Tehran University Medical Journal
Year:2005 | Volume:63 | Issue:6|Papers Count:14

Background: Difficulty in tracheal intubation has always been a problem in both elective and emergency setting. The aim of this study was to compare the newly designed test, the Upper Lip Bite Test, (ULBT) with prevailing Tests – the Hyomental /Thyrostemal distances ( HMD, TSD ) and the Mandible length (ML) in predicting difficulty in intubation.Methods and Materials: A total of 300 patients meeting the inclusion criteria were enrolled in this study. Each patient was assessed by a resident of Anesthesiology, regarding the ULBT, HMD, TSD and ML, and Laryngoscopy was Performed by the Anesthetics blinded to the measurements obtained and grading recorded using the Cormack and Lehane laryngoscopic grading system. The data obtained were analyzed using chi square and ANOVA. Results: The results showed 11.3% incidence of difficult intubation. Sensitivity and Specificity of ULBT were 94% and 100% respectively, being the highest compared to TSD which were the lowest being 88% and zero percent. respectively .ULBT class III had a direct correlation with HMD<3.5cm (p=0.00), and ML < 9cm (p<0.01). ULBT had the highest positive and negative predictive values (100% and 47%) respectively. Accuracy of ULBT was found to be 94%, again the highest among the four tests.Coclusion: In conclusion, ULBT was found to have the highest Sensitivity and Specificity and accuracy, and could be used as a single bed test in predicting difficulty in intubation.

Background: The objective of this study was to determine the prevalence of anencephaly and coincidental abnormalities and determine the impact of marriage of relatives on their incidence in tabriz during (1997-2003). Materials and Methods: 21074 pregnant women were examined using ultrasonography in Tabriz Fagr clinic. Presence or absence of any congenital abnormalities or other complications were recorded and followed up.Results: Results of this study indicated 29 cases of anencephaly. The prevalence of anencephaly was 1.3 per 1000, of these, (20.68%) fetuses had isolated malformation and (79.31%) fetuses had coincidental abnormalities. The prevalence of anencephaly was not significantly affected by marriage of relatives (p=0.4). Conclusion: The results of the study necessitates an early and careful sonography to avoid giving birth to newborn whit central nervous system abnormalities.

Retropharyngeal hematoma without cervical spine injury is rare. It may cause airway obstruction after development' of hematoma. Various mechanism have been described that may lead to retropharyngeal hematoma such as flexion-extension trauma, intrathoracic pressure rise,' direct trauma to pharyngeal wall by oral intubation, and ingestion of foreign body. Generally diagnosis of retropharyngeal hematoma is suggested in patients presenting with hoarseness, stridor, dysphagia, and neck pain. These findings may be immediately evident or may only become apparent after a few uneventful hours following trauma. Relative minor cervical trauma may result in delayed development of retropharyngeal hematoma with serious consequences.This report describes one case of retropharyngeal hematoma after minor cervical trauma.

Background: To identify anemia incidence and its effective factors and pregnancy outcome in pregnant women. Methods and Materials: in this prospective cross-sectional study, hemoglobulin, 970 pregnant women who had more than 28 weeks of gestation, were surveyed. Different variables and pregnancy outcome preterm labor, low birth weight was evaluated. Collected data has be~n analyzed by using student T-test and Chi-square statistic. Patients categorized into 2 groups Hb < 11mg/dl vs. Hb≥11 mg/dl. Results: Incidence of anemia was 14.9%. 13.4% of anemic patients had no prenatal care in which there was a significant statistical difference between two . groups in regards to prenatal care P-value = 0.030. There were no significant differences in small for gestational age and preterm labor incidences, between two groups. Incidence of low birth weights in anemic group was significantly greater than normal group P-value = 0.032.Conclusion: In our study incidence of anemia was 14.9%. Prenatal care and Iron supplement therapy were effective factors in decreasing rate of anemia. Anemia in pregnancy increases rate of low birth weights.

Background: Ischemic heart disease is the leading cause of death in the world. In addition to traditional risk factor, recent studies have shown that immune system and its mechanisms have a central role in the development of atherosclerosis. ANA have been suggested as a risk factor for coronary artery disease (CAD) .The purpose of this study was to determine the relationship between antinuclear antibody (ANA) and coronary artery disease.Methods and Materials: Thirty CAD patients (14 men and 16 women) and 30 age and sex-matched healthy controls were studied. CAD was confirmed by angiography (the vessels stenosis> or = 50% at least in one vessel considered as CAD positive ). A questionnaire was filled out for each person. ANA (through ELIZA method), TG, Total cholesterol, HDL, LDL, FBS and blood pressure were measured. The vessels stenosis were determined according to angiography with Gensini Score. Serum ANA levels> or = 1.2was considered as positive.Results: ANA positive was observed in 2 patients (6.7%) and 1(3.3% ) of control group. There was no significant difference in ANA levels between both groups. Total cholesterol (P= 0.009), systolic (P>0.000) and diastolic blood pressure (P>0.015), and Ejection Fraction (P=0.026) were significantly higher in case than control group. Positive ANA titer was not correlated with smoking and diabetes but it was related to MI history. All ANA positive was observed in three vessels.Conclusion: The presence of ANA (the hallmarked of autoimmune disorder specially SLE) is not more prevalent among CAD patient group comparison with control group but the serum ANA levels were higher in case than controls. Further investigations are needed to clarify all controversy about ANA role in CAD. It is suggested to evaluate other components of immune system such as humoral and cellular in CAD.

