TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2001 | Volume:59 | Issue:5|Papers Count:17

The main goal of this study is to determine the auditory feedback effects in improvement of speech production process in prelingual totally deaf children who used cochlear implant prosthesis. For this reason, we recorded speech of four prelingual cochlear implant children pre and post of operation. Then we extract some static features of vowels-such as fundamental frequency, formant frequencies, vowel duration and vowel energy-from their stable mid-section and analyze them using a longitudinal prosthesis-on/off analysis. These patients-where are in the range of 7-13 years old-were operated in the cochlear implant clinic of Amiralam hospital. At each session, patients read the sentences once in device-on condition and then after 30 minutes stay in device-off condition. Quantitative results show that at least for the features under study, the patient's reliance on the auditory feedback decreased consistently by time (about 65%-averaged on all three vowels under study and all patients). So we concluded that after a sufficient time of operation, the speech motor patterns of patients will be trained for the correct production of static features of vowels and the relation of patients to auditory feedback for the production of such features considerably decreased by time.

Population growth has been one of the main anxieties of different countries planners so far. Background and purpose growth of population has always had various impacts on society in economical, social, health and even political fields and its cure is controlling population growth. In order to study the efficient factors upon unwanted children, 1527 married women in Tehran have been randomly selected and data from questionnaire was selected. In this study, effective factors such as couple's education level, couple's occupation, number of children, age of marriage, age of last pregnancy, having stillbirth, breast feeding period in last born and effect of sex of infant in family planning upon unwanted children have been studied. Results show that some factors like husband's age, number of children, age of first marriage, age of last pregnancy, husband occupation, having stillbirth, breast feeding period and effect of infant's sex in family planning increase the chance of unwanted children and some criteria like women age, woman's education, fist pregnancy age, woman occupation, decrease the chance of unwanted children.According to logistic regression model, women age is one of the most important effective factors and one year increment in woman's age increase the chance of unwanted child 0.89 more times. Other factors is the number of children that in return for increasing one child to family, the chance of un wanting become 116.8 more times. It seems families don't have enough knowledge about family planning measures and their usage. Breast feeding period in wives who have fed their last children for more than six months, is another important factor which increases the chance of unwanted child to 1.02 more times than woman who have fed their last children for less than six months.

Congenital melanocytic nevi (CMN) are pigmented lesion which are present at birth or arise shortly there after. Some of these nevi have malignant potential, it's apparent is anxious for child and his parents. Little information is available on the prevalence of these nevi. Our purpose was to determine the frequency of CMN in primary school students in Tehran. From the students, 1902 persons were examined and 6.7%±2.2×10-3 percent had CMN. The size of nevi was small (diameter <1.5 cm) in 4.7 percent, medium (diameter 1.5-20 cm) in 2.1 percent and large (diameter>20 cm) in 0.1 percent of cases. The location of nevi in order to prevalence was trunk, lower extremities, upper extremities and head and neck. There was not any relation between age, sex, race, hair color, eye color and prevalence of CMN. The prevalence of CMN was higher in our study than other studies perhaps reflecting different race or definition of CMN or unknown factors.

In order to determine the frequency rate of urinary stress incontinence (S.I) after delivery and related factors a longitudinal study carried on primiparous women in Arash Hospital in 1379. Through a non probability sampling, 400 eligible women were recruited from available population. Patient with complain of urinary stress incontinence on third day after delivery, were examined and undergone for required diagnostic tests. After stabilizing the diagnosis of urinary stress incontinence, they were followed on 6th week, 3th month and the first year after delivery. The mean of maternal age was 23.5±4.3 years and the mean of gestational age was 37.9±2.1 weeks. The vaginal delivery and cesarean section rates were 83.7 percent and 16.3 percent respectively. From the cases, 50 women (12.5 percent) had S.I on third day after delivery, which 28 of them had this problem from their pregnancy (grup A), and in 22 patients (5.5 percent), S.I were began after delivery (group B). On first year after delivery, only 6 patients (1.5 percent) had complaint of S.I, totally. All patients with S.I had a vaginal delivery and no cases of S.I had found in cesarean section group (65 women). This difference was significant (P=0.019). Comparison of 3 groups A, B and C (including 285 women without S.I after vaginal delivery) had represented that the mean of maternal age and gestational age were significantly higher in group B than other two groups (P=0.0001 and P=0.0009 respectively).

