Shiraz E-Medical Journal
Year:2006 | Volume:7 | Issue:3|Papers Count:5

Herein  we  describe a rare case of pleomorphic adenoma (benign mixed tumor) of subglottic area that presented with dyspnea and upper airway obstruction. A 20 year old man was referred to our center with dyspnea and respiratory distress. Tracheostomy performed due to respiratory failure and subglotic stenosis, and then the mass resected by CO2 Laser. The specimens of the mass revealed distinctive features of pleomorphic adenoma. Based on our previous knowledge, this neoplasm had not been reported in this region.

Carpal tunnel syndrome is entrapment of median nerve in carpal tunnel of the wrist. This syndrome is associated with many conditions such as pregnancy which is one of the most frequent conditions. Up to 20% of pregnant women complain of nocturnal hands paresthesia. CTS is often bilateral and more severe in dominant hand. This syndrome can be diagnosed by manifestations and electroneurodiagnostic studies. Sensory nerve conduction velocity of median nerve is the most sensitive electroneurodiagnostic test for diagnosis, which is latent in 70-90% of patients. Treatment of CTS on the basis of severity of the syndrome is different from conservative to surgery for releasing the nerve. The aim of this study is to determine frequency and severity of CTS by electroneurodiagnostic studies in 90 pregnant women. Also it attempts to clarify the role of some factors such as age, gravity, trimester of pregnancy and body mass Index in patients with CTS. Finally it compares symptomatic and asymptomatic women with electroneurodiagnostic studies. This study is cross-sectional analytic research. A convenience sample of 90 pregnant women (30 women from each trimester) was referred from Al-Zahra Hospital of the electrodiagnostic ward of Emam hospital. All of the cases have been examined clinically and then by electroneurodiagnostic tests. There were suspected symptoms of CTS in 45 patients .The most frequent symptom and sign were hands paresthesia(34%) and positive tinel and phalen sign ( each 22%).CTS was definite diagnosis in 15 women (16.6%) by electroneurodiagnostic studies. Mild bilateral involvement was seen in 73.3% of patients. There was a meaningful relationship between CTS and trimester that 26.6% of patients were at third trimester. Also there was a meaningful relation to age. The CTS was more frequent in older women.  BMI and gravity relationships with CTS were not meaningful. It was concluded that CTS is frequent in pregnancy and this frequency increases in older women and in third trimester. However CTS Symptoms are frequent in pregnancy but not all the cases have definite diagnosis. Fortunately CTS during pregnancy is often mild and relieves with conservative treatments.  More attention must be paid to Electroneurodiagnostic studies in this patients for definite diagnosis and assure the patients that it is a benign and curable disturbance.  

Numerous pharmacological interventions had been proposed to treat postoperative shivering. Many opioid derivatives widely used to treat shivering. Meperidine is a potent opioid which also frequently uses to control shivering after general anesthesia. There are some controversies about the effects of opioid derivatives to control postoperative shivering. This study was a double blind study to compare the effects of fentanyl, sufentanil, alfentanil , tramadol and meperidine on post general anesthesia shivering. This prospective double blinded and randomized clinical study was performed to compare the antishivering effects among meperidine ,tramadol, fentanyl, sufentanil and alfentanil, in post general anesthesia shivering. One hundred and sixty patients who had shivering Grade III and IV were randomly allocated to one of five groups for intravenous treatment: group M (n=32) received meperidine 0.4 mg/kg, group F (n=32) received fentanyl 0.4µ/kg, group S (n=32) received sufentanil 0.1µ/kg, group T (n=32) received tramadol 0.25mg/kg and group A (n=32) received alfentanil 4µ/kg. The response rate, treatment time, minimal and maximal time to treatment and response duration were measured. Data were analyzed with ANOVA, two sample T test and Pearson correlation test where they appropriated. There were no significant differences among five groups with respect to the response rate, treatment duration, minimal and maximal response time to treatment and duration of treatment (P>0.05).Also side effects, such as purities, nausea, vomiting and dizziness were not significantly different. We concluded that all five drugs had a similar effect in the treatment of post general anesthesia shivering. Narcotics may be involved other mechanism than opioid receptors to control shivering post operatively.  

In order to assess the impact of the various treatment approaches adopted to manage diabetes mellitus (DM) in Nigeria, one hundred and ninety-five fresh cases of DM were investigated. Fifty-five non-diabetic individuals in apparent good health were included as control subjects. The DM patients were separated into 3 groups depending on the treatment they received. Group 1: diet, 2: insulin, and 3: oral hypoglycemic drugs. Basal plasma fibrinogen concentration (PFC), relative plasma viscosity (RPV), packed cell volume (PCV), hemoglobin (Hb) concentration, plasma sodium and potassium levels were determined in both DM patients and control subjects by standard analytical procedures, and the results were compared with those obtained after about 6±1 (5-7) months of managing the ailment. The data indicate that after about 5-7 months treatment of the disease, PFC for group 1 patients (4.00±3.0g/L; n=75) and plasma sodium levels (130.0±4.6mmol/L: n=75; 134.2±3.2mmol/L: n=55; and 132.1±4.3mmol/L: n=65) for groups 1, 2 and 3 DM patients were demonstrated to be significantly different (P<0.05) when compared with control values (PFC=3.02±0.31g/L; sodium=142.3±3.2mmol/L: n=53) using the Student t-test. Results suggest poor control of DM by diet and drug, and this may be due to patients’ non-compliance to recommended diets and drug dosage. Since not all cases require insulin administration in the first instance, then ways of enforcing strict compliance should be explored and tested.

Menopause is the permanent cessation of menstruation due to loss of ovarian follicular function. Due to increased life span among Malaysians, women will have to spend 1/3 of their life during menopause. Early and late complications of menopause calls for specific attention to this large group of women who need constant care. This cross sectional study aims at obtaining the age at menopause in women attending Greentown clinic in Ipoh. The incidence of early menopausal symptoms and correlation between socio-demographic characteristics of these women and severity of menopausal symptoms were also sought.  Result suggested that age at menopause was 47.96 years of age. No significant correlation was found between demographic data and severity of menopausal symptoms. High incidence of the menopausal symptoms found in this study group is the evidence of strong need for the establishment of a menopausal clinic to deal with particular problem arising in this age group.