MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2007 | Volume:29 | Issue:1|Papers Count:31

The health system of Iran similar to other countries; faces variety of challenges and problems due to the issues of equity, quality, relevancy and effectiveness. In order to respond effectively to these fundamental issues, as sustainable, planed and purposeful reform is necessary. In the latest decade, health sector decentralization polices have been implemented on a broad scale throughout world especially in developing countries. Decentralization actually involves the transfer of variety of service provision mechanisms from central authority namely Ministry of Health (MOH) to preferable units or alternate institutions. Function of stewardship has a fundamental role in performance of health system.In the descriptive and comparative present research mechanisms of decentralization in England, Turkey, Zambia, Ghana, Mexico, Thailand, France, Chile, Sweden and Philippines has been reviewed in order to suggest an appropriate Model for Iran.A model of stewardship function for Iran was reviewed by 65 experts including health management professors, head of medical universities and ministries of MOH and vice chancellors of them with Delphi techniques.Obtained results from the analysis of 35 collected questioners indicated that all participated subject agreed with appropriate these developed model. Statically the module was also confirmed the significant of results (a=0.05 Z=3.14(.It was concluded that:• Developing and situating policymaking agency at MOH, situating and participating health councils in management of health• Managing hospitals through board of trusts with enough autonomy.• Organizing the health enterprise (HE) and managing hospitals in the form of cluster.• Organizing and situating national committees of decentralization and accreditation.• Starting the decentralization process in the three next years.

Background & Objective: Necessity for rapid and safe recovery of patients for coming back to daily life with consideration the daily – increased development of outpatient surgeries is the main point. This study is comparing recovery time post operative nausea and vomiting after the use of two rapid-onset narcotic, alfentanil and remifentanil in anesthesia of elderly patients.Materials and Methods: In this double-blind clinical trial 40 elderly patients scheduled to cataract surgery with general anesthesia were studied. The patients were selected randomly into two groups and in each group alfentanil or remifentanil was injected one minute before induction of anesthesia during 30 seconds. Both two groups were under general anesthesia with same method and during the anesthesia alfentanil and remifentanil infused for each grouper respectively. The time intervals between end of anesthesia and spontaneous respiration, eyes opening with simulation, verbal response, nausea and vomiting incidence in recovery and the time of discharge from recovery room were recorded.Results: The time of spontaneous respiration in alfentanil group 1.3 minute was shorter than remifentanil group, But statistically, the difference was not significant (P=0.08). The time of eyes opening with stimulation, verbal response and discharge of recovery room were not significantly different in two groups. During recovery, nausea and vomiting in remifentanil group (30% of patients) was significantly more than alfentanil group (5% of patients( (P=0.045(.Conclusions: With consideration that faster return of spontaneous respiration after infusion of alfentanil than remifentanil group and especially the significantly lower incidence of postoperative nausea and vomiting in alfentanil group, the infusion of alfentanil as opioid supplement in anesthesia of elderly patients espessially in out patient surgery is suggested. 

Background and objectives: Delusional disorder is an uncommon mental illness with an estimated prevalence of 0.03%.Since these patients have no insight in their disease, psychotherapy of them accompanies by many problems. It seems that using an effective drug with least side effects has an important role in treatment of this disorder. The aim of this study is comparison of theraputic effects of Risperidone and Haloperidole in treatment and management of delusional disorders.Material and Methods: In this study, 35 patients (22 male and 13 female) suffering from delusional disorders according to DSMIV criteria and diagnosis of a psychiatrist, were selected and randomly divided into two groups. The Global Assessment of Function-sale (GAF) was measured in patients before treatment and then one group received Risperidone (2-6 mg/day) and the other was treated with Haloperidole (10-20 mg /day).Results: In the first group treated with Risperidone(19 cases) response to treatment was %89.5, which was higher than the second group ,which was treated with Haloperidole (16 cases) with %68.5 response to treatment (p=0.248). The mean increase range of GAF in first group was higher than the second group (55 and 44 respectively) (p=0.003).Conclusion: It seems that treatment of delusional disorder with Risoeridone is more effective than Haloperidole and ends to more increase in GAF.In the meantime Resperidone is tolerated better and has fewer side effects.

