MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2005 | Volume:27 | Issue:1|Papers Count:17

Background and Objectives: Pain after laparoscopy results from the stretching of the intraabdominal cavity, peritoneal infiltration, and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Proper postoperative analgesia is essential in facilitating early mobilization and discharge in these patients. One way to achieve this objective might be to infiltrate local anesthetics in the surgical field before surgery, attempting to capitalize on a pre-emptive analgesic effect. This study was performed to evaluate the efficacy of presurgical local infiltration of bupivacaine and intraperitoneal subdiaphragmatic instillation of lidocaine and to minimize postoperative pain after diagnostic gynecologic laparoscopy under general anesthesia.Materials and Methods: In the prospective, double – blind randomized study, 32 female patients with a history of infertility scheduled for diagnostic laparoscopy underwent general anesthesia. In the treatment group A patients (n=17) were infiltrated with 20 ml of 0.25% bupivacaine at incisional areas approximately 15 minutes before skin incision and 40 ml of intraperitoneal subdiaphragmatic 0.5% lidocaine was instillated at the end of laparoscopy. The control group received no treatment. When necessary, voltaren or petidine were administered IM after surgery. Postoperative pain was evaluated with the use of a visual analog scale (VAS) with scores ranging from 0-10 immediately after surgery and over the next 72 hours. The rate at which patients were discharged from the hospital 2-3 hours after surgery also recorded.Results: The treatment group had significantly lower pain scores both immediately after surgery and 12, 24 hours afterwards (P < 0.05). The time to first analgesia was longer in group A patients (p<0.002) .The need for postoperative analgesics also was significantly lower in the treatment group (p < 0.001). The rate at which patients were discharged 2-3 hours after surgery was significantly higher in the treatment group (p<0.001).Conclusion: Presurgical local infiltration of bupivacaine into the trocar insertion sites, and postoperative intraperitoneal subdiaphragmatic instillation of lidocaine of the trocar sites are useful methods for decreasing postoperative pain and analgesic consumption for up to 24 hours after laparoscopic gynecologic examination. In addition, the rate at which patients can be discharged from the hospital only 2-3 hours after surgery is increased significantly.

Background and Objectives: Complete maturation arrest (CMA) is one of the most common pathologic findings in azoospermic patients. The purpose of this study was to assess the results of percutaneous epididymal sperm aspiration (PESA) in these patients.Materials and Methods: From 2000 to 2002, 56 consecutive patients with azoospermia arising from CMA were studied. These patients classified according to the maturation arrest level into two groups: first group had arrested in primary spermatocyte (early), second group had arrested in secondary spermatocyte and spermatid (late). Results of PESA compared with testicular volume, size of epididymis and serum FSH.Results: Mean age of patients was 26.32±5.54. Thirty-two patients had late maturation arrest and 24 patients had early maturation arrest. In late group, spermatozoa could be harvested from epididymis by PESA technique (75%). We couldn’t find any sperm in early group. Main FSH serum level was different between two groups significantly (p=0.001).There was not significant correlation between epididymal distention and testicular volume and sperm recovery.Conclusion: Sampling of testicular biopsy should be reviewed for spermatid. We recommend that PESA attempt should be afforded to all CMA that had positive spermatid in histopathology.

Background and Objectives: The importance of effluent discharge into river and its destructive effects on ecosystems are obvious. Tabriz Power Plant (TPP) effluent discharge into river has negative effects on waterbody (ecosystems), soil, environment and human health. The main goal of this study included the qualitative analysis in relation to environmental polutents in power plant and Talkhehrood river. Then it was compared with Iranian Environmental Standards. Meanwhile, the practical goal was to suggest appropriate means to improve these polutents.Materials and Methods: In this connection, intial contacts were made to plan and coordinate with environmental protection agency (EPA), waste water, and Tavanir, in order to collect samples from Talkherood, and Power Plant effluent to do chemicial analysis, therefore samples were collected four times in each season of the year 1999.Results: The parameters measured include total dissolve, solids, phosphate, temperature, and etc. The comparison of the standard results of our chemical analysis with EPA in Iran indicates, (p=0.029) pH, NO3 (p=0.029) TDS (p=0.029) and temperature (p=0.02) significant differences.Conclusion: The discharge of TPP untreated into the river, based on having no control on the effluent and clarification of it has caused the quality variations in the river water. Therefore, it is suggested to establish a control treatment plant by using filter press and sluge concentration unit in order to bring the effluents polutents to standard levels.

