JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2001 | Volume:6 | Issue:3|Papers Count:27

Introduction. Determination of small sample size in some clinical trials is a matter of importance. In cross-over studies which are one types of clinical trials, the matter is more significant. In this article, the conditions in which determination of small sample size in cross-over studies are possible were considered, and the effect of deviation from normality on the matter has been shown.Methods. The present study has been done on such 2x2 cross-over studies that variable of interest is quantitative one and is measurable by ratio or interval scale. The method of consideration is based on use of variable and sample mean"s distributions, central limit theorem, method of sample size determination in two groups, and cumulant or moment generating function.Results. In normal variables or transferable to normal variables, there is no restricting factors other than significant level and power of the test for determination of sample size, but in the case of non-normal variables, it should be determined such large that guarantee the normality of sample mean"s distribution.Discussion. In such cross over studies that because of existence of theoretical base, few samples can be computed, one should not do it without taking applied worth of results into consideration. While determining sample size, in addition to variance, it is necessary to consider distribution of variable, particularly through its skewness and kurtosis coefficients. the more deviation from normality, the more need of samples. Since in medical studies most of the continuous variables are closed to normal distribution, a few number of samples often seems to be adequate for convergence of sample mean to normal distribution.

Introduction In duration steps of collection, transfer and disposal of solid wastes and also change of solid wastes to compost, produced leachate includes various pollutants such as heavy metals. The amounts of heavy metals don"t easily degrate in environment and would be concentrated in food chain and caused many problems for environment and human. Thus, the goal of present research is to investigation of heavy metals concentration in municipal solid wastes leachate of Isfahan city and reduction method for this case.Methods. leachate from four transfer station and composting plant was sampled ten times and in the first stage, quality of samples was evaluated from pH, COD, total solids (TS), total volatile solids (TYS), total fixed solids (TFS) and heavy metals such as Cadmium, Chromium, Zinc, Copper and Nickel viewpoints. Chemical coagulants such as lime, alum and ferric chloride were applied using the Jar test to reduce heavy metals concentration.Results. The results revealed that mean concentration of heavy metals Cd, Cr. Zn Cu and Ni in leachate was equal to 0.63, 1.22, 7.42, 2.15 and 2.22 mg/l respectively and also the results of statistical analysis (ANOVA) showed no significant difference between heavy metals concentration in various stations (P>0.05). The results of Jar test revealed that optimum pH for chemical precipitation, and also optimum concentration of the three coagulants were 2400, 1400 and 1000 mg/l respectively.Discussion. Under this study elements concentration of leachate as compared with effluent standard (Environmental Protection Agency) were exceeded the limits. Alum with 75-95 percent removal has the highest effciency as compared to other coagulants, lime with 70-88 percent removal and ferric chloride with 65-85 percent removal are in next order. Erom economical aspect, lime is cost benefit, ferric chloride and alum are in raked next respectively.

Introduction. The protozoan parasite Giardia is one of the important biological cotaminants in water. lts presence in water has caused the outbreak of a number of epidemics in various part of the world including the United States. The major impediment in detecting this particular parasite is unavailability of suitable filters capable of removing it from water. Regarding the fact yarn wound filters (cartridge) used in removing Giardia under laboratory condition are currently difficult to obtain in Iran, attempts were made to design and manufacture the filters according to standards recommended in the literature.Methods. To determine the efficiency of filters manufactured in this way, a pilot system was established and parameters of concern were investigated. A given number of cysts were introduced in each case to the water in the pilot tank after being counted on the hemocytometer lamella After the entire tank water (at least 4001)had been pumped through the filters, the filter were removed from the pilot system to have their yarns separated and washed. The cysts recovered were then counted and compared with the original input cysts to determine the efficiency of the filters. Formation of sediments on filters due to suspended solids in water was a great impediment in counting the cysts hidden in the sediments. To overcome this difficulty, the method of floatation in sucrose was used to remove the hidden cysts from the sediments.Regarding the morphological characteristics of the cysts, the method was also studied in terms of the sucrose film concentration and the effects of centrifugal speed and duration on the removal of cysts from sediments.Results. The results indicated an efficiency of 80.69±5.85, which was ideal for a first experience in Iran. a level of 2.5 molar of Sucrose with a duration of 10 minutes for the centrifugation time at 2,000 rpm were considered to be optimum levels to yield a certainty of 95 percent and an efficiency of 89.95±4.25 .Discussion. The comparison of the efficiency obtained with those obtained across the world from the application of other techniques associated with this method indicated that this filter was advantages to similar filters, keeping in mind also that this filter can be used in field situations. It is essential to modify in each region the method of cyst removal from sediments using Sucrose gradient according to the particular morphological characteristics and density of cystes. The optimization of Sucrose gradient and the centrifugation duration and speed seems equally important.

