Journal of Isfahan Medical School
Year:2006 | Volume:24 | Issue:80-81|Papers Count:36

Introduction: Mitral valve prolapse (MVP) is a known benign entity. However, in certain instances it may ensue cerebrovascular complication with ominous prognosis. This study was under taken in the past 9 years and 12 cases with mitral valve prolapse and cerebrovascular complications were diagnosed and their medical data were recorded. The main goals of this study were to try ana detect the possible risk factors and predisposing symptoms of stroke (including vertigo amorosis fugax faint and convulsion) in those patients, and to explore the possibility of prevention.Methods: MVP was diagnosed by physical examination and echocardiographic findings. The cases were divided clinically into two groups; group one which was hospitalized with cerebrovascular accident (CVA) as well paralysis. They include 6 cases aged between 18 and 42 years (average 33.5 years) with a male over female ratio was 2/4. Five out of 6 cases having had mitral regurgitation. Group 2 as the control group with 6 cases who were followed for 10-66 months at the cardiac clinic. Their age range was between 17 to 30 years (average age 22.5 years) one out of 6 had mitral regurgitation. The male to female ratio was 1/5. These cases with symptoms of risk factors as mentioned above were placed on Propranolol dipyridamol and aspirin with follow up of 10-66months (averaging 31 months).Results: In group 1 CT and MRI revealed embolic stroke in 4 cases and hemorrhage CVA in 2 cases, whereas in group 2 MRI and CT revealed ischemic changes without necrosis in 4 cases and normal pattern in 2 cases.Discussion: The conclusion of this study points to the fact that cases of MVP and true stroke as well as paralysis are older and patients with high risk symptoms such as faint, vertigo, convulsion, amorosis fugax, in combination with MVP which warrant the administration of anti thrombotic agents including aspirin dipyridamol while they are on Propranolol. The same is in cases with MVP associated with mitral insufficiency P.F.O. and migraine headache.

Introduction: The HLA-B27 has a very strong association with spondyloarthropathies especially ankylosing spondylitis. The prevalence rate of this disease closely parallels the frequency of HLA-B27 antigen. This frequency varies among different racial and ethnic groups. The goal of this study was to investigate the frequency of HLA-B27 using the flowcytometry method in blood donors in Isfahan.Methods: This study was a descriptive study. Two hundred fifty seven healthy blood donors without family history of spondyloarthropathies were studied and their blood samples collected. The HLA-B27 frequency was examined by the flowcytometry method using monoclonal antibody.Results: Among 257 samples consist of 242 men and 15 women, 3.11% of cases (8 individuals) were the HLA-B27 positive. Other cases were located in the HLA-B27 negative zone.Discussion: Frequency of HLA-B27 obtained in this research was the same as other Caucasian populations range and similar to Arabs, Jews and Armenians. Because of low frequency of the HLA-B27 in our community and its strong association with ankylosing spondylitis, HLA-B27 typing seems to be useful for diagnosis of this disease.

Introduction: Cigarette consumption is the most important modifiable risk factor for coronary artery 'disease and it has been shown to cause endothelial dysfunction, but effect of opium consumption on endothelial dysfunction and coronary artery disease has not received sufficient attention. The aim of study was assessment of additional effect of opium on endothelial function in comparison to smoking alone.Methods: In this study functional of endothelium was study on 30 smokers and 30 smoker and opium addicts. All of the subjects were healthy and had no history of hypertension, diabetes, and hyperlipidemia and without established CAD or family history of premature CAD. With using high resolution external vascular ultrasound, we measure basal brachial artery diameter at rest, in response to reactive hyperemia and to sublingual glyceril trinitrate. These vascular responses were determined in two groups of subjects for assessment .,of additional effect of opium on endothelial dysfunction compare to cigarette smoking alone.Results: Endothelial - dependant dilation (EDD/BBD) was impaired in the case group compare to control group (3.44±0.68% vs. 3.97±0.55%, respectively; p=0.02), but endothelial independent lilation (EID/BBD) in the case and control group had no significant differences (4.6±0.74% vs. 4.35±0.6%, respectively; p=0.1). Index of endothelial function (EDD/EID) was significantly lower in the case than control group (0.31±0.18 vs. 0.56±0.34, respectively<0.001).Discussion: Impaired endothelial dilation in individuals used cigarettes and opium compared to those with cigarette smoking only, suggests an additional opium influence on endothelial function that may be relevant to more susceptibility for coronary artery disease.

