JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2008 | Volume:26 | Issue:88|Papers Count:17

Background: Patella is uncommon site for all of primary and metastatic bone tumors; but in some reports chondroblastoma and giant cell tumor were the most common tumors in this site. Surgical management varies in patients based on the kind of tumor. Also, function of knee after treatment varies based on the kind of the surgery and tumor. Previous surveys on this object are a few case reviews or reports in literature reviews.Methods: 13 patients with patellar tumor treated between 1985-2006 in Shafa-Yahyaian, Pars, and Milad hospitals were assessed. Signs, symptoms and paraclinical data before and after operation were evaluated. All of the patients underwent surgical management. Results of treatment were assessed in long term fallow up.Findings: From 13 patients, 5 cases were chondroblastoma, 3 cases were giant cell tumor, 2 were ABC, 2 were metastases, and 1 case was UBC. Pain and knee effusion were the most common symptoms of patellar tumor. Range of motion of knee and the force of quadriceps muscle after surgery without patellectomy were better than the surgery of patellectomy. Recurrence was seen in one patella retained case.Conclusion: In our study, chondroblastoma was the most common tumor in patella. Pain and knee effusion were the most common symptoms in patella tumors. Range of motion of knee and the force of quadriceps muscle in patella retaining were better than patellectomy.

Background: In spite of surgical technique it is possible to treat recurrence of CTS and regression of symptoms. One of the causes of recurrence is nerve adhesion to soft tissue.Methods: 14 cases, with paresthesia, pain, and weakness after CTS surgery, were checked by clinical and paraclinical methods. Mean duration after surgery was 6 months (8-24). Resurgery was performed with classic approach but a little wider than the first incision.Findings: In 3 patients, transverse retinaculum has not been released completely and in 11 cases, nerve adhesion was seen; after nerve release, dorsal forearm vein was used for separation of nerve from scar tissue and prevention of new scar. Mean duration of follow up after revision was 11 months (8-36). Except 2 cases (because of reflex sympathetic dystrophy (RSD) Syndrome) in other patients all of signs and symptoms were relieved.Conclusion: In recurrent CTS, vein wrapping seems to be a simple and beneficial method.

Background: Malignancy as a common cause of mortality needs to be investigated for its epidemiology and pattern of distribution in population. Data collection about cancer epidemiology is the first step in preventing and controlling this health problem. Cancer registries provide basic information for many epidemiological studies. In this study, reporting and notifying the rate of cancers to Fars province cancer registry center (FPCRC) were examined during 2004-5.Methods: 10% of all admitted patients in Shiraz hospitals during 2004-5 were selected as studied group. So, 300 medical files were selected by multi-stage random sampling; then, then, 3 Shiraz University of Medical Sciences affiliated hospitals and 3 private hospitals were selected by cluster random sampling. Through medical records of patients diagnosed with cancer in 2005 in these hospitals, the study group was selected by systematic random sampling. These data were compared with data kept by FPCRC. Reporting and notification rates of different cancers to FPCRC were calculated.Findings: The reporting rate of cancer cases to FPCRC was 60%. The accuracy rate of those reported cases was 87.5%. The reporting rate of the cancers from SUMS affiliated hospitals was significantly lower comparing to other hospitals (p<0.001).Conclusion: The reporting rates of cancers to FPCRC are obviously low and appropriate interventions are necessary.

Background: The epidermal growth factor receptor (EGFR) also known as HER1 or ErbB1 is a prominent member of the erbB proto-oncogene family, which encodes a receptor tyrosine kinase with a pivotal role in the regulation of cell growth and differentiation. The aim of this research was to study the CA repeat polymorphism in intron I of EGFR among the patients with breast cancer and healthy controls. We have also evaluated risks for breast cancer, age of onset and grade of tumor associated with the CA repeat polymorphism.Methods: In the present work, the association of breast cancer with the polymorphic CA repeat in 108 cases of breast cancer and 108 matched controls was studied. After DNA extraction from blood, CA dinucleotide region was amplified by PCR technique and the number of CA repeats was determined by polyacrylamide gel electrophoresis and sequencing.Findings: Our findings demonstrate that women with two short CA repeat (<19) are at a significantly higher risk of breast cancer, at an estimated odds ratio of 1.86. We have also found that women with short alleles (<19) had much greater risk of developing cancer before the age of 55 (OR=3.36).Conclusion: Our results suggested that shorter CA repeat length may be associated not only with the risk of breast cancer but also with the age of developing cancer in Isfahanian population. We did not find any relation between the CA repeats length and tumor staging.

