MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2003 | Volume:37 | Issue:57|Papers Count:20

Background and Objectives: Varicocele is the most common cause of secondary infertility. The management of varicocele is surgical repair that is commonly done by retroperitoneal approach. Arterial preservation in this approach does not compromise the positive results of surgery and also spends the long surgical duration. In this study the results of arterial ligation were investigated. Materials and Methods: During a 2 years period (1995-1997) , 40 infertile and subfertile patients underwent varicocelectomy and were divided into two groups prospectively: one with and the other without gonadal artery ligation. Two different semen analysis were performed before surgery and were repeated 3, 6 and 9 months after surgery to evaluate the quality of sperm.Results: The total number of spermatozoid count increased in both the groups significantly. Also sperm motility and normal forms were improved in both the groups, however these differences were not significant. There was no difference between two groups in sperm quality. Conclusion: The arterial ligation has no significant effect on the sperm quality. On the other hand, it induces the long surgical and anesthesia period.

Background and Objectives: Despite the advances made in pediatric visceral leishmaniasis in recent years, still its treatment and some features, particularly in our country requires to be evaluated. The purpose of this study was to describe the characteristics of pediatric visceral leishmaniasis in Azarbaijan Province and to evaluate the new scheme of therapy.Materials and Methods: Hospital records of 50 children with visceral leishmaniasis were retrospectively reviewed for epidemiologic, clinical, biological and therapeutic features. The period of the study was from year 1994 to 1999.Results: Most of the children were living or had previously dwelled in Moghan, Kalaibar and Ahar (66%). The age of patients ranged from 6 months to 12 years. When admitted to the hospital, 11(22%) children were found younger than 1 year. The male: female ratio was 1:17. Fever and splenomegaly were presented in 100 and 98% children respectively. Anemia, leukopenia and thrombocytopenia were commonly observed in patients. Erythrocyte sedimentation rate (ESR) was elevated in all patients, and in 15 (30%) cases ESR was above 100 mm/h. A bone marrow aspirate was obtained in all patients, and direct microscopic examination identified organism in 41(82%) cases. Serology was done by direct agglutination test (DAT) in 32(64%) children. It was positive in 30 children and negative in two. All patients were initially treated with meglumine antimonate (Glucantime).Treatment failure occurred in two children (4%). One of them was subsequently cured with second course of glucantime, and the other was cured with amphotericin B. All children were finally cured and no fatality was observed.Conclusion: Our study suggests that antimony medication is effective therapy for visceral leishmaniasis in children of Azerbaijan, and amphotericin B and its lipid formulation may be useful in case of antimony failure.

Background and Objectives: The aim of this study was to determine the age and sex, etiology and clinical manifestations of hypokalemic periodic paralysis (Hokpp) in the patients. The serum level of creatine kinase, a muscle enzyme was also measured. Materials and Methods: This prospective study was conducted on 40 Hokpp patients hospitalized in Neurology ward and ICU of Imam Khomeini Hospital from Sep. 1998 to year 2000. These patients were carefully examined and all laboratory tests were performed including serum creatine kinase, necessary for evaluation of hypokalemia.Results: Of the total patients studied, 97.5% of them were males and most patients (80%) were in third and fourth decade of age. Primary Hokpp was observed in 31 (77.5%) patients, 8 (20%) patients had hyperthyroidism and one of them (2.5%) had Renal Tubular Acidosis (RTA). On admission 32(80%) patients were quadriparetic and the rare syndrome of dropped head was seen in 4 (10%) patients. Serum creatine kinase (CK) level which was measured in 27 patients was high in 14 (52.5%) cases. Conclusion: Hokpp was most common in males as compared to females and older people were more affected. Male sex ratio and age of onset along with CK level in our patients were higher in comparison with the results of similar studies reported elsewhere.