Introduction: Bacteremia is an early problem can lead to life threating conditions like septicemia, shock, and death. According to clinical approach, rapid detection of microorganism in clinical samples is crucial for management of infectious diseases. During the last decades many methods have been developed to rapid diagnosis of infectious agents such as biochemical, immunological, and molecular methods. Among molecular methods, Polymerase Chain Reaction (PCR) is more rapid, specific, and sensitive than conventional methods. Universal primer amplify a conserved region within 16s ribosomal DNA (16s rDNA) sequence that is a constant sequence among all of bacterial species. Detection of bacteria based on 16s rDNA sequence using a universal primer is an accepted method and have been documented in many papers.Methods: In this study, universal primer was used to detection of bacteria in blood specimens obtained from suspected bacteremia patients using PCR technique. During the period between November 2004 and February 2005 one hundred blood specimens collected from Alzahra university hospital in Isfahan, Iran.Results: The results revealed that PCR had 94% specificity and 84% sensitivity comparing to standard blood culture methods.Discussion: According to necessity of rapid initialization of treatment in bacteremia patients clinical diagnosis of bacteremia should be verified by amplification of 16s rDNA by means of a universal primer. This study showed that molecular detection of bacteremia is a fast and applicable method and can be set up in Iranian hospitals.

Introduction: The side effects of topical paromomycin (PR) and methyle benzethonium chloride (MBCL) in the treatment of cutaneous leishmaniasis (CL) is well known and the replacement of MBCL in the formulation has been the subject of many studies. Since Benzalkonium chloride (BACL) has been reported to increase the antileishmanial activity of PR and decrease the side effects in experimentally infected mice, the aim of the present study is to evaluate this formulation in a clinical trail.Methods: In a controlled, double-blind study 75 patients with CL were treated topically with an ointment containing 15% PR and 2% BACL in white paraffin twice daily for 20 days. Each case was assessed clinically in 5 days intervals up to 40 days and compared with control groups.Results: The average size of skin lesions were decreased from about 180mm2 to 20 mm2 on day 25 post-treatment and completely healed by day 40 in 74.2% of patients treated with PR+BACL for 20 days. No significant decrease was observed in the average size of lesions in control groups. A local inflammation and burning were observed only in 5.9% of 85 patients who received BACL. Discussion: These results suggest that BACL increases the antileishmanial activity of PR and decreases the local side effects in patients with ZCL.

Introduction: Corticosteroids and antihistamines has been effective in reducing adhesion formation. The objective of this study was to define the methyl prednisolone and clemastineaffect on adhesion bound formation.Methods: Ninety rats were divided into three groups (N=30) group I (control), group II (methyl prednisolone) and group III (methyl prednisolone combined with clemastine). All rats were submitted to incision of parietal peritoneum. (10 incision on the right sided and 2 cm2 resection on the left sided). After 20 days from this operation repeated laparotomy was done and the groups were compared from number and grading of adhesions. Data were analyzed by ANOVA and X2 and P<0.05 was significant.Results: The numbers of adhesions were 1-2 band in %60 of group I and %46/7 in group II and III (P<0.05). 3-4 band were band in %33/3 of group I, %20 of group II and 10% of group III (P<0.05). There were no grade 3-4 of adhesion in group III; and in 16.7% of group II no grade 3 and 4 were seen. In 40% of group I grade 4 with 10% grade 3 were seen in 40% of group I grade 4 with 10% grade 3 were seen (P<0.05).Discussion: methyl prednisolone combined with clemastine seemed to diminish peritoneal adhesions. (severity & frequency).