One of the common problems in children and specially in infants is gasteroesophageal reflux (G.E.R). Present study was performed to compare diagnostic value of lower esophageal sonography with barium swallow. This study was conducted on 50 patients 1 month to 15 years age in center of pediatric clinic of Tehran, during the years 1999-2000. Patients suspected to have G.E.R studied with lower esophageal sonography and barium swallow and at the end, their results were compared with esophageal PH monitoring as a standard test. In this study sensevity of sonography was 90 percent against 50 percent for barium swallow but specifity of two test was the same 35 percent. We can concluded that sonography is a non invasive, low cost, with less side effects than barium swallow. We recommend sonography in place of barium swallow in diagnosis of G.E.R.

Cut out or extrusion of the lag screw from the superior aspect of head and neck of the femur is one of the most common and devastating complications of the surgery of the intertrochanteric fractures with DHS. The exact cause of this complications is unknown, but it seems to be related to osteopenia, inappropriate position of lag screw inside head of the femur and inability of DHS to slide inside the barrel, which is the most ignored risk factor. We used short barrel Dynamic Hip Screw (DHS) for fixation of the intertrochanteric fractures in Dimon and Hughston procedure in 16 patients with unstable fracture, from may to August 2000. The only patient suffered from cut out is the one with static position of DHS in the center of the head. The other complications were delayed union in one, disingagement of the lag screw and side plate despite using compression screw, and one case of significant limb length discrepancy 6 months after surgery, mild limbing was the rule and the average of harris scores was 76. We think that, it is possible to reduce the rate of cut out with choosing short barrel DHS instead of the standard one, while using short length lag screw.

The healthy city is one that is designed to achieve optimal echological, social, and physical specifications for residents of the community that are developing constantly, and that comprehensive different intrasector cooperation, resources and existing utilities are developed so that an environment of mutual cooperation and assistance for every individual civilian are provided. An environment to maximize their potential ability. One of the specific goals of healthy city, is the development of public knowledge, and cooperative involvement in social health and hygienic programs. The project of healthy city is carried in the Koyee Sizdah Aban, Rey city for the first time. This article has compared the studies carried in the Koyee Sizdah Aban and the other one that in carried in the district of Dowlat Abad, in regard to above-mentioned points. In this study the rate of knowledge, attitude, and the practice of four hundred of 15-49 years old women within the limits of healthy city, was compared with other four hundred women residing in the district of Dowlat Abad in regard to hygienic programs. According to the result of this study the mean percent of knowledge in the healthy cities women were significant in relation to other group. The rate of attitude toward the hygienic problems in the health city and the district of Dowlat Abad did not show a significant difference. The rate of practice of the women of healthy city with 95% of confidence was more than the women of Dowlat Abad. This study clarified that literacy of women and their spouse have positive effect on their knowledge and practice in regard to hygienic problems, but there is not meaningful relation between profession and age of women in regard to the knowledge and practice.

Hypotention is hazardous for fetus and mother under spinal anesthesia in cesarean section. Prophylactic effect of crystalloid preload and ephedrine infusion were compared in preventing of hypotention in these patients. From the cases, 44 women candidate for elective cesarean section were randomly divided in two groups. In first group, 15 ml per kg Ringer infused before spinal anesthesia. In the second group, Ephedrine infusion 0.25 mg/kg/3 min started immediately after spinal. During the section, BP was more stable in second group than the first group. Therefore ephedrine infusion seems to be more effective in controlling of BP in these patients.

The newborn's weight at birth is an important measure for newborn's health in all communities. Among developed countries, 70 percent of low birth weight (LBW) newborns are preterm. The corresponding figure for undeveloped countries is only 30 percent, there are also evidence of intra-uterine growth retardation among these countries. Among effective factors on LBW, maternal related factors have important role in promotion and improvement of infants and mother's health.This study is a descriptive-analytic one and was conducted cross-sectionally through a questionnaire. The study population determined by simple random sampling from newborns under coverage of urban health centers in Kohgiloye and Boyerahmad province. Necessary data collected from existing medical and health records filed in the health centers. Among 285 newborns, 88.4 percent considered with normal weight, 4 percent with IBW and 11.6 percent with more than normal weight. 7.4 percent of cases were immature. 85.3 percent of the mothers in study population were in immune range of age for pregnancy and 7.6 percent of them were illiterate. Except the sex of newborn (P=0.0008) and gestational age at birth (P<0.001) none of the variables demonstrated a significant statistical relation with the birth weight. The results of this study confirm other research's findings and reveal that with improving material factors such as mother's age, employment and literacy, the factors which are effective on birth weight, will be dependent on physiological factors such as sex of newborn and gestational age at birth.