Background and Objectives: Various strategies for prevention of poisoning has been suggested by use of education policies or enhancing the awareness of poison information centers, specially in case of children. Accidental pediatric poisoning can be prevented if primary prevention strategies are timely followed. To evaluate the causes and mortality of poisoning in children and for prevention of poisoning, this survey was done to aid poison prevention educational efforts.Materials and Methods: The 502 poisoning cases referred to the Children Medical Center and Asad Abady Hospital in Tabriz over three years (1994-1996) were evaluated retrospectively.Results: The overall male to female ratio was 1:3, most poisoning occurred in the age group of 1-3 yrs. Ingestion of hydrocarbons was the most common cause of poisoning (25.5%), followed by Datura stramonium (13.5%), and organophosphore insecticides (10.36%). There was slight seasonal variation with the highest number of cases being observed in summer. Mortality rate was 0.2% for all exposures. The majority of these poisoning cases occured accidentally and only 0.6% were intentionally attempted.Conclusion: It is proposed that different fields of clinical toxicology such as poison control and clinical prevention of poisoning should progress. We focus on three major accomplishments with an emphasis on (a) poison prevention utilizing pre-event (primary prevention), (b) the event (secondary prevention), and (c) the postevent (tertiary prevention) models.

Background and Objectives: Trabeculectomy is a common surgical procedure that removes part of the trabeculum in the eye to relieve pressure caused by glaucoma. Mitomycin-C (MMC) assisted trabeculectomy has been reported more successful treatment in patients with advanced primary open angle glaucoma. The application of antiproliferative drugs such as MMC in various concentrations and contact time during surgical procedure has been published in various research studies.Materials and Methods: In this study patients received 0.1 mg/ml MMC with 3 minute contact time. Surgery was done in all of the 10 eyes with the same surgeon and surgical technique. After surgery patients were followed up at least for 6 months.Results: During follow-up period, none of the patients had high intraocular pressure (IOP).Complications were as the following: Retinal hemorrhage in 1 case (10%), severe choroidal detachment in 1 case (10%), persistent hypotony and progression of cataract in 4 cases (40%) and mild choroidal effusion in 2 cases (20%).Conclusion: Intraoperative MMC application may increase the success rate of glaucoma surgery but close follow up and meticulous management of the patients are required, specially in the early postoperative period.

Background and Objectives: Considering the BCG vaccination in neonatal period, a prospective study was done with following purposes: Result of PPD test after BCG vaccination in neonatal period, its comparison in breast and non-breast fed infants, evaluation of the size of BCG vaccination scar, if there is any relationship between the size of scar and PPD test and finally observing how many of these infants develop BCG adenites.Materials and Methods: To fullfill the above objectives 150 neonates (87males and 63 females) born in Kermanshah province and who received BCG vaccine by an expert technician after birth, at 3 months of age, were enrolled in the study. PPD test was done by 0.1 ml of 5 units tuberculin solution made by Razi Institute. Results: Of the total neonates studied, 146 infants (97.33%) were found to have BCG scar, the mean size of scar being 5.28±1.56 mm, and there was no significant difference between boys and girls (p>0.05). After 72 hours Mantoux test results showed mean size of 5.1±3.25 mm. In 68 infants (45.33%) the size of scar after Mantoux test was less than 5 mm,70 infants (46.66%) had between 5-9 mm ,11infants (7.33%) had 10-14mm and only one case (0.66%) had 15mm. There was no meaningful difference between males and females (p>0.05).Among those infants who did not had BCG scar, except in one case, others were negative for PPD test, while in infants who had BCG scar but the Mantoux test was negative, the mean size of scar was 4.42±3.72mm. Those infants who had Mantoux test more than 5mm , the mean size of the scar was 5.85±3.3mm.There was a direct relationship between the size of scar and Mantoux test (p<0.05). There was no statistically significant difference regarding the Mantoux test and BCG scar size between breast and non-breast fed infants (p>0.05).Axillary adenites were noticed in 5.33% of the infants.Conclusion: The present study shows that 97% of neonates who are vaccinated after 3 months of birth later develop BCG scar and they have increased immunity against tuberculosis. Secondly, the diagnosis of the tuberculosis on the basis of Mantoux test (more than 10 mm) in vaccinated infants is not absolute and thus, other complementary tests are required.