Background: Hypercoagulopathy is one of the complications of thalassemia; high incidence of right sided heart failure (due to pulmonary hypertension) in some surveys indicates on the importance of this complication. In this research we evaluated a frequency of protein C and S, and antithrombin-III (AT-III) deficiency in thalassemia major patients in Isfahan.Methods: Serum level of protein C and S, and AT-III were measured in 41 thalassemia major patients (age 7-20 years), and the relation between serum level and age, sex, splenectomy, transfusion intervals, pre transfusion Hb, and serum ferritin level was detected. All of these patients were also evaluated for cardiac disease and pulmonary hypertension by doppler echocardiography.Findings: Overall, 43% of cases had protein C deficiency, 53% protein S deficiency, and 30% AT-III deficiency; 82% of all patients had at least one factor deficiency. The frequency of protein C, S and AT-III deficiency was higher in patient older than 10 years, with transfusion interval more than 21 days, and with less pre-transfusion Hb level. High ferritin level was also significantly related to protein C and S deficiency (p<0.05). With echocardiography, dilated heart was found in 8 (11.8% in non splenectomized, and 57% in splenectomized) (p<0.001); only 2 patients had evidences of pulmonary hypertension.Conclusion: Also hypercoagulopathy due to protein S, protein C and AT-III deficiency is common, but unlike some researches, we didn't find high incidence of pulmonary hypertension in our patients.  According to the high frequency of factor deficiency, more attention for hypercoagulable state is required in thalassemia major patients with risk factor.

Background: Immunization of rabbit against Staphylococcus aureus type 5 did not increase antibody titer significantly in previous study. We proposed that lack of protection is due to low immunogenicity of this bacterium and a suitable adjuvant is needed to augment antibody production against it. In this study the effect of aluminium hydroxide [Al(OH)3], Freund's adjuvant and DTP vaccine on immunization of rabbit against encapsulated S. aureus type 5 by agglutination method was considered.Methods: 30 male New Zeeland white rabbits (4-6 months) were grouped in 6. They were injected intramuscularly using suspension of killed encapsulated S. aureus type 5 (strain Reynolds) with and without adjuvant. The last two groups were injected DTP vaccine and saline alone. Injections were done three times within 21 days intervals; blood sample was obtained from marginal ear vein before every injection and 21 days after the last injection and sera were collected in -20oC. Agglutination method was employed for detection of antibody titer.Findings: Immunization of rabbits to encapsulated s. aureus type 5 with Al(OH)3, Freund's adjuvant and DTP vaccine showed rise in antibody titer against it. Mean antibody titer of immunized rabbits with DTP vaccine after the third injection was more than those immunized with Al(OH)3 and Freud's adjuvant (p=0.049). Also mean antibody titer in rabbits immunized with Freund's adjuvant was more than those immunized with Al(OH)3 but this difference was not significant (p=0.27).Conclusion: In this study, DTP vaccine induced higher antibody titer against encapsulated S. aureus type 5 than Al(OH)3 and Freund's adjuvant. Therefore, it is suggested that DTP vaccine may be used as an adjuvant with suspension of killed encapsulated S. aureus type 5 in rabbit.

Background: Scoliosis may be due to neuromuscular or congenital diseases or occur in idiopathic forms. Today, disorders of the paraspinal muscles are viewed as a possible cause of scoliosis. Idiopathic scoliosis is considered as the consequence of primary connective tissue disorders by some researchers; others maintain that muscle deformities are secondary to compensation of the physical deformity and/or treatment of the patients. This study was performed to determine the primary or secondary nature of paraspinal muscle disorders in scoliosis.Methods: In this cross-sectional study, all patients with scoliosis undergone surgery two hospitals in Tehran, from November 2006 to June 2007, were included. To determine the degree of muscle atrophy, paraspinal muscle biopsies were obtained during the operation from the curvature at apex, on both concave and convex sides. In this study atrophy defined as pathology report of any degree of atrophy in any side. Other data including the degree of deformity according to the Cobb's angle, the use of brace and duration of its use were collected.Findings: 19 (59.4%) and 13 (40.6%) of 32 patients displayed some degrees, and no prominent signs of atrophy, respectively. All the patients with neuromuscular, 43.8% of Idiopathic and 33.4% of congenital scoliosis displayed signs of atrophy. Atrophy percentage in neuromuscular was significantly different comparing two others. Mean deformity in the atrophy and normal groups was 97.82±21.09 and 68.80±25.91 degrees, respectively, with a significant difference between the two groups (p<0.05).conclusion: It seems that the atrophy in idiopathic and congenital scoliosis is much lower than neuromuscular. We conclude that idiopathic scoliosis is not due to primary disorders of the paraspinal muscles and other factors such as vestibular disorders, melatonin secretion, platelet microstructure, and other postural control disorders are likely involved in its etiology. Further, the multifactorial nature of scoliosis should not be overlooked.