Background and objectives: Guillain Barre Syndrome is the most common peripheral neuropathy causing respiratory failure, and about 10-30% of these patients require mechanical ventilation sometimes during their illness.Materials and methods: Ninety one children under 15years old with GBS were studied over a period of 3 years. Thirteen (14.4%) of these patients required assisted ventilation. A comparison was made between the clinical, electrodiagnostic, and laboratory data from patients who required mechanical ventilation and those who did not. Results: Progression to respiratory failure necessitating mechanical ventilation was highly likely to occur in those with younger age (p=0.001), cranial nerve involvement (p=0.03), and loss of deep tendon reflexes in upper limbs (p=0.04), lack of motor unit action potential (p=0.009) or presentation of fibrillation potentials (p<0.0001) on electromyography and markedly attenuated (>80%) CMAP amplitude on nerve conduction study (p<0.0001) were significantly more common in the ventilated group.Conclusion: While inherently unpredictable, the clinical course of patients with severe GBS may be predictable to some extent, on the basis of clinical information and electrodiagnostic findings.

Background and Objectives: Primary acquired obstruction of Nasolacrimal duct is the most common cause of Tearing in adults requiring surgery. The aim of this research is evaluating the results of external dacryocystorhinostomy with and without silicone intubation in NLDO.Materials and Methods: This randomized clinical trial study was done on 80 patients with nasolacrimal duct obstruction. These were divided into two groups of Ex.DCR with and without silicone intubution incidentally.Results: Overall success rate were 77.5% in Ex.DCR and 90% in Ex.DCR with silicone Intubation (p<0.05(.Conclusion: Ex.DCR with silicone intubution is a procedure with more successful results comparing the other method. This can be advised as routin procedure for the management of nasolacrimal duct obstruction.

Background and Objectives: Bronchiolitis is the most common lower respiratory tract infection during first year of life and the cause of about 1% of infant’s hospitalizations. The treatment is mainly supportive but many studies have emphasized the role of bronchodilators. This study was aimed to show the efficacy of salbutamol spray.Materials and Methods: In a Randomized controlled trial, 100 patients with bronchiolitis were randomly divided in to two groups (50 patients to each). First group received salbutamol spray (2 puffs via spacer every 4 hours) and second group nebulized 1/1000 epinephrine (0.2 mg/kg plus 3.5cc solin every 4 hours(.Inclusion criteria: Infants' attueage of 2-12 months with bronchiolitis were diagnosed as lower respiratory tract infection accompanied by fever, rhinitis, tachypnea, wheezing, and dyspnea.Exclusion criteria: patients with cardiac or pulmonary problems, history of bronchodilator the rap or hospital admission with wheezing, history of corticosteroid consumption and ICU admission due to sever bronchiolitis.Results: The age and the gender differences were not significant (p=0.2 and 0.6 respectively). Outcome indicators such as length of hospital stay and the time needed to restart normal nutrition had no significant differences (p=0.1 and p=0.47 respectively).Conclusion: Considering feasibility of access and participation of parents in treatment and lack of significant differences between two groups, we suggest using salbutamol spray in treatment of bronchiolitis.

