MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:- | Issue:53|Papers Count:14

Background and Objectives: This cross-sectional study was conducted to determine the prevalence of glaucoma due to hyphema in patients suffering blunt trauma. Materials and Methods: We reviewed the medical records of 310 patients (257 men and 53 women), admitted to Nikoukari hospital between 1995-1999 with a diagnosis of hyphema due to blunt trauma, with respect to age, sex, hyphema grading and intraocular pressure. Results: Out of the total patients enrolled in the study, 37% of them were under 10 years of age and 67% had hyphema less than or equal to one third of anterior chamber depth (Grade1). Initial visual acuity was less than 20/100 in 180 (58%) patients that improved to 20/40 or better at discharge in 204 (66%) patients. 48 (15.5%) eyes developed intraoculor pressure greater than 21/mmHg, that was accompained by total hyphema (Grade4) in 50% of cases. Conclusions:Preventive measures for ocular trauma are recommended especially in children.

Background and Objectives: It is known there are many factors which have considerable effect on success of regional anesthesia. One of the most important factors is patients previous and present knowledge towards it. The aim of this research was to study predictors of patients toward regional anesthesia (spinal). Materials and Methods: This study was performed on about 100 pregnant female patients who selected elective cesarean section for child delivery. Data collection was performed by using a questionnaire about pre and post operative problems, and later analyzed by statistical SPSS WIN program, and with chi-square method.Results: This study was performed on about 100 pregnant females with average age of 25 - 35 years, who delivered by elective cesarean section. 74% of the patients were educated, while 26% were uneducated. The most important factors which influenced patients predictors were nausea and vomiting (27%), fear of getting pain (34%), fear of needle puncture (15%) and feeling pain during sensory and motor reflex return (6%). Being awake during surgery and the awareness of birth were the most pleasant stages of anesthesia in 19% of the patients.Conclusions: Results of this study showed that giving enough and appropriate informations at preoperative visit on the basis of principles and correct technique for management of anesthesia and its proper methodology can increase the acceptance of this regional anesthetic method.

Background and Objectives: Encephalocele is one of the brain congenital abnormalities commonly associated with various birth defects and syndromes. Prenatal diagnosis of encephalocele and coincidental abnormalities, using ultrasonography (US) is valuable and important. This abnormality is diagnosed in the second trimester of pregnancy. The objective of this study was to determine the prevalence and etiology of encephalocele and coincidental abnormalities by prenatal US. Materials and Methods: During a period of ten years 66,129 pregnant women, in their second trimester, were routinely examined using US in Fajr clinic of Tabriz. Presence or absence of any congenital abnormalities or other complications were recorded and followed up.Results: In this study 28 cases of encephalocele were detected on US. The prevalence of encephalocele was 4.2 per 10,000, the result being higher than expected. Of these 28 cases,10 (35.71%) fetuses had isolated malformation and 17 (64.28%) had coincidental abnormalities. In view of parents being wedded within the family relatives, 47.82% parents of these fetuses with encephalocele were found relatives and other 52.12% as non-relatives. The prevalence of encephalocele was significantly affected by relative marriages (p<0.05).Conclusions: Prenatal ultrasonography is a proper method for early diagnosis of brain abnormalities. Relative marriages have a great role in prevalence of such abnormalities.

Background and Objectives: Radiologists like other physicians are susceptible to commit diagnostic and sometimes therapeutic mistakes. Because of the extension of diagnostic and interventional procedures, nowadays, errors are encountered more often than in the past. The purpose of this study was to assess common errors in radiology and their causative factors and to suggest special comments for prevention of them or to reduce them to the minimum level at least.Materials and Methods: The medical records of the patients referred to the Imaging Department of Imam Khomeini Medical Center and Private Clinics of authors in Tabriz performing imaging since last 5 years, were reviewed retrospectively and at the same time, the related articles in some reliable international journals were also searched. Essential errors in radiology were collected and evaluated. Results: The findings were divided in three groups: A- Diagnostic errors and malpractices including cases related to conventional (general) radiology, ultrasonography, computed tomography and other diagnostic imaging procedures, B- Complications regarding different modalities of diagnostic and interventional radiology,C- Main causes of errors and malpracticesConclusions: In accordance with the extension and variety of radiologic examinations performed, growing number of malpractices and errors have been observed. In order to reduce them, it is very important to be familiar with different procedures and their advantages and limitations, as well as to spend enough time and meticulous care in viewing and interpreting images.

