Journal of Shahid Sadoughi University of Medical Sciences
Year:2001 | Volume:9 | Issue:3|Papers Count:20

Although,most causes of short stature are non pathologic but if pathological cause is diagnosed, medical treatment will be effective. This study was descriptive and crosssectional. The aim was to study the main cause of short stature in patients aged 7-15years referring to Endocrine centers in Yazd. 125 patients were referred, 25 patients were excluded in this study because of severe malnutrition, Systemic disease . 100 patients including 48 males and 52 females were studied and most of them were in the age group of 13-15 years. 57% of the short stature cases had non pathological causes (33% constitutional and 24% intrinsical, 43% of the short stature cases had pathological causes in cluding 16% GH deficiency, 12% hypothyroidism, 7% turner syndrome, 5% chondrodysplasia, 4% rickets, 3 % hypoparathyroidism the most common cause of short stature in males was constitutional short stature (50%) and in females was Intrinsically (23.1%). The most common causes of short stature were non pathological causes. and between inpathological causes, GH deficiency and hypothyroidism had more effects. Since, mean ages of patients referred to endocrine centers were high (13-15 Years),Therefore delayed of treatment affect on the final height of these patients. So, education of Patients and their parents with short stature has important role in the treatment outcome .

Myocardial infarction is the most common cause of death in many countries, including Iran. Thrombolytic drugs, like streptokinase can , dissolve the clot in coronary arteries, and decrease mortality of MI. These drugs are very useful, if they are given to the patients in first hour of beginning of MI. We evaluated the time duration between beginning of the chest pain of MI and infusion of streptokinase and also evaluated some causes of delay. We studied 60 patients (85% of the patients were male and 15% were female and average of age in the female was 64.4 and in the male was 56.5%) with acute myocardial infarction, and measured the time between beginning of chest pain and arrival to the hospital and infusion of streptokinase. The mean time duration between begining of chest pain and arrival to the hospital was 106 minutes and between arrival to streptokinase infusion was 51 minutes. The total time duration was 157 minutes. In this study, age and sex had no significant effect on time duration. The most common causes of out of hospital delay were lack of accessibility, far away from medical centers, unawareness of general papulation on importance of chest pain, and self treatment of patients. The most common causes of in hospital delay were: delay in taking ECG, delay in decision by doctors, and some other causes. We hope with education of general papulation, providing accessibility and education of medical and paramedical team, this time interval becomes shorter progressively.

Laparoscopic cholecystectomy (LC) in elective surgery has replaced open cholecystectomy (OC) . This study compared the safety and efficacy of these two methods in the treatment of symptomatic gallstones. This experimental parallel outcome study was carried out in Yazd . 140 cases were divided into two groups . 70 cases in LC (M.F=14.54) and 70 in OC (M.F=12.58). Respiratory complications in OC was two fold of LC, biliary injury in both groups were identical (1.4%). The mean hospital stay in OC was 4.08+ 1.9 days and in LC 1.57+0.75 days (P>0.001) . Also , the Mean of NPO time in post operative period in OC was 1.84+0.58 and in LC 1.50 + 0.23. In addition , 2.8% of patients in OC has wound infection and in one patient of LC has subcutaneous hemorrhage . LC provides a safe and effective treatment for most patients with symptomatic gallstones , Laparoscopy

There are various methods of treatment for primary nocturnal enuresis. The conditioning therapy by enuresis-Alarm is the most effective therapy for primary nocturnal enuresis. There are, however , a few studies in our society about its effect and side effects. In this study, sixty children with primary nocturnal enuresis were included in a randomly controlled trial. All had light sleep and no organic disease according to history and physical examination . The children were allocated to two match groups. In the first group, 30 children, each used enuresis-Alarm and in the second group 30 children were considered as control without any treatment. After a short period (1-2 Week), 4 children (belonging to the first group) refused to take the treatment by enuresis-Alarm (13.3%). All of them were under 10 yr of age. 26 children used enuresis-Alarm for 2-3 months. At the end of the treatment , 23 children developed improvement (Complete and relative) but in the control group, 4 children developed spontaneous improvement (P = 0). In the first group , 13 children had complete improvement (50%) and 10 children had relative improvement (38.5%), However, in the second group 1 child had spontaneously complete improvement (3.3%) and 3 children had relative improvement (10%). Two months after cessation of treatment, 3 children from the first group developed relapse (11.5%). One of them responded quickly to a second course of alarm-training. There was not any relapse in the control group. The main problem in this method of treatment was the breakdown of the enuresis-Alarm.

