MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2003 | Volume:- | Issue:59|Papers Count:28

Background and Objectives: Today, stress and related complications have gained special importance. Stress is a nonspecific input resulting in an output called behaviour. In this process, the neurotransmitter system is involved. This study aimed to evaluate the effects of brain noradrenergic system on stress-induced behavioral responses. Materials and Methods: Four groups of Albinowistar male rats (with 250-300 g weight) were selected. Control group were exposed to tail pinch stress for 5 minutes. Tail pinch stress causes a variety of behavioural responses in rats, including gnawing, licking and aggression. In this study, duration of gnawing was measured. Since implantation of microdialysis prob in locus coeruleus causes more damage and impairs results, in other groups microdialysis probes were implanted in the lateral ventricle under cloral hydrate (500 mg/kg i.p) anesthesia. In the sham group, ringer solution was perfused (2, µmol/min) and tail pinch stress (5 min) was introduced. In exam group, clonidine and noradernaline were added in ringer solution and rats were exposed to stress. Results compared with control and sham groups. Results: Sham group showed no significant difference compared with control group. In clonidine group, a statistically significant reduction was observed (p<0.001) and noradrenalin group showed significant increase in behavioral responses (p<0.001). Conclusion: Our results suggest that brain noradrenergic system is involved in special stress-induced beharviours and in α2-presynaptic autoreceptor regulation of noradrenergic system activity. Furthermore, the role of monoamines in stress is more elucidated. This results show that, for avoiding adverse effects of drugs, treatment of stress-induced diseases must be more specific.    

Background and Objectives: One of the important complications of smoking, is hemorheologic alteration. There is apparently increase in viscosity of plasma, total blood volume, and hemoconcentration in smokers, which may result in poor perfusion, leading to serious tissue damages. Materials and Methods: In order to evaluate whether these effects are reversible or not, two groups were studied: smokers determined to avoid smoking during Ramazan month (test group); and nonsmokers (control group). Each group consisted of 15 volunteers, and blood samples were taken before breaking their fast (Eftar) on 1st, 15th and 29th days of Ramazan month. Results: Whole blood and plasma viscosity, RBC count, WBC count, Hct, Hb concentrations and plasma fibrinogen; were measured. In nonsmokers, nonsignificant changes were found in the parameters mentioned above. In the test group, whole blood and plasma viscosity, fibrinogen concentrations and WBC count following 2nd and 4th weeks, and Hct, Hb concentrations, and RBC count following 4th weeks, decreased significantly. Conclusion: These findings suggest the reversibility of the hemorheologic alterations.    

Background and Objectives: Acupressure is used as a noninvasive technique in the treatment of some types of diseases and some pathalogical conditions. The aim of this study, was to evaluate effects of a nonpharmacological approach (acupressure) in comparison to metoclopramide (pharmacological agent) in prevention of nausea and vomiting in pregnant patients who are at risk for gastric contents aspiration, because of gastrointestinal physiological changes during pregnancy. Materials and Methods: This study was an applied, descriptive and double blind study. Patients were divided in three groups. Group one patients, were the study group, in which pressure was applied using a wrist, band and a bottom underneath 2 inches proximal to the wrist crease between the tendons of muscles flexor carpi redialis and palmaris longus (P6). Group two, included patients with placebo wrist band, received 10 mg metoclopramide intravenously. Group three patients, a group with placebo band, received 2 mL normal saline solution intravenously. Results of true acupressure group were compared with metoclopramide and saline normal placebo groups (wrist bands). Information was collected using a questionnaire, and results were analyzed by SPSS Win programme. Results: Results of this study revealed that the rate of nausea in both acupressure and metoclopramide groups was 16% and about 56% in normal saline group. Vomiting was observed in about 8% of cases in acupressure-metoclopramide group and in about 28% in normal saline group. Conclusion: These findings suggest that pressure applied on P6 is as useful as metoclopramide in preventing nausea and vomiting, and it is recommended for clinical use, because of absence of any side effects.    