Background: Postoperative pancreatitis in addition to surgeries involving the biliary ducts, the pancreas, or the surrounding organs, occurs in scoliosis surgery, with prevalence rates of 16-19%. This study was designed and conducted to determine the prevalence of pancreatitis following scoliosis surgery and its associated risk factors. Methods: In a cross-sectional descriptive study, we enrolled 50 patients underwent surgery for correction of scoliosis at two hospitals in Tehran, Iran, between November 2006 and June 2007. Levels of serum amylase and lipase were measured before and two days after surgery. Duration of fasting after surgery, clinical signs of pancreatitis, duration of hospital stay, length of surgery, original curvature of the spine and degree of correction after surgery, and demographic data were recorded. The diagnosis of subclinical or biochemical pancreatitis was established with trebling of serum amylase and lipase.Findings: Twenty-seven of patients (54%) developed postoperative pancreatitis following scoliosis surgery. Sex, type of scoliosis, type of surgery, correction of Cobb’s angle, and length of surgery were not found to correlate with the incidence of pancreatitis, whereas a significant relationship was found between the volume of hemorrhage and the incidence of pancreatitis (p<0.05).Conclusion: The higher prevalence of pancreatitis in this study (54%) may be due to pancreatic ischemia. Patients are prone to ischemia owing to massive intraoperative bleeding and hypotensive anesthesia directed to reduce it. In this study patients developed pancreatitis were found to have lost more blood during surgery. This study demonstrated that pancreatitis can develop as a complication of the single-stage or two-stage surgery for correction of scoliosis and can dramatically affect patient outcome; hence we recommend that patients undergoing scoliosis surgery be monitored for increase in serum amylase and lipase, as well as any suggestive signs of clinical pancreatitis.

Background: Posterior capsule opacification (PCO) is one of the most common side effects after cataract surgery. YAG laser posterior capsulotomy is used for the treatment of PCO. This study evaluated the improvement of visual function after ND: YAG laser posterior capsulotomy in patient with PCO after cataract surgery.Methods: In this descriptive study, 48 patients with PCO without underlying disease were selected for ND: YAG laser posterior capsulotomy. Their visual functions included visual acuity, contrast sensitivity and glare sensitivity was measured before and one month after Nd: YAG laser capsulotomy. In addition, we evaluate the correlation between the type of the lens and visual function.Findings: Among 48 patients studied, 21 (43.7%) were male and 27 (56.3%) were female and the average age was 70.6±10.7 years. Average visual acuity, contrast sensitivity and glare sensitivity before Nd: YAG laser capsulotomy was 20/37, 20/83 and 20/95 respectively that changed to 20/24, 20/50, and 20/64 after capsulotomy.Conclusion: Nd: YAG laser capsulotomy improved visual functions (include visual acuity, contrast sensitivity and glare sensitivity). The type of lens used in cataract surgery did not influence these parameters.

Background: Until now, Ammonia has been considered to have a major role in pathogenesis of hepatic encephalopathy. It is probable that helicobacter pylori (H. pylori) infection, due to urease activity of the bacteria or its effect on blood Zinc level, leads to hyperammonemia and aggravates hepatic encephalopathy. This study assessed the prevalence of Helicobacter pylori infection among patients with hepatic encephalopathy and cirrhotic patients without hepatic encephalopathy; as well as the effect of H. pylori eradication on hepatic encephalopathy.Methods: The prevalence of H. pylori was evaluated in 42 patients with hepatic encephalopathy (21 hepatitis B and 21 hepatitis C cases) and was compared with 100 cirrhotic age and sex matched patients (49 hepatitis B and 51 hepatitis C cases) without stigmata of encephalopathy; patients were referred to Al-Zahra and Noor hospitals between 2004 to 2007. Then 27 of encephalopathic patients with infection were treated for H. pylori eradication, and eradication was confirmed in 23 of them via UBT. Grade of encephalopathy, number connection test (NCT) and flapping tremor were compared before and after eradication treatment.Findings: Overall, 73.6% of encephalopathic cases were infected versus 76% of cirrhotics in control group (p=0.675). Grade of encephalopathy and NCT was reduced in comparison with pretreatment (p=0.023 and 0.038, respectively); but alternation in flapping tremor was not statistically significant (p=0.248).Conclusion: Although there was not any significant difference in prevalence of H. pylori infection in cirrhotic patients with and without encephalopathy, eradication of H. pylori may lead to improvement of hepatic encephalopathy.