To evaluate WHO and ADA criteria for diagnosis of diabetes mellitus . 1606 subjects that referred to Isfahan Endocrine and Metabolism Research Center were examined for oral glucose tolerance test. Blood sugar was examined by enzymatic assay. Sensitivity, specifity , positive and negative predictive value of both criteria were assessed. For WHO criteria, sensitivity of fasting blood sugar was 32% , specifity was 99% , positive predictive value was 65% and negative predictive value was 97%.For ADA criteria , sensitivity of fasting blood sugar was 44%,specificity was,98%,positive predictive value was 51% and negative predictive value was 98%.The sensitivity, specificity, positive and negative predictive values of ADA criteria for IGT diagnosis were 25%, 97.9%, 49% and 94% , respectively. This study suggests that although ADA criteria is more sensitive than WHO criteria for diagnosis of diabetes mellitus, but it is insufficient for screening of this disorder.

Acetaminophen poisoning is one of the most common drug poisoning in the world. N-acetyl cysteine (NAC) is a glutathione precursor with enhancing glutathione synthesis and increasing the amount of acetaminophen that is metabolized by sulfation. This antidote is used in PO and IV route but in some countries like U.S, IV form is not used and an on-going clinical trial of IV NAC is currently being conducted. This study done a cross-sectional research over adverse effects of IV NAC administration during one year in adults who had ingested toxic dose of acetaminophen and were referred to Tehran Loghman Hospital Poison Center. Results from 206 patients showed that male to female ratio was 1 to 1.6 . 130 patients developed adverse effects after IV NAC administration including nausea and vomiting in 118 cases (57.2% ) and anaphylactoid reactions in 48 cases (23.3%). Among the patients who developed nausea & vomiting, 77 cases were managed with a single IV dose of metoclopromide and in patients with anaphylactoid reactions , 26 cases were managed with antihistaminic medication and corticosteroid therapy , while others were managed by decreasing in infusion rate or temporary stopping of NAC administration. In spite of IV NAC administration in all of the cases, mortality was not reported . Also , mild signs of adverse effects in most cases occurred which was controlled with single curative drugs or decreasing in infusion rate of IV NAC. It is recommended that IV NAC can be used as the first step in management of cases ingested toxic dose of acetaminophen (after primary supportive care in all poisoning) , even if there is not any ability of serum acetaminophen level assay.

Complete hydatidiform mole is a type of gestational trophoblastic disease (GTD). GTD is a rare human tumor which is curable even in extension.The treatment of CHM consists of two phases: immediate evacuation of the mole and subsequent follow up for detection of persistant trophoblastic proliferation or malignant change. This was a follow up study carried out on patients with CHM. The patients were admitted to the Bahman and Afshar hospital in Yazd . 59.9% of patients were under 20 or over 35years old. 60% of patients lived in rural areas. None of them had previous CHM. The average of gestational age was 12.2 0.4 weeks. Uterine bleeding was the most common sign. 20% of patients developed persistant GTT and required chemotherapy. All of the patients had complete remission after follow up period. The average time of receiving HCG to normal level after treatment was 9.6 1 weeks. There was no relationship between patient`s age, gestational age, or residence and persistant GTT.