Background and Objectives: Diabetes mellitus is a disease with multiclinical features caused by relative or absolute insufficiency of insulin secretion. Hyperglycemia, hyperlipidemia and disorder in protein metabolism have been reported in these patients. In addition, there may be non enzymatic glycosylation of hemoglobin and lipid peroxidation. Secretion of pancreatic hormones might be effected by trace elements. The major aim of this study was to investigate changes in parameters related to iron metabolism.Materials and Methods: The study was carried out in 100 males and the same number of female diabetic patients referred to Isfahan Diabetic Center. These patients were classified according to their fasting blood glucose (FBS) into three groups: first group with FBS within the range of the 140-190 mg/dl, second group with FBS ranging from 190-250 mg/dl and third group with FBS higher than 250 mg/dl. Female patients were divided as follows: first group with FBS within the range of 130-180 mg/dl, second group with FBS ranging from 180-250 mg/dl and the last group having FBS more than 250 mg/dl.Hemoglobin was measured by cyanomethemoglobin, Iron and TIBC by Iron rapid test, ceruloplasmin by ferroxidase activity using paraphenylendiamine-hydrochloride as substrate and copper by atomic absorption spectrophotometry.Results: Plasma iron concentration was increased by 8.9, 13.8 and 17.8% respectively in the three groups of female patients and in male groups by 7.8, 14.5 and 17.6% respectively as compared to controls. TIBC was elevated in both the cases. Serum copper level in female groups was elevated by 10.2, 16.5 and 19.1% and in male patients by 11.2, 17.2 and 20.4% respectively. Serum ceruloplasmin level in female patients was elevated by 16.5, 22 and 26.8% and in male by 13, 21 and 25% respectively. There was a positive correlation between copper and ceruloplasmin (r=0.89).Conclusion: It can be concluded that serum parameters related to iron metabolism could be disturbed in patients with high serum level of glucose and thus, these parameters should be monitored regularly in these patients.

Background and Objectives: Early mild esotropia (10-14 prism diopters) following bilateral lateral rectus recession for intermittent exotropia has been shown to carry the best prognosis in future alignment. The current study was designed to establish the relationship between the early and late postoperative alignment.Materials and Methods: Twelve patients undergoing a bilateral lateral rectus recession for intermittent exotropia were prospectively evaluated. Patients were evaluated postoperatively after one day, one week and 6 months following surgery. Esotropia or exotropia deviation less than 10 prism diopter was considered a satisfactory result .Results: In this study all patients were followed for 6 months, and it was observed that an overall 66% of patients achieved a satisfactory alignment at the 6 months. Fifty percent of patients changed alignment status during this time. The average shift for the entire group was 1.75 ∆exoshift and was not satisfactorily significant (p> 0.05).Conclusion: Long term alignment success was correlated with 6 months data. It seems that applying fusional power to the patient within these six months for correction of the residual deviation, it will be the most important factor for better results.

Background and Objectives: Vincristine is an essential medication that is most commonly used in treatment of acute lymphocytic leukaemia. The major limiting factor for administration of vincristine is neurotoxicity. No agent capable of providing significant protection against vincristine neurotoxicity is available at present. The only way to reduce this side effect is modification of dosage or cessation of it. Thus, correct and early diagnosis of neuropathy and timely decision for declining or discontinuing treatment are most important. Determining the conduction velocity is one of the procedures that enables the physician for detection of neuropathy.Materials and Methods: For assessment and comparison of nerve conduction velocity before and after vincristine therapy, fifteen acute lymphocytic leukaemia patients were selected and studied. Results: A meaningful difference was observed in upper limb nerves conduction velocities before and after treatment and correlation index was found significant (p<0.05).Conclusion: The results showed that the motor and sensory nerve conduction velocities decreases following vincristine therapy.

