Journal of Shahid Sadoughi University of Medical Sciences
Year:2001 | Volume:9 | Issue:2|Papers Count:17

Head Injuries (HI) are one of the most frequently occurring incidents in the world. These types of injuries are the third leading cause of death in the world, and the disabilities following injuries are serious enough to be considered important. Due to the limitations of the treatment, it seems that the best approach is primary treatment or prophylaxis or at least preventing the CNS complications of HI. 993 patients with HI who were admitted to the Shahid Rahnemoon Hospital in Yazd between 1998 - 1999 were included in this cross - sectional study. Information was gathered via questionnaires and analyzed using SPSS program. The mean age of the patients was 25.38 years and 71.3% of them were male. The leading cause of HI according to the frequency was motorcycle accidents (43.4%), then falls (24.9%) and automobile accidents (22.3%). The falling was the primary cause of death among children, and the leading cause of death in both sexes was motorcycle accident. The highest rate of mortality was observed in motorcycle accidents (37%). The highest mortality rate was recorded in the pedestrian group(50%). This study points out the bitter fact that motorcycle accidents are the leading cause of HI in Yazd. This mode of transportation with minimum safety specifications is used by many families in their daily activities. Therefore, riding motorcycles usually pose a serious threat to the lives of both the motor rider and pedestrians.

Heel pain with obscure etiology, chronic status and resultant gait compromise could be a challenging matter of treatment. To clarify its charactristic and suggestion of therapeutic strategy, we studied the patients admitted to the orthopedic clinic for 2 years from 1998-2000. In this outcome study, the patients history, physical examination, appropriate lab tests and ankle and calcaneus radiographies were taken. 58 patients (65 heels) with mean age of 42±1.3 (28-65 years) included in this study. There were 7 bilateral cases. There were also 48 females (83%) and 10 males (17%). The right and left feet were about equally involved with right in 25 and left in 26 cases). Tinel"s sign that is a guide to neurologic etiology for heel pain was positive in three cases and in one of them conservative treatment failed. Phalen test and nerve compression test were not positive in any of the cases. In one patient, maximum tenderness was in zone II Baxter, which did not respond to conservative treatment. X-ray was taken in 49 heels and calcaneal spur was observed in 46% of the painful heel and 36% of asymptomatic ones. There was not statistical correlation between heel pain and spur . After follow up of 14.5 month conservative treatment was successful in 55 cases (95%) and failed in 3 cases (5%). Two of the individuals underwent surgery, one case by Baxter modified technique (with release of medial calcaneal nerve) was fully asymptomatic in follow up, and the other one, a 50 years old women, by DuVries technique. Conservative treatment will be cornerstone in management of patients with painful heels, and Baxter modified technique with release of medialcalcaneal branches is highly suggestive in resistant cases. However, stuctural bone disease, skin lesions, systemic metabolic, and artheritis should be ruled out before surgical intervention.

Anal fissure is a common disease of anorectal area. The cause of anal fissure is anal sphincter spasm and elevation of anal pressure which has been confirmed by manometry studies. The aim of treating fissure is to reduce sphincter tone and pressure. In this study, two methods of medical treatment of chronic anal fissure without causing fecal incontinence were compared. Sixty patients were randomly divided into two equal groups. One group was treated by local injection of 80 u botulinum toxin inside anal sphincter anteriorly and along both sides of midline. The other group was managed by local application of nitroglycerin ointment 0.3% two times a day for a period of 4-8 weeks. Wound healing and symptom improvement occurred in 27 out of 30 patients (90%) in the botulinum group and 24 out of 29 patients (80%) in the nitrate group. In the botulinum group, temporary fecal incontinence was reported in one patient. In the nitrate group, 5 patients suffered from headache (16.7%) which was transiant or treated by oral acetaminophen. One patient with headache was treated by switching to botulinum therapy which was successful. Tolerable anal burning was present in 2 patients (6.67%). One patient who did not respond to botulinum toxin was succesfully treated with nitroglycerin ointment. Two patients were subjected to surgical procedure. Five patients failed to respond to nitroglycerin. Therefore, changing to botulinum therapy or surgical procedure were suggested for them. Recurrent rate in the nitrate group was 16.6% (4 cases) and 7.4% in the botulinum group (2 cases). Betulinum is much more effective than nitroglycerin as a substitution for surgical procedure in the managment of patients with chronic anal fissure.