Background and Objectives: Vitiligo is a common idiopathic disease, associated with loss of normal melanin pigment and functioning melancoytes. We conduct this survey to reach an easy and effective treatment for vitiligo. Materials and Methods: In this study, liquid nitrogen used for 5 seconds in 6 times with 2 weeks intervals, for treatment of localized vitiligo at Sina Hospital in Tabriz. Results: 24 cases with 50 depigmented patchs smaller than 6 cm, treated and followed up. Two weeks after therapy, the lesions assessed and analyzed. Complete repigmentation was occured in 22 patches (44%); pigmentation> 50% was observed in 15 patchs (30%) and pigmentation ≤50% was noticed in 10 patchs (20%). Only in 3 lesions (6%) pigmentation was not occured. Efficacy of this approach in study groups was statistically significant (p < 0.05). Conclusion: Efficacy of cryotherapy in localized vitiligo was significant, and this method could be used as an alternative or complementary therapy in localized vitiligo.      

Background and Objectives: Brain tumor is one of the most common causes of mortality and morbidity. As the result of coordinated progress in diagnostic and therapeutic modalities, management of brain tumors undergo great changes. The main goal of this study, was to determine the frequency of recurrence in different types of brain tumors. Materials and Methods: In this review, the patients with brain tumor who were operated in Imam Khomeini Hospital in the recent ten years, were demarcated, and recurrent cases were studied, excluding those with incomplete records. Results: Of 1,112 cases with brain tumor resection, 51 had recurrences and underwent second operation. In recurrent cases, 28 were men and 23 were women. Neuroepithelial tumors consisted of 82% of recurrent cases: meningiomas (10%), pituitary adenomas (4%), and epidermoid tumors (4%). In 21.56% of recurrent cases, the pathologic grade was greater than the first report and disease-free intervals were shorter. Conclusion: In our review, neuroepithelial tumors included about one half of the brain tumors, as mentioned in other references. Glioblastoma multiform (GBM) and anaplastic astrocytoma (AA) composed 50% of neuroepithelial tumors; in comparison with other references, their frequency was fewer. In contrast to other references, meningiomas had a relatively lower percentage of total number of tumors, but from the other aspects (age, sex predominance, location and clinical course) their characteristics were similar to those in other references.    

Background and Objectives: Temporomandibular disorders (TMD) are he etiologic factors in the most patients with chronic pain of orofacial region; therefore, evaluating such disorders in clinical dental researches, is of great importance. The basis of this study was to evaluate the signs and symptoms of these disorders (which compromise the principles of proper diagnosis and treatment) and to study the factors influencing them. Materials and Methods: A total of 235 dental students studying in Faculty of Dentistry, Tabriz, took part in the study by filling a questionnaire, and finally 50 students with TMD symptoms were clinically examined.Results: The most common reported symptom, was a feeling of fatigueness in the jaws. Stress, oral habits and 'mental health, had a significant relationship with the prevalence of symptoms. The most common clinical signs in descending order of frequency included: deviation, clicking when opening the mouth, and pain in the masticatory muscles, especially lateral and medial pterygoid muscles. Class III occlusion was the most common type of occlusion among those with TMD symptoms. Conclusion: Stress and oral habits in the form of parafunctional activities, were the major factors in increasing the rate of reported symptoms in questionnaires, of which joint clicking, interlocking of jaws and limitation of mouth opening can be mentioned. These factors also increased the prevalence of signs such as deviation and clicking while opening the mouth and tenderness of muscles to percussion in clinical examination. There is controversy over the type of occlusion related to TMD in this study and previous studies, which emphasizes the fact that the type of occlusion possibly can not be a primary etiologic factor in the occurrence of TMD symptoms, but may be considered as a predisposing factor. Provided the adaptation capacity of the masticatory system can overcome it, termporoamandibular joint will be completely normal.    

