Tehran University Medical Journal
Year:2004 | Volume:62 | Issue:5|Papers Count:18

Background: Post operative nausea and vomiting (PONV) occurs in 25 to 35 percent of patients but its incidence is higher after some procedures like orthopedic surgery. PONY is a significant problem and may lead to severe complications; therefore the use of prophylactic drugs which have low cost and few complications is favorable. In this study we evaluated the efficacy of lidocaine, propofol and low dose dexamethasone in prevention of PONY in orthopedic surgery.Materials and Methods: Two hundred eighty ASA class I - P male patients (n=70 in each of 4 groups) undergoing general anesthesia for orthopedic surgery in upper extremities, were enrolled in this randomized double - blinded, placebo - controlled study in Dr. Ali Shariati hospital. All patients hydrated with ringer lactate (5cc/kg) before Induction of anesthesia and then premeditated with fentanyl (2μglkg). Induction of anesthesia in placebo group done by thiopental sodium 5mg/kg + normal saline 5cc.In lidocaine group done by thiopental sodium 5mglkg + lidocaine 1.5mg/kg (5cc) and in dexamethasone group done by thiopental sodium 5mglkg + dexamethasone 0.1 mg/kg (5cc) and in propofol group done by propofol 1.5mg/kg + normal saline (5cc). Tracheal intubation was facilitated with cisatracurium 0.2mg/kg. Anesthesia was maintained with N2O 50%, O2 50%, halothane (0.7%) and fentanyl (1μg/kg every 30 minutes). Results: The incidence of PONY, in control, lidocaine, dexamethasone and propofol groups were 48.57%, 27.14%, 25.71% and 24.29% respectively (P=0.005).Lidocaine and low dose Dexamethasone were compared with propofol and their efficacies were not found different. Conclusion: Prophylactic intravenous lidocaine or low dose dexamethasone significantly reduce the incidence of PONV in men after orthopedic surgeries.

Background: Cutaneous Leishmaniasis is a parasitic infection caused by different species of Leishmania. Some atypical forms of the disease were seen different from usual forms with respect to the course and appearance of disease. The aim of this study is to determine the Leishmania species, which are isolated from the mentioned forms. Materials and Methods: A descriptive study was done to determine the leishmania species in patients with atypical forms of the disease. Patients selected by easy sampling tested by direct smear and cultured in NNN media. For mass production, the isolates were transferred to RPMI 1640 media which was supplemented by 20% FCS. The promastigotes were coated in plates and were characterized with specific monoclonalantibody and ELISA methods.Results: Of 74 patients, L. major and L. tropica were found in 87.8% and 12.2% of them, respectively. Unusual lesions were seen to be satellite (40.54%), sporotrichoid (33.78%), chronic (9.45%), zosteriform (6.75%), verrucose (5.4%) and erysipeloeid form in 4.05% of the cases. 50 patients (67.56%) hadnt received any treatment before appearing atypical lesions. In contrast, 24 cases had undergone different treatments for cutaneous leishmaniasis. 36 patients (out of 74) were from urban area of which L. tropica and L. major were derived in 25% and 75% , respectively. The Others originated of rural ones have L. major in their lesions.Conclusion: Isolated species were L.major and L.tropica. There was no link between atypical forms and isolated species. The most of the atypical forms were found on extremity. No significant relation between the previous therapy, its presence or absence and form of the lesion was seen. Both species were isolated from the urban area. But in the rural regions only L.major was seen.

Background: Human brucellosis is a orldwide zoonotic infection caused by intracellular bacteria belong to the genus of Brucella. Based on the murine studies it has been shown that host resistance to Brucella depends on Th1 response, whereas Th2 response is involved in the severity of disease. The analysis of cytokine production is a valuable component of studies of immune response to stimulation such as pathogens, vaccines, and other immunological challenges. This article is introduced a simple, rapid throughput of clinical samples and a cheap and reliable assay.Materials and Methods: For this technique to be useful in clinical setting, we have used un-separated whole blood of healthy normal and patients with acute and chronic brucellosis as the source of cells evaluation of interferon gamma (IFN-g) and interleukin-13 expression. Diluted whole blood samples of patients with brucellosis (n=15) and, sex and age-matched healthy volunteers (n=14) were cultured in the presence of either mitogen; heat inactivated bacteria or medium alone. IL-13 and IFN- g were measured by specific sandwich ELISA and flow cytometry was detected the number of cytokine-producing CD3+ cells. Results: It was found that not only IFN-g production but also the number of IFN-g producing CD3 cells were significantly decreased in response to antigen in chronic group of patients. There was a reverse correlation between the number of IFN-g producing and CD3 IL-13-producing cells only in acute group which shown polarization of immune responses to Thl in them. Although the percentage of CD3 IL-13-producing cells was dramatically high in the chronic group of patients no correlation was found between the number of CD3 IFN-€-producing and CD3 IL-13- producing cells. Conclusion: In conclusion, the correlation of Th2 cytokines production and progression of chronic human brucellosis was not demonstrated. Nevertheless, diminished production of Th1 cytokines production in chronic group may suggest T cells unresponsiveness to Brucella antigen which helps prolongation of brucellosis in chronic patients.

