Journal of Medical Council of Iran
Year:2000 | Volume:18 | Issue:3|Papers Count:11

Termination of pregnancy by a procedure called cesarean section had been one of the commonest operations. This is of vital importance and can be life saving for mother and baby. In this study the prevalence of cesarean sections in health centers under university coverage and admitting about 51% of all deliveries is being evaluated. It was found that the cesarean rate is 22% in these centers and it is compared with western developed countries. Also possible causes for high cesarean rate in university centers are discussed.

Assessment of amniotic fluid volume has been one of the major strategies to evaluate the fetal wellbeing and a four - quadrant amniotic fluid index (AFI) is the best semiquantitative estimate of amniotic fluid volume. The purpose was to obtain A.FI and placental grading in Iranian pregnant patients and compare it with similar studies in the wester world. This study was carried out in Arash hospital, Tehran university of medical sciences from 1997-1998.In a prospective - descriptive study, four - quadrant A.FI and placental grading were evaluated weekly from 35th week of pregnancy up to delivery in 200 pregnant patients referred to our prenatal clinic. Statistical analysis was performed utilizing chi-square and t-tests.Mean four - quadrant AFI from 35th week to 40th week of pregnancy was 16.08±3.84 cm and the volume from 35th week l1p to delivery gradually decreased. The majority of placentas were grade I at 35th week and grade in at 40th week of gestation: Chi-square test showed a significant difference in distribution of AFI attributing to various placental grading (P<10-7). Hest analysis showed a significant difference (P<0.05) between our findings and other similar studies.Our study. Showed a gradual reduction in AFI towards the end of term, but mean AFI remained high necessitating further research in different parts of the country to arrive of a better conclusion.

Neuroendoscope is used for diagnostic and therapeutic purposes in neurosurgery. Examples of its diagnostic utility include ventriculoscopy, cisternoscopy and biopsy of intraventricular lesions. Its therapeutic role includes ventriculostomy of the third ventricle for the treatment of hydrocephalus.Hydrocephalus is usually treated by V-P shunts. Utilizing endoscope enables a contact between the third ventricle and cistern and this procedure obviates the need for using a shunt and its attendant innumerable complications thereby do not occur. In this study, 10 patients with obstructive hydrocephalus, dilated lateral and third ventricles and having small or normal IV ventricles were treated with neuroendoscope. The age of the study population ranged between 1-18 years and they had symptoms of raised intracranial pressure. Follow up ranged from 6 months to one year and the only complications found were transient visual impairment in one case and an external hydrocephalus in another one. The results obtained had been excellent in 6 of the cases, good in z and a relative success in another 2. In conclusion, ncuroendoscope can be a good substitute for many of the diagnostic and therapeutic modalities in neurosurgery.

During 5 years (1993-98), 89 pa tients suffering from tracheal stenosis or stenosis of the subglotic region secondary to tracheal intubation were treated in the department of General Thoracic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Patients comprised of 27 females and 62 males. Mean age was 27.25 years; ranging between 3 to 83 years. The major cause of tracheal intubation in 56 of the patients had been accidents culminating in central nervous system damage and unconsciousness for a period of time in 9 of the patients, the cause of tracheal intubation had been attempted suicide and in 24 others causes such as trauma to chest, or abdomen, cardiac surgery, fall from height myasthenia gravis, Guillain Barre syndrome and diabetic coma were found. 16 patients had subglottic stenosis and 73 patients had tracheal stenosis. Direct causes of airway stenosis were: cuff of the tracheal tube in 69 patients, tip of the tracheal tube or tracheostomy tube in 12 patients, stoma of the tracheostomy and a combination of these causes were found in 5 patients.Seventy patients were treated by 73 resections and anastomoses and the other 19 patients were treated by nonsurgical procedures such as laser treatments bronchoscopic dilatation, T-tube insertion or temporary and permanent use of tracheostomy tubes.In 70 patients treated with resection and anastomosis of stenotic segments the final results had been excellent (74.2%), good in 9(12.8%), acceptable in 6(8.5%) and death in 3(4.2%). 3 of the patients were reoperated for stenosis following in initial resection and anastomosis.In 19 of the patients treated by methods other than resection and anastomosis the results had been excellent in 9 of the cases (47.3%), acceptable in another 9(47.3%) and death occuring in one case (5.2%).Mean length of follow- up was 9.87 months, which ranged from 0-60 months and foHow - up was complete in all patients. Resection and anastomosis is an appropriate treatment for patients with postintubation airway stenosis. In a small number of cases, methods other than surgery such as laser therapy and dilation have been found to be satisfactory.

