Medical Journal of The Islamic Republic of Iran
Year:2003 | Volume:16 | Issue:4|Papers Count:11

Both midazolam and thiopental sodium are being used as induction agents and for maintenance of anesthesia. In contrast to other benzodiazepines such as diazepam, midazolam has a rapid onset of action and fast distribution and causes few cardiovascular or respiratory effects. Being water soluble, midazolam is also associated with a low incidence of venous irritation. The purpose of this study was to see whether midazolam is a suitable substitute for thiopental sodium as an induction agent. To compare the hemodynamic changes associated with midazolam and thiopental sodium as induction agents, this study was conducted in two groups each comprising of 30 patients. No significant hemodynamic changes regarding heart rate and blood pressure could be noticed in the two groups (p<0.05). All patients in the midazolam group exhibited anterograde amnesia but in the thiopental group, 20% of the patients had recall for operative events one hour after completion of surgery. To arrive at more conclusive results, preferably multi-center studies involving large numbers of cases are recommended.      

Mitral valve replacement (MVR) is usually performed in two methods of running and interrupted suturing. In running method, the suturing of the valve is usually with some traction on the annulus and also there is a risk of aortic valve injury. This study was conducted to evaluate a new technique for suturing to avoid these complications and decrease the time of cardiac arrest. One hundred and seventy-seven cases undergoing isolated MVR or MVR with other valve replacements were operated by the new method and compared with 77 cases of routine method, as control group. The patients were followed up 1-4years. In the control group, one case of mortality occurred due to heart failure. In both groups one case of late mortality was observed not related to surgical operation. No paravalvular leakage or aortic valve injury was observed. The highlights of this technique are the simplicity of operation, short period of valve implantation and aortic clamp time, which indicated 6 and 11 minutes decrease in average time, respectively. This method is recommended for all cases of rheumatic mitral valve disease, especially for those having a small atrium.      

The objective of this study was to describe the role of electrical stimulation in controlling peripheral vertigo. In a prospective study on 13 healthy volunteers, nystagmus was induced with caloric stimulation and the interval of nystagmus disappearance was recorded. This time indicates the basal response of vestibular end-organ. After caloric irrigation, pulsed signal was applied for each person through retroauricular transcutaneous electrodes and the interval of nystagmus disappearance was measured, secondarily. In second examination on three new volunteers, simultaneous caloric warm water irrigation in one ear and electrical induction in the other ear were done for a long period. There was a significant decrease in the duration of nystagmus with electrical stimulation in the first stage (p<0.05), and in the second not only was there no rotational feeling, but also at the end of irrigation no strong nystagmus was seen. Regarding the results of this study we conclude that electrical stimulation has a beneficial effect on vestibulosuppression.      

Neural tube defects (NTD) are one of the most important malformations of newborns. The aim of this research is to determine the rates of NTD, anencephaly and spina bifida cystica and the relations of these abnormalities to the factors including sex, race, ethnicity, maternal age and familial marriage in the south-east of the Caspian Sea border. A three-year descriptive-analytic and cross-sectional study was carried out on 19545 newborns delivered in Dezyani hospital in Gorgan during 1998-2000. From the total sample population (19545), the NTD rate was 3.12 per 1000 deliveries. In males the rate was 2.49 per 1000, in females 3.79 per 1000, and the female to male ratio was 1.44: 1. The rate of anencephaly and spina bifida was 1.25 per 1000 and 1.74 per 1000 respectively. In regard to different races the NTD rate was 7.48 per 1000, 9.5 per 1000, and 2.35 per 1000 among Turkmans, Sistanis and Farses, respectively. It can be concluded that there is a higher rate of NTD in this region that may be due to the race-ethnicity and the ecological variations.      

Recognition of the natural history and responsible leading factors for regression of left ventricular hypertrophy after successful renal transplantation are very important. The aim of this study was to assess the regression of left ventricular hypertrophy after successful renal transplantation among uremic patients. In this study 27 uremic patients (18 males and 9 females) with an average age of 38.5 years were randomly selected. Left ventricular mass index (LVMI) was calculated before and after renal transplantation at the beginning, and at 4, 6 and 8 months. The means of LVMI before and after transplantation were l80±19.3 g/m2 and 133.8±16.8 g/m2 respectively (p<0.001). The means of regression after transplantation  at 0,4,6 and 8 months of follow up were 1919/m2, 157.3 g/m2, 147.8 g/ m2 and 138.8 g/m2 respectively. There was a significant difference between the means of hemoglobin concentration and blood pressure before and after transplantation (p<0.001). For instance the means of hemoglobin concentration and blood pressure was 7.2±0.4 and 13.1±0.7 g/dL, 154±6/97±4.4, and 135±6.31 89±3.8 mmHg respectively. This study showed that maximum left ventricular hypertrophy regression occurred 4 months after transplantation, and then decreased to a minimum level of 147.8 and 135.8 g/m2 at 6 and 8 months after transplantation respectively. Restoration of hemoglobin concentration and blood pressure to normal levels may be recognized as a main cause of left ventricular hypertrophy regression.      