Background: common variable immunodeficiency (CVID) is a primary immunodeficiency disorder in which patients are presented by hypogammaglobulinemia and recurrent bacterial infections. CVID is characterized by low levels of serum immunoglobulin. Patients with CVID frequently show respiratory complications and are often presented by frequent and severe episodes of pneumonia before making the diagnosis. The standard treatment intravenous immunoglobulin (NIG) has been available for the past 20 years. The aim of this study was to present document on effectiveness of NIG treatment on the incidence of pneumonia in patients with CVID.Materials and Methods: In this study, data were obtained from the clinical files of patients with CVID. The number of episodes of pneumonia and admission to the hospital was documented before and after treatment with NIG. The past medical histories of 26 patients were reviewed (mean current age= 13.4 +/- 5.1 years, age range: 4.5-26.5 years, 16 males and 10 females). Results: Of the 26 patients with CVID, 80.5% had experienced pneumonia, at least once before making the diagnosis and receiving immunoglobulin treatment and 88.5% needed to be admitted to the hospital. After making diagnosis and starting treatment with NIG during mean period of 41.5 +/- 35.4 months, the number of patients experiencing pneumonia significantly decreased to 34.6% (p-value=O.0017) and the need admittance to the hospital reduced to 46% of the patients (p-value=0.0025). During treatment with gamma globulin the incidence of pneumonia requiring treatment or hospitalization fell from 3.3 to 0.6 per patient per year (p-value< 0.0005).Conclusion: Our study demonstrated that treatment with IVIG significantly reduces the incidence of pneumonia.

Background: Bacterial peritonitis is the most common infection in cirrhotic patients. The frequency of 8%-40% has been reported which would result in high mortality if not treated properly or at time. Clinical presentations usually are nonspecific. The aim of study is finding the frequency of bacterial peritonitis in pediatric patients with liver disease and ascites whom were admitted at ped. ward of Children Hospital Center from 1999-2000and necessity of routine peritoneal tap in them. Materials and Methods: This is a cross-sectional descriptive study on 91 children with liver disease and ascites admitted in ward and undergone bedside routineperitoneal tap at Children Hospital Center. Clinical and laboratory finding compared between children with or without peritonitis. Results: 22 (24%) of totally 91 patients had peritonitis. Age, fever, abdominal pain, poly-nucleosis, prolongation of PT, reduction of serum albumin were significantly related to peritonitis (p<0.05) whereas other factors like sex, rising of bilirubin, reduction of consciousness, leukocytosis and rising ESR were not. All of the patients were in group B&C based on Childs grade and commonest agents were pneumococcus and E Coli. Based on type of peritonitis most of patients were in group Culture negative neutrocytic ascites.Conclusion: this study emphasized on routine peritoneal tap and bed side culturing of ascitic fluid.

Background: Osteoporosis is the most common bone disease and is a leading cause of morbidity and mortality in elderly people. Multiple therapeutic regimens have been designed to prevent progressive bone loss in postmenopausal women and the elderly and to treat reduced bone mass by inhibiting bone resorbption and/or increasing bone formation. Although Monotherapy is preferred but combination therapy is recommended in many studies. In this study we used Alendronate, calcium &vitamin D and measured its effectiveness.Materials and Methods: We chose 47 patients who had osteoporosis and osteopenia complications and took them a combined Regimen of Alendronate, calcium supplement and vitamin D and had been advised to have regular exercise. We measured their BMD and T- score at beginning and end of the study. Results: After 12.7± 1.27 month BMD and T- score changed dramatically in our patients. They have 1.29 ± 4.22 percent increase in BMD of pelvis, 2.6 ± 4.86 percent in vertebra. T-score was increased 0.152 ±0.3 in vertebra and 0.84± 0.36 in Pelvis. Conclusion: Osteoporosis is a disorder of bone characterized by reduced mineral density and bone mass. Multiple therapeutic regimens have been recommended to prevent and treatment it. In our study, we found that combined Regimen of Alendronate, calcium supplement and vitamin D is effective in treatment osteoporosis and recommend it if economical and medical conditions of patients allow it.