Background: The Pennes bioheat equation is a well-known heat conduction equation in which the convective effects of the moving blood are treated as a volumetric heat source through a perfused tissue and the metabolic heat generation is also included as another heat source. Both of these sources regulate the temperature distribution within the human head. A natural convection heat transfer mechanism forms around the human head due to the temperature rise on the surface tissue. Methods and Materials: In this research a two dimensional model of the mid-sagittal plane of human head was created from a realistic anatomy data and it was simulated numerically to investigate the heat transfer phenomena within the head tissues and its effects on the natural convection in ambient air.Results: The maximum and the minimum tissue temperature occur in the brain and the nose, respectively. The prediction of the local Nusselt number distributions along the surface tissue shows a maximum and a minimum value at the front and the upper lip surfaces, respectively. The temperature distributions on the surface tissue show different trend from the Nusselt number and have a maximum value at the front and a minimum value at the nose.Conclusion: The numerical simulations have proved to be a powerful tool to investigate the heat removal and the thermal regulation in the human body.Key words: Head heat transfer, Thermal regulation, Natural convection, Bioheat equation, Pennes equation, Nusselt number, Thermal comfort.

Background: Systemic Lupus erythromatosus is a Rheumatoid disease which present in multisystemic manifestation. Nephropathy is seen in 2/3 of patients and is a common cause of mortality. In this study we investigated the clinical signs and made a suitable medical treatment protocol.Methods and Materials: This study was performed on 60 patients under 14 years from 1989 to 2000. Kidney biopsy was done for all patients and histological lesions were classified depending on WHO classification. Treatment and serologic parameters were written at management and follow up periods. Results: Kidney biopsy was done for all patients. 95% of all cases were undergone kidney biopsy in first year among these 80% were female. There was not any class I and VI in this group. The most common pathologic class was IV (70%) and the rarest one was class 11(3.3%). The most common Laboratory findings was proteinuria and the most common clinical finding was arthritis. outcome was better in female. In this study there was a significant association between pathologic indexes such as activity index, chronicity index, cellular crescent, interstitial fibrosis and clinical signs such as: nephrotic syndrome, occurrence of seizure and hypertension).Also we found a significant association between pathologic indexes, Lymphopenia,CH50 activity reduction and need to dialysis and mortality.Conclusion: This study was similar to study which was done from 1973- 1986 in our center, only a little difference were found in the incidence of class IV. On the other hand our findings were similar to other study in other countries, the only difference was the more microscopic hematuria finding in our study. It seems that pathologic indexes such as activity index cellular crescent percentile and interstitial fibrosis at the beginning of disease are good prognostic factors. Patients who have higher pathologic indexes, require more aggressive treatment.

Background: The effects of anesthetic drugs on fertilization and pregnancy rate by Assisted Reproductive Technology (ART) are controversial. study the effects of propofol anesthesia with thiopental sodium anesthesia are compared using ART. Materials and Methods: In a single blind randomized clinical trial in an ART setting, 68 women under age of 40 were divided into two groups. In group A, propofol and in group B, thiopental sodium were used. The amount of retrieved oocytes, fertilized oocytes, fertilization rate, pregnancy rate, anesthesia and recovery time were recorded for each patient.esultsR: Fertilization and pregnancy rate in group A was 64.8%, 29% and in group B was 61.3%, 23.3% respectively. There was no significant difference in fertilization and pregnancy rate between two groups (p>0105).However the recovery time of group A was shorter than group B (p=0104). Conclusion: It is recommended that propofol be used for outpatient surgeries in ARTsetting.