Background and Objectives: Cryoglobulinemia is a disorder which appears in hepatitis B and C patients in long term. It usually accompanied by production of rheumatoid factor leading to consumption of complement components in serum.As dialysis and kidney transplantation patients are highly subjected to viral hepatitis B and C infections, therefore this study has been designed to find the frequency of cryoglobulinemia, rheumatoid factor in these patients.Materials and Methods: Two hundred and twenty nine dialysis patients and 70 kidney transplant recipients randomly selected. HBsAg and anti - hepatitis C antibodies of both sexes with different prolongation of treatment were tested by third generation of ELISA method. Their serum samples were collected and then were stored in refrigerator for a whole week in order to precipitatation of cryoglobulines. Rheumatoid factors were immediately processed by quantitative agglutination, single radial immunodiffusion and hemolysis methods.Results: Cryoglobulinemia in dialysis and transplant patients were 36.68 % and 15.71% respectively. Rheumatoid factor percentages in dialysis and transplant patients were 53.57 % and 20 % respectively. The age apparently did not critically affect the results, while prolongation of dialysis period significantly increased the frequency of cryoglobulinemia and rheumatoid factor incidences. Cryoglobulinemia and rheumatoid factor incidence in hepatitis B infected dialysis patients was 32% and 50%, respectively compared to 60 % and 80 % in hepatitis C infected ones.Cryoglobulinemia and rheumatoid factor incidence dialysis in female patients were higher than male’s (53.26 % against 25.54 % and 64.13 % against 45.98 %). These results did not correlate with transplant patients results.Conclusion: Chronic hepatitis B and C may lead to exist of cryoglobulinemia and rheumatoid factor appearance and further tissue damage in dialysis and kidney transplant patients. Regular check up and proper treatment of these individuals could prolong and ease their surveillance.

Background and Objectives: Electrodiagnostic changes typical of peripheral polyneuropathy have been reported in patients with over hypothyroidism. There are controversial reports regarding the effects of subclinical hypothyroidism on peripheral nervous system function. The aim of the present study is to investigate the possible effects of subclinical hypothyroidism of peripheral nervous system function by electrodiagnostic studies.Material and Methods: A total of 28 patients (56 extremities) with subclinical hypothyroidism (defined as high serum TSH in the presence of normal free thyroxin by appropriate methods) including 25 adult females and 3 males (mean age of 46.07 ± 6.87y) and 30 normal subjects as control group (60 extremities). 27 females and 3 males (mean age 45±8.7y) had normal thyroid function tests enrolled in the study. Exclusion criteria were presence of diabetes mellitus, neuromuscular disorder, pregnancy, other disorders or drugs affecting neuromuscular function in all patients and control group. Electrodiagnostic studies including motor nerve conduction velocity (motor NCV), motor distal latency, CMAP Amplitude performed from tibial, median, peroneal and ulnar nerves bilaterally. Sensory function tests including sensory nerve conduction velocity, SNAP amplitude and sensory distal latency from median, ulnar and sural nerves bilaterally were studied by standard methods. Minimal f-response was studied from tibial, median and ulnar nerves bilaterally.Results: Mean of sensory NCV, SNAP amplitude and sensory distal latency from median, ulnar and sural nerves and motor NCV, motor distal latency and CMAP amplitude from median, ulnar, personeal and tibial nerves and mean of minimal F-response of tibial, median and ulnar nerves were not significantly different in patients and control group.Conclusion: The result of this study shows that there is no functional impairment in peripheral nerves in subclinical hypothyroidism at the time of diagnosis.

Background and Objectives: There is a growing awareness that vitamin D sufficiency is required for optimal health, and also the role of vitamin D in calcium absorption and metabolism for bone health is well known. The objective of this study was to investigate the serum vitamin D level in childbearing age and postmenopausal women and comparing with women who use oral contraceptive pills (OCP) and who take hormone replacement therapy (HRT).Material and Methods: Ninety-seven healthy non pregnant-non lactating women with a mean age of 32.67±5.14 years old (50 OCP users and 47 non- OCP users) and 56 healthy postmenopausal women, with a mean age of 51.42±3.22 years old (29 were taking HRT and 27 were not taking HRT) were studied using biochemical procedures ( measurement of serum 25- hydroxyvitamin D), anthropometric measurements (weight and height) and completing 24-hour recall questionnaire for determining daily dietary calcium intake.Results: No significant differences were found between either OCP and non- OCP users or HRT and non- HRT groups in terms of mean body mass index (BMI), and dietary intakes of calcium. Mean daily calcium intake in all groups was lower than recommended daily allowances. There was no significant difference in serum 25- hydroxyvitamin D levels between OCP- users and non-OCP users, However the mean serum 25- hydroxyvitamin D level in HRT group was significantly higher than that of non- HRT group (P<0.01).The majority of subjects in OCP and non - OCP, and HRT groups had serum vitamin D levels lower than normal limit.Conclusion: Vitamin D deficiency was common in the study subjects, which may have important health consequences. Using low- dose OCP had not resulted in altered Vitamin D metabolism compared to non -OCP users. However, in postmenopausal women, taking HRT had positive effect on serum vitamin D level. It is suggested to emphasize for overcoming vitamin D deficiency in community as one of the health priorities.

