Journal of Medical Council of Iran
Year:2001 | Volume:19 | Issue:1|Papers Count:12

Abscesses of the head and neck region appear in the vicinity of the great vessels, organs and mediastinum and are therefore of great importance. Absence of appropriate intervention cauld cause the death of the patient. These abscesses can result from odontogenic infections, infections of oral cavity, tonsils, sinuses, thyroid, middle ear, mastiod, petrous bone, cervical vertebrae, lymph nodes, esophageal rupture and trauma or local injections.In this study 55% of the microorganisms were , anaerobes, 27.5% were a mixed growth of aerobes and anaerobes and 12.5% were aerobes. The most common anaerobic microorganisms were Bacteroids, Peptostreptococcus, Lactobacillus and Fusobacter. The most common aerobic microorganisms were Diphteroids, Streptococcus a -hermolytic and Staphylococcus aureus.In our study, the most common areas involved were the submandibular and peritonsillar spaces. Involvment of vestibular, Pterygomandibular, submental, masseteric, para pharyngeal and multi space involvement were observed less commonly.With respect to gender, 67.5% of the patients were male and 32.5% were female and 25%, of patient's were in the pediatric age group (under 15).

Acute upper gastrointestinal bleeding is one of the emergencies in children. Initial management of these patients is hemodynamic stabilization followed by gastric lavage with normal saline which are necessary. After the general condition has been stabilized, endoscopy is the best modality to diagnose the etiology of bleeding during the first 48 hours. In this 15years study conducted at pediatric endoscopic ward, Ghaem(Aj) Hospital, out of 1168 pediatric gastroscopy files, 195 cases of hematemesis who reported as emergency cases were selected and the cause of hematemesis in these patients was evaluated. The patients ranged from month to 15years (mean age 6.9 years) and 56.9% were boys and 43.1% being girls. The most common cause of upper gastrointestinal bleeding in our patients was gastoitis or duodenitis with erosion which was seen in 81(41.5%) of the patients seen. Other causes included esophageal varices (28.7%). In 6.1% of patients, endoscopy was normal. Esophageal ulcer was seen in 2% of patients and rare causes such as duplication in one patient, brachyesophagus (1patient), Mallory weiss tear (1 patient) and posttonsillectomy bleeding (1patient) could be seen.Compared to the foreizn literature which report ulcer and varices as the common causes, our finding's were comparable to them. The most cause of acute ulcer has been reported to be due to aspirin ingestion and in 25 out of 81 cases suffering from acute ulcer gave a history of aspirin ingestion. In cases of esophageal varices, sclerotherapy was performed during endoscopy if needed, and in patients with ulcer and esophagitis, appropriate treatment was conducted.

Chronic renal failure is one of the causes of euthyroidism which is associated with some abnormalities in thyroid hormone metabolism. Although dialysis does not significantly affect these abnormalities, but renal transplantation leads to improve the conditions. In this study, first serum levels of thyrotropin and thyroid hormones and triiodothyronine resin uptake (T3 up) were measured in 30 patients under dialysis and compared with 40 persons from the control group. After renal transplantation the patients were subdivided in to two group: 21 patients had optimal primary graft function (group І) and 9 patients had delayed graft function (group ІІ). All patients received maintenance therapy with prednisilone, aziothoprine and cyclosporine, and thyroid indices were measured in them.In dialysis patients thyroid-parameters were in the normal range, but compared with the control, mean levels of thyroid hormones were low and T3 uptake high however no changes could be observed in the levels of thyrotropin.Ten days after graft, reduction in the levels of thyrotropin and thyroid hormones and elevation of T3 uptake were found in both the groups. The hormone alterations in group ІІ were more than in group І. On the 30th day after graft, changes in group І reached normal levels and comparing with pregraft conditions those of before a marked improvement was noticed, but comparing with the control, the levels of free and total triiodothyronine and total thyroxine were still low.In the group ІІ, the levels of free and total thyriod hormones were lower than those of befor operation and comparing with the control, decreased levels of thyroid hormones and elevation in the T3 Up were observed.Our studies demonstrated that there existed a relationship between the levels of thyroid hormones and function of the transplanted kidney and this relationship was more significant as regards thyroxine and triiodothyronine.

The major aim of all therapeutic programs in diabetes mellitus is maintenance of blood glucose level in normal range. At present, in achieving this purpose, measurement of fasting blood sugar (FBS) and glycosilated hemoglobin A1 (HbA1) are commonly used as glycemic control indices. Since the above two tests cannot depict the metabolic state of the patient under all conditions, thus this study was conducted with the aim to control diabetic patients by determining serum fructosamin levels allowing a direct surveillance over the mean blood sugar levels during tine intervals when assessment of it with other indices was not feasible.Serum fructosamin was evaluated in 90 diabetic patients not adequately controlled (Type І, ІІ), for 3 times with an interval of 2 weeks and in 100 normal samples as a medium index glycemic control. The method is colorimetric on the base of nitroblue tetrazulium reduction. According to the results serum fructosamin in comparison HbA1 is a sensitive parameter to show fluctuation of blood glucose, furthermore some agents such as age, sex, chronic disease, hematolgic disease and drug consumption don’t effect the serum fructosamin level.In this study direct estimation of mean blood glucose at 1-3 past week with application of multiple regression analysis, provided a diagram allowing monitoring blood glucose on the base of fructosamin concentration. By this method, in uncontrolled diabetic patients, using the above model and assessment of serum fructosamin levels, the course of treatment and improvement secondary to blood glucose control with the initiation of treatment and changes in treatment can be easily assessed and controlled.So, for assurance to do effective treatment, fructosamin in comparison with other glycemic parameter, has peculiar importance.

