TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2002 | Volume:60 | Issue:4|Papers Count:18

Background: Using the systemic opioids in pain relief has been known during the history. Several evidences indicate that exogenous opioids such as morphine can produce anti-nociceptive effects by interacting with local opioid receptors in peripheral inflamed tissues; In addition to analgesic effects of morphine, less clear is potential anti-inflammatory effects of it. Materials and Methods: In the present study we examined effects of intra-peritoneal (Lp.) injection of morphine (7mg/kg) on carrageenan (O.05ml, 3% WN in saline) induced paw edema in mice. Results: Carrageenan induced paw edema were measured by mercury plethysmometer and was maximal at hour 3 and pretreatment with morphine could reduce the edema significantly. At the same time the serum levels of interleukin-l alpha (IL-1a) were increased. Pretreatment with naloxone (2&10 mg / kg, Lp.) at 45 min before and 165 min after carrageenan, respectively, blocked the effects of morphine sulfate on edema in each groups. Pretreatment with naloxone abolished morphine anti-inflammatory while decreased IL-la serum levels, significantly. Although, administration of anti mouse IL-la (7, 14&28 µg/mice, Lp.) abolished morphine anti-inflammatory effects. Conclusion: These findings showed that increase in serum levels of IL-la play important roles in anti-inflammatory effect of morphine. The results indicated that morphine exert significant anti-inflammatory activity. Presumably, the anti inflammatory action of morphine may be due to change on the cytokine production. And /or release by host immune system.

Background: The purpose of our study was to assess the potential of color Doppler (CD) and Power Doppler Imaging (PDI) to differentiate benign from malignant solid breast masses. Materials and Methods: Seventy-one biopsy proven solid breast masses were evaluated with CD and PDI using 7.5MHz Transducer. Vascularity, Resistive Index (RI) and patterns of vascular distribution of masses were assigned before biopsy. Results: There were 22 cancers and 49 benign lesions. All malignant masses had vascularity in some degrees, except 3 cancers which were less than 10 mm in diameter. Most of cancers were hypervascular (15 cancers) and had penetrating or diffuse vessels (14 cancers). Most of benign lesions and fibro adenomas were avascular (35 masses). 12 cancers, 2 fibro adenomas and all vascular benign lesions had RI>0.6. 7 cancers and 6 fibro adenomas had RI<0.6. By using hypervascularity to indicate malignancy sensitivity for CD and PDI was 68 percent and specificity was 90 percent and by using penetrating and diffuse vessels sensitivity was 64 percent and specificity was 82 percent. By using RI<0.6 sensitivity was 32 percent and specificity was 88 percent and by using these three criteria together sensitivity was 73 percent and specificity was 82 percent (p<0.00001). Conclusion: The vascularity and pattern of distribution and morphology of blood vessels in solid breast masses seen at PDI and CD is a potentially important feature to predict the likelihood of malignancy. But RI appears to be of limited value.

Background: The preeclampsia / eclampsia is one of the most serious condition peculiar to pregnancy, which defined as occurrence of hypertension, proteinuria in pregnancy and convulsion in eclamptic women. There are major risk for eclamptic and pre eclamptic women due to maternal and fetal complications. Materials and Methods: In a prospective study, preeclamptic and eclamptic patients who were visited at Shariati hospital were divided into two groups due to having proper prenatal care or not. Maternal and fetal complication were studied in that two group. Maternal variables were included: incidence of preterm labor, eclampsia, mode of delivery, long term hospitalization, need for ICD, need to antihypertrnsive drugs over postportum, insistence of hypertension up to 6 weeks, postpartum trombocytosis, incidence of cesarean section due to abruptio placenta and IUGR , elevation of serum creatinine, incidence of HELLP syndrome and death of mother Fetal variables were included incidence of IUGR and IUFD, pre term delivery and for need NICD. Relationship of demographic characteristics such as maternal age, parity, educational level, mode of delivery, presence of underlying disease, and educational level of person who referred the patient were studied. Results: These variables except of educational level, and referral level were There was statistically significant difference between incidence of all of variables, in exception of mode of delivery. That means incidence of complications is lower in group with adequate prenatal care. Conclusion: It seems that adequate prenatal care can reduce or obligate maternal and fetal complication in hypertensive disorders in pregnancy.

Background: There are many surgical approaches for hyperinsulinemic hyperglisemic treatment. Subtotal pancreatectomy which has been used for many years, is abounded know due to high recurrence rate, and has been replaced by near total resection. This study focuses on "near total resection". Materials and Methods: In this study 15 cases of hyper insulinemic hyperglicemia patients which has been operated since year 1985 till 2000 in the Children"s medical center, has brought into consideration and described as a case series study. Results: From the patients, three cases were operated by subtotal pancreatomy and all of them have had recurrence. In the remaining twelve cases, the method used was different and "near subtotal pancreatomy" were used. The recurrence rate in this group was zero and there were not also any case of sepsis. Postoperative complications were rather low and the most common postoperative finding in these patients was transient hypoglycemia. Conclusion: Near total pancreatomy for hyperinsulinemic hypo glycemia which is implemented by an expert surgeon with low complication and high cure rate, can be considered as a safe technique with high cure rate and satisfactory results.

