JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:16 | Issue:54|Papers Count:20

Background and purpose: Upper gastrointestinal tract cancers are important malignancies in the entire world. Many Diagnostic procedures are frequently used for staging gastrointestinal malignancies. Laparoscopy has emerged as a good staging modality for most gastrointestinal cancers than many other preoperative modalities.Materials and Methods: Patients with gastrointestinal tract malignancies were selected for evaluation from 2000 to 2001. After complete physical examination and Para clinical evaluations, all patients underwent laparoscopy with general anesthesia and biopsies prepared from metastasis followed by laparotomy. Data were analyzed by statistical tests.Results: Fourty three patients, 41% female and 59% male with a mean age of 61.25±14 years were studied. Sensitivity and specifity of laparoscopy in diagnosing lymph node metastasis of upper gastrointestinal tract malignancies were 83.33%, 100% respectively. These indices were 75% and 100% in liver metastasis. Positive and negative predictive values of lymph node metastasis were 100% and 89.3% respectively and 100% and 20% in liver metastasis.Conclusion: Preoperative laparoscopy is an effective method for diagnosing metastasis in patients with gastrointestinal tract cancers and can prevent many unnecessary laparotomies.

Background and purpose: The aim of this prospective, clinical trial study was to investigate whether the administration of different doses of ketamine before induction with propofol improves its associated haemodynamic propofol during induction and tracheal intubations.Materials and Methods: One hundered and thirty adult patients ASA I were randomly allocated to one of six groups to receive either propofol 2 mg/kg (n= 23), propofol 1.75 mg/kg with ketamine 0.25 mg/kg (n=21), propofol 1.5 mg/kg with ketamine 0.5 mg/kg (n=20), propofol 1.25 mg/kg with ketamine 0.75 mg/kg (n=21), propofol 1 mg/kg with ketamine 1 mg/kg (n=24), and ketamine group alone 2 mg/kg (n=21). Ketamine was administered prior to induction with propofol, relaxant and tracheal intubations. Systolic, diastolic pressure and heart rate were automatically recorded before induction (Baseline), immediately after induction, and 1, 5 and 10 min after tracheal intubations by Armita devices.Results: Systolic, diastolic pressure and palse rate were not significantly different in different group's befor the induction. However theses difference were significant after the induction of anesthesia (P<0.001). The highest increase and decrease in blood pressure occurred in ketamine and propofol groups respectively. Haemodynamic stability was much better in patient's anesthetized using propofol plus 0.5 to 0.75 mg/kg ketamine.Conclusion: We conclude that the addition of ketamine 0.5 and 0.75 mg/kg improves haemodynamics when compared to ketamine 2 mg/kg alone or propofol 2 mg/kg during induction of anesthesia.

Background and purpose: Cervical radiculopathy is one of the most common diseases that must be diagnosed early and properly to prevent its serious side effects. For these purpose different paraclinical methods such as MRI, X-ray, EMG, NCV and SSEP are used. Each of these methods has its limitations and some of them are expensive or invasive. The aim of this study was to compare the electro diagnostic and radiologic methods in diagnosis of cervical radiculopathy.Materials and Methods: In this study 36 patients (22 Female, 14 Male) with complaint of cervical pain radiated to upper limbs were evaluated. The evaluation included EMG, NCV, MRI, X-ray and SSEP. Exclusion criteria were fracture dislocation and infection of bone joints or soft tissues .MRI and X-ray were performed in MRI centers of Isfahan, Sepahan and Alzahra hospital in Isfahan city. MRI was graded on severity of 1 to 3. EMG, NCV and SSEP were performed in electro diagnostic center of Alzahra hospital by one professional technician. Results were compared with text books and analyzed by SPSS software.Results: Sensitivity of SSEP was 28.6% and specifity was 100%. Partial agreement between SSEP and MRI existed in moderate and severe cervical involvements (P=0.005). Frequencies of abnormalities were: EMG 50%, NCV 5.6%, X-ray 33.3% and MRI 77.8%.Conclusion: This study shows that SSEP has lower value than EMG in diagnosis of cervical radiculopathy. Also in a patient with cervical radiculopathy, cervical MRI and EMG of upper limbs are necessary. SSEP abnormalities in the presence of moderate and severe MRI changes such as myelopathy, are more valuable. Therefore, SSEP in cervical radiculopathy is recommended before surgery.

