Tehran University Medical Journal
Year:2005 | Volume:62 | Issue:10|Papers Count:19

Background: Impingement syndrome accounts as the one of the numerous causes of the shoulder pain. The purpose of this study is to define the factors that can affect the prognosis of conservative treatment of patients with subacromial impingement syndrome. Materials and Methods: From July 2001 since 2002, 102 patients that have referred to orthopedic clinic of Shariaty and Imam Khomeini Hospital with subacromial impingement, confirmed by clinical test of Impingement, Job"s and Hawkinds"s test were enrolled in a prospective case-series study. They were conservatively treated in 12 month period with non-surgical conservative treatment consist of corticosteriod injection in subacromial bursa, NSAID s administration and physiotherapy and were followed for 12 months. Patients with follow-up period less than 12 months, with radiological evidences of glenohumeral and acromioclavicalur arthritis, history of acute traumatic rupture of rotator cuff, proximal fracture of humorous, Frozen-shoulder history and patients with diabetes were excluded from the study. For evaluating of the treatment, Constant score were utilized. For determination of each variable effect, logistic regression was used. Results: 89 patients (44 male and 45 female) with the mean ago of 56/4 yr completed the study. 67 patients (75/3%) were properly treated There was a significant difference between before and after Constant score (52/6 vs. 74/6 P<0/05).Atrophy of rotator cuff muscles as the most important factor and time between initiation of the symptoms 120 days or more, acromion morphology hocked (type III), moderate to sever weakness, AHI (Acromial Humeral Interval) less than 7 mm, moderate sever active range of motion restriction, spur in ant-inf edge of acromion, were inversely affected the treatment results; Age, gender, involvement of dominant hand, side of involvement and history of pervious trauma had no significant effect. Conclusion: it is concluded that in patients with mentioned factors, conservative treatment results may not be satisfactory and in order to shortening the clinical course, it might be better to consider surgical treatment as soon as possible.

Background: The aim of this study was the Determination of positive predictive value (Ppv), specificity and sensitivity of anti acetylcholine receptor antibody (AchR ab) for the diagnosis of myasthenia gravis (MG) and also evaluation of the correlation between antibody titer and sex, age, form and severity of the disease according to Osserman classification. Materials and Methods: We evaluated AchR ab titer in 54 documented myasthenic patients and 54 control cases by radioimmuno assay method and analyzed results with chi-square, Hest and Roc curve. Results: At cut off point= 2.5 nmol/l, PPV was 75% (79.2% for generalized and 50% for ocular MG), specificity was 100% and sensitivity was 75.2%. There was also a significant statistical relationship between the form of the disease and level of antibody but no relationship was observed between severity of disease, sex and age. Conclusion: AchR ab assay is a very specific and sensitive test for detection of MG.

Background: ACL ligament tear is a common injury of knee, especially during traumatic sporting events. Clinical tests that are used to diagnose ACL tears are mostly subjective and an inexperienced examiner may miss the diagnosis. The goal is to evaluated ACL tensile strength with regard to the amount of displacement after imposing a constant force. Materials and Methods: In this study, 26 cases with ACL tear (20 cases with complete tear and 6 cases with partial tear) and 76 normal controls were evaluated. Results: In patients with complete tears, the difference of displacement was more than 2 mm in 80% of cases with 89 N forces. CID (compliance index difference) was more than 0.5 mm in 90% of patients with complete tear and less than 0.5 mm in 82% of normal people. In patients with incomplete tear, the difference between the two knees was more than 3 mm in 50% of cases with 89 N force and CID was more than 0.5 in 50% of cases. Conclusion: In normal people, curves took a relatively similar course but in patients with complete tear a change was observed in shape or amount of displacement of injured knee curve. In patients with incomplete tear, the curve belongs to a spectrum of curves of patients with normal to completely tom ligament.

Background: To evaluate clinical course of patients with progressive MS treated with novantrone. Materials and Methods: This was a one year interventional study of 35 patients with secondary progressive, worsening relapsing-remitting or progressive relapsing MS. Inclusion criteria"s were age <45 years, duration of the disease <15 years, Kurtzke expanded disability scale (EDSS) < 7,active course of the disease, no administration of any other immunomodulator agents. The patients were treated with 12mg/m2 of the cytotoxic agent Novantrone, administered every 3 months for 12 months. Clinical assessments were performed every 3 months. Disabilities at the entry and every 3 months were evaluated based on the EDSS. The number of exacerbations over the 12 months were recorded. Results: A statistically significant decrease in the mean number of exacerbations in worsening relapsing-remitting group was observed (P value=0.0001). The mean percentage of decreased attack was 82% (St. error = 4.84). Significant improvement on EDSS was seen during treatment compared with the time before treatment (P value=0.0001). Mean decrease in EDSS was 0.1743 (Std= 0.3230). EDSS change in progressive relapsing group was not significant (P value=0.406).The change in EDSS was not influenced by the duration of the disease or age. Conclusion: Our study suggests that Novantrone might be effective in reducing disease activity, both by decreasing the mean number of exacerbations and by slowing the clinical progression.