Introduction. Regarding the fact that hepatitis B and its complications is a serious problem routine vaccination against it is recommended at birth. Fortunately, since 1991 all infants in our country are vaccinated against the disease. This study was designed to evaluate hepatitis B vaccine induced immunity 5-6 years after vaccination. If antibody titer is below the protective level booster dose should be considered.Methods. This study is a cross-sectional one which 394 cases selected randomly. After filling up questionnaires sampling was performed and sample sera were checked out for anti HBsAg antibody by ELISA method.Results were announced as positive and negative. Some variables Such as age, gender, growth and development and time of vaccination also were evaluated.Results. From the total number of 394 cases, 142 (36 percent) had antibody title less than (10 MIU) which is not protective. Rate of negative response was 32.2 percent for girls and 39 percent for boys. The same rate for children of 2-2.5, 2.5-3.5and over 3 kg weight at birth was 44 percent 36.percent and 34.8 percent respectively. Regarding the time, 16 cases had delayed vaccination with 44 percent negative response. Rate of negative response in children who received regular vaccination was 35.7 percent. Negative response rate for 25 cases above the acceptable level of growth was 8 percent and for 6 cases below the level was 17 percent. In rural and urban population negative response rate was 35.4 percent and 36.7 percent respectively. Discussion. Cases with negative response are suscoptible to infection so it is recommended to 1: Carryout investigations to determine causes of decline in antibody titer. 2: Carryout investigations in other parts of country to recheck the results of this study. 3: administer booster dose to high-risk cases with negative response.

Introduction. Retinal vein occlusion (RVO) may lead to visual loss or even to blindness. RVO may accompany with most of systemic disease as well as some eye diseases. Since no effective treatment is known to restore the full vision in none of the cases, it is necessary to determine and identify the precipitating factors and to treat them in order to prevent the involvement of another eye.Methods. Among 2500 patients with chief complaint of visual loss 62 patients had retinal vessel occlusion, 59 patients (95 percent) had RVO and 3 patients (5 percent) had retinal artery occlusion (RAO). 3 patients with CRVO who didn"t fallow up were excluded the study. The necessary medical examinations were done in internal medicine clinic after primary examination in ophtalmology clinic and raw data were recorded in special form for each patient.Results. From 56 patients with RVO, 55.36 percent (31 subjects) were female and 44.64 percent (25 subjects) were male. 76.79 percent of patients (43 subjects) were 50 years or more and 66.1 percent (37 subjects) suffered from hypertension, 35.7 percent ( 20 subjects) had hypercholestrolemia ; and 21.4 percent (12 patients) had diabetes mellitus. 23.2 percent of patients (13 subjects) were previously smokers, 14.28 percent (8 subjects) were current smokers and the rest had quitted smoking. Totally, 37.5 percent of patients) were menopausal women. In 57.14 percent of the patients body mass index BMI) were higher than 24.9 Kg/m2.In 80.4 percent and 44.6 percent of the patients serum a2- globulin and γ globulion was higher than normal, respectively.Discussion. The data showed that most of the patients with RVO were more than 50 years old. Associated systemic risk factors in this study are listed bellow from the most to the least frequency order: hypertension, high 8MI, LDL hypercholestrolemia, diabetes mellitus and smoking.