Background and Objectives: Considering the fact that choroidotomy during scleral buckling is occasionally associated with some complications, this study was performed on patients at Tabriz Nikookari Hospital, to evaluate the efficacy of dry cautery in drainage of subretinal fluid during scleral buckling procedure. Materials and Methods: In a clinical trial, 36 eyes underwent scleral buckling for primary retinal detachment. After sclerotomy, choroid and retinal pigment epithelium were perforated by dry cautery, subretinal space was opened, and fluid drained from the hole. The success rate and all intra- and post-operative complications, followed at least for 3 months after operation; the statistical data were analyzed by McNemar's test. Results: This technique was successful for drainage in 31 (86%) of 36 eyes (p < 0.0001).  Operative and post-operative complications that are occasionally associated with the drainage of subretinal fluid, including subretinal hemorrhage, retinal break or incarceration in sclerotomy site, were not seen. Conclusion: The dry cautery after sclerotomy was used for successful subretinal fluid drainage and was not accompanied with any complications. We suggest performing this type of study in other centers and recommend reporting results to evaluate therapeutic role of this procedure.    

Background and Objectives: Health care workers, exposed to blood, blood products and certain body fluids, are at risk for acquiring hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections; therefore, they should routinely use universal precautions to prevent skin and mucous-membrane exposure when they are in contact with blood or certain other body fluids. Materials and Methods: This is a cross-sectional study and includes 60 OR personnel from Sina Hospital, Tabriz University of medical sciences. Results: This study shows that 54.9% of OR personnel use these precautions "poorly" and 54.1% "well" for percutaneous, and 51.7% of them "poorly" and 48.3% "well" for mucocutaneous blood contact. The surgical assistants, scrub nurses and those working in elective procedures or in day shifts, use these precautions more effectively than others (p<0.05). Conclusion: This study suggests that it is necessary to evaluate other medical centers in this regard, and to increase application of these precautions with education and continuous monitoring.    

Background and Objectives: Infections acquired in the heart surgery, especially in coronary artery bypass grafts (CABGs), present as mediastinitis and sternal dehiscence. Their prevalence is about 0.8-1.5%. According to several studies, administration of prophylactic antibiotics is essential in CABG procedures. In these procedures, while inducing anesthesia, before establishing cardiopulmonary bypass, and after disconnecting it, intravenous antibiotics are given and maintained for 48 hours after operation, before extubation and disconnecting IV lines; then, antibiotics are discontinued. The aim of this research was to evaluate the present antibiotic therapies, to get information on the type and dosage of the prescribed antibiotics in patients undergoing CABG, and to introduce a new method for antibiotic prescribing. Materials and Methods: This research was a quasi experimental study on 100 male patients with coronary artery diseases who had undergone CABGs in Shahid Madani Heart Hospital, Tabriz. For collecting data in both groups, a questionnaire is used, consisting following features: gender, age, weight, risk factors, duration of operation, anesthesia and CPB, ejection fraction (EF), the number of grafts, expected time for surgery, the time of chest tube connection, the presence of infectious, urinary and pulmonary diseases, and also history of endocarditis, clinical laboratory tests (including ESR1, ESR2, WBC count, and blood, urine and wound cultures), body temperature 24, 48, 72 hours after the operation, and finally the doses of prescribed oral orparenteral antibiotics. The statistical analysis was performed with SPSS software and was done through descriptive statistical method. Results: The study was performed on 100 patients, divided into two groups, with mean age of 53.30±9.60 years old in the first and 54.66± 8.87 years old in the second group. The mean weight of patients was 74.40 ±12.45 kg in first group and 74.16 ± 10.50 kg in second group. According to results, not a single case was reported to develop urinary and respiratory tract infection or endocarditis. After surgery, based on clinical laboratory tests, all patients were in normal range. Blood, urine and wound cultures also were negative and 72 hours after surgery, no patient was reported to develop fever. Patients were followed for one month, for signs of infection. In this study, total dosage of antibiotics was decreased 15g, 10.47 ± 1.09 g of which was for oraldrugs. Conclusion: Findings suggest that oral antibiotic therapy plays no important role in management of postoperative infections. With the use of standard prophylactic antibioics, antibiotic overuse can be prevented. In this research, the dosage of antibiotics was decreased from 34 g to 199, which may be helpful also in decreasing complications and cost of treatment.      