Erythromelalgia or erythermalgia (EM) disease is characterized by severe pain associated with local warm redness in the extremities. The application of cold or elevation of the extremity will have the opposite effect of decreasing the pain. Because of this characteristic clinical feature, a local disturbance of vasomotor regulation has been hypothesized as the pathogenetic factor in primary EM. Therefore, evaluation of sympathetic nervous system seems to be a clue for elucidating cause of these complaints. sympathetic skin response (S.S.R) is a simple electrodiagnostic test for evaluation of sympathetic sudomotor activity. In this study, the test was performed for lower limbs of 22 patients with diagnosis of primary EM with no history of any other systemic disease or consumption of sympathomimetic or sympatholytic and antihypertensive drugs. Results of this group was compared with the results of 22 healthy subjects with no history of any systemic disease or drug consumption. There is a significant difference between the two groups as well as distal latencies and amplitudes. With at least 2 abnormal criteria from 4 measured criteria, more than 72% of the patients had abnormal S.S.R. Therefore, involvement of sympathetic nervous system (efferent, c fibers) in primary EM is highly suspected.

Three hundred and fifty samples from the patients suspected of having Cholerae were examined at the department of Bacteriology, Pasteur Institute of Iran. Using standard biochemical tests and serogrouping, 140 samples were identified as the Vibrio cholerae positive specimen. One hundred and thirty six samples had a biochemical pattern compatible with the biotype Eltor vibrio. Group specific sera identified 139 and 1 strains as ogawa and non- agglutinable (NAG), respectively. Antibiotic susceptibility test indicated that all strains were sensitive to ciprofloxacin and gentamycin. The resistance to doxycycline, chloramphenicol and erythromycin were found to be 2.9%, 2.2% and 8.6%, respectively. Furthermore, a significant resistance was found with cotrimoxazole, oxytetracycline and tetracycline with 98.6%, 87.6% and 61.9%, respectively. The betahemolysis reaction revealed that V. cholerae biotype Eltor may not always show a positive hemolysis. Overall, the data indicated that constant monitoring of the antibiotic susceptibility pattern of V. cholerae in Iran is essential.

Hepatitis B viral infection is the most common serious liver disease which may involve pregnant women. The most common routes of viral transmission are via infected blood transfusion, maternal transmission and penetration of an infected object into the skin. However، this disease can be prevented by vaccination and good hygienic conditions. This study was done to investigate the prevalence rate of HBSAg+in pregnant women in Yazd City. A total of 1904 pregnant women were screened for HBSAg+ from those attending the Mojibian private hospital and Bahman general hospital between 1997 and 2000. A questionnaire was completed for each individual, and Chi-square and Fisher Exact Test were applied for data analysis. The seroprevalence of maternal HbsAg+ was predicted to be 0.84%. No significant relationship was established between HbsAg and the following factors: age literacy, related risk factor, history of previous surgery, blood transfusion, HB vaccination, history of jaundice, outcome of previous pregnancies, history of abortion, history of dead children, gravidity, and size of family. Therefore، HBSAg+ rate is not high among pregnant women in Yazd. However, for the prevention of maternal transmission, it is advisable for all pregnants to be screened for HBsAg during the first visit for the early detection of all the diseases as well as prevention of maternal transmission.

