Journal of Shahid Sadoughi University of Medical Sciences
Year:2002 | Volume:9 | Issue:4|Papers Count:21

Traditional methods of opioid detoxification such as using methadone or nonopioid drugs such as Clonidine are relatively long processes in comparison to new methods such as " Rapid Detoxification" where in the detoxification period is very short, experience of withdrawal symptoms is at a minimum level and the relapse rate is also lower. In this study, 25 opioid addicts were detoxified under general anesthesia with Naloxone. Data which was collected by two types of questionnaires was analysed statistically by SPSS. 10 Sftware. Results were in favor of experience of mild withdrawal symptoms in almost all of the addicts 8-10 hours after detoxification regardless of the type or amount of used substances, in addition, cardiovascular changes during detoxification in most of cases were not significant and otherwise were controllable. From our results, it could be concluded that URD (Ultra Rapid Detoxification) is a safe and efficient method for controlling withdrawal symptoms in opioid dependence.      

Pulled elbow is one of the most common musculoskeletal injuries in children under four years of age. The lesion is caused by sudden traction on the wrist while the elbow is extended and forearm is pronated. In pronation, the lateral edge of the radial head which opposes the annular ligament is narrower and rounded at it's margin. The radial head is oval in shape and in pronation, the narrowest diameter of the radial head is in the anteroposterior plane. After longitudinal traction, a transverse tear in the annular ligament occurs, the anterior portion of the radial head escapes from under the annular ligament and subluxation occurs. Most authors recommend that the reduction can be achieved by supinating the forearm (reversing the mechanism). This outcome study without a control group, reviewed 29 cases of "pulled elbow" which referred to the hospital or a private clinic from Dec 2000 to Dec 2001. In this study, all subluxations were reduced by hyper pronation of the forearm while the elbow was in semiflexion (exaggerating the mechanism). The logic reason is that the anatomical situation of the radial head and annular ligament is in pronation.    

The present study aimed to compare the dyslipidemia in the offsprings of patients with premature coronary artery disease with dyslipidemia in offsprings of healthy parents. One hundred and sixty five children under 18y/o were divided into 2 groups: Group A, 81 children with one of their parents suffering from premature coronary artery disease according to the angiography report. Group B, 84 children with no history of ischemic heart disease in either parent. Both groups were matched for age and sex and their weight, height, blood pressure and BMI were measured. Blood samples for checking triglycerides, cholesterol, LDL& HDL were taken (after at least 12 hours fasting). The results showed that in group A, 35.4% of the children aged over 10 years old had hypertriglyceridemia, but in group B, only 20.8% of children in the same age group had hypertriglyceridemia (P value=0.05). There was no difference in the triglyceride levels of children aged less than 10 years old in both groups. The HDL levels were lower in Group A (P value=0.0124). The mean BMI of the children in Group A was more than that of the children in Group B, therefore, the children in Group A were overweight as compared to the children in Group B. There was no significant statistical difference in the cholesterol and LDL levels of the two groups.    

Recently, tumor markers are important for diagnosis and follow up of some malignancies Glutathione -s- transferase is an enzyme that may be a tumor marker in gastrointestinal cancers, especially esophageal and gastric carcinomas. Measurement of serum activity of glutathione - s- transferase µ in 42 normal volunteers, 29 esophageal cancer patients and 28 stomach cancer patients was done. This study was descriptive. Serum activity of glutathione -s- transferance µ increased significantly in malignant patients as compared to normal volunteers. G.S.T. P increases in esophageal and stomach cancer and can be a tumor marker for diagnosis and follow up of these patients      

