Journal of Mazandaran University of Medical Sciences
Year:2008 | Volume:18 | Issue:65|Papers Count:15

Background and Purpose: One of the important problems of major abdominal surgery is postoperative pain control. There are different modalities to control the pain after surgery, such as oral, local or intravenous analgesic drugs, regional nerve block, epidural catheters and pain killer pumps with their own benefits and complications. The aim of this study was to evaluate the effect of continuous peritoneal infusion of lidocaine by a pain killer pump for post-operative pain management following laparotomy.Materials and Methods: This double blind randomized clinical trial was performed on 76 patients (38 cases and 38 controls) who underwent laparotomy with midline incision, in Imam Hospital, Sari, Iran, in 2008. Two groups were matched in age and sex. After surgery a catheter infusion pump was prepared for all patients. In case group, 2% lidocaine (20 mg/kg/day) and for control, normal saline infused for 24 hours. Pain score (Visual Analog Scale), blood pressure, heart rate, respiratory rate, temperature and analgesic requirement was evaluated in 4, 10, 16 and 24 hours after surgery. Results analyzed by means of SPSS (15) software and chi-square, t test and repeated measurement. The p value less than 0.05 was considered to be significant statistically.Results: 76 patients, 39 (51.3%) females and 37 (48.7%) males, with mean age of 47.03±15.2 years were studied. There was no significant difference in age, sex and weight between two groups. The mean of admission days was 5.03±0.6in case and 5.29±1.3 in control, with no significant difference between them. Mean of opiod consumption was 16.05±13.05 mg and 25.39±11.4 mg in case and control respectively (P= 0.002). Mean of VAS score, blood pressure, heart rate, respiratory rate and temperature in case group was less than control group and the difference was significant statistically. Pain severity changes during 4, 10, 16 and 24 hours following surgery were significantly different in two groups, with linear correlation between time and pain reduction.Conclusion: Our study demonstrates that continuous infusion of 2% lidocaine by a pain killer pump can reduce pain and opioid requirements after abdominal surgeries.

Background and Purpose: There is evidence in literature that IVI is the first line treatment and the most cost-effective procedure for mild to moderate male factor sub-fertility, however, the relative influence of various semen characteristics with the likelihood of a successful outcome is controversial.This study is designed to show the correlation between semen parameters and the pregnancy rate in patients, with mild to moderate male factor sub-fertility and whose wives were normal and underwent hyper-stimulation, including IUI.Materials and Methods: From January 2005 to January of 2006, 95 couples with male factor infertility underwent 140 IVI cycles with husbands washed semen were included in this study .They were divided into two groups based on semen parameters, mild and moderate. Post- wash sperm parameters, type of infertility (primary and secondary), male / female age and duration of infertility were evaluated and correlated with clinical pregnancy outcome.Results: The clinical pregnancy rate per cycle was 26 (18.5%); 15 (21.4%) in mild group, while 11 (15.7%) in moderate group. The clinical pregnancy rate per couple was 27.3%.There were significant correlation between female age, duration of infertility, sperm concentration and progressive motility, and clinical pregnancy.Conclusion: Our findings suggest that post- wash sperm concentration and progressive motility, female age and duration of infertility are the most important factors for prediction of successful pregnancy.

