Tehran University Medical Journal
Year:2004 | Volume:62 | Issue:6|Papers Count:12

Background: The aim of successful treatment of spinal injuries is to result in a stable and painless spine throughout the normal lifespan without any deformities, and with the utmost neurological recovery in the least possible hospitalization period. This study has been designed to compare spinal stability indicators and improvement using "Rezaian" vertebral fixtures before and after operation.Materials and Methods: In a prospective case-series study, one hundred patients with spinal injuries who underwent Rezaian vertebral fixator in Tehran Imam Khomeini Hospital from the first of the 1988 to the end of 2001 were studied. After patient approval for enrollment in the study, all patients underwent the surgery in appropriate time after accurate history and physical examination and neurological deficit estimation, anterior and lateral x-ray and CT-scan with axial views of the injured segment and the other sections that were doubted to be injured. The patients were discharged when they were able to sit being assisted by brace, after control radiographies. Then they were examined in one, three, six month and finally ten year intervals.Results: The mean age of patients was 42.8+/-16.3 (min=17 and max=84). 56% of the patients were male. The etiologies of vertebral fracture were trauma (77%), infection (13%) and tumor (10%) respectively. The fractures were mostly compression Fractures (63%) and burst fractures (32%) and fracture dislocations (5%) came next. The majority of the injuries was at L1 level and was mostly confined to only one vertebra. Surgical approach was extra-peritoneal in 78% of the patients and TLSO brace was used to support the spine in 73% of the patients. The pain of patients was significantly reduced after surgery [7.11 vs. 2.11 (P<0.05)]. The severity of neurological deficits (according to Frankle classification) was significantly decreased after operation, at discharge time, and at the last follow-up visit as well. 8 patients (8%) experienced the complications (mal-positioning in 50%, dislocation in 25%, angulation Increase in 12.5% and pain-instability in 12.5%).Conclusion: This study showed that the complication rate was only 8% though we can possibly decrease the complication rate to the minimum possible rate by utilizing this instrument correctly. It was also illustrated that this instrument is very effective in pain reduction, reduction of neurological problems and early rehabilitation of the patients. Considering the fact that this fixture is not technologically complicated and comparing to the similar instruments is not expensive either, it can be regarded as a successful therapeutic choice.

Background: Genitourinary tract infections due to Chlamydia trachomatis and Neisseria gonorrhoae are a major cause of morbidity in sexually active individuals. Therefore, availability of a rapid method with high sensitivity and specificity that is capable of detecting both organisms from non-invasive specimen is highly desirable. Materials and Methods: In this study 10 to 15 ml samples of first void urine (FVU) from sixty-seven (62 males and 5 females), afflicted patients with urethritis were examined. In addition discharges from the beginning of urethral duct were collected for bacteriologic study. Each sample was cultured on special culture for N.gonorrhoeae. After extracting the DNA from these samples, the PCR and Multiplex PCR reactions were done and amplicons were examined by Agar Gel Electrophoresis system.Results: The results of this study showed that thirty-one (46%) of the samples with N. gonorrhoeae and fifteen (22%) of the samples with C. trachomatis were positive. In seven (10%) cases, infection with both of bacteria were observed, while the growth of N. gonorrhoeae on special culture were observed only in twenty-five (37.3%) of the samples. The KAPA coefficient indicating the degree of agreement of Multiplex PCR and uniplex PCRswas equal to one.Conclusion: Multiplex PCR provides a rapid and simultaneous test for detection of Chlamydia trachomatis and Neisseria gonorrhoae in first void urine specimens collected by non-invasive procedure. Testing of such samples by multiplex PCR could facilitate studies aimed at improving our understanding of the epidemiology of Chlamydia trachomatis and Neisseria gonorrhoae as important sexually transmitted diseases.

