MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2000 | Volume:34 | Issue:45|Papers Count:30

One hundred patients with severe low back pain were studied after routine physical examination for clinical diagnosis of radiculopathies.Electrodiagnostic examination (EMG, NCV) were performed for all 100 patients. Of 100 patients 62 were male and 38 female.The highest incidence of low back pain was in 3rd/4th and 5th decade of life. Paresthesia was present in 95 patients with radiculopathy, but SLR was positive in 57 patients. 65 patients had history of heavy weight lifting, most of them were workers, Clerical staff and housemaid women who were working in agriculture fieldes.The most involved root was L5, that was noted in 41 patients. the second most involved root was SI which was observed in 28 patients.The involvement of L5 root was more common in males than females, but in females the involvement of SI root was more common.

This study conducted on 56 jaundice neonates in Tabriz children hospital to determine validity (Sensitivity, Specificity, Predictability) and the estimation of the severity of hyperbilirubinemia through the neonates skin with icter. The results showed: Sensitivity of the method is 85%, and its specificity is between 60-100%. It means that whenever icter reaches to plantar area in 85% cases; its level is more than 20mg/dl; otherwise there is no hazard emerged from the bilirubin of more than 20mg/dl in 60-100% cases.

Achieving to the new goals in a dynamic management at the nearest time need that all the people involved in the system be familiar with all difficulties and limitations of the current position and believe in solutions that would be able to change the situation to the better way.For health units, and success of the PHC programs in this study, the management used all the personals and possibilities for building the health units in summer 1997. This was a huge cooperation between people and technology. Cooperation found very important in the success of PHC.During 4 to 5 months more than 600 buildings with full standard measures were made. It is important to mention that since beginning of health system only 244 units of health buildings were already made in 1200 rural area of East Azarbayjan. In this province the Tabriz university of medical sciences achieved to all of its second developing programs. Giving priority to health, the university provides a good condition to referring system, also made a good progress in publicity of nationalized medicine.The results of this program has proved once more that, the government by correct locally management and with getting help from people would achieve to its important political, cultural, social and economical aims.

There are continuing efforts to find antepartum tests that can identify the fetus destined to suffer asphyctic preinstall death. Such tests have focused increasingly on fetal biophysical events.At present however the biophysical profile can be applied practically in larger hospitals because the average testing time is at least 24 minutes per patient. At Tabriz medical sciences university, the authors performed biophysical profile testing on 30 fetuses with acoustic stimulation.Used a buzzer like device with output intensity of approximately 104 dB at the skin surface of the mother. The total testing time reduces to 5 minutes with acoustic stimulation (p<0.001).

Sinusitis, defined as an inflammatory process of the mucous membranes of the paranasal sinuses.The risk factors for causes of sinusitis include allergy, compromised immunologic function, anatomical deformity (i.e., septal deviation, turbinate hypertrophy, adenoid hypertrophy and foreign bodies). Sinusitis results from any condition causing ostial obstruction. abstraction of this space causes stagnation of secretions and ideal conditions for bacterial growth develop.In our studies nasogastric tube was a foreign body in nasal cavity. In patients with N.G.T for 7-10 days studies of sinuses before and after N.G.T. used. Maxillary and ethmoid were most common sinuses that infected. Early diagnosis and treatment of sinusitis is necessary, because if untreated, the infection spreads to bones and other organs, ie , eyes, brain. Of 100 Patients that had N.G.T, sinusitis observed in 23 patients.Antibiotic therapy is advised for patients having gastric tube as prophylaxis against sinusitis.

We have evaluated 45 episodes of fever and severe Neutrogena, with ANC (Absolute Neutrophil Count) of 92/mm3 and range of 500/mm3-10/mm3 in 38 children with immunocompromising underling diseases, generally post chemotherapy, in a period of 18 months. Their underlying diseases were mainly ALL (Acude Lymphoblastic Leukemia) 62.5% and AML (Acute Myeloblastic Leukaemia) 13.5%. Blood cultures were positive in 24% of episodes, and cultures of localized infectious sites in 7%. The infection was diagnosed clinically and/or radiographically in 37%, but there was no apparent cause for fever in 32%. Gram negative enteric microorganisms were isolated in 61.5% and gram positives in 38.5% of positive cultures, E.coli 22.5%, Staph. epidermidis 16.5%, Staph. aureus 16.5%, Pseudomonas aeruginosa 11% , Klebsiella pneumonia 11% , Providencia spp 11%, polygroup Salmonella 5.5%, and P hemolytic Strep. 5.5%. Herpes Zoster virus and Candida were main non bacterial pathogenes. The main localized infections were: pneumonias 23%, gingivostomatitis 23%, I.V. line infection 11.5%, perianal abscess 7.5%, septic arthrtis 4%, G.I. infection 4%, periorbital cellulitis 4%, surgical wound infections 4%, subcutaneous abscess 4%, esophagitis 4% and vulvovaginitis 4%. There was very good response to the first line antibiotics (Amikacine+ Ceftizoxime) in 77% of episodes. In 7% of episodes recovery came after adding another antibiotic(s), and in another 7% after complete change of antibiotics. Four patients (9%) died due to polymicrobial sepsis (3) and disseminated H.Z.V infection (1).