Background: Pancytopenia is the reduction of all 3 series of blood cells e.g. Erythroids, leukocytes, and platelets. The causes of pancytopenia are diverse. Some are related to bone marrow failure caused by toxins (Bone Marrow with no cells or low cells). Bone marrow may be infiltrated by malignant and foreign cells or bone marrow fibrosis. Genetics factor and geographical disease could be also a factor in different distribution of pancytopenic etiology.Materials and Methods: All patients with pancytopenia from 1373 to 1381 who were admitted to Army 501 hospital were evaluated. All hospital documents were evaluated. 188 patientsad pancytopenia were diagnosed.Results: 1. The commonest cause of pancytopenia was leukemia, 2. Most cases of leukemia were acute myelogenous leukemia, 3. Most leukemia cases were in 2nd decade of life in this group, 4. Most of the patient had Anemia, weakness and fatigue Conclusion: Pancytopenia should be regarded as a serious finding and evaluated thoroughly.

Background: Many prevalent disorders cause severe iron overload in different tissues of the human body. Liver is the main site of iron deposition and is relatively accessible for sampling. The standard method of determining hepatic iron content is the biochemical determination of hepatic iron concentration (HIC) in dried tissue.

Background: Low-molecular-weight heparins (LMWH) are an important new class of antihrombotic agents. They differ from Un-fractionated haparin (UFH) in having relatively more Anti-Xa activity, and greater bioavailability at low doses. Larger half life allow us to use as single dose therapy. In this research we evaluated the partial prothrombin time distribution during use of Fragmin (Dalteparin-sodium) as low-molecular-weight heparin and commercial heparin in hemodialysis patients and compared them also we compared the dialysis adequacy during using of these two drugs. Materials and Methods: This research was done in to steps, first with commercial heparin, on 30 patients, PTT before and at first 1/2h of beginning and the end of dialysis session (three sample). At second step with fragmin on 35 patients by hemodialysis center, sampling were the same. For commercial heparin we used the routine dose as 3000U bolus at the beginning after 1.5 hour injection of another 2000U bolus of heparin for Fragmin we injected a bolus of 5000U to the arterial line of apparatus. Moreover there were not any more need to compression of venous sites or bleeding in the case of Fragmin. Also dialysis adequacy was measured by Urea Reduction Rate (URR) formula; and compared with dialysis adequacy of previous month that was normally done by commercial heparin… Results: Analysis the data showed that at first 1/2 h of hemodialysis beginning the result of PIT disturbance with low-molecular-weight herprain was better anticoagulation, but at the end of dialysis there were differences between two methods of anticoagulation (more partial prothrombin time distribution in the case of Fragmin). More anticoagulation at the end of hemodialysis in the case of fragmin using can be due to longer bioavailability of the drug and was not associated with increase risk of bleeding. Comparing the dialysis adequacy with fragmin and the results of adequacy of previous month that normally was done by un-fractionated heparin show no difference and as a result fragmin can induce an equal dialysis adequacy by inducing an adequate anticoagulation. Conclusion: In general due to beneficial effect of low-molecular-weight heparin On uremic dyslipidemia, decrease the risk of bleeding, and make an appropriate dialysis adequacy can be a good replacement for commercial heparin.