Background and Objectives: The incidence of muscle pain following administration of succinylcholine, varies from 2-89% and this type of pain occurs more frequently following minor surgery, especially in women and in ambulatory rather than bedridden patients. To prevent this, we studied the pretreatment with phenytoin and pancuronium for their preventive effects. Materials and Methods: In a prospective randomized trial carried out in medical center of Imam Khomeini Hospital, 64 adult patients who underwent elective routine surgery with anesthesia of class ASA I (American society of anesthesiologists), were observed 24, 48 and 72 hours after surgery to evaluate muscular pain. To determine the efficacy of intravenously administered phenytoin (5 mg/kg) in prevention of induced myalgia, patients were allocated randomly in three groups: Group I received phenytoin 5 mg/kg 5 minutes before induction of anesthesia, group II received pancuronium 0.5 mg 3 minutes before induction of anesthesia, and group III did not receive any pretreatment before succinylcholine. Results: Incidence of myalgia in group I was 20%; it was 43.3% in group II and 71.4% in group III. Incidence of fasciculations in groups I, II, and III was 55%, 38% and 100%, respectively. Conclusion: Phenytoin and pancuronium both significantly reduces incidence and severity of pain and fasciculations induced by suxamethonium. The incidence and severity of pain and fasciculations after phenytoin administration are significantly less than those in pancuronium and control groups. Preinduction administration of phenytoin, effectively reduces myalgia and fasiculations and in this regard, acts better than pancuronium.    

Background and Objectives: The clinical and epidemiological importance of streptococcal infections and their infectious and non-infectious sequela, is obvious. This prospective study was performed in healthy school children, to determine the incidence of group A beta-hemolytic streptococcal (GABS) carriage. Materials and Methods: 1001 samples were drawn from school-aged children in two different socioeconomic parts of the city. Results: The carriage rate of group A beta-hemolytic streptococcus (GABS) was 4.3%. There were no differences in the carriage rate between both sexes and two parts of the city. Conclusion: The results of this study show that the carriage rate of beta-hemolytic streptococcus is one of the lowest rates that have been reported in the region.    

Background and Objectives: Although many studies have been carried out on therapeutic drug monitoring (TDM) of anticonvulsant drugs, there are few reports on TDM of these drugs in patients with refractory epilepsy. In this study, serum levels of carbamazepine, phenobarbital and phenytoin in epileptic patients and patients with refractory epilepsy, are investigated. Furthermore, in this study the efficiency of clinical-based drug treatment protocols designed and used by the physicians to treat patients with refractory epilepsy in Imam Khomeini and Razi Hospitals of Tabriz, is evaluated. Materials and Methods: The subjects of this study were 66 epileptic patients undergoing treatment in Imam Khomeini and Razi Hospitals of Tabriz, of which 29 suffered from refractory epilepsy. About 0.5 mL serum' was obtained from each patient and the concentrations of drugs were determined using HPLC method. Results: No significant difference was observed in the serum levels of drugs and average doses of phenobarbital and phenytoin in both groups (p >0.05). However, the average dose of carbamazepine in patients with refractory epilepsy was higher than that of other group. The absence of significant differences in the serum levels of carbamazepine in both groups, in spite of using higher average doses in patients with refractory epilepsy, could be indicative of the presence of differences in pharmacokinetics of this drug in both groups. The serum levels of carbamazepine and phenobarbital, were slightly higher than the lowest limit of reported therapeutic range of drugs; however, the corresponding value for phenytoin was even lower than the lowest limit of the reported therapeutic range for this drug. Conclusion: The results were indicative of necessity for renewing the treatment protocols used in Imam Khomeini and Razi Hospitals for patients with refractory epilepsy. There were also evidences indicating a difference in the pharmacokinetics of carbamazepine in patients with refractory epilepsy.    