The use of Antiepileptic drugs (AEDs) in children may be associated with adverse effects; especially behavioral and cognitive and teratogenic potential effects. The main propose of this study was to find an answer to the question of which factors in EEG of patients before AED withdrawal could have prognostic role in our decision. We studied 106 children whom their medication had been withdrawn 2 years after their last seizure. Before starting of this, an EEG was recorded and interpreted by an expert neurologist. Many variables such as background activity, focal spike, generalized sharp and spik waves, focal slowing, in comparison with the EEG of patient at the time of diagnosis, and also final result of the trace interpret also examined. Follow-up visits were scheduled every 3 months; at least for one year. If seizure relapsed, AEDs was resumed and follow up terminated. The overall probability of remaining seizure free was analyzed as a function of time by Kaplan-Meier survical analysis. Prognostic factors affecting seizure relapse were evaluated by using the log-rank test.The overall probability of seizure recurrences was 24.8 percent (95 percent C.I, 22.5 to 28.5) at 12 months. EEG comparisons with previous times were a significant factor for prediction of relapses. Relative risk of this factor was about 1.98 (95 percent C.I, 1.01 to 3.91) (P<0.05). We found that EEG interpretation at the time of diagnosis was not a significant factor but if it divided by sex, there is a significant difference in gender (P=0.06). According to our study the rate of AED withdrawal in children is small. The benefits of continuing AED therapy must be weighted against the risk of potential adverse effects. EEG comparison with previous traces could be evaluated as a prognostic factor before AED withdrawal in children.

The medical septal area (MSA) provides the major cholinergic projection to the hippocampus which is critical for function of the memory. Different brain areas through the MSA modulate septohippocampal functions. This study was designed to determin origins of inputs to this area. For this purpose, stereotaxic injections of one microliter HRP (25 percent, Sigma) by Hamilton syringe to the medical septal area were performed in 8 rats. Following brain tissue fixation, sectioning and enzyme histochemical reaction, the labeled neurons were detected microscopically. Retrogradely labeled perikarya observed ipsilaterally in diagonal band of Broca, lateral septum, hippocampus, subfornical area and ventral pallidum in the telencephalon, lateral preoptic area, lateral hipothalamicarea/tuber cinereum, posterior hypothalamus, submammillothalamic, supramammillary and lateral mammillary nuclei in the diencephalons, ventral tegmental area, interpeduncular nucleus, central grey area and locus coerruleus and also bilaterally in raphe nuclei of the brain stem regions. Based on this results, in addition to learning processes, MSA through its connections with subfornical and lateral hypothalamic area can also support the physiological mechanisms for dipsogenic, electrolytic, and pressor responses in living animals.

Postoperative nausea and vomiting is a common complication that all anesthesiologist are familiar with the problems of its consequences. Although continued research on the recognition of factors affecting the incidence of PONV is being done but they are not sufficient and the need for research along with advances in anesthesiology and newer drugs are considered. In this prospective cohort study 400 children of 3 to 12 age who has been operated for general surgery (other than eye, thorax and upper abdomen) and orthopedic surgery in the Imam Khomeini and Children Medical Center Hospital has been evaluated. Of these, 200 children who had smoking parent and according to definition were passive smokers and the other 200 children had no smoking parents. Both the groups were matched for sex, age, and type of operation. With the analysis of data we noted that the incidence of PONV in both groups was 19.5 and there was no significant difference between the two groups. (Passive smoker 19 percent and non-passive smoker 20 percent). We also noted a relation between the duration and the incidence of PONV. So operation with more than 2 hours had higher incidence of PONV. There was also positive relation between PONV and controlled ventilation. However, there was no significant difference as the sex and type of operation was concerned. In conclusion, children of smoker parents suffer more PONV than children of non-smoker parents if operation takes longer than two hours or the patient is mechanically ventilated during operation.

Esophageal cancer is one of the most common malignancies in our country. Patients often seek medical advice in advanced and inoperable stages or with cervical esophageal cancer, in which operation is accompanied by sever morbidity. In these conditions many of them cannot tolerate chemo-radiation, or refuse it. Therefore radiotherapy is applied as a single modality in palliation of many patients with esophageal cancer. One of the palliative radio therapeutic methods is application of 5000 CGY in 20 fractions (Long Course); but considering the great number of our patients and limited capacity of radiotherapy centers, as well as emphasis of literature on palliation with 4000 CGY in 13 fractions (short course), we decided to compare these two methods (which are both used in our departments). In this retrospective analytic study, the files of 283 patients with esophageal cancer referred to cancer institute of Imam Khomeini Hospital from 1989-1999 were studied. Patients were between 27-97 years old (mean age=58.3) and most of them were male (53.7 percent). The mean length of lesion was 8.5 cm. The most common site of lesion was middle third at esophagus (48.1 percent) and the most common pathology was squamous cell carcinoma (99.6 percent). Fifty-four percent of patients were hot tea drinkers habitually. From the mentioned variables, only length of lesion had significant relationship with overall survival (P=0.04). Thirty-eight of 283 patients were excluded from analytic study because of incomplete follow-up. The number of patients had been treated by long course (5000 CGY in 20 fractions) was 137 and the remainder (108 patients) by short course (4000 CGY in 13 fractions). No significant difference was seen statistically between these two groups in overall and dysphagia-free survival (Kaplan-Meyer test). Also total dosage of spinal cord is lower in the short course.Thus regarding to less required time in short course and comparable palliation and survival between two methods, the short course policy is more preferable in esophageal cancer patients.