Background and Purpose: Pre-menstrual syndrome (PMS) is one of the abnormalities associated with pre-menstrual cycles. Approximately 85% to 97% of women are suffering from psychosomatic of physiological and behavioral symptoms from PMS, prior to menstruation. The most common PMS symptoms include: f1atulence, stress anxiety, breast tenderness, depression, fatigue, unknown irritability, anger, poor concentration, and some degree in extremities edema. There are several therapeutic methods for PMS such as: oral contraceptive pills, GnRH antagonisms, diazole, use of Calcium and vitamin supplements, and dietary modification in which there is a controversy regarding type of diet. We assessed the effect of third- hour starch dietary regimen on pre-menstrual syndrome among high school students.Materials and Methods: This randomized quasi- experimental study was performed on students in grade 2 and 3 in Private and Governmental high schools in Sari. The sample size was calculated using randomize numbers table (478 participants). A questionnaire composed of two parts was prepared. The first part included demographic characteristics, while the second part consisted of data related to history of menstrual cycle, pervious diseases and use of drugs. The symptoms of PMS were assessed at the beginning of the study and also at the end of the first, second and third month after beginning of the third hours starch regimen. Data was gathered by self-reporting technique, analyzed by descriptive and comprehensive statistical techniques.Results: The age range of participants was 14 to 19 years of age (16.89±1.12). The mean of menstrual cycle was 28.87±2.1 days, and the mean of menstrual duration was 6.32±1.8. PMS symptoms score was 12.85±8.01 prior to dietary regimen, and at the end of one, two and three months, following dietary regimen in-take were 11.03±7.59, 12.47±7.79 and 11.13±6.71 respectively. This study indicated that there was a significant difference among the groups.Conclusion: The results of this study revealed that carbohydrate-rich diet in-take can improve PMS syn1ptoms. Therefore, it appears that codified teaching programs via medical health service and instruction to the students, is beneficial about the effects of diet on relieving PMS symptoms, and can reduce the usage of drugs during menstrual cycle.

Background and Purpose: Shoulder pain is a common complication from stroke that may cause some rehabilitation limits to achieve functional goals. The information regarding its prevalence and associated factors is limited. This study was conducted to investigate further details pertaining to its associated factors.Materials and Methods: This study was performed on 191 stroke patients at the Physical Medicine and Rehabilitation Ward at Shiraz-Medical School from 2001 to 2004. Each patient was fol1owed up for one year. A questionnaire was prepared containing information about shoulder pain compliant, thorough history and physical examination, previous history of open heart surgery, scoliosis, limited neck range of motion, type of stroke (based on MRI and brain CT), osteoporosis (based on bone mineral density and X ray), shoulder adductor muscles and biceps spasticity (based on ashworth scale). In follow-up,risits bi-monthly for one year, the questionnaire was filled out again and if present, shoulder pain was recorded.Results: Most patients developed shoulder pain between 2 and 6 months following their stroke.Forty-nine patients (32.2%) developed shoulder pain, 39 (79.6%) of whom had spastic tone and 8 (16.3%) had flaccid tone. In both groups, with shoulder pain and without shoulder pain respectively, 6.7% and 1.9% had a history of open heart surgery, 6.1% and 1% had scoliosis, 67.3% and 35.1% had Intracranial hemorrhage, 73.5% and 23.3% had limited neck range of motion, and 24.5% and 35% had osteopenia.Conclusion: Spasticity was significantly more common in the shoulder pain group, which can be due to capsulitis, soft tissue inflammation (especially ligament and rotator cuff muscle) and anteroinferior subluxation of the shoulder. There was a significant statistical correlation between intracranial hemorrhage, reduced neck range of motion, and hemiplegic shoulder pain. It appears that treatment and rehabilitation of spasticity and underlying cervical area problems are helpful in preventing hemiplegic shoulder pain.

Background and Purpose: Pre-eclampsia is a pregnancy disorder which increases maternal and pre-natal morbidity and mortality. The incidence is about 5% and is influenced by pariety, genetic background, and environmental factors. At present, the sole treatment is termination. It is suitable to use antioxidants for pre-eclampsia prevention. The aim of this study is to measure the maternal serum ceruloplasmin and evaluation of changes presented in pre-eclamptic women VS. Non pre-eclamptic ones.Materials and Methods: This study is executed in a case-control method. 100 cases were selected through pregnant women bedridden from obstetrics-gynecologic and maternity ward of Imam Khomeini Hospital in Sari. After examination of exclusion criteria in each case and receiving consent, information was entered in the questionnaire. Venous blood samples were sent to laboratory to measure ceruloplasmin. Data was analyzed by independent t-test.Results: The gestational age means in case and control groups were serially 36.01±2.90 and 37.86±2.82 weeks. The mean for systolic blood pressure for these two groups were serially 153.40±12.22 and 112.5±8.90 mm Hg. The average amount of serum ceruloplasmin in case group was significantly more than control group. 63.3% of women in the case group were in early pre-eclamptic phase and 36.7% of them were in late phase. 22% of women in this group had a history of pre-eclampsia in previous pregnancies and 16% additionally had a history of hypertension before pregnancy. 92% of women in the case group had an extra normal serum ceruloplasmin, while in the control group the number was42%.Conclusion: The variables of Body mass Index, Systolic and Diastolic blood pressure and ceruloplasmin showed a significant difference between case and control groups. The history of preeclampsia and hypertension were effective on the appearance of pre-eclampsia and increased in serum ceruloplasmin, can be considered as an early sign, while having a correlation with pre-eclampsia severity.