Background: Sport medicine is a relatively new scientific branch in Iran. In order to evaluate sport injuries in Iranian skiers we examined and followed all ski players who was injured while skiing in Shemshak slope during a skiing season( January to April 2000) Materials and Methods: During a period of 3 months, a total of 32050 persons skied in Shemshak slope and 76 case of injuries were identified; the injury rate \vas calculated as 2.3/ 1000 skiers. Among the injured organs knee (32%) and head and neck region (20%) were respectively the most common sites of injury. Sprain of the medial collateral ligament was the most frequent knee injury (28% of the cases). 26.7% of the injured cases were amateurs and 21% of them used hired ski instruments. Results: In this study such factors as lack of exercise before skiing, fatigue and time of skiing (beginning or end of the season) were not found to be related to the injury rate. However, head and neck injuries in contrast to knee injuries were most frequent in the end of the season (p< 0.01). Conclusion: This study confirms the necessity of greater care of knee joints during skiing and probable need of wearing helmet for head protection in the end of skiing season. More studies are necessary to clarify other details regarding sport injuries in skiers.

Background: The role prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with benefits obtained from the use of prophylactic antibiotics in surgery for chronic otitis media. Materials and Methods: The current study was designed to evaluate the role of phrophylactic antibiotics in the wound infection and outcome of surgery for chronic ear disease. It was the authors" impression that there was no difference between topical and systemic antibiotics in such surgery. Patients who met the inclusion criteria (n=193) were randomly assigned to a topical treatment group or a control group receiving only intravenous antibiotics for 1 dose intra operatively and 3 dose there after. Patients were followed post-operatively and observed for clinical evidence of infection, graft failure and hearing status. Results: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival. Conclusion: The use of prophylactic antibiotics in surgery for chronic otitis media can be recommended as an alternative method.

Background: Transbronchial lung biopsy (TBLB) is an attractive alternative to open lung biopsy as an initial diagnostic procedure for patients with diffuse parenchymal disease or localized densities beyond direct endoscopic vision. TBLB can be carried out safely without fluoroscopy in patients with diffuse lung disease. Since in our bronchoscopic department fluoroscopy is not available, we planned to evaluate the blind (without fluoroscopic guide) TBLB being performed in our department to determine the success rate in obtaining lung tissue, the sensitivity of the procedure and the risk of complications. Materials and Methods: Sixty - four TBLB were done in our department during a six month period (March - September 1999). Results: Lung tissue wasn"t detected in two (3.1 percent) samples. Pathological results were helpful in 46 (71.9 percent) cases. No evidence of hemoptysis was found after the procedure. Three (4.68 percent) cases of pneumothorax were detected. Only one of them required chest tube (1.51 percent). Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving. Materials and Methods: In our study CPT was compared with endotracheal tube (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, laryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia. Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (p<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (p<0.05). Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 Cm H2O.

Introduction: Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease of unknown etiology. It is characterized by symmetric joint involvement with progressive deformities. This leads to limitation of motion and reduction of activity daily living (ADL). Previous reports showed the beneficial effects of therapeutic exercises in these patients in the remission phase. Methods and Materials: A clinical trial as a self-control sequential control study was designed to determine the effectiveness of a range of motion (ROM) exercise program in patients with RA, referring to Rheumatology Research Center between 1994-1995. ROM of the selected joints by Goniometer, and ADL by a questionnaire was assessed in all patients in 3 phases: when entering the program, after 6 weeks of observation, and then after another 6 weeks with the therapeutic exercises. The mean difference in these 2 period were compared by student paired t test. The analysis of differences between different subgroups (job, education, etc.) was done by one way variance analysis. Results: Forty patients completed the program. The mean ADL increased from 0.437±0.252 before exercise to 6.691:3.06 after exercise (P<0.001), and the mean scores of ROM increased from 0.278±0.28 to 8±3.57 (P<0.0001), both statistically significant. This was more pronounced in women and in those with ankle joints involvement. The type of disease onset and duration of the disease did not influence the effects of treatment. No increase in disease activity was seen. Conclusion: This study showed the effectiveness of our ROM exercises in increasing functional capacities of patients with RA in remission phase.