The main routes of HCV transmission are blood transfusion and inoclusion. Although, HCV infection is highly prevalent in candidates for renal transplantation, the clinical value still remains unclear. Recent studies have showen that HCV infection may increase the risk of death among patients on maintenance hemodialysis.This prospective cross-sectional study was performed on 93 HCV positive patients with chronic renal failure referred for renal transplantation. Anti HCV was detected for all patients by Elisa II and then determined by RIBA. The mean age of patients was 39.8±13. There were 52.7% men and 47.3% women. The mean of SGOT & SGPT level were 53.1±32% and 77.4±41% , respectively; this was 1.5 time more than normal level. 51.4% of specimens with SGOT were less than 40,while 74.2% with SGOT were over 40, and had biopsy score more than 5 (P=0.05). Also 56.7% of patients with SGPT had less than 40 and 65.8% with SGPT more than 40 had biopsy score more than 5, which was insignificant (P=0.30). Liver biopsy was performed in 71 patients (76.3%) 2 patients (2.8%) were normal , 62 (87.3%) had chronic hepatitis and chronic hepatitis with hemosiderosis was reported in 7 patients (9.9%) the knodell score in 37.7% of patients was 4 and less than it and the score of 62.3% was more than 5. Further studies with repeat liver biopsies after kidney transplantation are necessary to observe the evalution of HCV- related liver disease after immunosuppressive therapy.

Premenstrual syndrome (PMS) is characterized by a wide variety of symptoms that occur prior to menstruation which affects the daily life in the patients suffering from severe PMS. Headache is reported by many of patients with PMS.Menstrual headache is the type of headache that occurs premenstrually and it is almost in the form of migraine headache and disappears before the first day of vaginal bleeding. In this study , the prevalance of menstrual migraine among 700 university students in the age of 18 - 25 who experienced PMS according to IHS criteria was investigated .The findings indicated that 115 (16.5%) of subjects had menstrual headache and144 (20.5%) had headaches not dependent to menses. Of these 259 subjects, 60 persons had migraine headache according to IHS. Among them 35(13.5%) suffered from menstrual migraine and 25(9.6%) had migraine independent of menses. There was a significant relationship between menstrual migraine and the age, pariety , menstrual disorders and heritage . Howevre, there was insiginficant relationship between menstrual migraine with marital status and family history.

There are many chemical receptors in the membrane of the tracheal smooth muscle cells through which different neurotransmitters and chemical agents affect them and result in an increase or decrease of airway resistance. Bronchial constriction is a relatively increasing symptom due to air pollution , thus many investigators are trying to find the agents that are involved in bronchoconstriction. Cholecystokinin (C.C.K) is one of these agents that is released from the nerve endings in the airways , but the function of this polypeptide is not known yet. In this study , isolated tracheal specimens lengthing about 5 cm were mounted in anoryan bath filled with krebs solution. Electrical stimulations in different voltage (10-30 V) and frequencies (20 - 60 Hz) were applied to the lower end of the specimens via a bipolar silver stimulatory electrode , and any altration in the tracheal length and tracheal pressure were recorded by using an isotonic transducer and a pressure transducer connected to a two channel oscilograph.To assess the effect of C.C.K on rabbits tracheal smooth muscle , different concentrations of C.C.K was added to the solution bathing the specimens. Our data showed that C.C.K alone had no effect on the tracheal smooth muscle but could potentiate the effect of electrical stimulation in a voltage and frequency dependent manner. This effect was also concentrations dependent up to 10-7 molar (C.C.K) which showed the maximum effect on tracheal length and intratracheal pressure which (0.01). were increased significantly from dose of the control (Since different concentrations of C.C.K had no on tracheal smooth muscles by themselves but they augmented the responce to electrical stimulation suggest that C.C.K may act as a neuromodulator in the respiratory airways.

Aspergilosis is a mycotic infection caused by various species of the genus aspergillus . This disease shows different clinical forms in regard to predisposing Factors and pathegenesis of the disease . Clinical and mycological diagnosis of the disease is unspecific and problematic , but serology can be helpful for diagnosis and for following up the treatment . The aim of this study is preparaytion of somatic antigen and related antiserum in Iran to perform precipitation tests for diagnosing the noninvasive froms of aspergilosis . This can cause needlessness from foreign products . Aspergilus fumigatus was cultured in glucose - peptone broth and shaken in 30o c for 3 days. The harvested colonies were homogenized by seasand in mortar and the cell extracts were purified concentrated and injected subcutaneously in rabbits for producing hyperimmune antiserume. Antigens and antisera was evaluated by counterimmunoelectro phoresis test . The prepared antigens had enough antigenesity for producing high titer of antibody in the rabbits . It also reacted with rabbit and human patients, serum . The number and pattern of the precipitation lines were similar and comparable with standard antigen and antiserum