Background and Purpose: According to the previous studies, Toxoplasma gondii excreted / secreted antigens (EISA) appear to be suitable marker for serodiagnosis of toxoplasmosis. Most of the previous studies used whole E/SA. The present study was carried out to evaluate the ELISA method using E/SA components from Toxoplasma gondii tor the diagnosis of toxoplasmosis.Materials and Methods: Components obtained by incubation of tachiziotes at RPMI-1640 culture medium were purified by Ion exchange chromatogeraphy and fractions were analyzed by native-PAGE electrophoresis. Forty noninfected rats were injected as IP with 4x106 Toxoplasma tachyzoites and their serum samples were collected at 8, 15, 22 and 60 days after infection then were tested by dye-test. Based on these results the sera of 15 and 60 days were selected and tested by ELISA using E/SA.Results: Second fraction of chromatography was selected as antigens. The cut -off point of ELISA with 99% confidence was found to be 0.41. Optical density of all sera samples of 15 and 3 of 60 days after infection and 2 negative sera were over the test cut-off. Therefore sensitivity and specificity of the method were determined to be 100% and 91% respectively.Conclusion: These results indicated that the second fraction of Ion exchange chromatography of Toxoplasma E/SA under these conditions may be useful tool for the serediagnosis and differentiation of acute and chronic phases of toxoplasmosis.

Background and Purpose: Hospital admission for surgery is an important event for patients.Canceling surgical procedures produce several unpleasant results for patients such as waste of time, including payment. The aim of this study is to identify the prevalence and causes of canceling surgical procedures, in order to achieve problem solving methods.Materials and Methods: This is a descriptive cross-sectional study. Statistical data regarding all surgical procedures (without sampling) performed during 2006 to 2007, were recorded in a checklist.Study variables were identified based on surgical procedures that were canceled during this study. Data was analyzed using SPSS software and statistical analysis tests.Results: Of 4.711 scheduled patients, 510 (10.9%) surgical operations were canceled. The highest number of patient candidates for surgical operation was related to gynecology, orthopedic, urology, while the least were related to reconstructive and vascular surgery groups respectively. The most canceled surgical procedures were related to neurosurgical operation 32.4% (68 from 207 cases) while the least canceled cases belonged to gynecology 4.4% (48 from 1094 cases).Conclusion: The results of our study showed that 54.2% of canceled cases were preventable. The results of this study and similar studies demonstrate that traditional pre-operative preparation for surgical scheduling, day before surgery is in need of serious consideration. We recommend a fundamental change by discarding traditional methods and creating a new committee including specialized bed or resource groups, monthly management meetings to discuss causes of canceling surgical procedures, in order to reduce its occurrence. Thus, decreasing the rate of canceling surgical operations can save hospital financial resources, preventing time wasted, while reducing anxiety in patients and their family.

Introduction: Lumbar segmental instability is one of the subgroups of non specific chronic low back lam and it seems that 30-40% of patients with LBP suffer from lumbar segmental instability. Pain intensity, functional disability and reduced muscle endurance are common in such patients. The aim of this study was to evaluate the effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspected to lumbar segmental instability.Material & methods: Following ethical approval, a randomized clinical trial was carried out on 30 patients suspected to lumbar segmental instability ranging from 18-45 years old. They were randomly divided into two groups; the first group underwent routine exercise only while the second group performed routine exercise plus stabilization training tor 8 weeks. Outcome measure included pain intensity, functional disability, and flexion and extension range of motion and flexor, extensor and side support muscle endurance which were evaluated before and after treatment. Data were analyzed using paired t test and independent t test.Results: Muscle endurance and flexion range of motion increased in both groups although the increase was higher in stabilization training group (p=0.00).Pain intensity and functional disability significantly decreased in both groups (p=0.00), but decreasing of pain intensity and functional disability were more in stabilization training group (p=0.00).Conclusion: Stabilization training is more effective than routine exercise in improvement of pain intensity, functional disability, muscle endurance and range of motion in patients suspected to lumbar segmental instability.