Background and Objectives: The assessment of urinary cytology is helpful in numerous clinical conditions, particularly the test is valuable for screening of patients with high risk for urothelial malignancy and is sufficient for patient follow-up as well as control of any residual of tumor.Materials and Methods: In this investigation urine (midstream) samples were collected from 900 patients with hematuria. Urine was quickly centrifuged, smears were prepared and stained with Papaniculao and Right staining method. Smears were reported on the basis of background, cells types and other sedimentary elements. Sensitivity, specificity and predictive values along with efficacy of this screening method as compared to other tests like cystoscopy and biopsy of tumor were calculated.Results: We observed from the study performed that sensitivity of urine cytology for diagnosis of tumor of bladder was approximately 73.87% and specificity of 99.18%, with positive and negative predictive values being 84.78% and 98.36% respectively. Efficacy of this screening test was found to be 97.67%.Conclusion: Urinary cytology can be used as a valuable screening test in the patients with hematuria, as well as for diagnosis of urothelial tumors due to multiple preferences for example: non invasiveness, high sensitivity, specificity and efficacy to the other tests. This test is suggested as a necessity in screening the high risk population.

Background and Objectives: Atherosclerosis is the most common complications of diabetes mellitus. Various reports available shows that control of body weight, serum cholesterol and triglyceride can prevent and improve atherosclerosis in diabetic patients. So, this study was designed to investigate the relationship between food habits and BMI, triglyceride and cholesterol in NIDDM patients.Materials and Methods: This descriptive - analytic study was performed in year 1998 on NIDDM patients, over 30 years old and referred to Endocrine and Metabolism Research Center. Using Passim & Bennett questionnare, 34 different sort of foods were divided into 3 groups: those foods eaten over 3 times a week, 1-3 times in a week, and less than 1 time in a week. The mean of daily food consumption was also obtained using weekly food consumption in exchange system.Serum cholesterol, triglyceride and BMI were measured using laboratory, and anthropometric methods. The results were analyzed using factor analysis, multiple regression and students T-test by SPSS package and p<0.05 was considered as statistically significant.Results: A total of 86 patients (31 males and 55 females) participated in this study. The results showed that raw vegetables were inversely related with serum cholesterol and body mass index. Mean of daily fat consumption was 68g which is less than 30% of total calorie intake and mean of cholesterol consumption was 270 mg/day (less than 300mg).Conclusion: We conclude that raw - vegetables are useful for lowering serum cholesterol and body weight.

Background and Objectives: Idiopathic scoliosis is sometimes progressive and probably genetically based disease in which adolescent’s spine develops deformity and in advanced cases may produce restrictive pulmonary disease, heart failure and psychological problems. Because of its position, which is hidden in the back, diagnosis is usually delayed. Screening the school children is the best way for early diagnosis.Materials and Methods: In this study we used inspection and Adams Forward bending test for screening. All of Urumieh midschool students, aged 11-14 years old, were examined and suspicious cases were referred to orthopedic clinic for further examination by radiography. Scoliosis was defined as curves more than 100 in AP standing thoracolumber X rays.Results: A total of 38,988 students were examined. Out of them,140 were selected for radiological studies. Finally 103 cases were diagnosed as scoliosis and these included 97 idiopathic, 2 congenital , 3 polio patients and one case of cp scoliosis. Prevalence of idiopathic scoliosis was calculated as 0.24%. When the estimated missed cases were added to these amounts prevalence rate equalled to 0.3% which is lesser than that reported in literature. Only in one study which is from Johansburg, prevalence of idiopathic scoliosis was found similar to ours.Conclusion: Prevalence of idiopathic scoliosis in 11-14 years old childern has been found as 3 in 1000. It is less than that is being reported in similar studies from other countries.