A total of 385 urine specimens from suspected urinary tract infections were subjected to bacteriological analysis and susceptibility testing at a major university hospital laboratory in Tehran. A battery of eight beta-lactam antibiotics, commonly prescribed in Iran, and three third-generation cephalosporins (ceftazidime, ceftriaxone and ceftizoxime) that are usually reserved for limited use in the hospital setting were tested against Ecoli urine isolates, using Kirby-Bauer disk diffusion method. E coli was the most common isolate from both the inpatient (37.8%) and outpatient (30.5%) populations. The susceptibility testing revealed a high degree of resistance to oxacillin, ampicillin, amoxycillin, carbenicillin and cephradine. Furthermore, a marked difference in the sensitivity/resistance ratio between the inpatient and outpatient populations was observed. The Ecoli isolates exhibited the highest rate of resistance to oxacillin, ranging from 49.4% in the outpatients to 81.6% in the inpatients. The frequency of the isolate resistance to first-generation cephalosporins was less widespread. Despite the absence of resistance to third-generation cephalosporins among the outpatient isolates, a significant resistance to ceftazidime (9.6%) and ceftriaxone (8.8%) was observed among the outpatient bacterial isolates. The susceptibility testing of the Ecoli isolates to a combination of amoxycillin and clavulanic acid revealed 6.9% resistance among outpatient and 12.5% among inpatient isolates. These results are particularly significant in that this study was performed immediately before the introduction of Co-amoxyclav to the Iranian drug market and can be served as a basis for monitoring the spread of resistance to this drug in Iran.  

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system of presumed autoimmune etiology. One of the best animal models of demyelinating diseases is experimental autoimmune encephalomyelitis (EAE), which can be induced in a variety of animals by injection of a target antigen such as myelin basic protein (MBP). The immune responses against the target amino acids cause tissue damages such as demyelination in the CNS. In this study, after isolation of myelin basic protein from bovine cord, we examined its purity and molecular weight by SDS-PAGE and in order to investigate its immunological properties, two varieties of guinea pigs were injected with different amounts of the isolated protein. Clinical signs of EAE and also histological changes were detected. Delayed type hypersensitivity, and anti-MBP antibodies to the isolated MBP were also investigated. Another form of EAE which has been called chronic-relapsing EAE (CR-EAE), was induced by injection of cord homogenate. EAE and CR-EAE are the best models for MS investigations.      

Currently available non-invasive clinical methods for diagnosing osteoporosis are mainly associated with ionizing radiation. Ultrasonic assessment of bone disease is a more recent technology. A theoretical explanation for the relationship between ultrasonic parameters and bone structure is necessary. Thus, two types of bone samples of perspex (HAP) and perspex-glass beads were produced. Each type was made with a different fraction of constituents. The ultrasonic properties of these samples were measured. The results of velocity measurement showed rise of velocity in the samples when the volume fraction of the HPA or glass beads increased with a different trend. A theoretical model for the velocity in a composite material was developed and the results of the two samples were used to test the model. The results showed a good agreement for the perspex-glass bead sample at different volume fraction, while the agreement between perspex-HAP was not as good as the other sample.      

The association of osteomalacia with neurofibromatosis is a very rare entity. Here a 34 year old man, a known case of neurofibromatosis, is reported who presented with bone pain, hypophosphatemia, renal phosphorus wasting, multiple Looser's pseudofractures, and low bone density. Treatment with high dose calcitriol and phosphate resulted in temporary treatment. Permanent cure was achieved after removal of two large superficial neurofibromas.    

A case of renal tubular acidosis (RTA) who had gradual onset of paralysis of lower extremities and persisted for a long time is presented. His primary workups were mistaken for muscular dystrophy. Eventually, an abdominal ultrasonography revealed small stones in both of the kidneys and his workup for the stones were in favour of distal renal tubular acidosis and advanced rickets with hypokalemia. He had a dramatic response to alkaline therapy. There are many reports of periodic paralysis in RTA but no report of prolonged paralysis is found in the literature.      

Liposarcoma of the digestive tract is very rare; only a few cases of liposarcoma of the stomach have been reported so far. In this article a 29-year-old woman is presented with a history o! Long-standing mid-abdominal pain and various treatments for anemia and peptic ulcer disease which did not improve her symptoms; until a barium-enema revealed a filling defect in the cecum. Under laparotomy a lobulated lipoma-like tumor with yellowish color was seen which measured 3×4cm. A right hemicolectomy was performed. The pathology reported a liposarcoma of the cecum with no mesenteric lymph node involvement. The patient is free of disease 1.5 years after surgery. As far as we know, this is the first reported case of liposarcoma of the large bowel in the world.