Introduction. In this study we wanted to compare the means of area under the curve (AVC) of glucose tolerance test in young women depending on dehydroepiandrosteron (DHEA) levels.Methods. Selected subjects were examined for DHEA and glucose tolerance test. At first, they were divided into two groups (under the mean of DHEA vs above the mean of DHEA) and then into three groups (under the mean-SD, between the mean±SD, above the mean+SD). 37 young women with no abnormality whose 8MI was below 30 Kg/m2 they were refered to research center of endocrinology and metabolism of IUMSHS.Results. The mean of DHEA was 2895±1113 ng/ml. The mean of AUC was 745±104.7 mmol/l/min in women under the mean of DHEA and 670±51.9 mmol/l/min in women above the mean of DHEA (P<0.05).In comparison of women based on mean±SD, the AVe was 786±88.3, 691. 7±77.5 and 670.8±92.5 mmol/l/min, respectively. Results showed a significant decrease of AVC in women above the mean+ SO of DHEA (P<0.05).Discussion. This study suggests that in young healthy women DHEA can increase the glucose tolerance.

Introduction. Methemoglobinemia is a condition characterized by increased quantities of hemoglobin in which the iron of heme is oxidized to the ferric(Fe3+) form. Methemoglobin is useless as an oxygen carrier and thus causes a varying degree of cyanosis. The condition may arise as a result of a genetic defect in red blood cell metabolism or hemoglobin structure, or it may be acquired following exposure to various axidant drugs or toxins. The most common cause of methemoglobinemia, as in this clinical case, is ingestion of or exposure of skin or mucous membranes to oxidizing agents (such as anesthetics and silver nitrate).Methods. In an experimental animal study, 30 rabbits with the same weight and sex are devided in two groups (A and B).-Vitamine C is administered to group B (200 mg/kg intraperitoneal). One houre after that, laparotomy was done. Then silver nitrate was injected intraperitoneal (1000 mg/kg) in both groups. Blood samples were examined 30 and 60 minutes after injection. Results. Methemoglobin before and after intervention in group A was 0.38±0.13, 1.63±0.02 (30 min) and 2.21±0.4 (60 min) percent respectively. Methemoglobin before and after intervention in group B was 0.39±0.13, 0.82 ± 0.19 (30 min) and 0.41 ± 0.1.7 (60 min) percent, respectively. Methemoglobin concentration was greater in group A in 30th and 60th minute after intervention (P<0.0l)Discussion. Ascorbic acid penetrate the erythrocyte membrane. Under physiological conditions ascorbic acid induced methemoglobin reduction is far less important than reduction by the NADH dependent methemoglobin reductase system. In methemoglobinemic conditions caused by toxic effects or by congenital methemoglobin reductase deficiency treatment with ascorbic acid is possible. However, critically increased methemoglobin content of the blood higher than 30% makes therapy with methylene blue necessary. So, vitamine C is recommended for methemoglobinemia therapy.

Introduction. Pain during labor is a physiologic pain cause anxity in mothers.There are many procedures to make labor painless in mothers. This study compare some of these methods.Methods. The study was carried out as a double blinded clinical trial on 149 pregnant women who refered to the Beheshti hospital (affiliated to IUMSHS)during 1998 to 2001 with labor pain. The term gravid women were divided randomly to five group. Control group (30 Cases),Placebo group (30 Cases), TENS (30 Cases), High voltage (26 Cases) and Interferential (30 Cases).Pain level was measured with modified Mc Gill and Visual Analog Scale (VAS) questionnaire at 4, 6, 8 and 10 Cm cervical dilation.Results. Difference was seen between TENS with placebo & control (P<0.05). The average time of active phase was significantly shorter (40-85 minute) in Interferential group in comparison with other groups.Discussion. This is probably an indication of augmentation of contraction and may be this kind of wave could be used in abnormal uterine contraction and abnormal progress of labor.