Background: Exudative pleural effusion (EPE) is a common clinical syndrome in internal medicine. Early diagnosis of EPE is important because it is a common presentation of several diseases with different prognosis. The purpose of the present study is to determine the etiology, clinical characteristics of EPE, and to evaluate the diagnostic methods. Materials and Methods: In this cross-sectional study, patients with EPE hospitalized in pulmonary division of Shaheed Beheshti hospital between 1996 to 2002 were studied. Diagnosis of pleural effusion was verified by clinical examination, Chest x-ray and thoracenthesis. EPE was confirmed by light criteria. Definitive diagnosis of tuberculosis pleurisy (TbP) was confirmed by the identification of acid fast bacilli (AFB) from the pleural fluid, biopsy sample or histological findings of granulomas with causes necrosis concomitant with compatible clinical and radiographic findings. Malignant pleural effusion (MP) was verified by finding bf tumor cells from the pleural fluid or tissue specimens. Other diseases were diagnosed by appropriate clinical and laboratory findings. Results: 100 consecutive patients (male, 62%) with EPE with mean age of 5717 (12-82) years were studied. Right sided pleurisy was observed in 44% and both sides in 5% of patients. The most common causes of EPE were malignant diseases and Tuberculosis which accounted for 41% and 33% of cases respectively. 95.3% of MP were due to met static caners and 4.6% were due to malignant mesothelioma. Other causes which accounted for 24% of patients included; parapnemonic effusion (6%), heart failure (3%), coronary bypass surgery comp0lication (2%). Rheumatoid arthritis (2%), lupus erythematos (1%), chronic renal failure (1 %), coexistence of Tb and malignancy (2%), and unknown etiology (8%). Pleural biopsy was the best diagnostic method for TbP, and pleural fluid cytology was the best diagnostic method of MP. Pleural fluid analysis detected TbP, and MP in 33% and 70% of cases (P<0.001) and pleural biopsy in 70% and 53.5% of cases respectively (P=NS), whereas both tests detected 97% and 91% of cases with Tb and MP. Conclusion: Even in geographic region with a high prevalence rate of tuberculosis, malignant diseases should be considered as a cause of EPE.

Background: Myelogenous leukemia is the most important hematopoietic system disease in today"s world. Previous studies have indicated that Immunogenetic factors play important role in the production of myelogenous leukemia. This study has attempted to recognize the immunogenetical factors in predisposition or prevention of chronic myelogenous leukemia. Materials and, Methods: In the present case-control study. Fifty chronic mylogenous leukemia pafient"s HLA class II alleles (DRB, DQA1 and DQBI) are detected and compared with eighty (80) healthy subjects by PCR-ssp method for the first time in Iran. Results: In chronic myelogenous leukemia patients, the frequencies of allele DQBl *030311 was significantly higher and by contrast, frequencies of alleles HLADRBl *1302, DQBI *0604, DQB1 *03032 were significantly lower when compared with healthy subjects. And frequencies of haplotypes HLA-DRB1 *11, DQB1*03011, DQA1 *0505 were significantly higher than in healthy subjects. Conclusion: The HLA system appears to have an important genetic influence in predisposition or prevention of chronic myelogenous leukemia.

Background: In the present time, analgesic and anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs and opioid compounds are used for the relief of pain, but due to their side-effects, economical issues, the significance of research on finding analgesic drugs with less side effects and their ability" to substitute these synthetic drugs, it seems necessary to search for newer analgesic compounds. In traditional Iranian medicine, rhizome of Glycyrrhiza glabra, is used as a topical medication in the treatment of inflammation and pain. Therefore, we decided to study the analgesic effects of this plant. Materials and Methods: Two methods-the tail flick test for acute pain and the formalin test for chronic pain - were employed to measure pain. Analgesic effect of 100, 200 and 300 mg/Kg doses of Glycyrrhiza rhizome extract were compared with 300 mg/Kg soduim salicy late as a positive control. Results:The plant extract and soduin salicylate relieved pain in the second phase of formalin test, but none of the two substances had analgesic effect in tail flick test. There were no significant differences between analgesic effect of plant extract and sodium salicylate. Conclusion: Based on the results, analgesic effect of plant extract is similar to sodium salicylate.

Background: Present studies shows that in comparison with normal peoples psychiatric disorders (such as PTSD) are more prevalent in chemically wounded soldiers. The aim of this search was to study in the prevalence of psychiatric disorders in chemical war wounded of Iran-Iraq struggle. Materials and Methods: Two hundred physical and chemical wounded individuals from Iran - Iraq war which ended in 14 years ago selected randomly and assessed by standard psychiatric interview. First, they were surveyed by SCL-90 and MMPI tests and then by EEG, for ruling out the organic lesion. .Finally they were interviewed in the basis of DSM-IV. Results: frequency. Prevalence of psychiatric disorders in these individuals: PTSD: 19% depression: 23%, Dysthymia 18.5% , mania 13%, Generalized anxiety disorder 4%, schizoaffective 1.5%. Conclusion: This study concludes that, although stress imposes destructive effects on human psyche.

