Carotid and vertebral arteries blood flow was measured in all subjects (ml/min) and SPSS was used for data analysis. Results: Mean blood flow in vertebral arteries in the case group was significantly lower than in the control group (P<0.001), however mean carotid artery flow was not significantly different between them (P=0.58). Conclusion: Based on our results and findings of some other studies, we recommend duplex ultrasonography of vertebral and cervical arteries in patients suffering from drop attacks, after ruling out the prominenent  etiologies, such as seizure, heart disease, etc.    

Hydatid cyst, caused by echinococcus granulosa, can produce tissue cyst everywhere in body. Skeletal cystic lesion is rare especially in long bones like tibia and because of its unusual presentation, its diagnosis may easily be missed, unless be kept in mind.

Silent sinus syndrome (SSS) is a rare clinical condition. In this report, we are presenting a 58 years old woman with chief complain of right global pain. All ophthalmic examinations were normal. In CT-scan of para nasal sinuses right maxillary sinus volume was decreased but she had no sinonasal symptoms.

Hydatidosis is a parasitic disease in all over the world which is caused by a Cestode (tape worm). Liver, lung, and brain are the most Common involved organs and involvement of muscles and bones is unusual. We report a 32years old man who had low back and radicular leg pain. He had a paravertebral mass with involvement of Spinal column. This patient was operated with differential diagnosis of tumor or hydatid cyst. The final diagnosis was hydatidosis of paravertebral muscles and vertebral column.      

Carotid cavernous fistula (CCF) is a rare and lethal condition; it can be spontaneous, traumatic or iatrogenic. This report presents a case of CCF subsequent to nasal septoplasty who was a 24 years old lady with proptosis and severe decreased visual acuity. After cerebral angiography, trapping and embolization of fistula was performed with good recovery. Like our case, review of articles shows that the patients are signs and symptoms free after embolization