Following the epidemic of zoonotic cutaneous leishmaniosis (ZCL) around Ardakan city and Anthroponotic cutaneous leishmaniosis (ACL) in some old quarters of Yazd city, central Iran. This study was carried out to determine the animal reservoir hosts of the disease during 1998-99. In Mohammadieh rural district on west of Ardakan city, Meriones libycus (42.2%) and Rhombomys opimus (57.8%) were present. Both were found to be infected with Leishmania. Three out of 19 M.libycus (15.7%) and 3 out of 26 R.opimus (11.5%) had positive results. Leishmania major was isolated from M.libycus by Rapid-PCR for the first time in the study area. Four dogs were also examined and none of them appeared to be infected. Meriones libycus and R.opimus are probably the main reservoir hosts of ZCL and play an important role in the epidemiology of the disease in this area. In the city of Yazd, forty-six stray dogs appeared to be uninfected because examination showed no active lesion or scar.

Inhaled anesthetics may produce adverse effects on the rate of oocyte fertilization and pregnancy. Therefore, these drugs are preferably not used in general anesthesia for egg retrieval and often intravenous anesthetics are used instead. In this study, midazolam - fentanyl was used and according to hemodynamic responses to surgical stimulations, depth of anesthesia was determined. 120 healthy infertile women scheduled for egg retrieval. They were divided into two groups. The case group recieved 0.07 mg/kg midazolam + 1.5 mcg/kg fentanyl + 2 mg/kg thiopental for the induction of anesthesia. These patients were compared with the control group, who recieved 4 mg/kg thiopental + 1.5 mcg/kg fentanyl for induction of anesthesia. In both groups, maintenance of anesthesia was with incremental doses 50 mg of thiopental. Blood pressure and pulse rate before and during the anesthesia was determined in all patients. Also, depth of anesthesia was evaluated accordingly. In addition, recovery time and respiratory depression during recovery was determined for all the patients. 85% of the patients in case group had deep anesthesia during surgery. Comparing with control group, midazolam was associated with a significant higher incidence of "deep" anesthesia. Also, the case group recieved 1 mg/kg thiopental as incremental doses during anesthesia while controls recieved 2 mg/kg. The aforementioned result also indicates that depth of anesthesia in case group is deeper than the controls. The recovery time in case group was more prolonged than the other group, p-value = 0.002. Also, 33.3% of patients in case group had respiratory depression in recovery time. These patients recieved flumazenil. In conclusion, midazolam administration for induction of anesthesia may produce a "deep anesthesia" in procedure of egg retrieval. However, midazolam can significantly prolong the recovery time and causes respiratory depression. These side effects can be reversed by flumazenil.

Respivatory Distress syndrome (ARDS) has not proven pharmacologic treatment. It has been shown that Tromboxane A2 is one of the main mediator in ARDS . Ketoconazole probably inhibits the synthesis of this mediator and prevents ARDS in patients with ARDS Risk Factors. This study was conducted to determine the efficacy of ketoconazole in prevention of ARDS in patients with risk factors. 46 consecutive patients with risk factors including sepsis, fat emboli, pulmonary aspiration and lung contusion randomly recieved either ketoconazol (400mg) or placebo via naso gastric tube in a double blind fashion. Then, the patients were followed for the development of ARDS. Prophylaxis with ketoconazol resulted in significant reduction (P value < 0.04) in frequency of ARDS in sepsis group but not all of patients compared with placebo group (16% vs 58%). A statistically significant reduction in mortality was not achieved. This study supports the use of ketoconazol in sepsis patients as prophilaxis.