Background and Objectives: Acromegaly is an important risk factor for carpal tunnel syndrome (CTS), observed clinically in 50% of the patients with acromegaly; however with electrodiagnostic tests, this rate increases to 80%. Because numerous diagnostic methods are available for CTS, determining a suitable screening test seems necessary. Materials and Methods: We analysed 15 patients with criteria for acromegaly and mean age of 39.9 years old, in whom mean duration of 4.8 years were past from successful treatment, for determining prevalence of CTS with various electro diagnostic tests. Results: Clinically symptomatic CTS were noted in 30% of patients. However, with electrodiagnostic tests this rate increased to 70%. Of various electrodiagnostic methods, median and radial nerves sensory action potential was more sensitive for CTS, and with this technique more than 80% of patients with acromegaly were included in CTS group. Conclusion: Median and radial nerves sensory action potential comparison, is recommended as a screening test for CTS. Despite successful management of patients with acromegaly, the reason for high rate of occurrence of CTS in these patients may be related to irreversible carpal tunnel stenosis due to bony hypertrophy and/or hyperplasia of tendons. Fortunately, CTS is often asymptomatic or mildly symptomatic; thus, the majority of patients are treated conservatively, and only in rare cases surgery is required.    

Background and Objectives: The alternative method for scleral buckling (SB) in the treatment of retinal detachment (RD), is pneumatic retinopexy (PR) which is developed in 1986. In this study, the results from 35 cases of RD treatment by PR are reported and compared with the results from SB method. Materials and Methods: The cases are selected from patients who are referred to Nikokari Hospital during 1991-1992. During operation, 0.3 mL of C3F8 gas is used for each patient and a day after operation, a scar is produced around the treated area using argon laser. Two weeks after operation, the patients are allowed to back to work and their follow up proceeded for 11 months. Results: The results showed that the rate of anatomic success in first PR is 76%, but it rose to 83% in second operation. The main reasons for failure were new or missed tears (3 cases). PVR was observed in 3 cases, while 2 cases were aphasic. In 60% of treated patients, the vision was better than 20/50. The side effects were restricted to increase in intraocular pressure, vitreous hemorrhage (8%) and sub-conjunctional gas accumulation (11%). Conclusion: In general, it is concluded that side effects of PR technique are less, and hospitalization period is short. Additionally, if PR is failed, still SB could be performed.    

Background and Objectives: Today, cardiovascular diseases are the leading cause of death and one of the major causes of morbidity in many countries. Although medical interventions lead to reduction of mortality rate for cardiovascular diseases in recent years, the risk of these disorders is yet significantly high in industrial societies. As most of clinicians emphasize the need fo prevention rather than symptomatic treatment, cardiac rehabilitation programs are medically and economically effective methods for achieving this goal. Materials and Methods: In this study we selected 100 patients who were referred to cardiac rehabilitation center, after ruling out those cases who had contraindications to exercise therapy. Then, second phase of cardiac rehabilitation was started with standard training program on tread mil and stationary bike along with stretching exercise before and after each training session, and this process continued for 8 weeks. Results: After 8 weeks cardiac rehabilitation, clinically and statistically significant improvement was seen in exercise capacity as demonstrated by increase in METs (+ 10%). Other alterations in various parameters included reduction at resting heart rate (-6%), increase in peak heart rate at maximal exercise (+ 18%), mild decrease in systolic blood pressure (-4%), significant reduction of total cholesterol (-9%) and LDL-cholesterol (-10%), increase in HDL-cholesterol (+6%), and reduction of triglycerides (-13%). Although exercise training had substantial effects on other parameters, there were no statistically significant differences in body fat percent, diastolic blood pressure and fasting blood sugar before and after rehabilitation. Conclusion: Exercise training as a simple therapeutic method with low risk and low cost after coronary artery bypass grafting, is effective to reduce many cardiac risk factors and leads to rapid and effective return of patients to daily living, and occupational and recreational activities.      