Lesch-Nyhan syndrome is one of the genetic disorders inherited as X-link mode. Its frequency is estimated to be one in every 100000 births. Severe deficiency of enzyme Hypoxanthine phosphoribosil transferase (HPRT) is the leading case of hyperuricemia, nephrolithiaisis, and devastating neurologic problems. Here we present a 30 year old man with chronic tophacious gout and multiple renal calculi since childhood. He had not tolerated the Allopurinol due to severe skin reactions. We claim this is the first reported case of allopurinol desensitization in Lesch-Nyhan syndrome.

Background: The general aim of this thesis is to report the results and complications of spinal arthrodesis of congenital deformities with or without instrumentations in admitted patients at Sina Hospital, from 2000 to 2002. Details are to report the demographic conditions of patients, time of diagnosis and surgery and duration between these times, complications after and during surgery and diagnosis of associated congenital anomalies.Materials and Methods: with detection of vertebral anomaly in A.P and lat X-ray of deformed spine patients, the patient is admitted in this thesis. Surgery is indicated in progressive or highly progression potential (line unilateral bar + contra-lateral hemi V) or initially severe deformed curves. The tractional and bending x-ray are obtained after admission of patients. In scoliosis, if the curve is more than 45-50 and less flexible than 5% and in kyphosis, if the curve is more than 50 and patient is more than 5 years old, two stage surgery (ant. release and fusion and post. fusion, with or without instrumentation) were planed, otherwise, post. fusion instrumentation alone was done. Before surgery, screening for detection of genitourinary, cardiovascular and intra-spinal anomalies were done. Minimum follow up after surgery was 6 months. In this period, the patients were evaluated for infection (early, late), neurologic deficits, pseudoarthrosis and device failure and other complications. In the end of 6 months, bone scan was done for pseudo-arthrosis.Results: From 15 patients, there were 11 female and 4 males. There were 7 scoliosis, 4 kgphscoliosis, 3 kyphosis and 1 thoracic lordosis. The mean time at diagnosis was 5.5 years, at surgery was 14.6 years (interval between these two, was 9 years). Mean time between admissions to discharge was 31 days. Mean time between Ant. And post. Surgery was 13 days and between last surgery to discharge, was 12.9 days. Mean follow up was 13.5 months. In 11 cases, Ant. Release and fusion + P.S.F, in 3 cases, P.S.F alone and in 1 case, vertebral excision were done. Instrumentation was used in 12 cases with correction in 75% of cases. Mean correction were 14.6% in kyphptic, 27% in scoliosis, 28.7% in scoliotic and 25.7% in kyphotic part of kyphoscoliosis. There were two intraspinal (one myelomeningocole and one diastematomyelia) and two genitourinary tract (one left system duplication and one single kidney) anomalies. In one case of kyphoscoliosis, due to hump bedsore klebsiella infection was occurred. In two patients, who were operated with retroperitoneal approach, there were warmness in leg, due to sympatic chain injury.Conclusion: Early diagnosis and treatment of congenital spine deformities, leads less complications and costs. To approach these goals, we need correct early screening and economic and scientific supports of governmental health organization.

Background: This investigation was conducted to evaluate the results of these three different techniques including: Supine position with full bladder and water bag on reducing the small intestine surface which is exposed to radiation about the patients involved in the cancers of prostate, cervix, uterus and rectum.Materials and Methods: Out of 35 patients in pelvic cancer who referred to the radiation oncology department of Imam Khomeini hospital in Tehran in year 2001: 11 males, 24 females with mean ages of 51.36 years old and the mean weight of 62.5 kg: 10 potients with cancers of rectum, 13 with cervix, 8 with uterus and 4 ones with prostate, before receiving radiation all these patients were simulated with three different techniques and the possible radiated surface of the small intestine were calculated and compared with each other. Results: At this study by investigating the mean small intestine surface of 31 patients out of 35 ones including on supine position and an empty bladder/ prone position with full bladder/ prone position with full bladder and water bag, the following results were obtained: 215. 48/ 159.4/and 122.97 cm2.Conclusion: By comparing the results of the mentioned three different simulation techniques, patients who were simulated on prone position with full bladder and water bag, the radiated surface of the small intestine was 43% lower than the patients were simulated on supine position and an empty bladder, and 23% lower than the patients were simulated on prone position and full bladder. These findings are satisfactory and comparable with belly board, ... technique simulation in which the reducing volume of the small intestine was 50%.

