MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:- | Issue:61|Papers Count:27

Background and Objectives: Somatosensory Evoked Potentials (SSEP) have been used in the evaluation of different aspects of radiculopathies. The purpose of this study was to investigate the changes of somatosensory evoked potentials in lumbosacral radiculopathies due to disk herniation before and after surgery.Materials and Methods: A prospective study was carried out in an electrodiagnostic Lab. on the 42 patients who were candidates for herniated disk surgery. SSEP was performed before surgery and 2 months later and the corresponding results were compared within two separate groups related to tibial and peroneal nerves. Results: Mean P1 latency of tibial nerve’s SSEP in 25 patients before surgery was 44.28 2.47 after which became 41.68 2.22 (P<0.05).Mean P1 latency of peroneal nerves SSEP in 17 patiens before surgery was 37.93 2.57 and after that was 35 1.56 (P<0.05). These differences were significant.Conclusion: Conduction changes in radiculopathies of the herniated disk surgery are detectable by SSEP, after 2 months. This, compared with the presurgical SSEP testing, could yield an optimal follow - up program after surgical procedure. Remyelinization accounts for the essential improvement mechanism.

Background and Objectives: Flexible endoscopy Plays a major role in the treatment of the upper gastrointestinal foreign bodies (FBs). Most of the literatures covering GIFBs are anecdotal which have been presented as case reports or review articles. Meanwhile most of them reflect the authors’ experience in their managements. We were to assess our experience with endoscopic removal of FBs from UGI tract through this study.Materials and Methods: We reviewed the records the of the patients admitted to Endoscopy Unit of Imam hospital in Tabriz during the last 10 years for retrieval of FBs from UGI tract.Results: Fifty - four patients were studied. The mean age was 36.2 (SD=21.5). Pins (27.7%),bone (25.9%), and coins (12.9%) were the most common objects. Most of the FBs were found in the upper third of esophagus (24 %) and the body of the stomach (24 %). There was an obstructive underlying lesion in 12.9 %. out of cases. Success rate for endoscopic removal of FBs was 81.5 % without any complication. Conclusion: The endoscopic procedure is a successful technique which allows removal of FBs without any significant complication. Surgery is required in special conditions

Background and Objectives: The process through which memory is formed and factors affecting it, are among issues under scrutiny in neuroscience. These, however, lack many undiscovered aspects. On the other hand, the wide spectrum of utilization of hypothermia for medical and surgical purposes, raises the question of the effect on memory. Materials and Methods: In the present study 70 male wistar rats were randomly divided into 7 groups (A-G, 10 rats each). Control group (group A) was trained using "passive avoidance technique" and then the degree of their consolidation of memory was tested 24hours later. This was incorpororated as basic protocol for other groups. Groups B and C also went under halothane anaesthesia for 15 and 60 minutes respectively immediately after training. These behaved as second line control groups. For the groups left, groups D and F received 15 minutes halothane anaesthesia plus hypothermia, 28±1 C and 24±1 C respectively. Groups E and G were the same as groups D and F but the length of hypothermia was 60 minutes. Results: Results obtained indicated no significant effect of halothane and superficial hypothermia (28±1c) for 15min on memory consolidation, but deep hypothermia (24±1C) for 15 and 60 minutes had significant effects (p<0.05) on memory retrieval.Conclusion: Results suggest that mild hypothermia in a short time has no effects on memory but deep hypothermia at the same time, produces significant effects on memory consolidation.