Background & methods: This study includes 43 cases who underwent pancreatoduodenectomy with reconstruction (pancreatogastrostomy in 20 cases and pancreato jejunostomy in 23 cases) with a preoperative diagnosis of periampullary malignancies from 1999 to 2003 in Amiralam Hops., sina Hops. And Cancer Institute. The postoperative course and in-hospital complications and mortality were compared between two techniques (PG Vs P J). Results: Mean age; sex ratio; past history of pancreatitis, diabetes mellitus and collangitis; and frequencies of different entities in post operative pathologic evaluation were not significantly different in two groups. Operation time and blood requirement during the procedure were roughly equal in two groups. Mean post-op hospitalization time was 12/3 days in PG cases and 16/8 days in PI cases (P<0/05). 4 cases in PJ group (17/4%) and none in PG group developed pancreatic leak or fistula (P<0/05). 35% of cases in PG group and 34/8% in PI group developed at last one of other complications (billiary leak or fistula, post-op fever, intra abdominal collection or abscess, renal failure, surgical infection) (P-value not significant). One patient (5%) in PG group and 7 patients (30/4%) in PJ group died because of post-op complications (P<0/05). The etiology of death in one cases (with PJ reconstruction) was credible to pancreatic leakage; in other mortalities infection and GI-bleeding were the ultimate cause. Conclusion: This study emphasize the superiority of PG over PJ in regard to post-op hospitalization time and pancreatic leak or fistula. Although the mortality rate was much higher in PJ group, irrelevance of mortality to pancreatic leak and fistulae in 7 cases renders the drawing of a postulate difficult in this regard.

Background: Asthma is an airway inflammatory disease Pertaining to specific cells and resulting the H.R of the airway eventually the asthma attack phenytoin with high mechanisms effects on the edema and the airway differently. Studies done concerning this field so the research done to can firm or refund the claim. Materials and Methods: The research has been done on 190 asthmatic patient (104 male - 80 female). The patient divided in to two groups (one 111 people and group 2-79 people) were examined monthly by a physical examination - observation and spirometry - physician and according to the severity of the disease they were prescribed beclotidt - atrovent (Inhaler), theophylin, corton (tab) and inhaler salbutamol considering the necessity. The medicines were changed regarding the severity of the disease. The more the sickness reduced, the less corton was prescribed and finally it was stopped theophylin and subsequently atrovent were cut successively. Asthma attacks and the maximum steps the patient could climb as well as the night a waking as the result of dyspnea and spirometry were recorded. The group I were advised to take 100 mg. Phenytoin (capsule) twice a day and the group 2 multi vitamin (capsuls) twice as well. The treatment lasted 12 month and then the patients group one took multivitamin for 18 months. Results: Applying the MANN whiteny wilcoxin analysis, the statistical data indicate the effect of phenytoin as follows to reduce the amount of prednisolon P. V: 0.01, For night awaking, P.V: 0.05, Number of the asthma attacks P.V: 0.437, FEVl increase P.V: 0.01. Conclusion: Phenytoin is recommended for those asthematic patients who suffer from epilepsy-considering the side effects or those who are already affected by using much corton.

Background: Cigarette smoking is one of major causes of cardio vascular and respiratory disease and cancer. It is the commonest causes of mortality Worldwide which is preventable. American heart association believes that Pharmaceutical products like nicotine gum that can substitute nicotine are helpful in quitting of cigarette. Smoking most of people who use nicotine gum can easily quit it 6 months. Nicotine gum only contains nicotine and they free of toxic and carding carcinoen gases are found in cigarette. The goal of this study is to assess causes of trend for cigarette smoking and quitting it using nicotine gum maybe we make progression in prevention of mortality from cigarette smoking. Materials and Methods: This study is in the from of cross sectional description all the recorder cases are the statistical results of questionnaire which were completed by smokers who referred to quitting center of Zafaranieh city of Tabriz province. The community consist of 100 cigarette depended people who referred to this center in 1381. All the information about causes of trends for cigarette smoking and the result of quitting center were recorded. Results: Using verbal consolation and minis traction of nicotine gum with the aide of considered questioners all these 100 people under taken for psychological consultation. 14 people of the did not quit smoking 28/5% quitted and the rest of them treated with nicotine gum under their own agreement. From these 80 people, 43 (50%) could quit cigarette-smoking success full which 12 at them (14%) had never tried quitting and the rest of them (80%) had at least one unsuccessful quitting. In this study the main causes and metrication for cigarette smoking in smoker were recommendation close friends and relatives. (Which 46 of them 64%) noted it Unemployment, mental disorder loneliness and bored. Conclusion: In this study we found this general result that people who had a previous history of quitting could quit easier and better using psychotherapy nicotine gum compared to other and only psychology consultation is not very effective in quitting of cigarette smoking.