Background and Objectives: An increasing trend in the rate of cesarean section has been observed during the past years. Due to surgical complications, long time needed for recovery and high costs of surgery, vaginal delivery is preferred as a favorite procedure. However, women's requests and attitudes play an effective role in this regard. The aim of this study was to evaluate the rate and reasons of women's attitude toward delivery procedures. Materials and Methods: This study was a descriptive survey. A total of women hospitalized in the first stage of labor without any complications, were selected. All information was gathered based on an interview by a questionnaire. Statistical analysis was performed using SPSS software. Results: Results showed that cesarean section was carried out in 26% of patients. Based on women opinion toward the type of delivery procedure, 55% of women had an inclination of more than average for cesarean delivery, while 45% of them had a comparable inclination for vaginal delivery (p<0.0001).The most important reasons in choosing cesarean section, were as follow: lack of pain during process, lack of injury to infant, lack of multiple examinations, and the inclination of their spouses. The following reasons were the most important criteria for the women selected vaginal delivery: low risk of process, fear of surgery, harmlessness for the newborn, and low cost of vaginal delivery. There was no statistically significant difference between cesarean section and vaginal delivery regarding to rate of satisfaction in women (p >0.05). Conclusion: It is speculated that before delivery, women have high inclination for cesarean section. However, no significant difference was found in women's satisfaction from two types of deliveries. Therefore, in order to encourage women to select vaginal delivery, it is necessary during pregnancy, to educate patients and get them familiar with advantages of vaginal delivery.    

Background and Objectives: Anterior cervical plating is one of the most useful methods for treatment of cervical collapses. This study was conducted to determine the indications, safety, efficacy, and complications associated with performing corpectomy for anterior decompression of neural elements. Materials and Methods: Between 1993 and 1999, 60 patients underwent cervical corpectomy for treatment of degenerative spondylotic diseases (8 cases), ossification of posterior longitudinal ligament (PLL) (2 cases), fractures of vertebral body (40 cases), tumor (7 cases), and infection (3 cases). Eight cases presented with myelopathy, 10 cases with radiculopathy, 2 cases with neck muscle spasm and 40 cases with radiculomyelopathy. Fifty patients were treated with one-level corpectomy and 10 patients with two-level corpectomy, and all of them underwent discectomy at both upper and lower levels. In all cases autograft (iliac crest) was used and fixation was performed with an anterior plate-screw system. Results: There was no operative mortality and new neurological sequela were not encountered. Postoperative hoarseness, dysphagia, and pain at the operation and graft sites, were transient. During the procedure, the vertebral artery was injured in one patient, that undewent ligation. The fusion rate was 91.7%. All patients presented with pain, improved completely (100%), as did 80% of the patients presented with radiculopathy and 60% of the patients presented with myelopathy. Conclusion: Corpectomy has an important role in the management of various traumatic, degenerative, neoplastic or infectious conditions of cervical spine. In this study, radiculopathy improved in all cases and myelopathy reversed in most patients, following treatment.    

This paper presents 10 years old boy with mercury intoxication from Children Hospital of Tabriz. His illness began two months before admission as lower limb and low back pain, maculopapular rash with pruritus in lower abdomen and extremities, severe drooling, and perspiration. Other symptoms included insomnia, weight loss and frequent defecation. He had also some neurologic symptoms as myoclonic movements in upper limbs, tremor in chin, transient diplopia and blurred vision. In physical examination, tachycardia and hypertension were found. His history revealed contact with elemental mercury; intoxication was confirmed by demonstration of increased mercury concentrations in blood and urine. Patient was treated with dimercaprol and dipenicilamin. These manifestations called acrodynia, that is a rare kind of idiosyncratic hypersensitivity reactions to mercury. Hypertension that is seen in this disease, served as a guide for diagnosis.