Background and Objectives: Coronary artery bypass grafting (CABG) is usually performed through cardiopulmonary bypass (CPB). CPB, However, has been associated with several adverse effects. Recently, off-pump CABG technique is offered as an alternative to the standard on-pump CABG technique. The purpose of this study was to evaluate the safety of the off-pump technique by estimating serum enzymes e.g. Creatin Kinase (CK), CK-MB, Lactate dehydrogenase (LDH), Aspartate Transaminase (AST), measurement of cardiac troponin I and some postoperative complications.Materials and Methods: Ninety patients (75 males and 15 females) with angiographically defined CAD admitted to Shahid Madani Heart Hospital in Tabriz for coronary artery bypass grafting were selected. The off-pump technique was performed in 50 patients with mean age of 58‏. In 40 other patients with mean age of 56, the on-pump technique was applied. The blood samples were collected from the patients before, 6, 12 and 24 hours after the operation. The activities of CK, CK-MB, LDH, AST in all serum samples were measured by Cobas Mira autoanalyser, and cardiac troponin I concentration also was measured by Evernest model 3200 motion. Data regarding patient age, sex, familial history of cardiovascular diseases, number of vessels grafted, procedural time, transfusion of blood and blood pressure were recorded for the both groups of patients. Postoperative data regarding the incidence of complications including myocardial infarction, need for inotrop adminstration and death were also recorded.Results: In this study the activities of serum enzymes such as CK, CK-MB, LDH and AST after on-pump CABG technique were higher than those of off-pump technique (P< 0.05 in all cases). The levels of troponin I were significantly higher after on-pump CABG throughout the entire measurement period (P<0.01) compared with off-pump procedure. In both groups of patients no myocardial infarction was occurred during operation. In the off-pump technique procedural time was shorter and transfusion of blood was less than those of on-pump technique, but no difference was noticed among the other recorded data.Conclusion: Significant reduction in the release of enzymes and troponin I during operation by off-pump technique suggests that the technique causes less myocardial injury. On the basis of little changes in the activities of cardiac enzymes and troponin I in serum and presented data including a marked decrease in blood transfusion and shorter procedural time, it is concluded that off-pump CABG is a safe and effective technique in selected patients with appropriate coronary lesions.

Background and Objectives: Malnutrition is one of the most important public health problems that affects millions of children in the world. Poor socioeconomic status and food intake are the major causes of malnutrition in developing countries.Materials and Methods: In order to assess the relation of food consumption and growth status of preschool children, 400 children from governmental and private child care centers in Tabriz were selected then weight and height measured.Results: Results showed that mild and moderate malnutrition on the base of NCHS were as 51.9%, 46.1% and 47.6% for weight for age, height for age and weight for height, respectively. These proportions on the base of z-score were 6.1%, 7.6% and 1.55%, respectively. Significant relationship was found only for height for age and sex (p=0.0256). The highest prevalence of underweight was related to 5-6 year - old children (10.3%) while stunting and wasting belonged to children less than 4 years old (13.7% and 3.7%, respectively). Mean frequency of essential food groups per week for studied children were less than recommended value and no significant difference was found between types of child care centers and consumption of food groups. Significant correlation was observed between mothers, education with mean frequency of meat, vegetable and fruit consumption and age of the children (p=0.023).Conclusion: Our findings indicate that growth status and mean consumption of basic four food groups of preschool children in Tabriz are not desirable.

Background and Objectives: Whenever the Ozone layer is destroyed or becomes thinner, damaging ultraviolet will threaten human health and environment. Through studying the impacts of ultraviolet on genomic instability of cells, one can estimate the rate of DNA destruction. Sister Chromatid Exchange (SCE) is an optimal characteristic to study genomic instability of the cells irradiated by UV.Materials and Methods: After isolating of lymphocytes by Ficol, 105 cells were irradiated under UV (20 cm distant from UV-C light with intensity of 420 LUX) for 3 or 5 minutes in the T25 flasks. The irradiated and control cells were cultured in 5 ml F12 medium which had been supplemented with 15% fetal calf serum, T lymphocyte mitogen of phytohemagglutinin and BrdU. Then they were placed in an incubator with 37 c temperature. The cultured cells were harvested after 72h and stained by SCE method. The frequency of Sister Chromatid Exchange (SCE) was studied in the 100 metaphasic plaques. Results: The frequency of Sister Chromatid Exchange in the 100 metaphasic plaques showed a mean SCE per cell value of 3.35% for control cells compared with a SCE per cell value of 4.33% and 6.8% for radiation during 3 and 5 minutes. Statistical analysis of the results showed a significant difference (p<0.001).Conclusion: The results indicate that UV-C induces genomic instability and destroys the human T lymphocyte DNAs, sothat the level of genomic instability depends on UV radiation time. Therefore, thinning or destruction of Ozone layer must be taken into consideration seriously.