Introduction. Extradural anesthesia is a successfull procedure in many operations.This is also a suitable and elective anesthetic procedure in many operations have particular hemodynamic conditions. Hence the onset time on this of anesthesia is slow and the degree of sensory and motor block is relatively variable in many cases, this procedure is not accepted by anesthesiologists and surgeons. So, inspite of its priority in many cases, it is less used. Thegoal of this study is to achieve a practical and effective solution to shorten the onset of analgesia and increasing analgesic duration which studies adding ketamin to bupivacain in extradural anesthesia.Methods. This study is a double blinded randomized clinical trial. Forty adult patients in class 1 and 2 of ASA who have been candidate for elective lower limb or lower abdominal surgery in Al-zahra and Kashani medical center in 1998 were selected. Without receiving any premedications, all of the patients received 500 CC ringer lactated solution before onset of anesthesia and they were divided into 2 groups. Group 1 received 20 cc of 0.5 percent bupivacain+0.5cc of 0.9 percent normal saline. Group 2 (interventional) received 20 cc of 0.5 percent bupivacain+0.5 cc of Ketamin (25mg). The onset of sensory block and the duration of sensory and motor block were measured and compared in both groups.Results. The onset of sensory block in interventional group was shorter than in controlled group. The duration of sensory block in interventional group was longer than in controlled group. The duration of the motor block was longer in controlled group than interventional group (P<0.05).Discussion. Adding ketamin to bupivacain results in earlier onset and longer duration of analgesia in extradural anesthesia. This effect may be due to the inhibitory effect of the ketamin on posterior nerve root activity in spinal cord which can be an effective mechanism of ketamin in making analgesia.

Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy.Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses). Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant.Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site.Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

Introduction. Acute lower respiratory infections (predominantly pneumonia) accounts for one third of all childhood deaths in developing countries. Because zinc deficiency results in impaired immunocompetence and zinc supplementation improves immune status, the role of zinc deficiency in incidence of acute lower respiratory infections was investigated. . Methods. Thirty children admitted to the children ward of Al-zahra hospital (affiliated to IUMSHS) during 1379; were submitted to a descriptive comparative and conventional study. In these children simulating and underlying causes of pneumonia as well as reactive airway disease were ruled out. Scalp hair from occipital area was cutted and zinc content were measured by neutron activator analysis (NAA). Results. In the case group, male to female ratio was 1:1.7, mean age was 58.4±48.9 months old, mean weight was 17.52±10.2 kg, mean height was 99.4±26.39 Cm, with no significant differences among the case and the control groups. Growth indices (weight: height and weight: age ratio) were similar among both groups. Hair zinc level was higher in the control group than in the casees (117.32±50.9 ppm V.S 88.24±45.1 ppm) (P<O.03). There is a direct correlation between zinc level and age in both groups (P<0.05).Discussion. This study supports a role for zinc in immunity to respiratory infections. Because of the substantial lower level of hair zinc in both groups in comparison with the other countries evaluation of causes of zinc deficiency and effectiveness of zinc supplementations is recommended for other extended studies.

Introduction. Early enteral feeding reduce the mortality and morbidity of head-Injured patients. However, many of these patients have atonic stomach and do not tolerate early gastric feeding. It is suggested that small bowel feeding will improve the patient"s tolerance of early enteral feeding.Methods. In a randomized clinical trial, sixty patients with moderate and severe head injury were divided in two equal groups. In experimental group, a feeding tube with a length, equal to distance from nose to earlobe and umblicus was inserted and interavenous metuclopramide was injected every 6 hours (10 mg in adults, 5mg in children between 6-14 years old and 0.1 mg/kg in children less than 6 years old). These patients also were placed in right lateral decubitus position. In control group, only a tube with a length equal to experimental group"s tube was inserted. After 48 hours, with injection of barium sulfate into the feeding tube and plain radiography of abdomen, the position of the tip of the feeding tube was determined (Prepyloric VS. Postpyloric).Results. The rate of passage of feeding tube from the sphincter of pylor was 63.3 percent in experimental group and 6.7 percent in control group (P<0.001).Discussion. This study introduces a new safe method for bypassing the atonic stomach in patients with moderate and severe head injury.