Background and Objectives: The main treatment of chronic renal failure is kidney transplantation. But unfortunately, patients should be treated by dialysis, until being transplantated. In spite of therapeutics effects of hemodialysis, these patients are faced with various physical and psychological stressful factors which lead to decreasing quality of life. There have been done a few researches on social support of hemodialysis patients in the world, and their quality of life in Asian countries, specially in Iran, so in this research beside of determining quality of life and social support of hemodialysispatints, we are going to measure their relationship with each other.Materials and Methods: For this purpose, all hemodialysis patients who had interface criteria and were hospitalized in hemodialysis wards of Tabriz Medical Sciences University hospitals; were selected and data were collected by interviewing and completing questionnaire including three parts of demographic, quality of life, and social support.Result: The results indicate that quality of life in 56.1%, and social support in 50.6% of hemodialysis patients were desirable, and there is a direct and significant relationship between these two variables (p< 0.001, r = 0.4). In quality of life subsecter, social dimension in 88% of patients was desirable, while physical dimension (57/3%) and psychological dimension (53%( in most of the patients were undesirable. In social support subsecters, emotional support (57.3%) was the biggest amount, while it was 14% of total variance of quality of life. The effects of instrumental support, and informational support on quality of life were not statistically meaningful.Conclusion: Nearly half of the mentioned patients had not desirable quality of life and social support, and regarding to positive relationship between these two concepts specially important effects of supports in emotional subsector, it is suggested that health care planner and managers in addition of increasing instrumental and informational support should take care of emotional support in such groups for improving quality of life in hemodialysis patients. 

Background and objectives: Lateral humeral condyle fracture is one of the most common fractures during childhood. Delay in operation and internal fixation often associated with hopeless treatment results. The goal of this study is comparison of complications and operation outcomes between the patients that underwent early operation with the patients that underwent delay operation.Materials and methods: This study was prospective and case series, performed on 60 patients from may 1998 to 2004. The patients were divided into two groups. The first group included 30 patients, treated during first week after lateral humeral condyle fracture, and the second group included 30 patients treated between 7 to 28 days after fracture.Method of operation was similar for the two group patients. All of the patients were studied for 12 to 30 months after treatment.Results: In the first group, 16.66% were diagnosed to have Milch I and 83.34% Milch II fracture, As for displacement, 10% of the patients were in stage I, 40% stage II and 50% stage III, in the second groups 20% of fractures were diagnosed to have Milch I and 80% Milch II. As for displacement, 13.3% of patients were in stage I, 33.3% stage II and 53.4% were in stage III.Most of the patients in the first group were in excellent conditions considering the range of movement of elbow; however, in the second group they were mostly in moderate and poor conditions. The most common cause of delay in treatment was fracture handling by bonesetter.Conclusion: Delay exceeding 1 week in treatment of lateral condyle fracture will be followed by numerous complications. To prevent delay in operative treatment the public culture for early and true treatment must be reformed.  