Background and Objectives: Diaphragmatic ruptures are often associated with severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. The aim of this descriptive study was to identify pitfalls in the diagnosis and treatment of diaphragmatic rupture. Materials and Methods: Medical records of 117 patients admitted to Imam Khomeini hospital from 1994 to 2003 with diaphragmatic rupture were evaluated according to the type of injuries, diagnostic methods, associated organ injury, surgical findings, morbidity and mortality.Results: Of patients with diaphragmatic rupture (101 male and 16 Female) 41 suffered from blunt trauma, 74 from penetrating injuries and 2 from iatrogenic traumas. With blunt trauma the rupture was in the left diaphragm in 73.2% 0f injuries, in the right diaphragm in 24.4% and bilateral in 2.4% of injuries. The diaphragm was delayed in 6 (5%) patients, 43 (37%) diaphragmatic ruptures were diagnosed before operation and 74 (63%) during operations. The most common associated injuries with diaphragmatic rupture were the liver (38.46%), spleen (35.04%) and colon (5.98%). Sixteen patients (14%) died due to accompanying injuries.Conclusion: It is important to combine a high index of suspicion with radiological diagnostic tests in patient at risk. Palpation and/or visualization of diaphragm during laparotomy is extremely important in detecting these injuries when they are not under suspicion preoperatively.

Background and Objectives: Linear alkyl benzene sulfonate (LABS) is a substance, that is used in anionic detergents as a surfactant. Nowadays, LABS is the most widely used surfactant in household detergents products after soap. Everyday, LABS enters into the nature as a pollutant by industrial and domestic wastewaters. A bacterial consortium is capable of LABS mineralization under aerobic conditions. This study carried out to consider the role of Pseudomonas and Aeromonas bacteria in degrading of LABS in wastewaters of detergent producing factories.Materials and Methods: In this research, gram-negative rods consisting of three Pseudomonas strains and one Aeromonas strain were used. For determining LABS biodegradation degrees, the method of methylene blue active substance (MBAS) was used. In this method, the microorganisms were inoculated in a container including culture medium and test surfactant. After two adaptive phases, percentages of biodegraded LABS were measured for the test bacteria or the bacterial consortium.Results: Results showed that LABS biodegradation degree was 23.1% by Aeromonas sp., whereas Pseudomonas fluorescens biodegraded 77.95% of this substance which indicates high ability of this bacterium in LABS biodegradation in sewage systems. P. aeruginosa biodegraded 44.85% of LABS which is nearly half of available LABS in growth medium. Also, P. putida could biodegrade 67.5% of LABS. Approximately, 90% of LABS was biodegraded by bacterial consortium in 8 days of biodegradation period which this level was reduced to 85.2% by eliminating Aeromonas sp.Conclusion: Aeromonas sp. as compared to other bacterial strains of Pseudomonas genus, had the lowest ability for LABS biodegradation. Comparing bacteria with one another, P. fluorescens had more ability to biodegrade LABS. The highest degree of biodegradation (>88%) in this survey, was related to aerobic bacterial consortium. The test gram-negative bacilli were able to biodegrade LABS and according to our findings, the bacterial consortium can be used in detergent producing factories refineries, for eliminating LABS from wastewater to acheive low harm in environment as the result of LABS entry into the nature.