Background: Infertility is a problem in health and economy system of Iran and in 10-15% of case major we cannot find any specific etiology. Prevalence of celiac diseasein Iran is 1/166 in asymptomatic blood donor. This disease has a wide range of clinical features. Recurrent abortion and infertility is a one side of this range. In recent studies there is relationship between celiac disease and unexplained infertility. So in this study we will show the prevalence of celiac disease in unexplained infertility in Iranian patients.Materials and Methods: This case-control study include 125 patients with primary unexplained infertility and 125 fertile women as control. In patients whom came to Shariati Hospital, infertility clinic and have criteria of our study we measure total IgA, IgA TTG (Bio system Spain) if TTG was positive to prove our study, we did biopsy of distal duodenum. For control group 125 patient that have two or more children with similar. .. with infertile group selected. Results: In four infertile patient unexplained infertility, 3% have positive TTG and in three of them (2.4%), biopsy of small intestine has shown celiac disease none of the women in control group had positive TTG (p=O.08). Conclusion: It seems that in some of the Iranian patients with unexplained infertility have celiac diseases. But with the P=0.08 in comparison to control group the screening for infertile PTs with unexplained infertility needs a wider study with more samples.

Background: There are many studies in recent years implicating oxidative stress as the causative factors of many diseases. Lipopolysaccharide (LPS) is suggested to induce septic shock with two mechanisms of burst formation of nitric oxide (NO) by stimulation of inducible NO synthase (iNOS) and oxygen free radical (OFR) formation. Septic shock is usually accompanied with vital organs dis-function such as renal failure. Vitmnin E is the most important fat-soluble antioxidant which protects the biological membranes in oxidative stress. Vitamin C, the most important water-soluble antioxidant acts via scavenging free radicals and regeneration of vitamin E which helps to protect the cells against lipid peroxidation.Materials and Methods: In this study the changes in renal tissue and plasma vitamin E levels after injection of LPS with and without vitamin C supplementation and L-NIL (a specific iNOS inhibitor) administration were studied. To do this we used five equal groups of rats as: Control, LPS., LPS+L-NIL, LPS+vitamin C, LPS+vitamin C+L-NIL. LDH, BUN, Creatinine, plasma and renal vitamin E levels were measured (with HPLC and UV detection). Results: LPS markedly decreased vitamin E contents of renal plasma and tissue (P<0.001) while BUN and LDH were significantly increased (p<0.001).L-NIL and vitamin C and their codministration returned all of the parameters back to normal .Coadministration of L-NIL and vitamin  C highly increased vitamin E levels (P<0.001). Conclusion:These results showthat iNOS inhibition and free radical scavenging prevents vitamin E reduction in septic shock and preserves renal function. 

Background: Breast cancer is the most common cancer and the second leading cause of cancer death in women in the world. The sequence and timing of chemotherapy and radiotherapy (RT) as adjuvant treatment is controversial. In conventional method, chemotherapy is used after surgery followed by radiotherapy. Concurrent chemoradiation is reasonable, but the risk of toxicity is high and is the prime concern in this method.Materials and Methods: In this study 70 cases of breast cancer were randomized in two groups. All of tlie patients were treated with adjuvant chemotherapy (CMF X6). In concurrent group RT began after 3rd or 4th course of chemotherapy and in sequential group it began after the 6th course of chemotherapy (50 Gray /25 fractions in modified radical mastectomy and 60Gy/30 fractions in breast conservative surgery) 1- Maximum grade of dermatitis was higher in concurrent compared to the sequential group.(p=0.001)2- Maximum grade of neutropenia was higher in concurrent compared to the sequential group. (p=0.024)Conclusion: In conclusion, adjuvant concurrent chemoradiation with acceptable toxicity is rational in breast cancer.