In traditional medicine some of plants have been used as analgesics. The aim of this search was evaluating of the analgesic effect of zingiber officinal that is used traditionally for relief of headache, rheumatic arteritis and tooth pain.For this purpose the suxhleted and perculated extracts of zingiber, with different doses, 50,75,100mg/kg, were injected intraperitoneally to mice and the analgesic effect was determined by formalin test.The data indicate that the injection of zingiber extract with different doses, 15 min before formalin injection, induced significant analgesia (p<0.01), and there was no statistically significant difference in analgesic effect between the suxhleted and perculated extracts of zingiber.

Guillain-Barre syndrome (G.B.S) is a clinically defined condition in which acute inflammatory demyelization polyradiculoneuropathy is one pathological substrate. The syndrome occurs in all parts of the world and at all ages.The present retrospective study was carried out in 264 patients, with the purpose of assessing: (1) the age and sex distributions of patients, (2) the antecedent events and seasonal distribution, and (3) the pattern of cranial nerve involvement.The results obtained showed that the cases occurred at all ages. Yet the distribution for decade of age, demonstrates a large peak in frequency in second decade, and a minor peak in the sixth decade.The sex distribution shows a male predominance with the male/female ratio of 2:1.With respect to antecedent events, the preponderance of acute infectious illnesses, particularly upper respiratory tract infections is observed.The cases studied in present investigation indicate no seasonal preponderance.With respect to cranial nerve involvement, the facial nerve palsy is about 24% and other cranial nerve palsies usually come later.

Tibial shaft fractures are the most common fractures of long bones in the body. We have studied complications and outcome of this fracture in 75 cases, hospitalized between years 1994-1997 in Shohada centre of orthopedic surgery, Tabriz. 23% of patients were female. Average age was 31 and most frequently between 20 - 30 years of age. Mean period of complete union was 17.2 weeks, mean time of PTB application 4.3 weeks, and the prevalence of nonunion, 13%. Average shortening of limb was 6.5 mm with rang of 0-3.5cm. Malunion was so common (40%), but almost always in acceptable range.

Stenotrophomonas maltophilia is an important opportunistic nosocomial pathogen, causing some infections particularly in immunocompromised patients.Chemical composition of this organism alters with variation in growth temperature. Alteration in fatty acids, proteins and lip polysaccharide (LPS) of this organism was studied. In analysis of fatty acid methyl esters, 11 fatty acids of 12:0, 14:0, i-15:0, 15:0, 16:0, 16:1, i-17:0, i-17:1, 17:0, 18:0 and 18:1 were identified. The most abundant fatty acid was i-15:0. Other abundant fatty acids were 16:0, 16:1, i-17:0 and i-17:1.In electrophoretic analysis of whole cell proteins, bands of c. 65, 55, 42.5, 26 and 21.5 kDa were increased with increasing incubation temperature, and intensity of c. 30.5 and 24 kDa bands were increased with decreasing incubation temperature.In LPS analysis, molecular weight of a-specific chain in ladder pattern decreased with increasing incubation temperature. The role of increasing unsaturated fatty acids with decreasing temperature to maintain membrane fluidity and. some of proteins in permeability to some antibiotics and also LPS alteration with changing temperature are discussed.

As the production, distribution and consumption of iodized salt has been increased in recent years, this study was carried out to monitor the IDD control program in Tehran, in 1996.931 children aged 6-10 years of Tehran were randomly selected. Thyroid size was examined by palpation and graded according to WHO classification. In 118 children selected randomly thyroid size was determined by ultrasonography and urinary iodine was measured by digestion method.Percentage of grades 1&2 goiter were 50 & 28 in girls and 48 & 28 in boys, respectively. Mean urinary iodine was 17.5±5.6 mg/dl. It was below 2 mg/dl in 1.6% and above 10 mg/dl in 91.1%. Thyroid volume in children was 4.3±1.9 ml (in 33% above the normal limit). No correlation was established between urinary iodine and thyroid volume.This study shows that iodine intake in the majority of children in Theran is adequate.