Background and purpose: Papain, a proteolytic enzyme, is found in the dried and purified latex from the fruits of Carica papaya L. (Caricaceae).Papain is used in medicine as a digestive and in the debridement of necrotic tissues. It is used in pharmaceutics as a spreading agent for drugs, supplied as an ointment (10%) with urea which denatures nonviable protein matter present in lesions. Large amounts of papain are used industrially to tenderize meat.Materials and Methods: In this research, crude latex was collected from Sarbaz region of Sistan-o-Baluchestan province. The full-grown but unriped fruit was subjected to shallow incisions on several sides (depth of incision was important). After collection, the coagulated lumps were shredded and dried by the use of heat (30°C).Extraction and sedimentation procedures were used for extraction of papain. In this method, cystein hydrochloride at adjusted pH was used for extraction and sodium chloride for sedimentation.The extracted papain was identified by the use of electrophoresis method and also by comparing its IR spectrum with the standard papain.Results: The activity of extracted papain was determined by USP procedure. In this research, 1.2 g papain was obtained from 100g latex. Electrophoresis pattern and IR spectrum of extracted papain were identical with the satndard papain.Conclusion: The extracted papain from Iranian Carica papaya (c=1 mg/ml) showed 5800 U/ml activity.

Background and purpose: Selection of suitable parameters for brain MRA requires accurate measures, because the image quality depends on the location of arteries, veins and also the velocity differences of blood, taking into account the low blood flow in small veins and arteries, use of paramagnetic contrast media is recommended. Hence, in present study, we investigated the imaging optimization of brain vessels using contrast media in 1.5 T field.Materials and Methods: For image optimization blood T1 was estimated after the injection of 0.1 mmol/kg of Gd-DTPA and the relative blood signals were measured at T1=300, 600, 900 and 1200ms using TR=20 ms and TE=7 ms parameters. Ernest angle and relative signal increased as the T1 decreased. MRA was obtained in three groups, each including five volunteer patients using parameters TR=20 ms, TE=7 ms and flip angle 10, 20 & 30 degrees in two series without and during contrast injection.Signals of carotid, M.C.A and thorcolar herofili and SD in air were measured and it was shown that in 20 degrees flip angle, C/N was maximum.At the last stage, three series of MRA, without, during c.i. and 15 minutes after c.i where obtained in 20 volunteer patients using parameters TR=20 ms, TE=7 ms and flip angle 20 degrees and calculated C/N.Results: After statistical analysis the highest C/N was observed during c.i MRA. Paired t-student test was performed to compare the differences between the C/N ratios. For clinical purposes one vein and two arterles were graded in 5 definite levels.Conclusion: Results indicated an important effect of paramagnetic contrast media on better observing of small arteries and vein. The best quality was taken during c.i, but in some arteries contrast media did not improve the quality of MRA.

Background and purpose: In Iranian folk medicine, the leaves and rhizomes of the plant Sambucus ebulus have been used topically for curing painful joint diseases. This study was undertaken to evaluate the anti-inflammatory and antinociceptive efficacy of different parts of Sambucus ebulus in mice and rats.Materials and Methods: Different parts of Sambucus ebulus were collected from Sari. Fruits, leaves and roots were fractionated by successive solvent extraction with hexane, ethyl acetate and finally methanol. Anti-nociceptive and anti-inflammatory activities of extracts were determined using hot plate, writhing and carrageenan-induced inflammation tests in mice and rats respectively.Results: Nearly all extracts showed a dose dependent and marked analgesic and anti-inflammatory activities when compared to the control. Only hexane extract of leaves did not show any anti-inflammatory activity up to 600 mg/kg i.p. Hexane extract possessed significantly higher activity than methanol extract. Ethyl acetate extract were withdrawn because of severe nociceptive response in mice. No extracts exhibited any toxicity up to 2 g/ kg body weight intraperitoneally in mice for one week.Conclusion: The results of the present study support the folkloric utilization of this herb. Hexane extract of fruits showed highest analgesic and anti-inflammatory activities. Phytochemical analysis, the elucidation of exact mechanism of action and active components responsible for the hypernociceptive effect of ethyl acetate extract requires further investigations.