Background and Objectives: Simple renal cysts are more common with increasing age patients without related clinical symptoms. This was a preliminary study performed to determine the prevalence of this condition and to compare the results of ultrasound findings in patients with acquired renal cystic disease due to chronic renal failure as well as in patients with transplanted kidney.Materials and Methods: The study was performed prospectively from July to November 2000 in 1,103 patients referred to Imam Khomeini Hospital, Amiralmo’menin Hospital and Azerbaijan Radiologic and Sonologic Clinic for abdominal sonography to investigate symptoms unrelated to urinary tract.Results: Among 1,103 patients, 113 were found to have at least one simple renal cyst. This condition was primarily more frequent in those aged 70 years and over (27%), followed by patients who were in 60 - 69 years old (14.4%) age group.Conclusion: According to the findings of our study prevalence of simple renal cyst in patients having no prior clinical symptoms was less than as reported in some other studies, but is comparable to other references. The result of this study also shows different prevalence rate among various age groups with significant statistical figures (p<0.01 and CI=99%).

Background and Objectives: Blood pressure is one of the most prevalent chronic diseases and because of the chronicity it needs a life long therapy. Many patients are not compliant to continue their treatment and after a long period discontinue their drugs and seek for non-drug treatments. In this study, we evaluated the effect of two techniques of behavioral therapy, relaxation and biofeedback assisted relaxation on blood pressure.Materials and Methods: Fifty-six men (aged between 30 to 60 years) with mild hypertension, who did not use any pharmacological treatment, took part in this study. Participants were randomly divided into three groups, relaxation or group I (19 participants), biofeedback assisted relaxation or group II (18 patients) and control or group III (19 patients). Treatment period consisted of ten sessions (every other day). Group I and II performed relaxation for 15 minutes during each session. In group II at the end of each relaxation session for another 15 minutes blood pressure was measured at 2 to 3 minute interval and declared to the patient. Heart rate and blood pressure were measured and recorded before and after each session. In control group only blood pressure was measured at each session. Stress state was measured by Malekpoor questionnaire with 67%validity. Anxiety was measured by Ketel questionnaire. Before and after study period patients filled stress and anxiety questionnaires (total 20 days).Results: The mean of systolic and diastolic blood pressures was reduced after study period in group one and two. There was a significant difference between group one and three (p<0.05) and between groups two and three (p<0.05).Conclusion: Relaxation and biofeedback-relaxation techniques reduce systolic and diastolic blood pressures, and these behavioral techniques can be useful as the main therapy or an adjuvant to the routine drug therapy of hypertension

Background and Objectives: After the progressive improvement in the technology and results of organ transplantation, we now face the challenge of shortage in organ supply. Despite various attempts to encourage organ donation, a lack of donors still exists. The question is being raised concerning loss of potential organ donors and the role of health personnel in educating the public to donate. It is being presumed that attitude and beliefs greatly influence the efforts of health personnel, which direct to educate the public, and encourage them to donate organ.Materials and Methods: This qualitative survey was carried out in Tabriz to examine the attitude and beliefs of the health personnel towards organ donation, which play an important role in developing educational strategies, and encouraging public to donate organs. The subjects were chosen to conduct a focus group discussion.Results: The overall beliefs of health personnel were not satisfactory. Majority of subjects revealed that they have never thought about organ donation and do not tend to donate their own organs. Almost one- third of the group believed that social, economic, educational, and cultural class has no influence on their willingness to donate organs, and one half of the subjects were not sure about donating their own organs.Conclusion: The findings of this survey shows that all of the personnel believe that in order to motivate public to donate organs, the efforts must be directed from health worker and through educational strategies developed by using the features related to the knowledge and attitude of the public.

Supernumerary axillary breast may occur in any size or configuration. It is a relatively uncommon occurrence but is relatively common variant of supernumerary breast.This paper presents a case of supernumerary breast (polymastia) in a 32 years old woman. She had two small yellowish brown spots in both axillary regions at birth with no symptoms until puberty. At first menstruation their size increased slightly. She had three pregnancies. At first pregnancy the development of axillary breast increased with no other changes. There was a significant growth in accessory breast at third pregnancy with milk secretion after delivery.