Introduction. Although common theraputic methods for myocardial infarction are conducted, mortality and morbidity of this disease are high, yet. Therefore, finding a new economical therapies such as metabolic modulation of ischemic myocardial muscle with thrombolytic therapy can somehow improves this situation. This study investigates the effect of glucose, insulin, potassium (GIK) and Magnasium (Mg) along with thrombolytic therapy on such patients.Methods. In this double blind randomized clinical trial study, two hundred patients, with myocardial infarction who have thrombolytic therapy indication, were randomly selected and divided into 6 groups of 30. Each group were treated based on their specific treatment protocol. Finally, people in the first five groups were compared with the sixth group about mortality and morbidity both in hospital and during 3 and 6 months after their treatment.Results were statistically analysed based on the questionares.Results. The patients aged from 58.77±2.6. From these people 77 percent were men. Heart failure and in hospital arrhythmia and ejection fraction of the people at the time of discharge in the five groups which recived metabolic intervention in same way were had better conclusion than the control group. In-hospital mortality and morbidity was not significantly different in any of the groups. Three month later, mortality and morbidity of the group who received GIK and Mg was significantly less than the control group. After six month none of the patients who received high dose GIK and Mg along with thrombolytic therapy, died, while at the same time the rate of death in the control group was 44.4 percent.Discussion. The results showed that GIK infusion and Mg along with thrombolytic therapy can significantly decrease the mortality and morbidity of the patients with myocardial infarction either in hospital or after a long time.

Introduction. Dental erosion is a multifactorial lesion (acids, nutrition consisting of sour lemon, soft drinks and alchole) and is result of gradual dissolution of dental tissue according a mechanicochemical procedure. The purpose of this study is evaluation the prevalence of dental erosion in battery workers as a high risk job in Isfahan city.Methods. In this study, 332 battery worker were selected randomly. They were between 15-65 years old. each person examined and had to fill a questionnair separately. The results were analyzed by the SPSS software.Results. 27.1 percent of patients had dental erosion in buccal and lingual surfaces. Severity and frequency of dental errosion was related to age and work exerience and nutrition (sour lemon, soft drink and alcohole). There wasn"t any relationship between dental plaque dental erosion.Discussion. The results of this study accomodates partially or fully other studies results. It is needed to arrange programs to aware the battery workers of acid dangers and its effects on teeth and respiratory system.

Introduction. Considering the high frequency of osteoarthritis of the knee and varus and valgus deformities in this disorder, there are several methods of treatment to reduce patients symptoms. Hight tibial osteotomy and arthroplasty are knowm surgical methods for these patients. Because of socioeconomic problems (about arthroplasty) in our country and unfavorable long term results of it, osteotomy has found a specific position in the treatment of these patients. Osteotomy, itself can be performed in different ways. High tibial osteotomy without internal fixation and secure the osteotomy site on the basis of inherent stability and cast application (external support); reduce the complications and cast of operation and the surgen is able to recorrect the deformity after operation. Also, there is no need for implant removal by the second surgery.Methods. This quasiexperimental study was performed on 42 patients with osteoarthritis of the knee who refered to Al- zahra hospital orthopedic clinic from October 1997 to October 1999. Their age, physical and radiographic conditions were acceptable for osteotomy (on the basis of texts ). Therefore, the osteotomy was performed and 30 patients were followed for 4 months for probable complications and outcomes. Complications which had been cheked in every visit by physical examination and radiographic imaging, included: loss of reduction, maluniun, nonunion, infection, knee stiffness.Results. Non of the before mentioned complications were seen. Also no nervous (proneal nerve palsy) and vascular complications were seen in patients in the following period.Discussion. It can be said that with meticulus operation technique, osteotomy without internal fixation resulted in less complications and costs, ability to recorrect the deformity and no need for implement removal.