Background and purpose: Regarding the importance of quality of sexual life in patients with cancer especially breast cancer, and because of controversy on the impact of counseling on QOL promotion in such patients, this study was performed at cancer Institute of Imam Khomeini hospital Tehran, in 2004, to determine the effects of group counseling on QOSL of patients with breast cancer treated with chemotherapy.Materials and Methods: In this randomized clinical trial, 114 women 25-55 years old undergoing chemotherapy due to breast cancer and with the history of mastectomy were studied in two groups: control group (Standard care n=63) and case group (standard care+ counseling n=51). Five sessions of counseling were performed for case group and QOSL of patients were measured at start and end of the study by standard questionnaire (QLQ-Br 23).Results: Results revealed that group counseling promoted these items: body image, sexual function and sexual enjoyment. QOSL of such patients were improved by means of group counseling (p<0.001).Conclusion: Regarding the results of the study, group counseling program can be recommended as an effective approach in QOSL promotion in such clients.

Background and purpose: Pectin is widely used in food, cosmetic and drug industries. Because of high production and consumption of citrus fruits in Mazandaran, fruit peel is available in large quantities. The objective of the current investigation was to determine the amount of pectin, degree of estrification, a key factor in rheological properties of pectin, and galacturonic acid content as a criterion for pectin purity.Materials and Methods: Thirteen species of commonly used citrus fruits, orange cultivates (Citrus sinensis; Washington navel, Sanguinello, Valencia, Acidless, Moro, Shahsavari, Italian orange), Clementine, Unshiu, Grapefruit (C. paradisi), Bitter (sour) orange (C. aurantium), Lemon (C. limon) and Tangelo were collected at the ripening stage. All the trees were cultivated in the experimental fields, Fajr citrus experimental institute. Amount of pectin was determined by acidic extraction from dry albedos of fruits. Degree of estrification and galacturonic acid content were determined by USP standard titrimetric procedure.Results: The highest amount of pectin was found in Italian orange (27%), Shahsavari orange (25%) and Sanguinello (20%) on the basis of dry weight. The highest degree of estrification (11.5%, 10.9% and 9.6%) was found in Lemon, Washington navel and Bitter (sour) orange respectively. The highest galacturonic acid contents were found in Washington navel, Lemon and Italian orange (89.3, 85.4 and 77.7 respectively).Conclusion: Six fruits were suitable for utilization in drug industries including: Washington navel, Acidless, Shahsavari, Italian orange, Bitter (sour) orange (C. aurantium), Lemon (C. limon). Washington navel and Lemon had the most suitable pectin for pharmaceutical purposes.

Background and purpose: Toxoplasmosis is a widespread zoonosis caused by Toxoplasma gondii. In addition to economic losses, this disease is transfer able to human and regarding the special ecological conditions of this parasite in nature of Mazandaran province, it is necessary to determine the situation of the disease. The purpose of this study was to determine the frequency of antibodies against T. gondii in cattle, sheep and goats slaughtered in official slaughterhouses in Mazandaran province, in 2004.Materials and Methods: To determine the prevalence of toxoplasmosis in slaughtered animals, in a descriptive cross-sectional study, 639 blood samples were obtained from cattle, sheep and goats between December 2004 and April 2005, from the three main geographical zones of Mazandaran province, Iran. Nine slaughterhouses were randomly selected in Western, Central and Eastern regions. Sera were extracted from 5mL venous blood samples, by centrifugation at 2000xg for 10 min, and were stored at –20º C prior to testing. Sera were screened for T. gondii antibodies by immunofluorescence antibody test (IFAT) and serum samples showing a titer of 1:16 were further diluted to determine the end point. Data were analyzed using Chi-square (X2) test.Results: Of the 639 serum samples examined, 27.5% (176/639) showed positive titers equal or higher than 1:16 by IFAT. The highest frequencies of antibody titres (1:16 titre) were found in sheep and the least in cattle (9%). The highest infection rates in cattle were seen in western region with 5.5 % antibody titres of 1:16. In three regions, 35% of sheep sera showed positive titers with high frequency of 1:16 antibody titre (17.3%) in Western region. Thirty percent of goat sera in 3 regions were seropositive and the highest infection rate was seen in 1:16 titre (18.5%) in Western region.Conclusion: The results of this study show that the presence of T. gondii specific antibodies for sheep and goats in Northern Iran is high, and the consequent risk of acquiring toxoplasmosis from human consumption of sheep and goat meat may be greater in this region.