Background and Objectives: Achieving complete anesthesia is a major problem in dental procedures, especially in endodontic treatment. Several studies on local anesthesia have indicated the highest rate of failures in mandibular teeth. The aim of this study was to compare the rate of local anesthesia failure in mandibular and maxillary first molars and find out the rate of failure and recognize the potential factors involved in order to achieve a profound local anesthesia rendering endodontic treatment as painless as possible.Materials and Methods:50 first molar teeth from 50 patients (25 mandibular first molars and 25 maxillary first molars) with vital pulps and normal PDL , lamina dura on radiographic examination and without any sensitivity to percussion and palpation needing endodontic treatment were evaluated.Results: Of 25 maxillary first molars only 2 teeth needed supplemental injections, whereas 8 teeth out of 25 mandibular first molars needed supplemental injections. Results of the statistical analysis (Chi-square) showed a statistically significant higher rate of local anesthesia failure in mandibular first molars compared with maxillary first molars (P=0.034).Conclusion: The current study indicated that local anesthesia failure rate was significantly higher in mandibular first molars compared to maxillary first molars and that achieving a proper local anesthesia in the teeth having preoperative pain was more difficult. Therefore, in order to achieve a proper anesthesia and render painless endodontic treatment supplemental, injections should be carried out especially for mandibular first molars.

Background and Objectives: The aim of this study was to estimat the proportion of illegal abortion in the range of 15-49 year-old married women. Determination of illegal abortion prevalence is one of the main researches priorities in reproductive health in Iran, but it would be difficult to obtain reliable information by using questionnaires. Therefore, we had to use a randomized response technique to collect data.Materials and Methods: This is a cross-sectional descriptive study involving 550 married women in the range of 15-49 by using a simple sampling method in October 2001.Results: Prevalence of illegal abortion was estimated to be 2.86% with variance of 0.0718.The difference between our estimation and other studies was statistically significant (p<0.001).Conclusion: By using this statistical technique, it seems that the rate of illegal abortion prevalence is actually higher than previous studies. However, we suggest to conduct other studies through this technique with larger sample size, especially in high-risk populations of women.

Background and objectives: Diarrhea with an acute onset and lasting at least for 14 days is termed as persistent diarrhea. It is one of the major cause of morbidity and mortality in diarrheal diseases .The purpose of this study was to identify the incidence and underlying risk factors associated with persistent diarrhea.Materials and methods: During a 7- year retrospective study, 150 medical files of patients with persistent diarrhea were reviewed.Results: On an average, 10% of all patients admitted with diarrhea had persistent diarrhea. There was, however, a rate decline from 11% to 7.5% during the six years from 1993 till 1999. The highest incidence of persistent diarrhea in infants younger than 6 months was among those who feeded with cow milk or formula diet (50%), and in infants elder than 6 months it was among those who had received low protein calori and were not on breast feeding (40%) .Almost all patients with persistent diarrhea had some degree of malnutrition and all of them had received different kinds of antibiotics along with anti diarrheal drugs.Conclusion: This study showed that breast feeding as well as improvement of nutrition during diarrhea are the most effective factors involved in reducing the rate of persistent diarrhea.

Background Objectives: Odontoid process fractures consist 7% to 14% of acute cervical injuries. Neurological deficits in type II of odontoid fracture are more than other types.Material and method: Forty -three patients with odontoid fractures who admitted at Imam Khomeini and Shohada Hospitals in Tabriz from 1998 to 2001 were analyzed retrospectively and prospectively. Age, sex, etiology, neurological signs and symptoms, associated traumas, imaging and therapeutic procedures were evaluated. Results: Ten percent of cervical injuries were of odontoid fractures, 84% of the patients were male and about 50% of patients were 20 to 50 years old. The commonest cause of trauma was vehicle accidents (60%).Four cases had type I, 22 cases had type II and 17 cases had type III fractures. Neurological deficits in type II were more than other types. Mortality rate was higher in patients with associated traumas. Patients with type I were managed with cervical collar and patients with types II and III were treated with halo- vest in 10 cases and posterior fixation in 16 ones.Conclusion: The ratio of odontoid fractures in cervical injuries was 10%, so that is near to similar studies in the literature. The age and sex ratio of patients in our study are the same as others. Motor vehicle accident played a major role in 60% of our patients. This finding was higher in rate than similar studies (48%) which seems to be of higher occurrence of vehicle accidents in our country. The proportion of type II fractures in our study was 50% but in similar studies it was 60% to 90%.