Introduction: The bone mass density (BMD) may vary in different countries due to different genetic and environmental factors. This study was performed to determine the BMD of the normal population in Iran. Methods and Materials: Subjects were selected randomly from different works and social classes in Tehran (from the lowest to the highest). For each decade and sexes, 20 normal subjects were selected (140 men and 140 women). BMD was measured with a Hologic 1000 plus machine by dual energy x-ray absorptiometry (DEXA) method for the lumber spine (L1, L2, L3, L4, L1-L4) and the femoral neck (neck, trochanter, intertrochanter, ward, total). Data were treated by polynomial approximation (3 rd degree). The obtained curves were compared with the standard Hologic curves for Caucasians. Results: In female the Peak. bone mass (PBM) was 1.019 glcm2 for the lumbar spine and 0.832 for the femoral neck. In male the peak. bone mass) PBM) was 0.987 glcm2 for the lumbar spine and 0.907 for the femoral neck. The BMD of both lumbar spine and femoral neck were lower than the Hologic standards. For the lumbar spine the mean difference was 6.5 percent (2 to 21 percent, CI=1) for women and 13.8 percent (2 to 36 percent, CI=1.45) for men. In femoral neck the mean difference was 5.4 percent (2 to 16 percent, CI=0.96) for women and 4.6 percent (I to 14 percent, CI=0.96) for men. Conclusion: The BMD of the lumbar spine and the femoral neck was lower in Iranian compared to the Hologic standards for Caucasians. This was seen in all age groups and in both sexes. It was less pronounced for the PBM in spine was lower in men than women. The lower BMD of the spine in men was also seen in a cohort of patients with different diseases (inflammatory and non-inflammatory).

Introduction: Unwanted pregnancy is one of the most important problems in family planning programs especially in developing countries. This cross-sectional study was conducted to determine the prevalence of unwanted pregnancy and factors that contributes to it"s existence in ten cities in Islamic Republic of Iran. Methods and Materials: From cases, 1548 subjects referring to the antenatal clinics of university hospitals in the following cities were included in the study: Fars, Systan and Balochestan, Hamedan, Kerman, West-Azarbayjan, Gillan, Korasan, Khozestan, Esfahan. A face to face interview was conducted to fill out a questionnaire. Results: The result suggests that the rate of unwanted pregnancy was reported around 34.96 percent. Familiarity with contraceptive methods was quite poor in some cities. Usage of contraceptive pills and condoms were also not correct and led to failure of the method by the rate of 12.5 percent and 8.8 percent respectively. Conclusion: It is concluded that there is a need to plan a suitable educational plan in order to reduce the rate of the unwanted pregnancy.

Introduction: Children with coronary renal failure has problems with their catch-up growth. The aim of this study was the Assessment of catch-up growth of children ater renal transplantation by analyzing the 6 months cahnges in height deficit and hight standard deviation scores (SDS) on age, sex, initial heght deficit, initial SDS , graft function, renal faiure duration and renal transplantation duration. Methods and Materials: Between 22 Septamber 1998 and 2000, 25 pediatric recipients followed up quarterly for heght in the Labafi-Nejad hospital. Data on height submitted at each 6 -month follow-up were converted into height and SDS. All the results were analyzed by simple and multiple regression and t-test. Results; 68 percents were male and 32 percent were female Mean age at transplantation was 10.39±2.95 SD years. The average duration of renal transplantation was 20.7±8.96 SDmonths. The aerage of height deficit was 20.7 cm (±10.55 SD) and SDS - 3.5 (±1.72 SD) at the time of renal transplantation. The height deficit was more significant in the patients with tubulopathy. Catch-up growth observed at month 12. That was more obvious in females, in patients with tubulopathy disorders, in preemptives and in all three age groups. Simple and stepwise regression analysis showed that at month 12 only initial heght deficit (p<0.05) and at month 24, only sex (p<0.05) were independent predictor of improved height post transplantation. Catch-up growth were seen in more student patients and girls. This may be the result of puberty spurt that ocure two years sooner in girls than in boys. Conclusion: In this study we concluded that the renal transplantation alone is not sufficient measure for correction of catch-up growth in renal failure children and because of that the other treatments should come under consoderation.

Introduction: For the time being we have considered that the myocardial infarction is an increasing event in Islamic Republic of Iran and there are many procedures and methods which can help us to diminish the number of death from this ongoing event. The main aim of this research is to determine the survival rate in those patients who have had acute myocardial infarction and the association of it with different variables. Methods and Materials: The present research is a descriptive case-series study which evaluates the 100 cases of acute myocardial infarction who had been admitted in Tehran Emam Khomeiny hospital during the year 1999. Results: The mean age of patients was 57 years. The peak of attack rates was in spring and autumn. Investigating of the past history of these patients reviled that 41 percent had been smokers, 63.5 percent have had the history of previous ischemic heart disease, 41 percent have had hyper cholestrolernia, 34 percent had hypertension, 18 percent had diabetes mellitus, 9 percent had mitral rigurgitation and 9 percent had heart block. The Survival rate in our study has been calculated 68 percent in first 28 days of disease. Conclusion: In our study we concluded that there is significant correlation between survival rate and past history of hypertension, ischemic heart disease, tobacco smoking and clip classification.