Background and Purpose: Childhood overweight and obesity can be an underlying cause of atherosclerosis. An early stage of atherosclerosis is shown by intimal thickening. The purpose of this study is to evaluate intima-media thickness (IMT) of carotid arteries on 12 to 18 years' old obese children in comparison to control group.Materials and Methods: In a case-control study, height, weight, blood pressure, cholesterol, triglyceride, mean IMT of body and bulb of carotid artery (of both sides) were measured in eighty (40 obese & 40 normal), 12 to18 years old students. Data was analyzed by X2 and student - test in SPSS-15 analytical software at P<0.05.Results: The mean age in obese and control groups were 13.9±1.7 and 14.4±1.9 years respectively (P=0.192) .The mean weight, cholesterol and triglyceride in the obese group was 72.05 kg, 175.9 mg/dl and 154.9 mg/dl. In control group, 47.9 kg, 146.9 mg/dl and 90.05 mg/dl respectively (P<0.000). The mean carotid artery IMT in obese and control groups were 0.4806, 0.4167 (P<0.00) and the mean IMT of bulb were 0.4885, 0.4362 (P<0.00) respectively.Conclusion: Increase in IMT of body and bulb of carotid artery, were Shown obese adolescences and these increases of thickness were associated with high blood levels of cholesterol and triglyceride.

Background and Purpose: The obstruction of the upper respiratotri for tract (URT) is one of the most important reasons patients recurrent referral to the ENT clinic. Adentonsilar hypertrophy is almost common reason of the upper respiratory tract obstruction, and it will cause some changes in lung volumes and also in blood gases. The purpose of this study was to determine the effects oftonsilJectomy on respiratory symptoms and arterial blood oxygen saturation.Materials and Methods: In a clinical trials study, in a pre and post operative manner, 62, 2-14 years old children were imposed to adentonsilectomy in an easy sampling way. The respiratory symttoms such as: snoring, dyspnea, feeling airway obstruction, mouth breathing and oxygen saturated hemogolobin condition (Spo2), prior to surgery and one month after operation, has been studied and recorded. The results were compared with paired t-test.Results: In a preoperative manner, 80% of patients had mouth breathing symptom and mouth dryness which were reduad? To 10% after surgery.Spo2 measurement had no significant difference before and after surgery, and, it was in a normal range.Conclusion: The correction of respiratory obstruction due to adenotansil is hypertrophy does not make any changes in arterial blood oxygen. The surgery which is used for correction of these obstructions, whill just improve the clinical respiratory symtoms such as snoring and mouth breathing.

Background and Purpose: Asthma is the most common chronic disease in children. The aim of this study was to investigate the relationship between pre-term delivery and breastfeeding with asthma.Materials and Methods: We studied 228 asthmatic patients who were referred to the Allergy Department in Children's Medical Center (Tehran). Asthma was diagnosed based on the history, physical exam and dspirometery (if possible) by an allergist. Pre-term and method of delivery was on delivery card and breastfeeding duration (divided 6 months or more), was based on Mothers statement to gain data and was analyzed by T-test.Results: 228 asthmatic patients (aged 5-17 years) of who were 132Males and 96 Females.216 cases were term and 12 cases pre-term. Exclusive breastfeeding duration for at least 6 months was reported in 183 cases. Cesarean section was in 78 cases (34.22%), while nom1al delivery was observed in 150cases (65.78%).Conclusion: In this study, breastfeeding (at least 6 months) and normal delivery can be decreased by asthma; however, pre-term delivery was not affected by the asthma prevalence.

Fever is considered a common symptom in children. Periodic fever with less luadeuce produces additional complications. In this study, we present a rare periodic fever syndrome which contains; aphthus stomatitis, pharyngitis and cervical adenitis (PFAPA) in a 3 year old child with typical symptoms. His fever was present for 2-4 days (100%), in addition, cervical adenitis & pharyngitis associated arthritis (only one tries) was observed. The sedimentation rate was increased. Its treatment consisted of antipyretic and corticosteroids. This lead to a good prognosis and with the passage of time had a complete resolution.