Background and Objectives: Radial keratotomy is one of the current techniques in correction of myopia which has high prevalence in general population. The main purpose of this study was to evaluate changes in pattern and profile of corneal topography before, one week and third months after surgery. Secondary aims of this study were to record the subjective complaints and their correlation with topographic changes after surgery. Materials and Methods: In a clinical trial, comparison of corneal topography before and after RK was done in 50 eyes of 26 patients from 19/3/1997 to 20/9/2001. In all patients, routine eye examinations were performed before surgery along with determination of pattern and profile of corneal topographies (asphericity coefficient). Surgery were done under topical anesthesia with 0.2 mm diamond knife. Incision technique was as the American method with present standard nomograms. Corneal topography in first week and third months after surgery was done with special attention to central optical zone (COZ) pattern, presence of multifocality and asphericity coefficient. Patient’s complaints also were recorded.Results: The mean age of patients was 29 (18-60) years. 74% out of patients were male and 26% female. The mean duration of follow up was 10.5 months. The most common patterns of topography before surgery were asymmetric bow-tie (44%), symmetric bow-tie (40%), and spheric (8%). Corneal profile was prolate in 92% and spheric in 8% of cases. No case of oblate profile was found before surgery. Prevalent corneal patterns after surgery were regular polygonal (circular or elliptic) in 50% , Band like in 22%, and split in 28% of cases. Corneal multifocality was found in 38% of cases after surgery. Corneal profile was oblate in 94% and prolate in 6% of cases.Conclusion: Radial keratotomy induces various changes in corneal pattern and profile after surgery. Increased corneal asphericity and switching from prolate to oblate profile were noted. Multifocality in central flat zone can increase uncorrected visual acuity without considerable optical complications. Split pattern of central optic zone can cause diurnal fluctuation of vision.

Background and Objectives: Traumatic brain injury is one of the most common and important causes of mortality and morbidity. These lesions are divided into two types: primary, which are due to direct impact and secondary, which are due to traumatic complications like hypoxia, hypotension and traumatic space occupying lesions .The secondary type of brain injury is mostly preventable and treatable. Appropriate treatment of these lesions obviously improves the prognosis.‏ The goal of this study was to determine the relationship between the type of traumatic lesion and the treatment results.Materials and Methods: 230 patients with traumatic coma were studied during 40 months at Imam and Shohada Hospitals in Tabriz. These patients were comatose when admitted and patients with other lesions such as abdominal or chest traumas as well as underlying diseases were excluded from this study.Results: The mean age of patients was 32.4 years. The patients had several types of lesions. Almost half of patients had been operated. Brain contusion was the most common finding and subdural hematoma had the poorest prognosis. Glascow coma scale and mydriasis were two factors affecting the surgical outcomes.Conclusion: Diagnostic and therapeutic procedures must be done as soon as possible. Patients, if indicated, should undergo the surgical operation before the deterioration of consciousness and occuring mydriasis.

