پژوهش در علوم پزشکی
سال:1375 | دوره:1 | شماره:3 |تعداد مقالات:12

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerulopathies in children leading to end stage renal disease (ESRD). Different values of median renal survival have been reported among different ethnicities and races. Many factors are assumed to be responsible for ESRD in these patients. In this study, we tried to determine median renal survival (MRS) and also some clinical and histopathological features predisposing FSGS patients to ESRD in two referral hospitals in Tehran.METHODS: The study involved 103 FSGS patients (61 males and 42 females) with a mean age of 7.08 ± 0.68 years. The diagnosis was made based on kidney biopsies. All kidney biopsies were studied by light and immunofluorescent microscopes. Ocular grids (counting squares) were used as the standard method to calculate the percentage of cortical interstitial fibrosis (CIF). The percentage of glomerular sclerosis was presented as renal injury score. Glomerular filtration rate (GFR) 950 ml/min was considered as renal death or the end point. Patients were followed for 1 to 15 years, until occurrence of renal death.RESULTS: The MRS was 9.04 ± 1.8 yrs. The renal survival reached 72%, 47% and 17% after 5, 10 and 15 years, respectively. Univariate analysis showed significant reverse correlation (P<0.05) between renal survival and the following variables: hypertension, anemia, GFR at the time of first admission and also renal injury score >50%, peritubular fibrosis, periglomerular fibrosis, tubular atrophy and CIF³20%. However, multivariate analysis revealed only a reverse correlation between renal survival with CIF³20% and also hypertension (P<0.0001 and P<0.05, respectively).CONCLUSIONS: In our patients, FSGS showed a rapid course towards ESRD compared with patients of western countries. Perhaps some ethnic and genetic factors such as angiogenesis converting enzyme genotypes (ACE-DD) can be considered as a cause of this rapid progression. Also, we carried this study only on children and adolescents which might change the MRS results.  

BACKGROUND: The aim of study was to screen the risk factors of inflammatory bowel disease (IBD) in north-western Chinese population by case investigation.METHODS: 72 determined IBD patients and 72 paired healthy subjects were surveyed with an organized inventory comprising of relevant items to IBD. Cox regression method was used to screen the statistically significant risk factors for IBD.RESULTS: Cox regression indicated the statistical significance in stress, milk and fried food over the other postulated risk factors for IBD in the north-western Chinese population.CONCLUSIONS: Stress, milk and fried food are the potential risk factors for IBD in the north-western Chinese population.

BACKGROUND: Tonsillectomy is one of the most common methods in Head and Neck operations and in ENT all over the world. Children are the most affected group. There are different methods of tonsillectomy including: the common method of using sharp instruments or a newer method the electrocautery, the monopolar or the bipolar, method. This study was conducted to compare cold dissection with bipolar electrocautery tonsillectomy.METHODS: In a clinical trial carried on 60 patients between the ages of 6 to 15 at Amir-al momenin Hospital in Rasht, one tonsil underwent the bipolar electrocautery tonsillectomy and the other underwent the cold dissection tonsillectomy. The amount of bleeding, duration of operation, throat pain and referral otalgia during hospitalization and after discharge were evaluated.RESULTS: The average amount of bleeding related to electrocautery tonsillectomy was 41.2±2.46 ml and in cold dissection, tonsillectomy was 73.13±3.37ml (P<0.001). The mean time of operation was 9.1±0.39 minutes and 15.11±0.65 respectively (P<0.001). On the second day after operation, 21.67% of the patients had more pain on the cauterized side and 31.67% experience pain on the other side. 46.66 of the patients had equal pain on the two sides.15% of the patients had referral otalgia in the cauterized side and 16.67% in the other side. There was no pain in 68.37% of the patients.CONCLUSIONS: The bipolar electrocautery appears to cause less bleeding and postoperative pain and it seems to be less time consuming in compare with the cold dissection tonsillectomy.