Background: This study was conducted to measure 1-year stability of diagnoses in a group of patients with first episode psychosis in a developing country.Materials and Methods: During a 35-month period, 61 patients with first psychotic episode from Roozbeh Hospital were selected. Their illnesses couldnt be attributed to any medical condition and substance use. Patients were assessed at the time of admission, discharge and at 3, 6, and 12-month intervals following admission .Two psychiatrists made consensus DSM-IV and ICD-10 diagnosis based on all available information. Stability was defined as the consistency between diagnosis at the time of discharge and 12-month follow-up.Results: Forty-seven patients (77% of the sample) completed the follow-up period. Affective psychoses and schizophrenia diagnoses in both classification systems were highly stable .In addition, all diagnoses of Brief Psychotic Disorder and Acute and Transient Psychotic Disorder were highly stable. The only unstable diagnosis was schizophrenifom disorder. Conclusion: Consistent with previous studies, affective psychosis and schizophrenia were stable diagnoses, However in contrast to previous studies, diagnoses of brief psychosis were highly stable. This could reflect the validity and good prognosis of this group of psychotic disorders, especially in developing countries.

Background: Meningocele is one of the rare congenital Nasal masses which can be found in newborns. Definitive treatment is surgery which may be done intracranial or extracranial, success rate for both approaches are similar. Unsuccess rate for both approaches are similar. Unsuccess rate for endoscopic repair has been reported 0-24 percents and for intracranial repair was 6-33 percents.Results & Conclusion: Present case report of meningocele was done on an 11 years girl at Amir Alam Hospital of Tehran Medicine University in Aug, 2001 endoscopically, which is tought to be successful. Risk of complications has been declined by. this approach compared with intracranial approach. We think that endoscopic management of meningocele is superior to intracranial approach. We hope that our approach be accepted by our dear colleagues.

Background: Acute coronary events are the main cause of death in patients with end stage renal disease (ESRD). A large series of cross-sectional and retrospective studies indicate a positive relationship between mild and moderate hyperhomocysteinemia and atherosclerosis. It has been determined that the plasma homocysteine level in patients with ESRD is high. However, a few studies have been done to determine the effect of dialysis type on the plasma homocysteine level.Materials and Methods: In this analytic cross-sectional study, 120 patients with ESRD were examined. Among them, two groups of twenty-two patients who were undergoing hemodialysis or peritoneal dialysis were randomly elected. The members of each group had been matched according to their age, sex and the quality of dialysis (KTN). The plasma homocysteine level was measured in each group. Accordingly, the effect of dialysis type on the plasma homocysteine level was analyzed.Results: The mean plasma homocysteine level of all samples taken was 16.2 ± 8.7 μmol/L. It was 17.95 ± 10 μmollL and 13.2 ± 5.3μLmol/L in patients who were undergoing hemodialysis and peritoneal dialysis respectively. The mean of the differences in the plasma homocysteine levels from the matched pairs was 4.37±11.34μLmol/L (p=0.064). In addition, there was not any relation between the plasma homocysteine level and serum creatinine level or duration of dialysis. Conclusion: There is not any significant relation (p=0.064) between the plasma homocysteine level and the type of dialysis of patients with ESRD. Nevertheless, in this study, the mean homocysteine level in the patients who were undergoing hemodialysis was higher than in the patients who were being treated with peritoneal dialysis. In conclusion, none of two current kinds of dialysis have any advantage over the other in decreasing plasma homocysteine level in patients with ESRD.

Background: In this study the efficacy of botulinum toxin type A (Dysport) in the prophylaxis of migraine headache was compared with normal saline in this study.Materials and Methods: This is a double-blind placebo controlled study of 40 patients with history of migraine headache consistent with international headache society (IHS) criteria for migraine. The patients were randomized to receive a single injection of 125 units of dysport or the same volume of saline. Participants filled out daily diaries including: migraine frequency and severity, number of lost working days, nausea and vomiting due to attacks, attack duration, and number of oral or parenteral analgesics used to treat each attack during a I-month baseline period and 3-months post injection period of dysport or saline. Results: Demographic characteristics and baseline efficacy variables in both groups were similar. There was no statistically significant difference between two groups regarding primary efficacy variables including: frequency, mean severity, mean duration of attacks, nausea and vomiting associated with attacks and number of lost working days due to attacks. Changes from baseline in moderate to severe headaches (mean severity and mean duration >5) in third month after injection and changes from baseline in frequency of moderate to severe headaches requiring parenteral analgesics in third month after injection were significant (p =0.047 and p = 0.048 respectively).Conclusion: Botulinum toxin type A is effective in reducing the frequency of moderate to severe migraine headaches, and also the frequency of moderate to severe migraine headaches requiring parenteral analgesics. But the efficacy of botulinum toxin type A in prevention of all migraine headaches in general is not more than placebo.