The purpose of this study is to determine the prevalence of breech presentation and asses the corelation between breech presentation maternal age, parity; infant's weight and gestational age in addition to characteristics of singleton births at Arash hospital.A population-based case-control (335 breech cases, 441 control and total of 12067 deliveries) was conducted with data collected from the medical records.The results showed the mean maternal age with breech presentation to be 25.07±1:5.81. However this difference was not significant. Breech in primipara was 47.7% compared to 35.6% cephalic presentation in the control group. Taking odds ratio of 1.65, primparity is considered a risk factor for breech presentation. Mean maternal age was 38.9±2.28 in those with cephalic presentation compared to 37.7±3.6 in those with breech presentation. This difference was statistically significant (P <0.001). Mean infants' in the breach group was 2885 ±691 grams compared to 3231±410 grams in the cephalic group, and the difference was found to be statistically significant (P <0.001).In our study, low birth weight, primiparity and low gestational age influenced the incidence of breech presentation. However, accompaniment of advanced age and multiparity were not established with increased incidence of breech contrary to other reports.Overall several different infant and maternal factors appear to increase the risk of breech presentation, suggesting that there may be several different biological mechanisms leading to breech presentation.

Buerger's disease is a kind of obstructive vascular disease specially occurring in the lower limbs and appears to have a high prevalence in the eastern countries. Because of a lack of knowledge of its definite etiology, its treatment is usually accompanied by multiple amputations and failures. Various methods have been used to control pain and healing of extremities' wounds in those affected with Buerger's disease. The objective of this study was to assess to the degree of efficacy of epidural anesthesia in the control of pain and wound healing in these patients.In this experimental study, 17 patients with Buerger's disease were hospitalized in the surgical ward and after conducting the primary conservative measures, an epidural anesthesia was initiated after placing an epidural catheter and injecting marcaine at intervals of 4 hours. The degree of pain and wound healing were evaluated and compared before and after the procedure and then at 2 weeks interval. 16(94%) patients reported a reduction in pain and warning of extremities soon after placement of the catheter and injection of marcaine. Two weeks later, in 88% of the patients, there had been a relative or absolute improvement in lower extremity wounds. At discharge, 15 patients did not complain of pain and could walk comfortably. 9 of the patients had undergone surgical sympathectomy but had proved in vain in controlling the disease.Epidural anesthesia in the acute stage of Buerger's disease by speedy reduction in pain can bring about early ambulation if hygienic conditions of the extremity are observeal and thus can prevent the progression of the lesions. Further studies are needed to determine the mechanism and effect of this procedure.

Iron deficiency anemia is a significant public health problem. The elimination of iron deficiency in children has been a major concern of research workers in the past few years of those who care for in this study, we investigated the importance of serum protoporphyrin for the detection of iron deficiency anemia. The purpose of our study was to evaluate serum protoporphyrin screening in young children. 79 children between 6-11 years of age and having signs of iron deficiency anemia and low serum ferritin levels were enrolled as experimental group over a 4 year period, and 74 children between 8-12 years with no signs of iron deficiency anemia and having high serum ferritin levels were enrolled as a control group again over a 4 year interval protoporphyrin was determined asing Shimadzu RF 5000 spectroflurophotometer. The excitation wavelength was 457 nm and the fluorescence spectra were scanned from 400-600nm. Hematocrit was performed by contrifugation of a tube. Serritin, transferring saturation, total iron binding capacity and serum iron were determined by Cecil-CE spectrophotometric method. Serum protoporphyrin method has a sensitivity of 93.3%, specificity of 91.5% and a predictive value of 68.3% and is appropriate compared to other methods used for the detection of iron deficiency anemia serum protoporphyrin concentration in iron deficiency anemia group was 4 times higher compared to that the control group and a statistically meaningful difference existed between the control and patients' groups (P<0.05). The data indicate that the serum protoporphyrin value obtained by this method could be used as a screening test for iron deficiency anemia.

Gastric perforation with massive hematemasis is a relatively rare clinical finding in newborn infant in this article, with the objective to review risk factors for acute gastric perforation and massive hematemasis, we report a near-term neonate with massive hematemasis and gastric perforation following weaning from ventilator. The risk factors for hemorrhage and perforation in this neonate may be fetal distress, hypoxemia, indomethacin for PAD, aminophyline and dexamethason to expedite and frequent insertion of OG tube during the treatment.A conclusion drawn from this report shows that in order to prevent this complication, as far as possible the occurrence and cumulation of risk factors initiating gastric perforation and hematemasis in neonate admitted in the neonatal intensive care unit should be avoided.

Cervical cancer is in most parts of the world is the most common cancer among women after cancer of the breast. Regarding the known etiologies, availability of the organ, the possibility of proper screening test and the long latency between the precancerous lesion and the full blown clinical cancer, screening programs have been able to drastically curtail the incidence and fatality rate of the disease. It appears that by the application of regular screening tests, the disease could be considerably controlled on the face of the fact that in our country, most of the patients still suffer from advanced, invasive and almost irremediable cervical cancer at their first clinical presentation.