The population, as a factor, has an important role in the economic growth. Population in itself is affected by knowledge, attitude and practical women of 15-49 years age in relation to regulate the population.This study is a comparison between literacy, fertility and occupation among the married women which are 15-49 years old in the years 1977, 1993 and 1996 in Tabriz. The results show that literacy level of women in Tabriz has increased from 24% to 70% and the first average pregnancy age has increased from 17.2 to 19.5 years. The total fertility has decreased from 4.3 to 2.7 each women and the proportion death rate of children have decreased from 0.25 to 0.04.43% of women have been pregnant more than 5 times in 1977 but it was only %15 in 1996. The abortion ratio has increased from 0.014 to 0.144 and the occupation rate had decreased from 6.5% to 3.8%. χ2 test in all of the studies was (p<0.001) .The statistical analysis was significant in all cases (p<0.001).So it is suggested that the internal and external capitalization should be encouraged and the factors such as inflation and increasing in the medical and training expenses should be reviewed.

Forty three head- injured patients who had tracheotomy were followed during rehabilitation by fiber optic laryngoscope. Complications of aspiration 20 cases, airway stenos is 11, and phonation dysfunction in 14 cases were followed. Spontaneous resolution of aspiration may require a prolonged period. Majority of patients (32 cases) improved and decanulated. prognostic factors correlated to eventual decanulation included age, level of Glasgow coma scale and type of head injury. Those with poor neurologic improvement and glotic incompetence are poor candidates for decanulation (22 cases). Significant airway stenosis can involve both laryngeal and tracheal sites. Neurologic dysfunction may complicate the decanulation process after airway anatomy has been restored by surgery. Dysphonia resulting from intubation, peripheral laryngeal nerve injury or central dysfunction are common. Preventive maintenance with ongoing evaluation can avoid airway crisis such as aspiration pneumonia, hemoptysis, and in nominate artery lesion.

Which therapy should be adopted as the definitive treatment with alleviation of suffering with the minimum of unnecessary invasive methods:We reviewed the 579 patients treated in our department from Sep 1990 to Oct 1995. They included 236 cases of lung cancer, 53 case of bronchiectasis and 290 cases of nonsorgical empyema. 12 cases of lung cancer and 5 cases of bronchiectasis developed empyema postoperativly. There were 4 cases of empyema necessitates. There were 25 cases of bronchopleural fistula, and was diagnosed by persistant air leakage from chest tube. If bronchopleural fistula was not present, empyema cavity was vigorously irrigated with saline and appropriate antibiotics. If bronchopleural fistula was present irrigation was cautiously irrigated.After open window thoracostomy muscle plombage and omental flap was some times performed.Empyema occurred in 10-12% of pneumonectomy. There were 85 females ans 222 males. Empyema developed from 27 days to 4 months, after the initial thoracostomy. 25 cases had bronchopleural fistula. All empyemas without bronchoplemal fistula were treated with closed drainage and irrigation.The outcome was good. All 25 cases of bronchopleural fistula treated first with closed drainage and cautious irrigation, when empyema was diagnosed concurrently. Nine cases died. Nine cases required open window thoracostomy. Four cases required omentopexy. The other 3 cases treated with closed drainage and cautious irrigation.Empyema with bronchopleural fistula needs further procedures, for example open window thoracostomy, omentopexy, bronchoscopic application of silver nitrite to the bronchial stump, thoracoplasty or other methods. implications: From clinical standpoint the next problem is which therapy should be adopted as the definitive treatment. open window. Thoracostomy or omentopexy? Open window thoracostomy is a widely accepted method and it's outcome is good.

Patients with severe eye injuries are frequently admitted to eye hospitals. Complications are common in these patients. Epidemiologic study to define its incidence and risk factors is an important step for prevention of such injuries.A prospective study was conducted on 346 patients (275 males, 71 females) who were admitted to Nikookari and Alavi hospitals in Tabriz due to ocular trauma between 1992-94.Male to female ratio was 4:1 and nearly 50% of patients were younger than 12 years of age. The mean age was 19.7±17.3 years. The majority of injuries (44%) took place at home. Surgical intervention was done in 85% of patients with sharp injuries and 30% with blunt trauma. 9% of patients had no light perception. Laceration of the globe was the most common eye injury (40%).Prognosis of ocular trauma especially those of sharp injuries is poor. Individuals need to be educated on the use of safety eye wear.

