Journal of Shahid Sadoughi University of Medical Sciences
Year:2002 | Volume:10 | Issue:1|Papers Count:22

The aim of this study Was to compare the antihypotensive effects of sublingual phenylephrine and parenteral after spinal anesthesia. 120 patient who needed spinal anesthesia were selected.In 60 patients. 2mg of sublingul phenylephrine and in others, 2mg parenteral ephedrine was used before anesthesia. Systolic and diastolic blood pressure, MAP, heart rate and O2 Saturation were compared. The mean systolic blood presure in the phenylephrine group (group1) was 120.3± 6.5 mmHg and 119.2±6.7mm/Hg in the ephedrime group (P=0.97) . The mean diastolic blood pressure in group I was 74± 14.39mm/Hg and 69.1± 5.9mm/Hg in group II(P=0.21) . MAP in group I was 104.5 ±6.4mm/Hg and 102.4 ± 5.6 mm/Hg in group II ( P=0.82) . The mean heart rate in the two groups were 74.07± 4.9 and 79.3±4.7 perminute respectively (P=0.9) . Our findings suggest that sublingual phenylephrine can be used to prevent hypotension due to spinal anesthesia.

1 % of the total neoplasic lesion are located in the nasal cavity and sinuses and 1000 new cases are discovered in USA every year. Neoplasms in the nasal cavity and sinuses involve males and females .In the ratio 2:1 and the highest rate of incidence is between the 5 th and 7 th decades. Importance of early diagnosis and extension of disease is clearly known. In our study, 12 Patients (9 males and 3 females, between 43 to 65 years old) who referred to the CT Scan center of Sayyed AI Shohada Hospital were examined by CT scan and MRI with and without contrast media and then the CT and MRI reports were corelated with tissue pathology reports. Size of the mass has a direct relationship with malignancy. Bone destruction was better visualized by CT while real size of the mass and soft tissue invasion was differentieted by MRI . In our study accuracy rate was 88% for CT Scan and 98% for MRI , but further evaluation for better and more reliable results is recommended.

Bronchoalveolar lavage cytology findings place at our disposal valuable diagnostic infonnation a bout varlous lung diseases. One of the most important uses is the diagnosis of lung cancers which is made possible by bronchial lavage or broncho- alveolar lavage. In various studies conducted in different countries, the diagnostic accuracy of this test has been reported to be 6075%. To determine the diagnostic value of this procedure. files of 140 suspected lung cancer patients who had undergone bronchoscopy and lavage between the years 1375-1379 (1996-2000) were included in this retrospective study. From among these patients, 49 cases were con finned lung cancer by results of tissue biopsy taken during bronchoscopy or incisional biopsy. These positive biopsy findings were considered as gold standard, and the bronchoalveolar lavage cytology findings were compared with them. From among the 49 reported cases of cancer, 34 (69%) were men ,and 15(31%) were women. 25(41 %) had small cell carcinoma, 15(31 %) had adenocarcinoma 6(12%) had small cell carcinoma, and 2 cases (4%) each, had the following bronchoalveolar carcinoma, large cell cancer, undifferentiated cancer and metastatic cancer. The results of cytology were positive for carcinoma in 30( 61 %) of the patients, the cytological finding results without taking into consideration the type of cancer (histopathology) were as follows: sensitivity 66% , specificity 100% , positive predictvie value 100% neg.pred. value 82% and accuracy 86%. The highest percentage of sensitivity shown by the cytological results was for squamous cell carcinoma (66%) and the last sensitivity was for small cell carcinomas (50%). The highest specificity was for small cytology with 60% . Bronchioalveolar lavage cytology with 66% sensitivity and 100% specificity can be used for diagnosis of lung cancers.