Background and Objectives: Improved sanitary and medical services lead to an increased life expectancy. The prevalence of hypertension grows higher with aging. Many studies confirm that the treatment of hypertension is very effective in decreasing cardiovascular side effects even in systolic hypertensions. In this study the prevalence of hypertension in people>60 years old was determined. Results were compared with the group aged 13-34 years old.Materials and Methods: Well-trained interns referred to randomly selected families. Measurements of blood pressure in sitting and supine position, arm circumference, height and weight done in two groups >60 and 13- 34 year-old persons. The results analyzed by t-test, paired t-test, and chi-square. Results: From 2496 persons whom we studied 533 were >60 years old and 1963 were in the range of 13-34 with prevalence of hypertension 66.4% and 10.1% respectively. 33.9% of elderly people and 86.4% of the youth were unaware of being hypertensive. The comparison of BMI, arm circumference, weight in hypertensive and healthy groups showed significant difference in all parameters. Conclusion: Hypertension was asymptomatic in considerable percentage of whom they were studied and is a major risk factor for deaths and cardiovascular diseases. Therefore, any lapse in diagnosis and treatment increases the mortality rate. Our study suggestsa periodic measurement of blood pressure especially among eldery people.

Background and Objectives: Bacterial vaginosis is one of the most common infectious diseases affecting women. Several types of antibiotics have been used to treat. Although metronidazole has been introduced as the most effective drug, no antibiotic is completely successful in therapeutic or preventional processes. The purpose of this study was to compare the efficacy and safety of oral clindamycin and oral metronidazole in the treatment of bacterial vaginosis.Materials and Methods: Sixty women in the range of 16 or elder with bacterial vaginosis diagnosed by Amsel’s diagnostic criteria and grams stain were enrolled in a randomized, double - blind study to receive either oral clindamycin 300 mg twice daily for 7 days or 500 mg of oral metranidazole twice daily for 7 days. Women with coexiting vulvovaginal candidiasis or vaginal trichomoniasis were excluded. Test of cure was repeated 7 to 14 days following treatment. Vaginal symptoms, complications, side effects and other complaints were noted. Results: There was no statistically significant difference in cure rates for oral clindamycin (93/3%) and oral metronidazole (86.6%). Adverse reactions were mild in both groups. Four patients who received clindamycin developed non - bloody diarrhea and 4 patients who received metronidazole developed symptomatic viginal candidiasis.Conclusion: We concluded that clindamycin would be a safe and effective alternative to metronidazole for treatment of women with bacterial vaginosis.

Background and Objectives: Foreign body aspiration is one of the critical emergencies in Otolaryngology that could be life-threatening. Early diagnosis and treatment prevent complications and deaths. Airway foreign bodies can mimic other conditions such as asthma and pneumonia.Materials and Methods: The retrospective study on 1000 cases with foreign body aspiration established by the Department of Otolaryngology at Tabriz central pediatric Hospital included variables as age, sex, clinical and radiological findings, type and location of foreign body, duration of enlodgement, referral system, and negative bronchoscopy.Results: Foreign body aspiration in boys was 1.7 times more than girls.The most common age group was 1-2 years old. The cough was the most common symptom. In 24.6% the bronchoscopy was negative. CXR was normal in 54.2% and the most common abnormality was obstrucive emphysema.The most common location was right bronchus (44.2%) and the foreign body was of vegetative matter in 82.5%.In 29.7% duration of enlodgement was 1-5 days. Patients were referred by parents much more than others (42.4%).Conclusion: Delay in diagnosis leads to some complications. The lack of clinical and radiolgical findings could not rule out foreign body aspiration. In any patient with a suspected history of aspiration the bronchoscopy is necessary for definitive diagnosis. However, "Prevention is better than treatment".Therefore it would be better to give parents much more information about foreign body aspiration in children.

Background and Objectives: Snoring is a common symptom or disorder involving 19% of population. Snoring occurs mainly at velopharyngeal area. It belongs to a spectrum of sleep disorders which varies from habitual snoring to sleep apnea syndrome. This study presents a simple surgical technique for the relief of snoring.Materials and Methods: This study was conducted on 8 patients with a chief complaint of snoring. Data consisting history, physical and anatomic characteristics were obtained through a questionnaire. The results of operation were recorded as complete, significant, minor and non recovery at a period of 2 months follow-up. Diagnosis and follow-ups were done on a clinical basis. In this technique mucosal soft palate was resected elliptically and the consequent defect repaired with some sutures. Results: in 62.5% of patients complete or significant recovery occured. The results in patients with low BMIs were better. The postoperative complications were pain (%100) and uvular protrution (25%).Conclusion: This is a simple and cost-effective technique which lacks important complications. It’s successful results are at the limit of other procedures such as laser, cautery assisted and snare palatoplasty.