Colorectal cancers are the most common malignancies of the alimentary tract & the 3rd leading cause of death due to malignancies. Early diagnosis & appropriate treatment certainly provide a longer survival. This study has been done to determine the relation between survival rate of colorectal cancer and age, gender, stage of the disease, differentiation of the tumor & the treatment. This study which was a historical prospective one identified 130 colorectal cancer patients from the records (1981-2000) of the pathology department of Shahid Rahnemoon Hospital. Special questionnaires were filled from the data in the records, and for determining the survival rate, death and its causes and auxiliary treatments it any, information was gathered by visiting the residences of all the patients. Neither age, nor gender influenced the survival of the patients, P value= 0.26. The most common tumors were adenocarcinomas & the least common were squamous cell carcinomas, P value=0. The mean survival for patients with adenocarcinoma was 92.36 months with the longest survival in stage A & the least survival in stage D. P value=0.08. Stage B was the most common initial presenting stage, P value=0.08, with a mean survival of 109.19 months. Pt.s with WDA had the longest survival and pt.s with PDA, the shortest. P value=0.0016. The mode of treatment influenced the survival meaningfully, as the patients who underwent surgery and got chemotherapy had longer survival. P value= 0.      

Schwannomas are rare, benign nerve sheath tumors, but most tumors of peripheral nerves are the result of proliferation of the active and versatile Schwann cells that sheathe the fibers. Schwannomas can occur anywhere in bone, soft tissue or the viscera, but the more common locations include the soft tissue of head and neck, extremities, trunk, mediastinum and retroperitoneum. They are usually solitary painless lesions, but when they attain a larger dimension, they can produce pressure symptoms of paresthesia or local tenderness. This study has been carried out at Imam Khomeini hospital on patients suffering from benign and malignant schwannomas during the past 30 years. This cross-sectional study on existing data was performed on 539 patients with benign and malignant schwannomas from 1971 to 2001. In this study, tumor distribution between males and females has not shown any significant difference. In the central nervous system, the tumor was more common in females, but at all other sites, it was more common in males. The minimum age was 3 years and the maximum age was 88 years. The mean age was 33.8 years with 31 years median and 33 years mode. The benign form was more common, but the foot was the most common site for the malignant form. Though the number of patients included in this study was considerably large, the results didn't differ from other studies and reports conducted elsewhere. As a schwannoma can occur at any location in the body at any age, we recommend that it should be on the differential diagnosis list of any firm, nontender soft tissue mass in the body.      

Obesity is an excess storage of triglycerides in adipose cells. Generally, the BMI of a majority of the people is 20-24 and BMI>30 is regarded as obesity. In this study, prevalence of obesity in women between 15 to 65 years has been measured in Yazd city. In this survey, 30 families representing 30 clusters were chosen randomly. Totally, 570 women from 30 different areas were under investigation. Risk factors were asked on the questionnaire and also, BMI and ratio of waist to hip,T.95 with a confidence range of 95% were used ( P value=0.5). The prevalence of obesity on the basis of W/H is 16.3% and in the age-group of 50-65 years has the most incidence. Severe obesity on the basis of BMI is 13% and obesity is more prevalent among housewives and married women. Regarding statistics, the prevalence of obesity in Yazd is approximately the same as that in developed countries and age, number of pregnancies, level of education and menopause have an influence over obesity. Obesity is considered to be a risk factor for many problems and diseases.    

Serous otitis or otitis media with effusion is one of the common diseases which if left untreated can lead to complications like tympanic membrane atrophy, cholesteatoma formation, behavioural changes, osteonecrosis and sensori - nueral deafness. One of the treatment options for serous otitis is VT placement which has its own complications like ottorhea, perforation and tympano - sclerosis. The rejection time of VT is closely related to the location of the ventilation tube. The complications arising due to VT placement are related to the time period since placement of the tube, social status of the patient, age, personal hygiene including prevention of water entry into the affected ear, etc. This prospective analytical survey with a one year follow up was carried out on children suffering from serous otitis who had been operated (VT placement) during the first half of 1378 at Shahid Rahnemom Hospital. Most of the VT rejections in all age groups occurred about 7-9 months after the operation but no significant difference was observed between the age groups. In the study determining the relation between gender and VT rejection time (P.V= 0.536), it was realized that the maximum number of VT rejections were between 3-6 months after the operation (47.7%) of which 44.3% was seen in boys and 51.9% in girls, thus, no significant difference was observed between the two sexes (P.V=0.691). 33.9% of the total had ottorhea. 35.1 % sclerosis, and 3.4% had a perforation. 27.6% of the patients had no complications. 7.7% of those patients who had a VT in the anterosuperior compartment of the tympanic membrane had a perforation, while only 2.7% of those who had a VT in the postero – interior compartment had a perforation. Age and gender have no effect on VT rejection time. The probability of a VT remaining in place is more in Shepherd type ventilation tubes than Richard type VT. Ventilation tubes placed in the antero - inferior quadrant are rejected earlier than those placed in the antero - superior quadrant. In the population under study, perforation is the least occurring complication in all age groups. There is on significant difference in the complications arising in either gender.      