Iron Deficiency Anemia (IDA) is the leading cause of anemia in the world. In the 6-24 months age group and infants fed mainly with cows milk, even very mild to moderate anemia can lead to future growth retardation in these children. In this diagnostic study, children between 6 months and S years of age who had been involved in the study for detecting the prevalence of IDA , and their serum hemoglobin (Hb) levels was low (<11 g/dl) were given a therapeutic trial of iron (TTI) . They were given 3mg/kglday of oral ferrous sulphate for 3 weeks and their hemoglobin levels were measured again. Those children whose Hb levles had increased by 1gr/dl or more were considered as IDA cases. The results were compared with the results of the study for detection of the prevalence of IDA cases, and the results were as follows: 24 cases (72.7%) from the total of 33 cases were recognised as IDA by TTI , where as the ferritin test recognised only 14 cases (42.4%) with levels <12nglml as IDA. We, thus concluded that TTI is a very good diagnostic test, and in patients 5months - 5years old with mild to moderate anemia , TTI can be preformed before any other test.

Acute renal probability failure is not very common in childhood, but regarding its high mortality and morbidity, high probelility of it becoming chronic and cost, a true understanding of its etiologies and predisposing factors is fundamental for prevention and management. During a.16 month period, all children, 1 month to 15 years old with final diagnosis of acute renal failure were evaluated for predisposing factors (diarrhea, vomiting, hemorrhage, drugs, infectious diseases etc) and urinary indices. Diagnosis of acute renal failure was made on the basis of rising BUN and creatinine and eventually by exclusion of chronic renal failure. Etiologies of acute renal failure were determined by history, physical findings, laboratory data, imaging studies, urinary indices and in some cases by kidney biopsy. Fifty children, 37 boys (74%) and 13 girls (26%) with final diagnosis of acute renal failure were evaluated. Their age range was 3 months to 15 years, (6.29±4.76). They were categorized into 5 major groups. In order of frequency, they were tubulointerstitial diseases 18(36%).pre-renal 14 (28%), glomerular 13(26%). Hemolytic uremic syndrome 4(8%), and obstructive (2%). Nephrotoxic drugs were the major cause of ATN in this study. Many different factors may give rise to acute renal failure of "which, a majority of them are preventable. Appropriate fluid therapy in dehydration, avoidance of nephrotoxic medications and frequent monitoring of in-patient renal function, especially in intensive care units are some of the fundamentals of prevention.

Ingrown toenail, caused by inappropriate growth of the nail plate into the lateral internal holding folds, usually is secondary to tight shoes, & poor nail cut. This disease is classified into 4 stages & treatment of stage III is surgical. This is a clinical trial study with a 6 month, follow up patients which has been performed at Afshar & Shahid Rahnemoon University hospitals between July 1997. and octobr 1999. A total of 120 patients were included in the study, and were divided into 2 equal groups by simple randomization. General objective of this research was comparison between the two surgical methods Winograd & NMP (Nail Matrix Phenolization). For this purpose, recurrence, rate, infection, morbidity, surgical operation duration and cost, were studied and compared. The rate of recurrence, and infection, was higher in patients who underwent NMP , but the duration of surgical operation, cost and morbidity were lower in this method. Overall in our opinion the Winograd technique seems to be more suitable than NMP.

Electrocardiographic Repolarization Abnormalities(ECGRA) ;ST segment and T wave changes,QT prolongation and prominent U wave are common in patients with intracerebral hemorrhage. These ECGRA have an effect on the rehabilitation and prognosis of the patients .This descriptive - prospective study was carried out in patients with thalamic, putaminal and temporal lobe hemorrhages during a 19 month period at Emam Reza Hospital ,Birjand. The new ECGRA findings were compared with a recent ECG. Volume of hematoma was calculated by Broderick formula using brain CTScan. The relation between the hematomas volume and severity of ECGRA was tested by" Pearson " analysis .The correlation coefficient of hem atom a volume and severity of ECG RA in 14 thalamic, 18 putaminal and 8 temporal lobe hematomas were r=0/16,r=0,r=-0/2 respectively . Patients with small hematoma(less than 20 cubic centimeters) in thalamus had more sever ECGRA than those with putaminal and temporal lobe hematomas. The higher correlation coefficient between hematoma volume and ECGRA in thalamus is probably due to the effects of these hematomas on hypothalamic sympathetic centers.