Background and Objectives: Elevation of intra ocular pressure after cataract surgery is a common finding. For this purpose oral acetazolamide was used and effects of extracapsular cataract extraction and intraocular lens implantation with hydroxy propyl methyl cellulose were evaluated.Materials and Methods: A clinical trial was performed on 75 eyes of 75 patients. All of the patients underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation with hydroxy propyl methyl cellulose 2%. Acetazolamide was used 4 and 12 h after operation in the case group but not the control group.Results: Pre operative IOP were 14.03 ± 2.85 mmHg in acetazolamide group and were 13.15 ±2.5 mmHg in control group. Difference of mean IOP before and 7h after operation were + 0.5 ± 3.41 mmHg in acetazolamide group (not significant) and were + 4.94 ± 3.71 mmHg in control group (p= 0.0001). Difference of mean IOP before and 24h after operation were - 0.39 ± 2.66 in acetazolamide group (not significant ) and were 5.17 ± 4.05 mmHg in control group (p=0.0001).Conclusion: Use of acetazolamide after extra capsular cataract extraction and intra ocular lens implantation with hydroxy propyl methyl cellulose can prevent of IOP elevation. Therefore routine use of acetazolamide control post operative IOP may be taken into consideration.

Background and Objective: Taking an accurate history and establishing physical examination are the main components of preoperative patients assessment. However, currently neumerous diagnostic and laboratory tests are performed in patients candidated for operation, as preoperative routine tests. These tests partly have no indications and even their abnormal results maybe unuseful in the patient care process during and after operation.Materials and Methods: This study has developed for evaluation of cost – effectiveness in preoperative routine tests. The study has performed retrospectively through gathering information from 500 patients admitted in the surgery wards of hospitals related to Tabriz University of Medical Sciences.Results: The results showed that 68 percent of preoperative routine tests appear to be performed in patients without known indications for that test. Abnormal results of tests without indication including 0.15 percents of cases, were not «significant»; that is, they had no effect on the surgery or anesthesia or patient care processes.Conclusion: This study suggests the unusefulness of preoperative routine tests and emphasizes that selective use of diagnostic tests regarding to history and physical examination is the most effective method for screening the patients preoperatively. So, cost – effectivenessly, canceling a part of diagnostic tests can decrease in as much as 2 billion Rials from the cost of health and treatment annually in East – Azarbaijan, without causing disorder in patients care processes.

Background and Objectives: Cement plays a crucial role in economic and industrial development and its role in developing urban area has always been being insisted .12 cement producing factory are working in Iran that employ at least 10000 presonels. Since cement composed of various artificial materials, disease related to this materials has been always the focus of attention and dermatitis is the most compelling disease that impose cost and waste the working time. This study aims at determing the incidence of dermatitis among workers considering different variables mentioned below.Materials and Methods: This deseriptive study was performed on Suffian cement factory (Tabriz) workers. 542 workers between 21-60 years old were randomely selected. We include different variables such as: work period, type of contact with cement, the place of work in the factory, the duration of work, the site of commencement of the disease and predisposing factors. The worker were asked to fill in the questionaires.Results: Of 542 persons enrolled, 153 (% 27.06) suffered from dermatitis and most of them mentioned that they found their disease first on the palms. Furthure more there was a significant correlation between the place of work in the factory & the rate of incidence. As the workers in loading place suffered more from dermatitis. A direct relationship between the duration of work and the rate of incidence was found.Conclusion: High prevalence of cement dermatitis can be ascribed to lack of direct hygien observations and saltey in the factories. Besides the high potential of inducing allergy in cement should not be reglected. 80 more accurate observations, using preventive messures and also performing more detailed researches on methods to decrease the allergic pottential of cement can reduce the rate of Cement Dermatitis

Background and Objectives: Febrile convulsion (FC) is the most common type of seizure in childhood. The most important factors affecting the incidence of febrile convulsion are age, fever and genetic base. As sodium is important factor in neuronal cell depolarization and production of electrical discharge and finally seizures, we evaluated correlation between serum sodium and ionized calcium in febrile convulsion.Materials and Methods: In this study two groups (53 patients as case and 53 patients as control group) were studied. The case group had fever (at least 38°C) and convulsion for the last 24 hours. Control group had the same characteristics but without convulsion. Serum sodium and ionized calcium were determined in both groups before any therapeutic procedures be established, and results were statistically analyzed.Results: In exposure groups the mean serum sodium level was135.4 ± 4 meq/l, lower than control groups (137.94 ± 2.92).There was statistically significant difference between two groups(P<0.001).But serum ionized calcium in two groups had no meaningful difference(P=0.460).Conclusion: Although sodium plays an important role in cell physiology and neuronal stimulation in developing seizure, according to the study and literatures as well, it would be better to conduct extensive studies on the likliehood of correlation between serum sodium level and febrile convultions.