Background and objectives: Restoration of endodontically treated teeth by a simple method, with low cost in a short time is one of the major problems in dentistry. The purpose of this study was to evaluate the effect of horizontal pins in fracture resistance of endodontically treated maxillary premolars restored with composite.Materials and Methods: In this study, 48 sound, closed apex, maxillary human premolars, without crack, extracted for orthodontic reasons, were randomly divided into 3 groups of 16 as follows:Group 1: intact (unprepared) teeth Group 2: composite restoration without horizontal pinGroup 3:composite restoration with 2 horizontal pins in buccal cusp.In groups 2,3 after preparation of the standard access cavity and endodontic treatment, the palatal cusp was reduced to 1.5 mm coronal to the CEJ, leaving the remaining buccal cusp 3mm in buccolingual thickness at the height of contour. After thermocycling, each tooth was loaded in compression until fracture occurred. Data were analyzed with one-way ANOVA and Tukey test. The pattern of fracture was analyzed by Chi-Square test.Results: The mean fracture resistances in groups 1-3 were 689.59 ± 179, 632.86 ± 119 and 533.49 ± 168 (in N) respectively. The differences between group 1 and group 3 were statistically significant (p<0.05). Among patterns of fracture, the maximum number of favourable fractures occured in group 1 and the minimum number were in group 3.Conclusion: 1) Composite restoration with dentin bonding agents in endodontically treated maxillary premolars increased resistance to fracture.2) Horizontal pins caused statistically significant reduction in fracture resistance of teeth.3) The use of horizontal pins did not result in favorable fracture pattern 

Background and objective: As a cause of treatment failures, lack of a working knowledge of pulp anatomy ranks second only to errors in diagnosis and treatment planning. The purpose of this study was to investigate variations in the root canal system of maxillary first and second permanent premolar teeth.Materials and Methods: In this study, 188 maxillary first premolars and 138 second premolars, after access cavity preparation, the teeth were decalcified by 5% Nitric acid, dehydrated, cleared using Methyl salysilate, dye-injected and studied.Results: The results showed that 6.38% of maxillary first premolars had one canal, 90.43% had two canals and 3.19% had three canals, and also 50% of maxillary second premolars had one canal and 50% had two canals.Conclusion: The first and second maxillary premolars should always be considered as having two root canals, unless other wist is proved, and also first maxillary premolars with three canals should be considered.

Background and Objectives: Delayed diagnosis of musculoskeletal injury in multitrauma patients may potentially cause functional or cosmetic sequelae remaining for the rest of survivors, life. Identification of factors which hide injuries from early diagnosis in multitrauma patients will decrease their occurrence and prevent many functional disabilities and cosmetic sequelae. We planned this study to assess the reasons for injury concealment in multitrauma patients and provide resolutions to reduce them.Materials and Methods: This cross-sectional study on 487 patients was carried out in Tabriz Shohada Hospital from February 2004 to February 2005. After collection of needed data, a questionnaire was filled for every multitrauma patient who had a missed injury.Results: The relative frequency of multitrauma was 18.51% among all studied trauma patients (487 cases), but 7.6% of included patients (28 from 367 trauma cases) had missed injury (ies). 32 missed injuries were found in 28 patients. Most injuries were musculoskeletal, involving the distal part of the limbs (feet, hands, wrists and ankles). Fracture was the most common type of musculoskeletal injury (19 out of 32 missed injuries).Causes that leaded to concealment of injuries were founded to be inadequate physical and /or, radiographic examinations, commonly after severe penetrating injuries which are mostly due to motorcycle accident.Most of the missed injuries have been ultimately diagnosed upon the patient’s complaints in hospital wards, within 1 to 30 days after trauma.Conclusion: We can prevent missing of injuries by complete and accurate physical examination and perfect radiographic evaluation according to the standard protocols. Repetitive serial examinations during admissions and after discharge can reveal missed injuries.