The refractive error is the commonest cause of defective vision. The purpose of this study was to evaluate refractive errors among 500 boys between 18 to 20 years old in Nikookari hospital in 1997.Incidence of refractive errors, were 82.4% for myopia, and 17.8% for hyperopia. In our study, myopia was the most common cause of refractive error and high incidence of myopia increased with visual near work such as education and carpet maker. Most of the myopia had a familial tendency.The most important factor in myopia correction was spectacle lense and prevent amblyopia in anisometropic patients.

The present study demonstrates the detection of mutagenic effects of mustard gas metabolites in urine samples of rabbits which were used as experimental animals in this study. We used micro titer fluctuation test and Salmonella typhimurium (TA102) as bacterial tester strain. Three groups of rabbits were exposed to 0.8, 1.6 or 3.2 mg/kg of sulfur mustard, diluted in dimethyle suffixed (DMSO). The fourth group was received only DMSO and considered as control group. The urine samples were collected from all animals at 3 periods after treatment (3, 6 and 9 days) and assayeq for the presence of the mutagenic agents after ether and chloroform extraction.The results indicate that the samples collected at periods of 3 and 6 days exhibit significant mutagenic activity, while the samples collected in the period of 9 days were not significantly mutagenic. It was also concluded that fluctuation test is a useful procedure for quick detection of the most hazardous metabolites of the chemical agents.

In order to survey dermatophytosis among girls attending primary schools in Tabriz 1900 girls were examined for cutaneous lesions.OF these, a total of 114 girls were suspected to have dermatophytosis. The samples (Skin scales, hair stubs and nail scrapings obtained from these individuals were studied using two methods: the direct method and culture in two media, Sabouraud Dextrose Agar (S) and Sabouraud Dextrose Agar containing cycloheximide and chloramphenicol (SCC) .In this study, 15 samples (0.79%) were found to be positive regarding dermatophyte factors involved in fungal infections. Of these, 14 cases were detected by direct examination and 13 cases, through the culture method. The frequencies of clinical features of dermatophytosis were distributed as 8 cases of tinea corporis, 5 cases of tinea capitis and 2 cases of tinea faciei, respectively. The frequencies of dermatophytes isolated from the cutaneous lesions were Trichophyton verrucosum in 6 cases, Microsporum cains 4 cases and tonsuans in 3 cases. Trichophyton verrucosum accouunted for 83.3% of the fungal lesions of the body, Micros Porum cains accounted for 75% of the fungal lesions of the scalp (ectothrix type ) and Trichophyton tonsurans accounted for 66.7% of the fungal lesions of the scalp (endothrix type).Using Statistical methods a significant relation was found between the percentage of cases affected with dermatophytosis and history of exposure to animals (p<0.01). This finding points to the presence of infected animals as a source of infection in zoophilic dermatophytes.On the basis of the findings obtained in this study, it appears that geographical location, poor socioeconomic conditions and duration of exposure to animals were among the factors predisposing to fungal infections of the skin.

Prevalence of atherosclerosis in renal transplant recipient (RTR) and its correlation with plasma lipids and lipoprotein changes has been reported in the literature. In present study serum levels of lipids(cholesterol and triglyceride) and lipoproteins (HDL-C, LDL-C, VLDL-C and HDL-C/LDL-C and fasting blood sugar (FBS), were measured in 74 RTR (53 males and 21 females) aged 15-69 years by commercially enzymatic methods. The levels of total lipids were also estimated by colorimetric method. The results were compared with those of obtained from 74 healthy individuals at similar age group as control. Statistical analyses showed significant increase in the mean levels of serum triglycerids, cholesterol and total lipids in male and female patients (p<0.001, p<0.05, p<0.001, respectively). Significant elevation was found in the mean levels of serum LDL-C and VLDL-C in male and total patients (p<0.025, p<0.05), respectively). Increase in mean levels of serum LDL-C, VLDL-C and HDL-C were meaningful in the female patients (p < 0.001, p<0.001, p<0.05 , respectively). Reduction in HDL-C/LDL-C ratio in female patients compared with the control group (p<0.05). No marked differences were observed between serum levels of FBS in the patients and the control groups (p>0.l) in all cases.There was no relation between the measured parameters and age and time since transplantation, but direct and significant correlation was observed between the weigth and serum triglyceride values (p<0.05 , r=0.29).In conclusion, according to the results of this study, in patients with RTR, some abnormalitis arise in the serum levels of lipids and lipoproteins which can cause atherosclerosis. Specific treatment of hyperlipidemia may be necessary in these patients.