Background: There is evidence that opioid receptors are present in peripheral tissues. This finding led to the application of peripheral opioids. The aim of this study was to evaluate the effectiveness of pre-incisional subcutaneous infiltration of morphine on post operative pain intensity in patients were candidate for upper abdominal surgeries.Methods: 70 patients undergoing upper abdominal surgery entered into this prospective double blind study and divided into two equal groups. After induction of general anesthesia, they received a subcutaneous infiltration of morphine (10 ml, 0.1 mg/kg) or saline (10 ml) at the site of surgery. The operation was started 15 minutes after local infiltration and hemodynamic variables and also post operative pain intensity were assessed to 24 hours after surgery. Post operative cumulative morphine requirement and the time of first analgesic administration were recorded. Data was analyzed statistically using t-test and chi square.Findings: Mean pain score was significantly lower in morphine group than saline group at 4 and 6 hours after operation. (4.97±1.82 vs. 5.97±1.80, p=0.012 and 4.30±20 vs. 5.20±1.90, p=0.04 respectively). Mean pulse rate and its changes were significantly lower in morphine group than saline group at 5, 10 and 15 minutes after induction of anesthesia (p<0.05).Conclusion: This study could not show the efficacy of subcutaneous infiltration of morphine on reducing post operative pain intensity in patients undergoing upper abdominal surgery. The reduction of pain intensity at 4 and 6 hours after surgery may be due to systemic absorption and analgesic effects of morphine.

Background: Reperfusion therapy is the standard treatment of acute myocardial infarction (AMI). If the percutaneous coronary intervention (PCI), as a preferred reperfusion strategy, was not available, thrombolytic therapy is chosen as an alternative treatment. However, the affect of thrombolytic therapy in old patients is still controversial; especially because of its effects on increasing the incidence of intra cranial hemorrhage (ICH). In this study, we evaluated the incidence of neurological symptoms and ICH after thrombolytic therapy in more than 65 years old patients with AMI.Methods: 300 patients of 65 years old and more with AMI in which their symptoms had been begun more than 12 hours before admission to the hospital, and with no contraindications for receiving thrombolytic therapy, were chosen. The patients were admitted in Noor hospital between 2004 and 2006. All of them received streptokinase (SK) in the same way, and the information's were pulled out from their files and gathered in a check list.Findings: Among 300 patients in our study, there were 124 women (41/33%) and 176 men (58/66%). Their mean age was (74±9) years (from 65 to 92 years). 78% were discharged after one week hospitalization and 22% (66 patients) died. Arrhythmias or myocardial re-infarction were the leading cause of death in 56/06% of all deaths. No death due to ICH and no evidence of ICH, such as hemi-paresis or loss of consciousness, were occurred.Conclusion: We suggest that thrombolytic therapy in old patients with acute myocardial infarction is a good alternative treatment when there is no ready access to a skilled PCI facility. In our study, increasing of mortality rate due to ICH was not enough to exclude giving SK to more than 65 years old patients.

Background: Ventriculoatrial (VA) shunts remain as one of the valid options for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and are impossible in bilateral stenosis or thrombosis of internal jugular vein. There is not substitute technique in these situations. Here, a new technique for the insertion of ventriculoatrial shunt via innominate vein in bilateral internal jugular vein stenosis is described.Case Report: We performed a new technique for treating a 20-years old man with dysfunctional bilateral ventriculo-atrial shunt. The surgery was performed with cooperation of vascular surgery and neurosurgery teams. Initially, previous shunt was removed by neurosurgery team and patient was underwent implantation of flow-regulating shunt OSVII (Orbis Sigma Valve). Then, partial sternotomy was done by team of vascular surgery and innominate vein was explored. Following purse string suture and perforation of vein, end of catheter was inserted in the innominate vein and the tip of catheter was placed in the right atrium. Correct positioning of the distal end of the catheter in the right atrium was evaluated by C-arm portable radiography.Conclusion: This technique should be considered for use in patients with a history of failed ventriculo-atrial shunts due to internal jugular vein occlusion.

Background: Chorioangioma is the most common vascular placental tumor. Usualy its size is less than 4 cm and its prevalence is 1% (pathologicaly examined). Rarely, with prevalence of 1/3500, it is larger than 4 cm. A multiparus 27 years old G4D1L2 woman with gestational age of 33 weeks and with placenta tumor was refered to Al-Zahra hospital in December 2006. Due to abdominal distention, the patient underwent sonography and a large placenta chorioangioma was considered. Because of early onset of drops fetalis with spontaneous labor a newborn with 2250 gr weight and APGAR score of 10 was delivered; the weight of the placenta was 1100 gr with an 8×1×6cm tumor. The pathology result was chrioangioma.

Tuberous Sclerosis (TSC):  TSC is inherited as an autosomal dominant and affects the brain, skin, kidney, heart and other organs. Cutaneous lesions of TSC include hypomelanotic maculae, the shagreen patch, ungual fibromas and facial angiofibroma (adenoma sebaceous); neurological features of TSC include mental retardation, seizures and behavioral abnormalities; retinal features of TSC include retinal hamartomas; systemic features include cardiac rhabodomyoma, renal angiomyolipoma, and dyspnea and spontaneous pneumothorax.