Background and purpose: High concentrations of respirable particles may cause high incidence of respiratory diseases and mortality. Epidemiological exposure assessment is based on fixed site measurements in ambient air. However, major studies reported good relationship between indoor fine particulate air concentrations and personal exposure. This study is focused on personal exposure to PM2.5 in different transportation modes and factors that cause high indoor PM2.5 levels.Materials and Methods: In this study, a calibrated real time monitor (MicroDust Pro) was used to measure PM2.5 levels in 3 mode of transportation (bus, car and train) on the same route. Results were also compared with PM10 concentrations measured by fixed site monitors. A small Poly Urethane Foam (PFU) filter was designed for PM2.5 size fraction monitoring and a small personal sampling pump was used to provide a continuous airflow through the gravimetric adaptor and photo detector.Results: The mean PM2.5 concentration measured in the train was lower than the mean fixed site PM10 concentration. However, the mean PM2.5 levels in car and bus were much higher than those mean PM10 concentrations measured by fixed site monitors. Boarding, picking up, dropping off, and movement of passengers inside the bus and train were significantly related to short-term increases in PM2.5 concentrations. However, stopping at the traffic light was the most important factor associated with peak PM2.5 concentrations inside the car.Conclusion: Penetration of particles that were created by road traffic and resuspension of fine particles in the vehicles were the most important factors that may increase respirable particles in transportation modes.

Background and purpose: Preeclampsia as the most common complication of pregnancies has unknown physiopathology. Because the role of serum Beta-human Chorionic Gonadotropin (B-hCG) in pathophysiology of preeclampsia is not well known, we decided to determine the correlation between serum concentration of B-HCG and preeclampsia.Materials and Methods: This case-control study performed on two groups of 40 preeclamptic nulliparous and 40 healthy term pregnant women at obstetrics and gynecology ward of Sh. Yahyanejhad Hospital in Babol during 2003-4. Serum B- hCG concentration was measured in all patients. Patients with chronic hyprtension, diabetes, multiple pregnancies or medial diseases were excluded. The data were analyzed using Chi-square, T-Test and ANOVA, Mann-Whitney and Kruskall-Wallis tests.Results: The maternal serum Beta hCG levels in patients with preeclampsia were (39840±24630) IU/L which is higher in comparison with healthy ones (27460±25862) IU/L (P=0.031). The mean of serum beta hCG levels were 31991±16758 and 84312±9257 in mild and severe preeclampsia (P<0/0001).Conclusion: Serum Beta hCG level is higher in preeclamptic women than normal pregnancies. It is also noticed that the higher the levels of serum Beta hCG the more severe the preeclampsia. This finding, in turn, reinforces the association between elevated HCG concentrations and placental damage.

Background and purpose: Malignancies are the second most important cause of mortality in many countries. Leukemia and lymphoma happen with significantly high incidence rates throughout the world particularly in Iran where it causes remarkable mortality as well as high diagnosis and treatment expenditures for both families and health system. Leukemia and lymphoma totally include about 11 percent of cancers in Mazandaran province. The purpose of this study was a general and specific description of leukemia and lymphoma in Mazandaran province.Materials and Methods: In this study, the medical records of all patients with certain diagnosis of leukemia and lymphoma along with valid laboratory or pathology reports were reviewed from 1376-1382. Data collection was undertaken by Babol health research center affiliated to Tehran University Medical Sciences. This research consists of cross-sectional, descriptive and analytic studies and examines variables including: age, sex, city of inhabitation, year of incidence and type of malignancy. The incidence rates in 100,000 persons of related population have been calculated and analyzed.Results: In Mazandaran province, 1146 cases of leukemia (lymphoidic and myeloidic) and lymphoma (Hodgkin's and non Hodgkin's) were diagnosed from 1376-1382. an average of 5.9 leukemia and lymphoma cases per 100,000 occure annually. The highest incidence rates were obtained at age of 70 or above (26.4) and the least at age of 0-9 (2.26).The incidence rates in males and females were 7.05 and 4.76 respectively and the male to female incidence rate was 1.48. The highest incidence rate was observed in Babol (7.29) and the least was equally calculated in Neka and Tonekabon (1.47). The highest and lowest incidence were obtained in 1380 (7.75) and 1377 (3.15) respectively. Regarding the type of malignancy, non Hodgkin lymphoma, 2.53 in 100000 persons, was the most prevalent and myeloidic leukemia, 1.07 in 100000 persons, the least prevalent cases. Conclusion: The results indicate obvious differences of incidence rate based on age, sex, residence, year of incidence, and type of malignancy. Therefore it is suggested that in addition to promote data collecting program, research projects should be under taken to define leukemia and lymphoma risk factors in this province. By making use of these results, as well as community education, and implementing some rules and regulations, the risk of suffering from these malignancies can be reduced leading to reduction of the burden of the diseases, lost lifetime years and promotion of community health.