Background and objectives: Gingival recession can cause several complications such as esthetics, root caries and plaque control that treatment of each necessitate time and cost from the patient. Regarding the importance of gingival recession, this study was undertaken in order to evaluate prevalence and severity of this clinical entity in anterior and premolar teeth.Materials and Methods: This study was performed on 246 patients between 10-70 years old who referred to Tabriz Dental Faculty. All measurements of recession depth and width were done with periodontal probe and under sufficient illumination. Furthermore the type of gingival recessions was evaluated based on Miller’s classification. Some measurements were done twice randomly in order to examine intra-observer agreement of data. Statistical analysis was accomplished using Kappa, chi-square and T.Test.Results: Our findings showed that 45.9% of patients had gingival recession. The trend of recession was upward between 10-30 (22.3%) to 50-70 years of age (100%). Prevalence of recession in males was significantly higher than females (P <0.05).The most prevalent recession sites were detected in lingual surface of lower right lateral (37.4%),lower left lateral (37%), buccal surface of lower left central (20.7%), lower right central (20.3%), respectively. Class I Miller was the most common type of recession.Conclusion: Considering the high prevalence of this clinical entity, implementation of oral hygiene instructions and conducting analytical and experimental researches would be a necessity. 

Background and Objectives: Zinc deficiency is a cause of taste disturbances. The purpose of the present investigation is to examine the effect of zinc supplementation on improvement of taste acuity in chronic hemodialysis patients.Materials and Methods: 65 chronic hemodialysis patients were studied in two groups, group one consist of 35 patients and group two consist of 30 patients. Group one received placebo and group two received 100 mg elemental zinc daily for 2 months. Then the placebo and supplement disrupted in next 2 months and afterwards, this study continued as a crossover design 2 months. Taste acuity for the four primary tastes was determined byasking patients to identify them at varying concentration. Taste acuity, body mass index (BMI) and the levels of serum zinc at the 0th, 60th,120th,180th days in fasting, predialysis samples were determined.Patients completed 1-day food record at nondialysis mentioned day and their dietary zinc were analyzed.Results: Basal serum zinc levels in both groups were below than 80 mg/dl. The zinc supplementations lead to significant increase the levels of serum zinc in both groups. Taste thresholds for the primary tastes significantly increased during the placebo period in both groups. Zinc supplementation lead to decrease taste thresholds for the four tastes in both groups. This decrease was significant, except for salty tastant in group two. BMI values significantly didn’t change during of study.Conclusion: It can be conclude that in chronic hemodialysis patients: 1)Taste thresholds increased in the absence of zinc supplementation. 2) Zinc supplementation lead to improve of taste acuity. 3) Low serum zinc levels are improved by zinc administration.

Background and objectives: In our country about 20% of couples are using natural methods of family planning or none of the family planning methods. The Standard Days Method is a fertility awareness-based method of family planning in which users avoid unprotected intercourse during cycle days 8 through 19. The aim of this experimental study was to determine the use-effectiveness of the combined contraceptive methods: Standard days method, condom and emergency contraceptive pills.Materials and Methods: A total of 240 women, age 17- 40 years, in rural area in the west of Tabriz city, with self- reported cycles of 26-32 days, desiring to delay pregnancy at least one year were admitted to the study. After teaching the method to the subjects, they followed-up for12 months to complete the study or excluded from study. Pearl pregnancy rate was used to determine percentage of protection of unplanned pregnancy.Results: Analysis of data indicated that 117 women didn’t get pregnant until the end of study (12 months). Only 8 women got pregnant, and a total of 1956 woman-months out of 240 women was calculated. So first-year pregnancy rate was 4.91% and percentage of protection of unplanned pregnancy was 95.09 irrespective of correct or incorrect use.Conclusion: the results show that this combined method may be an effective and acceptable method for couples.

Background & objectives: Otosclerosis is one of the causes of hearing loss in different ages, which its treatment capability with surgery is remarkable. The goal of this study is to determine the extent of clinical and audiometric correlation with tympanotomy findings.Materials and Methods: In this study, all patients’ have been studied in a prognostic manner. Suspected to otosclerosis, they were received to oto- rhino- laryngology department of Imam Khomeini hospital from April 1999 to September 2003. The differentiations studied were compared with studies done in other sources and areas. Then all of these patients have been performed stapedectomy surgery to restore hearing. During three weeks after surgery, the complication prevalence and the results of the patients treatment have been recorded, and compared with other sources.Results: According to this study, it was determined that in the society studied, the prevalence rate of the disease in women were more common than men, and the majority of the patients have been received the treatments in the third and fourth decade of their life, and the family prevalent rate was less than the statistic of the world presented. The hearing loss was more conductive type the most frequent complication after surgery has been reported, was dizziness and a high percentage of the patients received a significant hearing recovery.Conclusions: Results of this study indicated that early diagnosis and exploratory tympanotoy of these patients could provide adequate hearing, and prevent severe hearing loss.