Background and Objectives: Helicobacter pylori (HP) infection in man has several disease outcomes, varying from asymptomatic chronic gastric inflammation to HP-associated dyspepsia, peptic ulcer disease, gastric adenocarcinoma, and MALT lymphoma. This study was undertaken to evaluate Helicobacter pylori infection and assess the sensitivity, specificity, positive and negative predictive value of two commonly used diagnostic tests for Helicobacter pylori i.e. Rapid urease and ELISA tests.Materials and Methods: The present prospective study was performed on 120 patients (with dyspepsia) referred to Imam Khomeini hospital in Tabriz. Antral biopsy specimens were taken for rapid urease test and IgG anti-Helicobacter pylori was evaluated with a serological test (ELISA). If both the tests were positive, the patients were taken into account to be Helicobacter pylori positive. Results: In this study, patients with two positive tests (rapid urease as well as ELISA) were considered to be Helicobacter pylori positive. Of the total patients studied, 86 (71.6%) were found Helicobacter pylori positive and 34 (28.4%) were negative. The sensitivity, specificity, positive and negative predictive values were as follows respectively: rapid urease test 89%, 92.6%, 97%, 75.8% and for ELISA test: 97%, 75.8%, 89%, 92.6%. Conclusions: Our results indicate that due to non- invasiveness and high sensitivity of ELISA method in comparison to rapid urease test, it is favourable to perform this test for H.pylori in suspicious patients and if the test is positive with clinical presentation, endoscopic procedures should be applied.

Background and Objectives: Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed to compare different surgical techniques. This study reviewed cholesteatoma in pediatric patients to determine which factors influence the outcome of surgical treatment.Materials and Methods: Fifty eight patients aged 2-15 years who had ear cholesteatoma and were retrospectively operated at Children Hospital over a period of 10 years (from 1987 till 1997), were taken into the study. Patients information was collected from their case files.Results: A total of fifty eight patients were treated and followed for an average of 37.7 months (range: 12.2 month till 12.5 years). Seventeen patients underwent canal wall down mastoidectomy with tympanoplasty. Initially two patients (12%) had residual cholesteatoma found at planned second stage procedure, however no recurrent cholesteatoma was encountered. Seventy two percent maintained a speech reception threshold of less than 30 db hearing loss (HL). Intact canal wall mastoidectomy with tympanoplasty was the primary surgical treatment in 41 patients and at a planned second stage surgery nineteen percent had residual disease, while 22% developed recurrent cholesteatoma. A speech reception threshold of less than 30 db HL was achieved in 75% of these patients. Conclusions: These results support the continued use of ICW mastoidectomy with tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long- term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy and hearing, canal wall down (CWD) mastoidectomy with tympanoplasty provides a safe ear and good hearing results.

Background and Objectives: Evaluation of the effectiveness of contraceptive methods and also the knowledge of users about the efficacy of them are very important in the management of programme family planning. The purpose of this study was to evaluate the effectiveness of contraceptive methods in women, aged 15-49 years, living in one of the villages of Tabriz.Materials and Methods: This longitudinal study was carried out in 20 Health centers of Tabriz, in year 1997-98. The age of women studied ranged from 15-49 years. Statistical analysis was performed using X2 test and SPSS software package.Results: The results obtained in this study indicated that injectable Depo-Provera, Norplant and vasectomy had high effectiveness (100%) as compared to condom usage (88.51%). These findings did not reveal any significant statistical difference among chemical, mechanical and sterilization as preventive methods (p>0.05). No statistical meaningfull differences were found regarding education, occupation, age and number of children. However, the relationship between effectiveness to contraception and sex of the next child was statistically significant (p<0.05). Thirty-three. per cent of mothers with prior child as female became pregnant during contraceptive use, while only 0.8% of mothers having prior male child could get pregnant.Conclusions: Our finding indicat the necessity of evaluating contraceptive methods and to educate couples about their proper usage according to the best method that suites them.

Background and Objectives: Orbital sinusitis, usually secondary to sinusitis in children, may develop serious complication if not diagnosed and treated timely and properly. Modern diagnostic techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can be valid imaging choice for sinusitis and orbital cellulitis.Materials and Methods: A review from case histories of 18 children was undertaken. These children were admitted to the Children hospital from 1994 - 1999. All of them had undergone preoperative CT scans. Six of these patients underwent surgery for subperiosteal abscess of the orbit (SPA), and 12 of them were treated with antibiotic therapy for cellulitis of the orbit.Results: Amongst the patients studied, opacified sinuses were seen in all of them. Collection of abscess was found in six patients (33.3%). All patients did well following surgical intervention for abscess and antibiotic theraphy for cellulitis without visual sequelae.Conclusions: We conclude from this study that CT scans should be obtained when orbital cellulitis is suspected, and antimicrobial therapy should be directed toward the pathogenic bacteria isolated from these abscesses.