Background: The use and application of medicinal plants or herbal medicine in therapy is well known. In this investigation aim was to determine the hepato protective effect of hydroalcoholic extract of Vitis Vinifera as a crude extract in hepatotoxicity induced by toxic dose of acetaminophen in mice. Materials and Methods: In this study doses of 160, 180,200,220, 240, and 260 mg/kg were administered to mice orally (test groups). The positive group received toxic dose of acetaminophen (500 mg/kg) and the negative control group received normal saline.Results: Then sleeping time, enzyme activities such as SGOT and SGPT and histo-pathological examinations were measured. The results obtained in this study showed a significant protection as compared with the control group because the level of SGOT and SGPT as well as sleeping time and histo-pathological findings were mostly similar to the results of control group.Conclusion: From these observations it seems that this crude extract may be a good candidate in liver toxicity after purification and separation of active ingredient.

Background: This investigation was conducted to determine and compare the effect of Electroejaculation on the quality and quantity of sperm and seminal fluid in spinal cord injured men (SCI) and normal fertile.Materials and Method: A retrospective study of electroejaculation and different methods of semen collection were used in SCI and normal fertile men to find out the quality of semen, fertilization Rate, and cell cleavage after intracytoplasmic sperm injection (ICSI).The quality of seminal fluid and sperm parameters in 89 SCI examined based on WHO protocols. The semen collection, retrieved by masturbation, intercourse, percutaneous epididymal sperm aspiration (PESA) and electroejaculation. Intracytoplasmic sperm Injection procedure was performed for homologous MII oocystes Fecondation.Results: Quality and quantity of semen in SCI was significantly (P<0.001) lower normal fertile men and leukocytosis Was significantly higher in SCI electroejaculation leads to decrease. The sperm parameters include normal sperm (10%) - motility (10%) and viability (15%) decreased (P<0.001) significantly. EE/ICSI oocytes fertilization was 60% in compare with ICSI of oocytes in normal Fertile which was 71.7% (P<0.001). But the number of pronucleated oocytes which leads to embryo in both groups was the same and was not different (P<0.133).Conclusion: The quality and quantity of semen in SCI is lower than normal fertile (P<0.001).The electrojaculation method of semen Retrieval added to the factors byalteration the seminal fluid and decreased the normal morphology- motility and Viability significantly (P<0.001). Necrosperamia in this method affect sperm functional which in compare with other method of semen retrieval and affect fecondation of oocytes and embryo cleavage in spite of ICSI protocole for insemination. 

Background: Pulmonary disease secondary to occupation and environment is one of the most common Cases of obstructive lung disease. In view of presence of greater than 10,000 employees involved in textile industry in Yazd province, high prevalence of bysinosis, un-compensable lung damage and financial losses following them, this study with aim of evaluating the role of air particles present at working places of textile industries on pulmonary function with consideration of factors such as job experience and cigarette smoking.Materials and Method: This study is a cross sectional survey on 473 employees of textile factory Seadat Nassajan, Yazdbafe, Afshar Yazd, in year 2001 in form of clustering and vulnerabilities included job experience amount of particle exposure (with Instrument dosage GS 312), FEV1, FEV1/FVC% with Instrument (Fukda 100) post H/O cigarette smoking, post occupational history, and shortness of breath was considered. For analysis purposes statistically descriptive, T Test and analysis regression multiview was analyzed. Results: Prevalence of bysinosis on bases of history was 11%. In evaluating relationship among variability, amount of particle, Cigarette smoking, and job experience with FEV1, FEVl on basis of regression analysis with (stepwise) only FVC variables amount of cigarettes smoked, job experience in exchange was found to be significant. The difference in FEV1, FEV1/FVC in person with or without past H/O shortness of breath, cough was not significant (P Value of 0.64 and 0.97 respectively).Conclusion: No significant difference in pulmonary function among employed working in different section of sparing, carding or weeding. Their relation with pulmonary function on this study was not significant. The reason may be due to shape size of particle, type of endotoxin present in stoking, raw or ripper textile material, amount of dampness present at every section and type and degree of persons activity at every section was enumerated.