Thalassemia is a disease that is congenitally transmitted from the parents With diseased genes to their descendants and affects an important percentage of the children in certain parts of the world. It leads to an anemia due to a defect in production of one or chains certain of hemoglobin. Depending on the type of defect, thalassemia has been divided into two types: Alpha and Beta. Transmitter of the defective genes of minor thalassemia have quite healthy apearances these defective cases in fathers or mothers can be realized only through blood testing. Thalassemia has been known as an endemic and local disease incertain areas. Kerman is one of those ten provinces in the country in which thalassemia is widely endemic. In order to determine the rate of incidence of incidence minor in Kerman , the recent research was carried out among the marriage candidates Tir 1377-1378. This sectional descriptive study whose purpose was to determine the rate of incidence of the disease among the marriage candidatestir carried out in Kerman between 77 and 78. The total number of samples studied was 27946 of which 1606 (5.7%) were thalassemia minors (829 men & 777 women). The percentage of affected individuals varied greatly according to the geographical location (31.3% to 2%). Results did not show a significant relation between disease and gender, but it is noteworthy that educational qualifications as compared to family and vesidential location had a significant relationship with the disesae (P<0.001). A very important finding was that of the 110 couples who were carriers of thalassemia , only 7 decided to part ways, and this points out to the high level of unawareness among the general population which is responsible for increase in the number of thalassemia magor cases in our society. Therefore, all the responsible authorities and mass communication instruments, especially those which can reach the rural areas should seriously chalk out strategies and plans in order to increase the general awareness and decrease the rate of incidence of thalassemia major in our country .

Post operative pain, nausea and vomiting are common and important complications which lead to numerous dangerous effects on multiple organs, thus prevention of these complications are vital and essential. To determine the effect of betamethasone on post operative pain, nausea and vomiting. In this prospective analytical study, 60 patients scheduled for elective surgery were divided in two groups. Under similar conditions of general anesthesia , one group received 12 mg betamethasone (3ml) and the other group received 3ml normal saline intramuscularly before the operation. Patients were followed for pain, nausea and vomiting for 6 hours after the end of the operation and, the data was analyzed statistically using t .test. During 4-6 hours after operation 53% , in betamethasone group and 23% in normal saline group did not have pain. Also 93% of patients in betamethasone group and 50% of patients in normal saline group did not have nausea. Vomiting did not occur in any patient from either group. There is a significant statistical difference between, the two groups regarding prevention of post operative pain and nausea (P = 0.00) but there is no significant statistical differenece between the two groups regarding prevention of post operative vomiting,(P= 1). Injection of intramuscular betamethasone preoperatively can decrease incidence of post operative pain and nausea but does not have any effect on post operative vomiting.

Verotoxin producing E.coli belonging to several different "0" serotype, have been associated closely with Hemolytic Uremic Syndrome (HUS) and Hemorrhagic Colitis (HC). In order to isolate EHEC and carry out verotoxin assays of EHEC strains in Ilam Province 1557 faecal samples were collected- stool samples were cultured for initial isolation of EHEC on sorbitol Macconkey agar medium and biochemical tests were used for confirmation of EHEC. The colony sweepy polymyxin-B extraction method was used for extraction of toxin.In this study, 26 isolates of EHEC were isolated and all of them produced a cytopathic effect on Vero cells. No significant difference was seen between the rate of separated EHEC and diarrhea was observed in rural areas and most of the cases who were EHEC positive were normal and had no diarrhea , but this difference was significant in urban areas. (P=0.001). Neutralization assay revealed that the cytopathic effect on vero cells induced by 18 samples(69.2%) could be neutralized with anti-VT1 serum, and 7 (26.9%) with anti-VT2. The effect of 1 sample (3.9%) could only be neutralized with a mixture of anti- VT1 / VT2 sera. In serogrouping test among the 26 isolates, one isolate(3.9%) showed an agglutination reaction with antiserum 0157:H7. The findings indicate that in Ilam, EHEC isolates are present and VT1 are produced by most of the strains.