Background and purpose: Breast cancer is one of the most important non contagious diseases with high incidence and mortality in females. It is the most commonly reported cancer and consists 18.9% of all reported cancer cases.Screening is a very important method for early diagnosis of breast cancer. Considering the important role of beliefs in performing as the most effective available method in diagnosis, this study was designed and done about the health beliefs of women towards mammography.Materials and Methods: This descriptive study was performed on 400 randomly selected women above 40 years of age referring to the health service centers in Sari. Their health belief about mammography was assessed by a questionnaire using Champion method. The obtained data were analyzed by inferential and descriptive statistical methods.Results: Majority of the women (69.5%) did not practice mammography until the time of this study but 13.9% of their first family members did it. About 55.8% of them accepted that mammography insures individuals of their breast health. About 41.6% of them believed that early diagnosis of breast cancer prevents mastectomy. The most common obstacle of mammography was the concept that lack of any mass observation in breast self examination rejects requirement for mammography. About 34.5% of the patients agreed that breast cancer affects their job activity and 34.7% agreed that breast cancer may lead to mastectomy.Statistical analysis did not reveal any relation between the occupation of the women and their beliefs about benefit of mammography and their vulnerability to breast cancer and its severity. Statistically significant relationship was observed between the education and the concepts of the women about the benefit and barrier of mammography (p<0.05).Conclusion: Despite positive concept, about mammography, it is not routinely performed in the society. Hence, it is recommended to encourage women to take advantage of this method for breast cancer screening and also the procedure should be free of charge for women above 40 years of age attending heath cancers.

Background and purpose: Love is one of the most significant predictor of marital satisfaction. The present study aimed to examine the relationship between three components of love in Sternberg’s triangular theory and marital satisfaction. Reliability and validity of the Sternberg’s love scale was also assessed in this study.Materials and Methods: A sample of 123 married individuals selected by convenient sampling method from various communities were requested to complete three questionnaires: Sternberg’s triangular love scale, marital satisfaction scale (ENRICH) and demographic questionnaire.Results: The results revealed that the Persian version of the Sternberg’s love scale is a valid and reliable scale and the three components (intimacy, passion, commitment) were also significantly related to scores of marital satisfaction. Intimacy was the strongest predictor of marital satisfaction and there was no significant difference in scores of intimacy, passion, commitment and marital satisfaction between men and women.Conclusion: Sternberg’s triangular love scale could be used together with other marital satisfaction questionnaires in marriage counseling. Intimacy score is the strongest predictor of both men’s and women’s marital satisfaction.

A 6 years old girl was referred to Booali Cina hospital, Sari, Iran for abdominal distention. Physical examination showed ascites. The fluid was milky in color. Biochemical test showed cylous ascites. The patient was treated with albumin-Vitamins-YPN. Ascites decreased, but second ultrasonography and abdominal CT showed a solid mass.Laparatomy was done and there was a big mass in Para vertebral area, biopsy confirmed the diagnosis of neuroblastoma.

Tuberculosis especially tuberculous meningitis rarely accurse before 3 months of age. Though treatable, it may be fatal despite modern treatment. The diagnosis of congenital TB/TB meningitis should be considered in any neonate/infant with pneumonia –meningitis who fails to respond to conventional treatment, particularly in a child from ethnic or socioeconomic environment where tuberculosis is prevalent.

A child with aggressive and resistant Kawasaki disease with coronary aneurysm is described. Despite two doses of immune globulin and high dose of aspirin the patient was treated with the third dose of immune globulin. The patient apparently responded to normalization of symptoms and signs, with no more progression of coronary artery abnormalities.

We report a case of a triple pregnancy after tubal ligation (TL) in a 24-year-old woman. The patient found out that she was pregnant about 2 years after TL. A live fetus and two other dead fetuses were reported in sonography at 17th week of pregnancy. In a determined time, Cesarean/Section and TL was done and the single term girl fetus and the two other dead fetuses in a papyrus form on the placenta were born.