Dental and periodontal abscesses, because of their proximity to many important anatomic sites, can cause several dangerous and dreadful disorders. This study was carried out to investigate the causative organisms of dental and periodontal infections. Pus samples from fifty dental abscesses were collected by needle aspiration and examined by direct inoculation techniques using different aerobic and anaerobic culture systems. In addition, for finding of the presumptive relation between the causative agents of dental infections and commensual organisms in the oral cavity, 50 swab samples from free gingival sulcus of individuals with apparently healthy dental and periodontal tissues were collected. The most common site of involvement was the first upper premolar tooth. Anaerobic infections were found in 38 samples (76%) and in 34(68%) of them, mixed cultures of aerobic and anaerobic bacteria were isolated. Anaerobic gram negative bacilli (black - pigmented bacteroides species) were the most common isolates. Aerobic bacteria were isolated in 46(92%) of the patients, with Streptococcus viridans being the most prevalent isolate. In samples obtained from the healthy dental tissues, aerobic bacteria were the most common isolates. In addition to this, the anaerobic bacterial flora isolated from dental infections and healthy tissue samples were significantly different (p< 0.05). Dental infections are the result of very complex microbial flora in which both aerobic and anaerobic bacteria play important roles in initiating the infection and it seems that the pathogenic bacteria and the commensual flora in healthy dental tissues have a great degree of similarities.        

Adhesion band formation and its complications are well known problems in pelvic and abdominal surgery. About 30.Yoof all intestinal obstructions are due to adhesions and foreign bodies are among the most important causes of adhesion formation. One well known foreign body responsible is the Talc powder. In this study, the effect of talc powder on the intraperiotoneal adhesion formation in rats is evaluated. Twenty eight female rats were divided into two equal groups and in one group, 4mg sterile talc powder dissolved in 1ml normal saline was injected intraperitoneally, and in the second group after laparotomy and making an abrasion on the uterine horn surface, the same solution as in the first group was added to the peritoneal cavity. After 28 days, relaparotomy of the rats was performed and the adhesion formation was evaluated with modified Swolin system. According to the modified Swolin grading, there was a significant difference between the two groups and in the operated rats, the grade of adhesions was higher than the first group (P=0.002).The mean length of adhesions in the first group was 1.7±2.23 (X±SD) and in the operated group was 22.85±15.27 (X±SD) which was significantly higher than the first group (t=5.126, DF=18, P>0.0001).The number of adhesion points and their strength was significantly different between the 2 groups (P<0.0001). Multiple regression model has shown statistical significant differences in length, number of points and strength of adhesions between the two groups. In the literature, there are several papers mentioning the adhesion producing effect of Talc powder in abdominal and pelvic operations, but in this study we tried to show that Talc powder by itself can not produce adhesions though it may have a synergistic effect with the trauma of surgery for producing adhesions.      