Background and Objectives: Pemphigus vulgaris with chronic Presented mucocutaneous bulla and erosions is the most prevalent form of chronic bullus diseases all over the world. It would be fatal if remains untreated or delayed. The treatment has always been controversial. This study was concluted to make comparison between the results of conventional treatment (oral corticosteroids and immuran) and that of cyclophosphamid and corticosteroid pulse therapy.Materials and Methods: This study is a longitudinal randomized clinical trial. Patients were randomly selected. In this survey we analyzed the results of randomized treatments in 85 patients who were hospitalized in dermatology ward of Sina hospital from 1995 to 2001 during 4 months after treatmentResults: Of 80 patients enrolled, 60 were treated with conventional therapy. Abort which 37 (61.4%) patients showed complete remission, 16 (28. 7%) noted partial improvement and 6 (10.8%) patients showed no changes in their disease course. The rest of the patients (25 individuds) were treated with the second method. Of Twenty four Patients ( 96%) showed complete remission and in one patient (4%) no improvement was observed . Most of the patients were aged between 40 and 50 years. The average time of hospitalization for conventional and cychophosphamid pulse therapy was 42±8/5 and 16±1 respectively.Conclusion: According to statistical methods we concluded that pulse therapy would be more efficient as well as harboring less complications. The average time of hospitalization was lower in those with pulse therapy than those with conventional treatment. So it would be prudent to evaluate more patients with pulse therapy and analyze the results in prospective studies.

Background and Objectives: Structure of a eukariotic gene consists of different parts at upstream and downstream regions of genes. These parts include promotor, special motifes before start codon, start codone, exprerssion regulatory sequences, conserved sequences during evolutionary, intron(s), exon and their especial elements and finaly the sign of poly A tail.Materials and Methods: During this study using degenerate PCR and Inverse PCR (IPCR) search for detection and sequencing of plb2 gene from A. fumigatus was carried out. Then, the arrengement of gene structure elements was considered in this gene.Results: Analysis of plb2 gene showed specific sequences on upstream and downstream regions of the gene. At the upstream part of the gene there are three TATA box or TATA resembling sequence in -71 – 252 positions of +1 nucleotide, two CAAT motifes in -124 and -227bp positions, two CAAC motifes in -146 and 306bp position from +1 nucleotide and an unusual GTG start codon after three nucleotide of the last CT (pyrimidine) rich region. Also several CT rich areas, one 59bp intron with the usual TACTCAC internal nucleotide, six GATA effective motifes as expression inhibitor under nitogen influence (AREA) at the upstream region and a GTGGGG sequence as effective motife for expression inhibitor under the influence of cabon (CREA) were investigated. Gene regulator sequences under the effect of pH (PACC) was not detected in this gene.Conclusion: Analysis of plb2 gene showed typical characters of a eukaryotic gene structure including TATA box, CAAT, CAAC and CT rich sequences at the expected distance from +1 nucleotide. Also, sequenced gene had an unusual GTG start codone, one intron like introns of phospholipase genes in other fungi, gene expression regulator sequences under nitrogen and carbon influence but not gene regulator sequences under effect of pH.