Background and Objectives: In order to achieve to food safety and promoting health protection, water used in food and drinking industries should be in compliance with quality requirements. Presence of any chemical and microbial contamination in water has potential of transmission to final food products. So quality control of water in order to compliance with legislative standards is important. At present study to address the existing condition and to present the suitable and applicable quality control method, the main drinking, dairy and caning industries in the East Azerbaijan province were investigated as a representative sample of all kind of mentioned industries.Materials and Methods: Considering the frequency of industries, number of labors and production capacity, 9 industrial units with variety of products such as fruit juice, dairy products, lemonade, beverage, tomato derivatives, jams, was selected. To collection of required information, a questionnaire was designed and filed out by direct surveillance and interview.Results: After analyzing and interpretation of data, the results showed that there are many critical points without having any quality control plan which may lead to water pollution and it’s transforming to the products matrix among these industries. The majority of factories did not have acceptable program for sampling of consumed water and chemical and microbial analyzing and only water of boilers was controlled for hardness and alkalinity levels. Unfortunately occurrence of heavy metals and pesticides in water was not being investigated. Most of authorities had not adequate awareness and specialty about water pollution and water quality control. At 45% of studied industries, there was not acceptable control program for water quality. Application of HACCP program as an effective tool for food safety was not practically implicated.Conclusion: Control of chemical and microbiological quality of water at studied industries was not satisfying. For protection of consumers health and achieving food safety, the necessity of application of water quality plan and control system with all educated personnel and facilities is extremely undeniable.

Background and Objectives: Laparoscopic adrenalectomy is the operation of choice for benign adrenal lesion. We report of our experience in laparoscopic adrenalectomy that was performed for first time in Tabriz.Materials and Methods: From September 2003 to September 2005, six patients with adrenal lesions underwent laparoscopic adrenalectomy through transperitoneal approach.Two of them were simultaneous bilateral adrenalectomy Preoperative evaluation including CT Scan, MRI, MIBG scan, endocrine tests such as, cortisol, ACTH, mineralocorticoid, 17- hydroxy progesterone and VMA .The results were analyzed by SPSS.Results: six patients, (3 females and 3 males), underwent on laparoscoic surgery. Mean age was 40.2 (range 30-65) years. Lesion was located at right in 5 patients and 3 at left. Mean operative time was 180 ± 30.62, (126-300), minutes. Mean hospitalization was 3.1 (3-5) days. Mean size of mass was 4.5 ±1.8 (4-8) cm. In one case, because of the adhesion of mass to the posterior side of venacava, convertion was necessary. No significant major intra or post operative complication and we didn’t need to transfusion. at the 9 months following, hormonal tests and blood pressure were normal. The mean postoperative follow up time were 9 (range 3-24) months.Conclusion: Due to our limited experience on advanced urologic laparoscopy this study showed that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal disorders with the least morbidity.

Background and objectives: Percutaneous surgery is based on needle and guidewire access to the kidney and the upper urinary tract. This study designed to assess retrospectively the safety and efficacy of the percutaneous nephrolithotripsy (PCNL) for treating the renal and upper Ureteral stones.Material and methods: 613 patients underwent PCNL, between September 2000 and September 2004, for renal or upper ureteral stones in Ekbatan and Beheshti hospitals in Hamadan. PCNL was done as a standard method under X-ray guidance and after tract dilatation with metal dilators; pneumatic lithotripsy was used for fragmentation.Results: Complete clearance was 90.7%. Complete stone free rate among patients who need 1 tract (93.8%) obviously was more than the others that more than 1 tract was needed (61.7%).Variables such as age, sex, weight, grade of hydronephrosis, type of anesthesia, and incision site did not have effect on stone free rate.Conclusion: PCNL is a safe and effective method for any type of renal and upper ureteral stone especially in developing countries that renal stone is more common.