Background: Upper extremity musculoskeletal disorders (UEMSDs) may occur as a result of work with video display terminals (VDT). In this study we have investigated the prevalence of work-related UEMSDs among a group of Iranian bank clerks using VDT.Methods and Materials: In a cross-sectional study we evaluated 264 randomly selected bank clerks using VDT; 94 females and 170 males (mean age:29.8 years);, both by subjective measures of musculoskeletal symptoms and also by physical examinations in four areas of UE (neck, shoulders, elbows, wrist/hands) using a researcl er designed standard criteria. We also assessed association between some personal and occupational factors with UEMSDs.Results: The prevalence of work-related UEMSDs in our sample was 35.9% and women were more likely than men to have UEMSDs;43.6% versus 31.8% respectively (p=0.055). The most affected areas of UE were neck and shoulders. Duration of work with VDT and continuous, prolonged sitting at work-station showed positive significant associations with UEMSDs.Conclusion: This study indicates that work-related UEMSDs are common among bank clerks who use VDT, and that occupational factors are related to occurrence of these disorders. Obviously, physical/ergonomic design improvements are effective approach to reducing the occurrence of work-related UEMSDs.

Background: Carpal tunnel syndrome (CTS) is by far the most common entrapment syndrome of the peripheral nerve and is a significant cause of morbidity. In diabetic patients, the rate of CTS has been reported to be as much as 15- 33%. We investigated the postoperative prognosis of CTS in diabetic patients compared with non-diabetic.Methods and Materials: The outcome of 12 diabetic patients were evaluated and compared with those of 28 non-diabetic patients undergoing surgery by open release method for CTS (CTR). Analysis of electrodiagnostic findings and assessment of symptom severity were performed preoperatively and one and six postoperatively.Results: An improvement in all parameters occurred in both groups after the surgical decompression. However, a significant improvement in symptom score was observed in the non-diabetic group than in the diabetic group (all of them P<0.05). Conclusion: These findings suggest that underlying pathophysiologic mechanism in CTS may not be exactly alike in diabetic and non diabetic patients regardless of known extrinsic factors in non diabetics. Internal factors such as metabolic and vascular causes may have a role in diabetics which should be noted in the treatment.

Background: The number of argyrophilic Nucleolar Organizer Regions (AgNOR) correlate with cellular proliferative activity. This study compares the potential of recurrence and malignancy in meningiomas using AgNOR counting. Materials and methods: All of the meningiomas cases operated in Sina hospital during 1997-2002 were reviewed and their grading determined using both WHO and Mahmood systems. 81 cases selected as below:14 benign non-recurrent meningiomas (until March 2004); 14 primary benign recurrent meningiomas and their subsequent benign recurrences; 14 atypical; 11 malignant and 14 spinal meningiomas. Silverstained slides were prepared and mean, median and standard deviation of AgNOR dots determined.Results: There was a proportionate increase of AgNOR dots with increasing tumor grade. There was a significant difference between benign non-recurrent turners with benign recurrent (p<0.0001) and atypical or malignant (p<0.0001) tumors. No significant difference was seen between recurrent and atypical; atypical and malignant; intracranial and intraspinal; and primary of recurring meningiomas with their subsequent recurrences: Mean AgNOR counts of <2.3 could separate benign tumors from atypical or malignant meningiomas with 93% specificity; and 93% of tumors with benign histology had no recurrence potential if their mean AgNOR count was less than 1.8. Condusion: This study indicates that in meningioma the AgNOR count has a good correlation with turnor grading and recurrence, which may aid pathologists and clinicians in predicting the tumor behavior.

The presence of cardiac metastasis from cervical carcinoma is extremely rare. Most of the cases were diagnosed postmortem. There are a few cases of premortem diagnosis and it is believed that in these cases, the prognosis is extremely poor. We present the only case of premortem diagnosis of cardiac metastasis of more than 500 cases of cervical carcinoma in our center during the last 10 years. We present a 59 -year - old woman with multiple ventricular metastasis from cervical carcinoma, 2.5 years after the primary diagnosis. She died 10 days after echocardiographic diagnosis of multiple metastatic lesions in heart, following a massive DIc.The rapidly progressive DIC, and death, in the presenting case, confirms the previous finding of poor prognosis of patients ( pts.) with premortem diagnosis of cardiac metastasis of cervical carcinoma

Background: Hearing impairment or loss is a common disorder at birth. Auditory brainstem response (ABR) testing in the pediatric population is widely accepted in clinical audiology. However, there are some problem to detection of waves with conventional protocol of ABR testing in neonate and infant population. The purpose of this paper is to evaluate new proto'Colof ABR: testing for improving to detection of waves in young infants.Materials and Methods: Participants were evaluated using the ABR to detect hearing impairment or loss in neonates twice, before and after six months age.Results: With new protocol, wave V was detected in 160 neonates (94.1%) whereas with conventional protocol, it was observed in 77 neonates (45.2%) (P< 0.05). Ten neonates who was not detected wave V before six months age by new protocol, after age cif six months, the patients were known sever hearing loss and deafness by other audiological tests.Conclusions: Our study showed that we can improve results of ABR test in young infant's population by changing of some parameters.