A correlation study was conducted to investigate the degree of stress experienced by nurses with their exhustion in intensive units of Yazd hospitals . Since the population of the study consisted of a limited number of nurses , all the 24 persons were included in the sample . The tool was a three part questionnaire. The first part provided some demographic information , the second part measured role producted stress using osipow and co-workers , occupational stress inventory and the third part was concerned with the intensity and frequency of exhustion according to maslach and jackson,s burnout inventory . The finding revealed that the majority of nurses experinenced a normal degree in five aspects of role producted stress ( role overload, role insufficiency , role ambiguity , role responsibiltiy and role boundar ) but the stress experienced of role environment was higher than others. Also , the nursese experienced moderate degree of emotional exhaustion depersonalization and personal accomplishment . In additon , certain background variables like age, sex and marital status and education was correlated between marital status and personal accomplishment . Regarding correlation between work environment producted stress and burnout there were significant correlation between ( role boundary and role responsibility and role ambiguity) with emotional exhaustion of burnout . There was a significant correlation between role induced stress and emotional exhaustion aspect of burnout. It is recommended that more attention be paid to assess the nurses working in intensive care units for emotional exhaustion .

The purpose of this report is introducing of a patient with bilateral corneal perforation due to neurotrophic keratitis who is followed with simultaneous penetrating keratoplasty (P.K) in both eyes . Neurotrophic keratitis usually occur after fifth cranial nerve damage , Iathrogenic ,toxic process , stroke , irradiation , aneurysm , multiple sclerosis , brain stem hemorrhage and herpes zoster and herpes simplex keratitis then resulted in corneal sensory disorder , lacrimal dysfunction and change in corneal epithelial cells morphology . Above mentioned patient underwent simultaneous penetrating keratoplasty (P.K) in both eyes . In spite of propotative general condition of the patient,s and his cornea and post operative risk factors in this case P.K saved the eyes and its vision. Therefore , P.K in this group of patients is helpful as a final stage of treatment.

Chronic aortic dissection is a sequle of untreated, asymptomatic acute aortic dissection when the process is more than 14 days old . chronic aortic dissection usually is asymptomatic .This case is a 65 years old man with history of severe blunt chest trauma 17 years ago that admited in cardiovascular surgury ward with chest pain , dyspnea and syncope from 5 months ago. In physical examination positive findings was grade III regurgitant aortic murmur and colapsing pulse. In investigations diagnosis was ascending aortic aneurysm with severe aortic regurgitant and abdominal aortic aneurysm. In surgical exploration diagnosis was chronic aortic dissection type I Debakey.Operative technique was replacement of entire ascending aortic with dacron graft and repair of aortic valve .After operation patient become asymptomatic with trivial aortic regurgitation and abdominal aortic aneurysm collapsed due to collapse of false lumen.

Camurati Engelmann Syndrome is a skeletal developmental disease which is inheriteds by a dominant Autosomal gene. In this syndrome , diaphysis of long bones become wide and fusiform and these is periosteal and endosteal new bone formation without metaphyseal and epiphyseal involvment. The reported case is a young adult 14 years old. The chief complain are upper and lower limbs pain, muscular weakness and fatique while walking there was not mental retardation, and muscular atrophy on examination. X-Ray of tibia and femure showed increase bone density and fusiform shape tibia. Lab investigation showed increases Alp. Considering patient,s history, clinical examination and para clinical investigation the diagnosis was comurati Engelmann or progressive diaphyseal dysplasia.

Hemorrhagic shock and cardiac temponade are presentation of penetrating chest trauma . CXR cause delay in diagnosis and treatment . Some authors suggest sub xiphoid window for diagnosis . Ressuscitation and thoracotomy for repair of cardiac injury must be done early after penetrating cardiac injury that cause 80 percent of the patients alive. This report is a 8 year old boy with chest stab wound and decreased left lung sound and massive left hemothorax with normal echocargiodraphy . Early thoracotomy was done and laceration of anterior and posterior sides of right ventricle repaired . The patient was discharged after 8 days with good condition.