Poisoning in one of the most common causes of referal to the emergency department in all age groups. This study was designed to determine the local pattern of acute poisoning in children of Shiraz . All poisoned children who were referred to Nemazee Hospital Emergency Room, the largest hospital of Shiraz University, during 1997-1998 were enrolled in this study. Amonig 690 poisoned children, male to female ratio was 1.5. The most common age group was the "1-5 years" age group (P = 0.009) and the most common age group of admitted was the 11-15 years of age group (P = 0.003). The most common causes of poisoning according to decreasing frequency were as follows: Accidental ingestion of drugs, toxic chemicals and norcoties . The maximom number of reported cases were in summer. From among the total number of patients . 125 (22%) were under observation for less than 6 hours while 368 (53%) were under observation for less than 6 hours at the emergency department 164 patients (24%) were transferred to the pediatric department and 6 patients (0.8%) expired. The maximom number of reported cases were in the 1-5 years age group and accidental ingestion of drugs was the leading cause of poisoning, Therefore , parental education regarding prophy lactic measures, Keeping drufs out of reach of children, and special packaging of durgs preventing their access to children are suggested.

Non Stress test is the most common well being test before delivery that is done in probable cases of fetal distress. Decision for continuation or terminating the pregnancy is based on the result of NST along with some other criteria. The aim of this study was to determine the sensitivity and specificity of NST in cases with decreased fetal movement or decreased amniotic fluid volume on the basis of sonography, report. This cross-sectional study was carried out on a group of 120 women who had referred to the Niknafs clinic of Bahonar hospital in Kerman. Mean age of patients was 25.7±4.8 years old, mean gravidity and pariety was 2.3±1.3 and mean gestational age was 40.3±1.1 weeks (38-42 week). 1.1 (84.2%) of mothers were complaining of decreased fetal movement and 61 % of them showed decreased amniotic fluid in their sonographies. The result of NST in 64.1% of patients was nonreactive and in 35.9% was reactive. In 41.7% of cases of fetal distress was during labor or delivery of which 94.1 % had nonreactive NST. The sensitivity and specificity of NST were respectively 89% and 74.5% in cases that decreased A.F had been reported in sonographies, and in cases with compliment decreased fetal movement by mothers. The sensitivity and specifity of NST were 68% and 32% respectively.

Hydatid cyst or echinococcosis is caused by a Parasite which belongs to a sublass of cestodes. The adult form of this parasite is usually seen in the dog"s intestine and its larvae may develop in mammals like humans, sheep, cattle, goats, camels and horses. Humans are an intermediate host of this parasite. This cyst is chiefly found in the liver, and less frequently in the lungs. However, the CNS is very uncommon site. This article discusses a very rare case of development of this cyst in the cerebellum of an eight year old boy. This disease was left undiaognosed unitl aCT - Scan and MRI were performed. Hopefully, this article will bring into mind that hydatid cyst can be one of the differential diagnosis of a space taking lesion in the CNS.

Alkaptonuria is a rare autosomal recessive metabolic disorder that affects one in a million. It is historicaly important as it was the first disease labeled as "Inborn error of metabolism" by Garrod in 1902. Genetic deffects on chromosome 3 cause abnormal production of hemogentisic acid which accumulates in connective tissue and is excreted in urine, thus darkening it. This 22 month old baby from kharanagh came with dark history of urine since three months of age. His mother mentioned that his diapper turned black on standing. In past history there was no pertinent data except consanguinity, without any specific illness in family, Sonographys & IVP, were normal, His urine did not change its color in acidic media. It had a reducing property which was determined by benedict reaction but showed no activity with glucose oxidase reagent. As the other differential diagnoses of black urine were limited phenol poisioing , malignant melanoma porphyria, myoglobinuria. hemoglobinuria with acidic urine and methemoglobin and none of their characterestics were present this diagnosis was made The aim of this presentation is to present the various differential diagnoses of black urine and clinical features of alkaptonuria which can be diagnosed easily by virtue of its clinical features, thus limiting the necessity for further unnecessary investigations.

"Human bites" and its complications are more important and more severe than animal bites. There are various causese of these type of injuries which include habitual sucking of fingers , paronychia, clenched fist bloods, occassional bites as a from of atteck to various parts of the body and love bites. The complications and infection rate are more common and serious in the upper extrenities. The human oral aerobic and anaerobic bacteria can be the causes or infection. Eikenella corredclens is a specific human oral cormmensual bacterium. Most patients require hospital admission surgical drainage, irrigation and debridement of wounds with intravenous antibiotics. We have introduced two grevious cases of human bites in this article.