polymerase chain reaction (PCR) was applied for the diagnosis of cutaneous leishmaniasis in the DNA extracted from paraffin - embeded skin biopsy specimens . The leishmania specefic 120 base pair fragment of the kinetoplast DNA has been amplified and demonstrated by gel electrophoresis. Leishmania were noticed in all of the 32 patients that leishman body are seen histologically. Control speciemens from patients with skin disease other than cutaneous leishmaniasis were all negative. PCR was positive in the skin lesions of 24 cases of 29 patients in whom parasite could not be demonstrated by histopathology, although lesions were clinically suggestive of cutaneous leishmaniasis. Sensitivity of PCR in diagnosis of cutaneous leishmaniasis was 91.8% in 61 patients were clinically suggestive of cutaneous leishmaniasis; however, using histopathologic examination sensivity was 51.6%. This data indicate that PCR on DNA extracted from formalin - fixed and parafin - embeded tissue specimen is a valuable method for diagnosis of cutaneous leishmaniasis, specially in chronic cases where the leishman body is not seen.

Herbal medications are used for traditional treatment of many diseases since the old time. This type of medication has been continued and emphasized up to now. One of the harbal medication classes is the one related to pain inhibition. One of those, which is called chamomill in Iranian traditional medicine has been prescribed as an anti - nociceptive and anti spasmatic drug. In this study, we assessed the effect of this plant on pain which was induced by formalin in rat. Chamomill extract in different concentrations (1,2ml/kg diluted in 1 ml normal saline) were injected intraperitoneally. After fifteen minutes, 50 ml of 2.5% formalin injected subcutaneously into the right limbs. Pain score was made for 1 hour following the injection of formalin. For pain assessment, we used the classic formalin test in which the pain score is rated from zero to three. When no response was observed, the score would be zero. Score 1 is for the time when rat would not press on its right hind limb. When rat does not put the injected limb on the ground, score 2 is given and finally if the animal shakes, the injected limb was considered as score 3. Then, the average pain score was calculated for each five minutes block up to one hour after formalin injection. Data obtained from 2 test groups and 1 control group (recieving 1 ml normal saline I.P) were tested by ANOVA followed by Newman - keuls. Results showed that 2ml/kl chamomill antract induced a significant analgesic effect during one hour post formalin injection as compared with control group P<0.001. This analgesic effect in second phase of formalin test (25-60 min, P=0.0008) was more prominent than the first phase (First 5 min., P=0.17). Our data showed that chamomill extract attenuated pain score in a dose dependent manner which was significantly different from that of the control.

Several ethiologics are responsible for submental region masses, among these dermoid cyst is the most common. In a patient with submental mass of 1.5× 2cm, the only clinical finding was a palpable mass. The result of excisional biopsy was reported as Leishmaniasis despite the fact that leishmaniasis can rarely manifest itself as a submental mass. After making diagnosis, the patient was referred to infectious disease service for further treatment.

Torsion of the omentum is a condition in which the organ twists on its long axis, causing vascular compromise. Torsion of omentom is primary and secondary. The primary type is rare and in secondary type, omentum rotates along its long axis between two fix points. A 38 year old man with chief complaint of fever and abdominal pain since 3 days proir to admission was admitted to general surgery service of Afshar hospital. He was ill non toxic and on abdominal examination, a tender mass was palpated on left lower quadrant of abdomen. This was diagnosed as secondary omental torsion. C.T scan showed a big soft tissue mass on left lower part of pelvis and laparatomy showed torsion of omentum. In literature there are some reports of torsion of omentum, majority of cases are secondary torsion. Overall, this condition is rare. The finding of free serosanguineous fluid at the time of laparatomy in the absence of a pathologic condition in the appendix, gallbladder or pelvic organs should suggest the possibility of omental torsion.

About one century ago, Garrot defined the first disease of inbron error of metabolism. Many diseases have been classified in this category. Organic acidemia with multiple manifestation is one of them. A 12 year old boy with several episodes of metabolic acidosis and one attack with loss of conciousness, but with lack of skin manifestation was admitted to the clinic. His diagnosis as methyl malonic acidemia has definitly been confirmed by sending a sample aboard. Although such diagnosis is difficult to make in Iran, but our information about such case will be helpful in correct diagnosis of any cases with unexplained metabolic acidosis and developmental delay.