Background and Objectives: A variety of non - surgical and surgical techniques have been used for treatment of high AC/A ratio esotropia (ET). This study was conducted to compare the results of conventional and posterior fixation (PF) suture techniques in the treatment of high AC/A ET at Nikookari Hospital from Jan 2001 to Mar 2002. Materials and Methods: In this sequential matched randomised double blind clinical trial, 20 patients aging 3-13 years old with high AC/A ET (esodeviation measured in near fixation at least 10 pd more than distance fixation) were studied. These patients were divided into two groups randomely: 10 patients underwent the conventional operation (recession of both medial recti) and the other group operated on for posterior fixation technique. All the patients were examined one week, one month and six months after operation considering the distance and near deviation and the far near dispariety.Results: All the patients (100%) in PF group showed acceptable results (near deviation less than 10 pd and far near dispariety less than 10) one week after operation and during the six month follow up period (P<0.0001). In conventional group only 20% out of patients achieved acceptable results six months after operation.Conclusion: This study showed that PF operation is more effective in treatment of high AC/A esotropia than the conventional technique.

Benign fibrous histiocytoma (BFH) is a mass rarely occurs in nose and paranasal sinuses. However, nose and paranasal sinuses are the most common sites in head and neck areas to develop BFH of which the most important manifestations are nasal obstruction and mass. A patient was admitted with the nasal discharge and obstruction .He did not respond to antibiotic treatment. A big mass in the left maxillary sinus was diagnosed on CT scan and excised enbloc with transnasal endoscopy. Pathologist reported BFH. Sinonasal polyps and masses must be considered as the differential diagnosis of BFH. Since excellent exposure of tumor and lamina papyracea, transnasal endoscopy with transnasal approach is an appropriate method to excise the mass for mass excision without cutaneous incision.

Mucormycosis is an acute and often fatal infection caused by fungi of the class mucorales. There are some clinical types such as rhinocerebral, pulmonary, abdominal and cutaneous, all of which are associated with an underlying disorders.Pulmonary mucormycosis often appears with lymphoma and leukemia and is rarely observed in diabetic patients. To the best of our knowledge, this is the first report in Iran: A 16 - year-old diabetic boy who had been suffering from cough, fever, weight loss , purulent and occasionally bloody sputum, associated with progressive dyspnea was unsuccessfully treated with antibacterial agents and finally referred to Imam Khomeini Hospital in Tabriz. X-ray examination demonstrated a right paracardiac opacity with reduced lung volume. Serum glucose was 215 mg/dl, test for acid fast bacillus (AFB) was negative and ESR was high.A severe destruction of carina stretched to the main branches and local tracheal stenosis were revealed through bronchoscopy. There were some fistulae with a massive milky clot in left main bronchus. The clot was taken out after washing and sent to the Medical Mycology Unit, No. 2 Clinical lab of Tabriz University of Medical Sciences. Wet mount study of the speciemen showed wide, branching and nonseptate mycellium and after 48 hours a gray colony with many aerobic mycellia was observed in Sabourad Dextrose Agar medium. Rhizopus was reported as the underlying agent. The patient received amphotericin B and tracheal stenosis treated by Nd-YAG laser and finally got rid of the disease. This article presents such a rare case of mucormycosis in a patient with diabetes mellitus.

In spite of great improvements in medical-care services as well as equipments, tracheoesophageal complications such as tracheal stenosis, tracheomalacia, tracheoesophageal fistula, and tracheoinnominate fistula occur increasingly due to the long-term intubation of critically-ill patients. Tracheoesophageal fistulae (TEF) usually result from erosions of the tracheal and esophageal walls by endotracheal or tracheostomy tube cuffs, especially when a rigid nasogastric tube is in place simultaneously. In this article we introduce a 68 year-old patient who developed a TEF after a 10-day period of mechanical ventilation through an orotracheal tube and her diagnosis and treatment at Imam Khomeini hospital in Tabriz.