Introduction. Recently there has been increased hypertonic and hypertonic-hyperoncotic solutions for the initial resuscitation of hemorrhagic shock. Since compensatory mechanisms during hemorrhagic shock in hypertensive patients is different from normotensives, the objectives of this project was studing the therapeutic effects of these solutions on resuscitation of controlled hemorrhagic shock in hypertensive and normotensive rats.Methods. 39 rats were randomized in two groups: control and hypertensive groups. To obtain hypertensive animals, the rats received desoxycorticosterone acetate (DOCA) [10 mg/kg, twice/week] 3 weeks before the experiment. Then all rats were anesthetized and were subjected to hemorrhage until mean blood pressure was reached to 40-50 mmHg and maintained for 30 minutes. Then animals resuscitated in each group with either:1) Hypertonic (HT) or 4 cc/kg 5 percent NaCI. 2) Large volume isotonic (LV) or 22 cc/kg normal saline. 3) Hypertonic Hyperoncotic (HTIHOC) or 4 cc/kg 20 percent NaCI and 20 percent serum albumin; 3: 1v/v. 4) Small volume isotonic (SV) or 4cc/kg normal saline. All animals were monitored 1 hour after infusion.Blood pressure, electrolyte and osmolality was measured in each subgroup and group after resuscitation. Finally all animals were sacrified and brain water content was measured. Results. Before hemorrhage, systolic and mean arterial blood pressure (MAP) in hypertensive rats (149.5±3.80, 119.44±3.23 mmHg) were significantly higher than normotensive rats (131. 70±4.14, 108.11±3.31 mmHg) (P<0.05).HT/HOC resuscitation was associated with pronounced improvement in MAP in hypertensive rats during 1h after resuscitation. Serum osmolality was significantly different between subgroups in control group 1h after resuscitation (P≤0.05).(HT subgroup osmolality was different from SV subgroup). The comparsion between similar subgroups of two groups indicates significant difference of osmolality in SV subgroup (P<0.05). No significant difference was observed in other variables before hemorrhage and after resuscitation between four subgroups in each group and between similar subgroups in two groups of hypertensive and normotensive.Discussion. HT/HOC resuscitation leads to increased MAP after controlled hemorrhagic shock in hypertensive rats, but there were not any significant difference in HT,LV,HT/HOC and SV solutions in control group. This difference may be attributed to increased vascular permeability in hypertension. Increased osmolality in HT subgroup in control group can be attributed to high osmolality of hypertonic solutions.

Introduction. Various factors affect on the incidence of atherosclerosis, that most important of them is the high plasma concentration of cholestrol in the form of low density lipoproteins (LDL). This study evaluated the effect of leptin (the product of the ob gene) on the cholesterol, triglyceride, LDL and HDL plasma level. Fatty streak induced hypercholestrolemia in rabbit was studied.Methods. Rabbits were divided to six groups and feeded as followed. Group one: regular diet, 2nd group: high cholestrol diet (HCD), 3rd group: regular diet +leptin 0.1 mg/kg/day, 4th group: HCD + leptin 0.1 mg/kg/day, 5th group: HCD+leptin 1 mg/kg/day and 6th group: HCD+leptin 10 mg/kg/day. Blood samples were taken before and after the study and the plasma level of cholestrol, triglycerid, LDL, HOL and blood pressure was measured. Arterial wall was histopathologically on aorta.Results. The plasma level of cholestrol, triglycerid, LDL, HDL in all HCD group showed significant increasing. LDL between 4th and 6th group had no difference (P>0.05). Fatty steaks in all HCD groups were equal.Discussion. According to the results, we suggest that doses of 0.1, 1 and 10 mg/kg/day of leptin in a short period (30 day), increase the plasma level of LDL, but it have not any effect on the mean blood pressure, plasma level of cholesterol, triglycerid and HDL in rabbit.