Background and Objectives: The relation between clinically obvious polyhydramnios and poor perinatal outcome has been described. Much less is known about mild unexplained polyhydramnios which usually is initially suggested by sonography late in gestation. The purpose of the present investigation was to relate mild idiopathic polyhydramnios to perintal outcome.Materials and Methods: we selected 1000 pregnant women from five health centers overs 12 month period and performed sonographic examinations monthly after 26th week of gestation. All subjects had singleton gestations not complicated by conditions known to be predisposed to polyhydramnios. Mild polyhydramnios was defined sonographically as an amniotic fluid index of 24.1-39.9.Results: we dignosed mild polyhydramnios in 125 out of 1000 patients (12.5%) undergoing sonography at 26-42 weeks of gestation. The mild polyhydramnios group showed a significantly higher incidence of birth weight greater than 4000 gr than did the control group (18% versus 8.6%, p<0.05).Conclusion: we conclude that diopathic polyhydramnios in late gestation is relativily common. Except for a higher incidence of large for gestational age fetuses. This condition by itself is not associated with an increased risk of adverse perinatal outcomes.

Background and Objectives: Use of sutureless 3.2mm clear corneal and 5.5mm scleral incision in phacoemulsification cataract surgery and comparison of postoperative keratometric results in them.Materials and Methods: This semi-experimental study was done on 100 eyes of 97 patients in 2002. Phacoemulsifcation cataract surgery was performed with foldable acrylic lens in 3.2mm clear corneal incision (70 cases) and small optic, P.M.M.A lens in 5.5mm scleral incision (30 cases). Both incisions were made in superior vertical meridian and keratometric alterations recorded preoperatively 5 days, and 3months after surgery. Comparison was done with T test & simple subtraction and polar – value methods.Results: The study was conducted in equal number of males and females with mean age of 66.41, with superior sutureless clearcorneal (S.S.C) and superior sutureless scleral (S.S.S) incisions. In S.S.C group, the mean amount of preoperative astigmatism (0.81D) raised to 1.44D in 5 days and 1.06D in 3months after surgery. That is, mean astigmatism 3 months after sugery raised 0.25D with respect to the preoperative amount. In S.S.S group, the mean amount of preoperative corneal astigmatism (1.09D) raised to 1.12D in 5 days after surgery and 3 months after operation reduced to 1.02.That is, there was 0.07D reduction in mean corneal astigmatism 3 months after surgery with respect to preoperative Value. Number of eyes with W.T.R astigmatism from 46 cases before surgeries reduced to 15 cases after the operations. Number of eyes with A.T.R astigmatism raised from 29 cases before surgeries to 60 cases after those.Conclusion: 3 months after phacoemulsification cataract surgery with suture less 3.2mm Clear corneal and 5.5 mm Scleral incisions, very little amount of Corneal astigmatism was induced. Thus, small incisions were ideal for cataract surgery with many advantages.Comparison of S.S.C and S.S.S incisions suggest that there was no significant difference between the two incisions. We recommend S.S.C incision for easy phaco cataract surgery.

Schwartz Jampel syndrome or chondrodystrophic myotonia is an autosomal recessive syndrome, that is presented with stiffness, short stature, muscular hypertrophy and severe voluntary and percussion myotonia.In this report a 6 y/o boy from Tabriz is Presented who developed slow movement and gait distrubances since infancy. On exam he had facial dysmorphism, low set ears, thightness in achille and hamstrings and muscle stiffness. In electrodiagnostic study, motor and sensory NCS was within the normal range, and RST was normal. On needle EMG examination continuous, spontaneous high frequency electrical discharges (neuromyotonia) were observed in some muscles of lower limbs and face. Mild improvement was seen with carbamazepin.

Thyrosinemia type 1 is an autosomal recessive inherited disorder caused by deficient fumarylacetoacetate activity. Treatment with 2-(2-nitr-4-trifluro-methylbenzoyl)-1,3-cyclohexanedion (NTBC) an inhibitor of 4- hydroxyphenylpyruvate dioxygenase, has successfully been applied for the last few years. In this paper one patient with the diagnosis of tyrosinemia type1 has been treated with NTBC and restricted diet. Within five years follow up, patient’s signs and symptoms alleviated and no evidence of hepatocellular carcinoma developed and the patient’s growth and development were normal. This drug was as effective as showed in similar studies. The needed amount of NTBC for this patient to live normally is provided through a Franch company with difficulties. The patient’s life depends on continuous availability of this drug.