The records of 73 patients with diaphragmatic hernia (CDH) with late manifestation which admitted to three different centers (Amirkabir and Children's hospitals two main referral centers for pediatric surgery (in Tehran and Tabriz respectively, and a private hospital) were reviewed. Clinical and radiological findings and operative data of 25 patients with CDH with delayed onset were analyzed. Age range was 2 months to 6 years, 15 males and 10 girls, 23 had left sided hernia and 2 had right sided. Presenting features included: chronic respiratory symptoms in 25 patients (60%), gastrointestinal (GI) complaints in 8 patients (32%), and respiratory distress in one patient (4%).The defect was an incidental finding in one patient (4%). One patient had previously normal chest radiograph. 10 patients (40%) were originally misdiagnosed clinically and radiologically as having either infective lung changes, or pneumothorax Inappropriate thoracocentesis had been performed in one case, misdiagnosed as having a pneumothorax. Operative repair was performed for all patients with abdominal approach. At operation 4 peritoneal sacs (16%) were found and all were excised. Intestinal malrotaion was most common anomaly (n=15 60%).None had evidence of pulmonary hypoplasia. One death occurred as a result of inappropriate thoracocentesis. Congenital diaphragmatic hernia did present beyond the neonatal period in significant number in this series (34.2%). Therefore the symptoms, signs and radiologic findings of patients with CDH presenting after the neonatal period may be difficult to interpret and may result in diagnostic delay, misguided therapy, and a potentially fatal outcome.It is the purposes of this study to familiarize the physicians and podiatrists with presenting features, diagnostic difficulties and errors, differential diagnosis and complications in late presenting CDH. In the hope that this will facilitate the diagnosis and management of this potentially dangerous disease to prevent mortality and morbidity. The interval between diagnosis and surgical therapy should be as short as possible. Early diagnosis is important as early surgery is recommended even in those without symptoms.

Mycoplasma has drawn interests because of its variety, distribution an its role in pathogenicity.In this study 139 females having symptomatic cervicitis and 64 females with asymptomatic cervicitis were studied for Mycoplasma hominis and Urea plasma urealyticum.Of 139 cases, 21 and 13 cases were positive in the liqiud and solid media respectively. M.hominis was recovered from 2 cases in the liquid and one case in solid media. Both M.hominis and Ureaplasma urealyticum were isolated in 11 and 5 cases in liquid and solid media, respectively.No significant differences was found regarding the level of education and method of contraceptive used. Age of marriage and rate of infection was not showed significant difference. Neither the numher of leucocytes and the result of culture revealed significant differences.

1315 boold specimens from children (0-12 years old) were examined for value of cytoplasmic vocalization of neutuophils in septicemia.Concerning vacuolization and septicemia and occurrence of Gram-positive or negative organisms in the studied age group meaningful statistical findings were obtained (p<0.005).Comparison of septicemia and some parameters such as vacuolization, toxic granulation and WBC showed sensitivity, specificity and predictive value of 72%, 96.6% and 68.8% for vacuolization, 77%, 85% and 43% for toxic granulation and 55%, 72% and 12% for WBC, respectively.

A wide variety of clinical presentation, organ involvement and complications have been reported in brucellosis including arthritis, carditis and neurobrucellosis. Brucella pericarditis, endocarditic, and myocarditis are well documented but myocarditis in adult is very rare.Myocardial involvement is manifested by T- wave abnormalities and prolongation of PR-interval. On occasion patients develops fulminate myocarditis with lymphocytic and polymorphonuclear infiltration. Although not uncommon accompaniment of brucella infection, pulmonary involvement frequently goes undetected or if detected, it is treated as a different diseases. Endocarditis and myocarditis are rare but serious complications of infection with brucella.

Skull fractures in infancy and childhood frequently heal, but only in 0.05-0.6 per cent of cases enlarge.This title is a rare complication of skull fracture in this age group, 90% of cases occure under 3 years of age and 50% under one year. In most cases head injury is severe or moderate (G.es. less than 10), but can occure in all ranges of head injury. Symptoms present later, thus cerebral injury becomes wider and more progressive, so operative difficulties will be more. So early diagnosis is important. Some believe that MRI is the best way of early diagnosis, but there is need for sedation. Recently some use color doppler sonography as a method of choice, because it is less time consuming and does not need sedation. Both of the above mentioned methods are good when bony, dural and cerebral injuries are progressive. We subscribe criteria in immediate post - traumatic period, and advise to operate patients immediately before progressive problems occure. We operated all the babies with diastatic skull fractures that is accompanied by a scalp bulging, brain contusion and or small cortical clots under fracture. In 10 years, from March, 1988 to March, 1998, we had 18 such patients, 12 of them were operated immediately with above criteria, but 6 patients were operated later with a lot of complications. Results in the first group were excellent but in the second moderate and poor.