Insulinoma is the most prevalent kind of tumor in pancreas island. This tumor with exessive secretion of insulin, causes severe symptoms and sometimes even fatal hypoglycemia. The definite treatment is only possible through resection of the tumor part.A 58 old woman was brought to the hospital having symptoms of malaise, sweat, loss of consciousness and convulsion. She was immediately undergone treatment by injecting glucose. At initial phase of her treatment. Her blood sugar was 25 mg/dl (before glucose injection).She was hospitalized and after diagnostic steps she underwent a laparotomy surgical operation through which a tiny, one centimeter tumor was taken out of the body of pancreas. Finaly she was discharged having regained her normal condition and blood sugar.

Introduction. Stroke is a sudden onset of neurologic signs as a result of the ischemic or intracranial hemmorhage because of the cerebrovascular disease that stands for at least 24 hours. Cerebrovascular disease is one of the most important factors that causes speech disorder. The aim of this study is to show the characteristics of speech and language related to the various parts of the brain lesion.Methods. In this study 64 patients with CVA and speech disorders were tested. Lesions in 36 patients were ischemic, 17 patients were hemmorhagic. 11 patients had no any significant lesion on CT-scan. The test unndertaken included "Farsi Aphasia Test" written by Dr. Nilipoor.Results. Fifty percent of patients were in 61-70 years old group. 70.3 percent were male and 29.7 percent were female. In aspect of the hemisphere involved 50 percent were left hemisphere and 28.1 percent Right hemisphere and 4.7 percent with both hemisphers involvement.Discussion. In CVA patient with speech disorders the temporal lobe of the left hemisphere is mostly involved, and in respect to oral speech disorders in CVA, most of the problems were seen in non verbal fluency and the least problems were seen in repetition.

A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. Transfemoral Coronary Angiography is the rare cause of this condition.We diagnosed 5 patients with this syndrome from 1998-1999 as a complication of angiography. Four patients were male. Diagnosis was confirmed by physical exam and diagnostic tests (NCV, EMG). This syndrome typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral, thigh. It is a purely sensory nerve and has no motor component.The clinical syndrome is well defined, and further evaluation by electrodiagnostic .studies may be unnecessary. Evaluation with nerve conduction studies and needle examination electromyography (EMG) is warranted if no risk factors are identified, if a mass lesion in the retroperitoneal space is suspected, or if back pain also is present.LFCN conduction studies can be technically difficult. When obtained, compare with the asymptomatic side.The EMG should be normal in LFCN lesions, but the test is helpful in ruling out upper lumbar radieulopathy. Removing the cause of compression is the best therapy. In some patients, this entails weight loss and wearing loose clothing. Most patients with meralgia paresthetica will have mild symptoms that respond to conservative management.

Introduction. Electrodiagnostic tests are one of the ancillary procedures that are used for diagnosis of multiple sclerosis (MS). This study investigates the frequency of abnormal blink reflex in patients with MS.Methods. In this cross sectional diagnostic study, 100 patients (26 male and 74 female) with definite MS were selected based on clinical and MRI findings. they were referred to Al- zahra hospital (affiliated to iUMSHS) during year 2000. Blink reflex (BR) waves including R1, R2, R2 were recorded inpatients through the stimulation of supraorbital nerve.Results. The frequency of abnormal BR in MS patients with brain stem involvement was 77.9 percent and in those without brain stem involvement was 36.6 percent (P<0.001). There was a significant relationship between the duration of MS and the abnormality in BR.Discussion. The frequency of abnormal blink reflex in MS is significantly associated with site of involvement in the brain. The majority of MS patients with brain stem involvement have abnormal BR. It is proposed that in patients with symptoms and signs of MS if there was no accessibility for MRI or if the results of MRI were equivocal, blink reflex test should be performed in addition to other ancillary tests.