Toxoplasmosis is one of the most important infectious diseases common in both human and animals and various serological findings from all over the world point out to the fact that this protozoal infection is on the rise all over the world. Considering the fact that the rate of contamination is absolutely related to geographical conditions, eating habits, existence of cats and since the cat is the most popular pet in a large number of families in Yazd, we decided to have an epidemiological study on the mentioned subject. Since there is a high morbidity risk in single females, this group was also evaluated for the rate of contamination. Thirty areas were selected randomly and using statistical records of the health care center of Yazd province a questionnaire was filled and blood samples of one hundred persons were taken by referring to their houses, and the same things were done for over 300 single females who had referred to Nikoopour health care center, for premarriage tests. I.F.A was done for all blood samples at the central laboratory of Yazd province. Overall, 3320 persons were evaluated, including 1041 (31.4 %) males and 2279 (68.6 %) females, with the following results: 60.2 % were negative, 14.8 % with titer of 1.100, 13.5 % with titer of 1/200, 9.5% with titer of 1/400, 1.2% with titer 1/800, 0.3% with titer of 1/1600, 0.3% with titer of 1/3200, 0.1 % with titer of 1/6400 & 0.1% with titer of 1/12800 positive. Antibody titer in single females had the following pattern: 64.4 % negative, 14.5 % with titer of 1/100, 12.5 % with titer of 1/200,4.6 % with titer of 1/400, 4 % with titer of 1/800 and higher. There is a direct relationship between age and prevalence of toxoplasmosis, therefore there is more chance of contamination with increase in age. The age group of less than ten years had the lowest, while 30-39 years age group had the highest contamination rate. Housewives and butchers had the highest contamination rate. There is a correlation between prevalence rate of toxoplasmosis and consumption of half-cooked meat, raw vegetables and contact with cats. Not using half-cooked or kabob-type meat, good personal hygiene by cooks and those handling uncooked meat & proper cooking methods are recommended.      

Choroidal osteoma is a benign bony & rare tumor of unknown etiology that arises from choroid. It is observed unilaterally or bilaterally in young adults, more commonly in women. In this report a case of left eye choroidal osteoma was detected in a 60 year old man who had reduced visual acuity (V/A) since 15 months. The diagnosis was confirmed by flourscein angiography, ultrasonography and CT scan. The significance of a correct diagnosis is in differentiating it from other intraocular tumors. There is no known effective therapy for choroidal osteoma, but periodic observation is warranted for C.N.V management.      

A 30 year old man referred to Afshar Hospital with chief complaints of severe weakness, weight loss, and vomitting. The above signs started one year ago intermittently and many para clinical tests were performed at that time, but all were normal. Brain MRI performed at the end of the first month was normal. At the time of referral, he was severely cachexic, had nystagmus without meningeal signs, serum Wright was positive (1/320) and CSF Wright was also positive (1/80).      

Thyrotoxic periodic paralysis is an uncommon disorder characterized by recurrent episodes of motor weakness of variable intensity associated with thyroid overactivity that occurs primarily in males of Asian descent. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. We describe three men, aged 26, 34 and 31 years, who complained of several episodes of proximal muscular paralysis and weakness without any significant clinical manifestation of thyroid hyperactivity. At paraclinical workup, we observed ECG changes in the first and second cases, especially supra ventricular tachycardia. Lab data clearly revealed raised levels of T4 and T3Ru, and depressed TSH and potassium levels. Therefore, Thyrotoxic periodic paralysis should be considered in the differential diagnosis of all acute episodes of motor paralysis in young patients. Determination of the plasma levels of potassium and thyroid hormones helps in diagnosis. Early diagnosis is important so as to be able to establish antithyroid treatment and avoid further episodes of weakness.      

Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology. While any tissue or organ may be affected, the disease most often involves the lungs. Skin lesions occur in about 10 -100% of patients, predominantly on the face and limbs. Skin lesions commonly observed in sarcoidosis include erythema nodosum, macular or papular rashes, nodules, plaques, lupus pernio, hypopigmented or hyperpigmented patches, sarcoid scars and rarely mucosal lesions. This report describes a case of sarcoidosis in a 48-year old diabetic man with only skin involvement, who developed sarcoidal skin lesions like papules, plaques, and nodule. Sarcoidosis is a rare disease in Iran; but we would hereby suggest that sarcoidosis should be considered in any patient presenting with non-ulcerative granulomatous lesions especially on the face and limbs and a chest radiograph if possible as well as a skin test for cell-mediated immunity to tubercle protein (Tuberculin test) should be done.