BACKGROUND: This was a study to determine the correlation between the common bile duct (CBD) diameter and demographic data, fasting, and the history of opium addiction.METHODS: This was a cross-sectional study on 375 patients (>16 years old) including 219 females and 156 males. They had no evident hepatobiliary or pancreatic disease and underwent abdominopelvic ultrasonography for measurement of their CBD diameter. Ultrasound (US) was performed to measure CBD diameter at the porta hepatis (proximal part) and behind the head of the pancreas (distal part). Correlation coefficients for the association between CBD diameter and predictive factors were calculated. T-test was applied to compare the means between the groups.RESULTS: The mean CBD diameter (1 standard deviation), in proximal and distal parts were 3.64 mm (±1.2) and 3.72 mm (±1.2), respectively. The CBD diameters (proximal and distal) were significantly (P<0.05) correlated with age (r=0.55 and 0.54, respectively), BMI (r=0.25 and 0.27, respectively) and portal vein diameter (r=0.24 and 0.22, respectively).Distal diameter of CBD was significantly larger in opium addicts (5.66±2.65) in comparison with non addicts (3.68±1.17, P=0.04).CONCLUSIONS: CBD diameter associates with age, BMI, portal vein diameter and opium addiction. CBD dilatation, if it can not be explained by age, opium usage or large BMI, should be evaluated further to rule out obstruction.

BACKGROUND: This study was performed to evaluate the effects of psyllium on kinetics of alimentary carbohydrate absorption in diet-treated type 2 diabetic patients.METHODS: This was a double blind, prospective, controlled clinical trial. Twelve patients (6 in each group) participated in the present study. After an overnight fast, a standard 435 kcal breakfast was given to participants. Fasting, 1- and 2- hour postprandial plasma glucose was measured in the case and control groups. Cow’s milk containing 5 grams of psyllium granules for the case and without psyllium for the control groups was also delivered.RESULTS: Plasma glucose changes in the first hour were significantly different between control and case groups (53.8 versus 17.8 respectively, P=0.037). Also, mean 2-hour postprandial plasma glucose was 167.67 and 117.67 mg/dl for control and case groups, respectively (P=0.05).CONCLUSIONS: This pilot study revealed that psyllium may effectively reduce postprandial plasma glucose possibly by retarding GI carbohydrate absorption. Larger studies are needed to confirm the results of this study and define its role compared to acarbose or meglitinides.

BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT), and lacunar versus non-lacunar infarcts.METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes, smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity, atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P=0.02), and hypertension (P=0.02) had a significantly higher percentage of history of prior CVA (P=0.03) and a significantly higher percentage of non-lacunar infarct.CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies should be done in our country to find ways to prevent stroke and its complications.

BACKGROUND: Preterm labor with intact membrane is responsible for approximately one-third of preterm births, which account for about 70-80% of all neonatal deaths among normally formed neonates. Premature delivery is the leading cause of perinatal morbidity and mortality. In this study we have compared the safety and efficacy of nifedipine and magnesium sulfate in treatment of preterm labor.METHODS: In this study, 120 pregnant women experiencing preterm labor at 26-36 weeks gestation were randomly selected to receive either oral nifedipine or intravenous magnesium sulfate. The efficacy and side effects related to nifedipine or magnesium sulfate were recorded and all data was analyzed with SPSS software, using t student, chisquire and fisher exact tests.RESULTS: Twenty two of 57 (38.6%) patients in the nifedipine group and 31 of 63 (49.2%) patients in the magnesium sulfate group were delivered before discharge. In 25 (43.8%) patients in the nifedipine group and 24 (38%) patients in the magnesium sulfate group, pregnancy was continued until the 34th-36th week, at which time the patients were delivered. No significant difference has been found concerning any of the following: delivery postponement, drug side effects or neonatal outcomes between nifedipine and magnesium sulfate groups (P>0.05).CONCLUSIONS: Oral nifedipine may be a suitable alternative to magnesium sulfate, with the same efficacy and side effects.

Bilateral maxillary sinus aplasia is an extremely rare congenital anomaly. Only a few cases have been reported in the literature. We present a 24- year-old woman with bilateral maxillary sinus aplasia associated with the bilateral absence of the uncinate process and infundibular passage on CT images.

A 14- year-old girl who had an upper eyelid mass for 3 months (without any pain or other symptoms) was referred to us. The orbital CT-scan revealed a superomedial orbital mass and excisional biopsy reported a giant eccrine hidrocystoma.

We have performed the ipsilateral vascularized fibular transfer for the treatment of congenital pseudoarthrosis of the tibia (CPT). In the case under study, the conventional treatment by intramedullary rod and autogenous iliac bone grafting had failed. The follow up took place during the next 4 years and the patient can now walk without assistance. Combining a pedicle ipsilateral fibular transfer with an internal fixation and iliac bone graft may be a good option for the treatment of congenital pseudoarthrosis of tibia.