Background and Objectives: Diabetes mellitus is the most common endocrine disease. It has many implications and the most important is the cardiovascular ones, which are one of the causes of death in diabetic patients. Blood viscosity is one of the main factors impairing microcirculation and producing microangiopathy.Materials and Methods: In this study 13 male diabetic patients, 43-60 years of age with cardiovascular implications and 10 healthy male subjects in the same age groups were studied as controls. Whole blood viscosity and plasma viscosity were measured. Other factors such as glucose, fibrinogen, hematocrit, albumin and total protein that can affect viscosity were also measured.Results: Results showed increased total viscosities in the diabetics compared with controls, but only whole blood viscosity showed a significant difference (p<0.01). All factors except albumin were higher in diabetics than in controls, but only glucose and fibrinogen showed statistically significant difference (p<0.001) between diabetics and controls. Albumin level was lower in diabetic group, but not significant.Conclusions: It seems that the main reason for increased viscosity in these cases was change in plasma composition ( high glucose and fibrinogen). It is likely that high glucose and fibrinogen in diabetic patients may increase blood cell aggregation that results in high blood viscosity.

Background and Objectives: Strontium - 90, one of the radionuclides produced during the fission of uranium and plutonium in the nuclear explosions and reactors, can readily replace calcium in the milk. It can put public health in danger both through its physical long half-life (over 28 years) and its existence in the milk that is a perfect nutrition of children.Materials and Methods: In this study, we collected 50 samples of fresh milk from Tehran, Mazandaran, eastern and western Azarbaijan and another 25 samples of milk powder imported from Netherlands, Denmark and Japan. After extraction of strontium by the method of Tri-butylphosphate (TBP) and preparation of the samples, Sr-90 reached in the radioactive equilibrium with Y-90 that was measured by the low-level beta detector.Results: The observations obtained in the study shows that the mean value of concentration of Sr-90 in the samples of fresh milk from Tehran, east and west Azarbaijan and Mazandaran was 5.43, 1.76, 1.70 and 2.90 Bq/kg respectively, while in the milk powder imported from Japan, Denmark and Netherlands, it was 6.93, 11.8 and 19.64 Bq/kg respectively.Conclusions: These results showed that the mean value concentration of Sr-90 in the imported milk powder was significantly higher than normal and thus, indicate the necessity of a precise control of imported nutrition products for children.

The Landau-Kleffner syndrome or acquired epileptic aphasia is a rare pediatric epileptic syndrome occuring in children who have already developed age-appropriate speech. It is characterized by a marked deterioration of language functions associated with clinical seizures and epileptic abnormalities in electroencephalogram. Hereby a case of six year old boy is presented, who was admitted to the hospital with seizures and aphasia. He was diagnosed as a case of Landau kelffner syndrome on the basis of detailed case history, clinical signs and symptoms as well as epileptic findings on electroencephalogram. He was treated with steroids. He responded well to high dose corticosteroid therapy and was followed up for 30months. In this case, a close relationship between language functioning, paroxysmal EEG activity and the effect of steroid therapy on these abnormalities was observed.

Presence of inhibitor to factor VIII (FVIII) is a rare occurrence. The incidence of acquired inhibitors in the population is 0.2-1 per million / year and majority of such patients are older than 60 years. Presence of these antibodies is observed sometimes in association with an autoimmune disorder, hematologic and nonhematologic malignancies, pregnancy, drug usage, infection and or idiopathy. Patients commonly present with hemorrhage into soft tissue ecchymosis, overt bleeding after trauma or surgery. Laboratory tests shows prolonged partial thromboplastin time (PTT), decreased level of factor VIII and increased level of factor VIII inhibitors. These patients are treated with prednisolone and cyclophosphamide. Hereby, we report a 75 years old man with ecchymosis and swelling of left knee, prolonged PTT, decreased FVIII level and increased FVIII inhibitor. He was treated with prednisolone and was followed up for any compliant or symptoms.He improved symptomatically within 15 days. After one month, he had no symptoms of disorder and normal PTT. However, after discontinuation of prednisolone, PTT level raised again and cyclophosphamide was prescribed. PTT was normal after one month.