Background: The incidence of skin cancers has rapidly increased and non-melanoma (basal and squamous cell carcinoma) skin cancers (NMSC) are now the most common types of cancer in the white populations. The purpose of this study was to evaluate the demographic and cilinco-pathologic patterns of skin cancers at the Loghman and Booali Hospital, Tehran ,Iran,from March 2001 to March 2003.Materials and Method: The data related to all patients whose skin cancers were proved pathologically, were collected in questionnaires and analyzed according to the personal features, anatomic location and dimension of the lesion, changes of skin due to sun exposure and also clinical and histopathological type of skin cancer.Results: A total number of 400 patients aged between 26 to 87 (mean 60) were included of which 83.5 % had a,C.C and 12.5% had S.C.C .Of all the patients 271 were male and 129 were female. The most frequent pathological type for BCC was the Solid type and for S.C.C it was the solid type. 46% of them had a history of radiotherapy and 77% of our patients had radiodermatitis. the most frequent location for B.C.C was the scalp and for S.C.C was the lower lip. 6T% of our patients had outdoor jobs, of which 82.7% were male. Most of patients were residents of Tehran province.Conclusion: The most frequent skin tumor amongst our cases was B.C.C and the majority of them were located on head and neck in males with outdoor jobs. Since there is a high frequency of the superficial type of B.C.C among patients with a history of the superficial type of B.C.C. among patients with a history of radiotherapy (32.4 %) compared to those without such experience (12%), some further studies are recommended inorder to specify any relationship.

Background: The existing hazards and insufficiencies in the university laboratories which due to their variety of works and large number of students as users and academic staff and expensive equipment, are considered as an important and sensitive work place, were identified by safety audit.Materials and Method: The existing 45 laboratories of a faculty were chosen as example of university laboratories.. For perfomance of safety audit, the published checklists of laboratories from 20 different national and international organizations were studied. Then 45 chosen laboratories were carefully surveyed and their present conditions were recorded. Apart from their location and sizes, number of doors, windows, location of benches, equipments , instruments, the condition of utility system ;electricity, gas, water, sewage system, safety devices; emergency showers, portable fire extinguishers, exit doors, and number of people working in laboratories permanently and/or temporarily, all were recorded. By comparing the published checklists with the recorded conditions of laboratories proper checklist for under study laboratories was designed in 9 parts with 285 questions. The checklist was completed in every 45 laboratories and then analyzed. Results& Conclusion: Totally 55 hazards and insufficiencies were identified and listed. The evaluation of these hazards, due to lack of required data for determination of risk, was impossible. Therefore the first priority was given at a glance to the insufficiencies of management system and training program. Lack of proper ventilation. system and lack of written procedure for disposal of broken glass and sharp edge wastes, and lack of written safety manual and safe operation procedures were among them.

Background: Endoscopic sinus surgery because of its close relation with vital elements and complicated anatomy of the region, is a dangerous procedure. Initial cadaveric study and attention to identical anatomic landmarks in the continuity with the visual endoscopic experience will pave the way in prevention of surgical complications.Materials and Methods: Forty Nasal fossae in twenty cadavers were dissected endoscopically. After fronto-ethmoidectomy, the distance between the anterior ethmoidal artery at the base of the skull and two identical anatomic landmarks was measured with colis.Results: The anterior ethmoidal artery was always present. The mean distance between the artery and the anterior turbinate axilla was 19.6mm on the right side and 19.98 mm on the left side. The anterior ethmoidial edge artery the middle turbinate axilla, and the superomedial edge of the nostril were in a straight line.Conclusion: In comparison between our results and the results of Chinese study (Lee etal). The distance measurement between the anterior ethmoidal artery and the anterior turbinate axilla is similar (20 mm) and should be more useful in the clinical setup.