Background and objectives: Otosclerosis is the most common cause of conductive hearing loss in population between the ages of 15 to 50 years. The treatment of otosclerosis has been largely restricted to surgical efforts to reconstruction of the conductive hearing loss. Stapedectomy and stapedotomy have been the common surgical techniques for clinical otosclerosis and have a high success rate. Objective of this study was to investigate the results of the surgical treatment of otosclerosis.Materials and Methods: We did a retrospective study of 50 patients who had undergone stapes surgery. Among these 50 patients, 39 cases at Tehran Amir Alam hospital and 11 cases at Tabriz Emam Khomeini hospital had been operated by a single surgeon. 32 cases were stapedotomy and 18 Cases were stapedectomy.Results: 32% of patients had pre-operative air-bone gap of more than 40dB, the postoperative air – bone gap closure was ≤ 10dB in 76% and ≤ 20dB in92%. The average closure of the air-bone gap was 28.4dB at mean speech frequencies. The minimum closure of the air –bone gap was 15.66dB in 4000 Hz and the maximum of it was 34.2 in 500Hz. There were no meaning statistical differences between surgical technique and also intraoperative problems and complications and the closure of the air – bone gap.Conclusions: There was adequate closure of the air – bone gap after surgery in all frequencies and if was higher in lower frequencies. There was a close relationship between the pre- and post – operative air – bone gap in all frequencies. In the larger pre- operative air – bone gap, the closure of the post operative air- bone gap at these frequencies was more. 

Background and Objective: True aortic Stenosis is localized Protrusion of middle layer to its lumen. That cause reducing of blood flow. If untreated serious complications may be occur. The evaluation of follow-up results of coarctation treatment in patients admitted to Shaheed Rajaie Medical center Hospital between 1993 and 2004.Materials and Methods: This is a cross sectional study encompassing all the patients admitted to Shahid Rajaee Hospital with coarctation of aorta between 1993 and 2004. The data from the patients’ files were extracted.Results: Sixty-four cases (29.8%) were female and 145 cases (70.2%) were male. Mean age in the time of treatment was (6.51±9.91) yrs. Twenty-three cases (11%) were treated with balloon angioplasty; 177cases (84.7%) underwent surgical operations; and 9 cases (4.3%) have not been operated on in this center yet. Duration of follow up was 1 to 14 years. 5 cases died after treatment. Mean follow up was 3.72 years. During of follow up period, 25.4% became hypertensive that frequency of hypertension was significantly higher in older cases (P<0.05).67.5% had pressure gradient equal or more than 20mmHg by echocardiography. 30 cases (14.3%) had recoarctation by catheterization (26 cases after surgery and 4 cases after native balloon angioplasty); there was no relation between age and this variable.Conclusion: On the basis of results of this and same studies treatment of coarctation in lower age had lower frequency of hypertension and about effect of treatment in lower ages and higher frequency of recoarctation there is controversy.

Infant Botulism, one of the three forms of human botulism results from Clostridium botulinum. Absorbed toxin causes flaccid paralysis. Disease produces a spectrum of clinical severity from mild to sudden infant death syndrome. The first sign is almost always constipation. Botulism is manifested clinically as a symmetric descending paralysis. The first signs of illness are found in cranial nerves, it is not possible to have infant botulism without having bulbar palsies. Diagnosis established by identification of organism in the feces. In ambiguous situation electrodiagnostic study is helpful. In this article we reviewed the Infant botulism and reported a10 month case.

Chondromyxoid fibroma is a rare benign neoplasm that rarely involves mandible. In this case a chondromixoid fibroma was reported in the posterior region of the left mandible. The relevant clinical, radiologic, and pathologic features and treatment of this case are presented. Surgery was performed under general anesthesia with extra oral access and resection of the lesion from the mesial of canine to distal of the third molar and AO plaques was used to maintain space and for secondary reconstruction.