Regarding the prevalence of cancer in tongue and the management procedure of cases who have recurrence in cervical lymph nodes after partial glossectomy and in order to determine appropriate management of neck in early oral tongue cancer it was decided to conduct a study.A retrospective review of 62 patients with T1,2 N0 M0 SCC of the oral tongue treated by only partial glossectomy at Cancer Institute of Tehran university was conducted (from 1991 to 2000). Most of these patients were in 7th decade of life, men were affected more than women. Cervical lymph node recurrence at 2 years was 45.1 percent (28 patients from 62). In 34 patients (54.9 percent) who had not any recurrence in neck, 12 patients had received prophylactic neck radiation therapy after operation. With excluding this group of patients, the rate of cervical recurrence in early oral tongue cancer will rise to 56 percent. According to these findings, it is recommended that elective node dissection should be considered in the initial management of T1,2 N0 M0 oral tongue squamous cell carcinoma in our country.

Nodules in the thyroid have always commanded a great deal of attention because of the fear of their being cancerous. The estimated incidence of thyroid nodules in children and young adults is about 0.22 to 1.8 percent. According to different epidemiological data, about 10 to 35 percent of thyroid cancers occur in the first two decades. The present study based on microscopic review of tissue slides obtained from thyroid nodules in cancer institute during 24 years focusing on malignant lesions in the mentioned age group revealed the following results: The average age of patients was 16.5. The female to male ratio is about 3.3/1 (76.7 percent female and 23.3 percent male). About 84 percent of thyroid nodules were benign with the following incidence of different morphologic features: nodular goiter 78.6 percent, follicular adenoma 1.96 percent, 16 percent of thyroid nodules were malignant with the following incidence of different morphologic variants: papillary CA 91.3 percent, follicular CA 3.5 percent and modularly CA 5.2 percent. Papillary carcinoma as the predominant from of thyroid cancer was accompanied by unilateral cervical lymph node metastasis in 53.8 percent of cases and distant metastasis (to lung) just in one case. According to major variation of papillary carcinoma, we found the classic type in 33 cases, the follicular variant in 18 cases and micro carcinoma in one case. Based on the above results once again we reach this belief that every thyroid nodule especially in children and young adults demands careful appraisal.

Testicular germ-cell tumors are the most common malignancy among men aged 20-40 years, and 60 percent of them are seminomas. These tumors are now an important socio-economic problem, considering their growing incidence. Thus we undertook to evaluate the results of curative irradiation in our testicular seminoma patients and compare them to literature results considering the use of cobalt-60 systems in our department (in contrast to the use of linear accelerators). All testicular seminoma cases referred after orchiectomy to Radiation-Oncology Department of Tehran Cancer Institute and treated curatively during the 12-years period of 1987-1998 were reviewed. These included 147 patients. The results showed a mean age of 34.5 years. Eighty-six patients (58.5 percent) were in stage I, 57 (38.8 percent) in stage II and 4 (2.7 percent) in stage III. With a mean follow-up time of 53.5 months (range 2-158 months) after radiotherapy, there were 12 (9 percent) local relapses and 8 (6.5 percent) distant metastases among the 122 patients who came back for follow-up. The 10-years overall survival was 97.9 percent and disease-free survival 79.7 percent (life-tables). Mean overall and disease-free survival time was 155 and 133 months respectively, with a median survival time of more than 158 months (Kaplan-Meier). The only significant prognostic factor was stage of the disease (P=0.01), though lactate dehydrogenase (LDH) was significant only in multi-factorial analysis (P=0.02). In conclusion, our survival figures were all favorably comparable to literature results, considering the higher ratio of stage II in our patients. We recommend training of young men for testicular self-examination and a greater attention to LDH measurement, and hope for installation of linear accelerators in our department to further improve the treatment results with less side effects.