The differentiation of glomeruli was studied histologically in newborn spurge Dawley rats. Five groups of animal were anesthetized with chloroform. The left kidneys were removed and fixed in 0.10 formalin salin. Parafin sections with 5 nm1 thickness were stained with, Hematoxilin-Eosin, PAS and colloidal silver nitrate.The glomeruli are differentiated through four stages:1- Vesicle stage2- S-shaped stage3- Developing capillary loop stage4- Maturing stageIn the processes of differentiation, the number of capillaries and diameters of golmeruli increased and distinct space between the visceral and epithelial cells was distinguishable. The basal layer of glomeruli appeared at 3th stage. The Juxtamedullary glomeruli developed faster than that of intermediate and cortical glomeruli. However, at 12th day after birth all of glomeruli had been developed.

One of the major problems in the parasitology unit of medical laboratories is diagnosis of amoebic dysentery and distinguishing it from other forms of dysentery.The correct diagnosis of intestinal amoebiasis depends on many factors including the degree of personal skills, choosing the appropriate technique, and rapid examination of freshly passed stool specimen. This study was performed from September 1998 to March 1999.53 cases of amoebic dysentery and 18 cases of nonamoebic dysentery were reexamined in 7 public and private laboratories in different areas of Tehran and Karaj. Three different methods used in this study were direct examination of the stool diluted with saline, cultured in Hsr+s medium and trichrom staining. Among 53 cases reported by laboratory personnel as positive for Entamoeba histolytica, 12(22.6%) were true positive and 41(77.4%) were false positive. All 18 cases reported as nonamoebic dysentery were true negative for Entamoeba histolytica.The most common agents confused with Entamoeba histolytica were macrophage and polymorphonuclear cells. Entamoeba coli trophozoite, Endolimax nan. Dientamoeba fragilis and Blastocystis hominis were also mistaken with Entamoeba histolytica.

Insulin resistance, impaired glucose tolerance and diabetes mellitus secondary to acromegaly, mostly subside after treatment of the underlying disease. Rarely, despite the presence of normoglycemia in active phase of acromegaly, diabetes melltus occurs in patients following hypophysectomy, which needs insulin therapy.We report five such cases who underwent hypophysectomy in Imam Khomeini and Shariati hospitals during 1985 to 1996.Owing to the presence of this phenomenon, it is felt that serial blood sugar levels in acromegalic patients seen necessary even if they had normal blood sugar levels prior to surgery.According to this phenomenon, we suggest serial blood cheching in acromegalic patients after hypophysectomy, even so they were normoglyccmic befor surgery.

During the last few decades, prognosis of children suffering from cancer has improved. Thus it is important to diagnose oncological emergencies in time and treat them. Respiratory distress or circulatory problems might occur because of comepression of the airway or because of superior vena cava syndrome. Epidural compression of the spinal cord because of tumor might result in irreversible paraplegia and urinary incontience if immediate steps are not taken. A rise in intracranial pressure as a threatening sympton is seen in tumors of the brain. In malignant metastasis of the bone marrow; bone marrow suppression along with anemia and thrombm; ytopenia are seen. If hyperleukocytosis is not treated quickly, thrombotic events will ensue. During the diagnosis, majority of the malignancies in children are associated with coagulation problems. Dangerous metabolic abnormalities are seen in children with lymphoma. Although hypercalcemiais rare but it is difficult to treat.A speady alteration to these emergencies and their correct management can save the livesof children sufferingfrom malignant disorders.

These days when an extensive debate is going on at the university and decision making circles to replace hygeinic thinking with that of treatment and diagnostic thinking, there arises a question as to whether Avicenna, the famous astronomer, philosopher with all that control over mathematics, logic and medicine was essentially in clined towards a "hygeinic concept of thinking or that of medical thinking".In this context, we searched Avicenna's fanmous book "Canon of Medicine" and with an ainr to achieve Precision and expedite the research process, fed the entire contents which exceeded one hundred and sixty thousand lines and over a million words to the computer to gain access to our keywords and phrases.We found subjects pertaining to health and diseased states, observance of health and diseased states, observance of health measures, environmental hygiene (water, air, housing and food), the significance of health, sports, Maternal health, health of the newborn and health of the elderly in Avicenna's book. Zost of the items despite the passage of more than 1000 years retain their validity are being referred to and reflect Avicennas trend of hygeinic thinking. In short these concepts could be categorized under the title "General health system" and taught as such.