Introduction: Preeclampsia is one of the most important cause of maternal and fetal mortality and morbidity. Imbalance of arachidonic acid metabolites is one of it's etiology and fish oil as an antioxidant is introduced as a preventive treatment .In this study we studied effect of fish oil supplementation in high risk pregnant women and compared with control group.Methods: In a case-control prospective study, women with high risk pregnancy for preeclampsia since 2005-6 in Isfahan Clinics were randomly assigned to receive fish oil (1gr/day) or placebo for 12 -38 weeks of their pregnancy .Cases group were 200 patients and controls were 600. There were primigravid without age limitation or multigravid with at least one of the following: <18or>35 years old, familial or previous history of preeclampsia, chronic hypertension, diabete mellitus, multigestational pregnancy, obesity, antiphospholipid syndrome, chronic renovascular or connective tissue disease. Then we compared blood pressure, mother's and neonate's weight, preterm labor incidence, incidence of preeclampsia and it's severity between 2 groups.Results: Significant difference between 2 groups in systolic and diastolic blood pressure (Respectively; P=0/023 and P=0/021), preterm labor incidence (P=0/022) and severity of preeclampsia (P=0/037) were founded but there were no meaningful difference in neonates and mother's weight and preeclampsia incidence. There were 20 intrauterine growth restriction (IUGR) only in control group (P=0.0001).Discussion: Fish oil supplementation may be reduce the risk of preterm delivery and IUGR but have no effect on pregnancy induced hypertension, and neonates weight. Fish oil probably reduce the severity of preeclampsia.

Introduction: Comparision of oral and rectal midazolam for premedication in children.Prevention of fear and anxiety of children from separation of parents needs preoperative psycho logic and pharmacologic preparation.The aim of this study was comparison of two forms of oral and rectal premedication to decrease anxiety of children and determine the best way of premedication.Method: Forty patients aged 6 - 84 months ASA class I, candidated for elective surgery (inguinal hernia, hydrocele,) randomly divided in two groups, one group received oral midazolam 0.5 mg/kg and second group received rectal midazolam 0.5 mg/kg as a premedication. For oral premedication drug dissolved in 20 cc of fruit juice. In rectal premedication the drug dissolved in 20cc of distilled water and given by suction catheter No 12. Hemodynamic changes and intensity of sedation observed by blind observer.Results: The rectal group patients had better sedation (90%) during separation and (100%) during mask induction, 90% of this group didn't need postoperative analgesia. In the oral group 45% of patients need postoperative analgesia (P<0.05).Discussion: In comparison of complications (induction, intubation), speed of recovery, evaluation of first postoperative 24 hour, the rectal group had better results, the blood pressure changes, pulse rate, and SP02 between two groups had no significant differences.

Introduction: Vomiting is an important side effect of utrine curettage. Many drugs have been used to treatment this complication but they had many side effects. The aim of study is comparison of metocloperamide and atropine's effects on controlling of nausea and vomiting after uterine curettage in pregnant women.Methods: It was a randomized clinical trial study. 70 women ASA-I with age between 20-40 years old divided in two study groups according to simple random sampling method, and they had been anesthetized with same method and drugs. Each group of women with vomiting in the recovery room randomly received atropine 0.25mg or metoclopramide 150µg/kg intravenously and their effects had been determined on control of vomiting.Results: According to age and weight and gestational age and previous pregnancy parameters two groups were homogeneous (p=0.61783 & p=0.90108 & p=0.68 & p=0.59) respectively. Vomiting responsive rates were 87.1% in atropine group and 50% in metoclopramide group (p<0.0001).Discussion: According to results of this study, atropine was more effective than metoclopramide on control of nausea and vomiting due to uterine curettage and had less side effect than metoclopramide.

Introduction: Fetal biological markers present in maternal serum are important in non-invasive prenatal diagnosis. Among them, maternal serum alpha-fetoprotein (MSAFP) has especial value, which its abnormal levels in maternal serum during the pregnancy is associated with a number of congenital and genetic disorders. The normal values for this factor, in clinical diagnostic laboratory around the country, are based on the values provided from studies in other populations. Therefore, it is necessary to determine the normal values for (MSAFP) in Isfahan population.Methods: Several sites and health centers in the province of Isfahan were chosen for sampling, and for 14-18 weeks of gestation, from 155 individual blood sampling was prepared. The serum was then separated and the level of alpha-fetoproteinwas determined using radio-immunoassay. The condition of pregnant women through the delivery was followed up, and the condition of babies was carefully monitored after birth. The data were evaluated using student statistical test.Results: No congenital and/or genetic abnormality was observed in the babies born by mothers under the study. This could confirm that the population was normal. The amounts of MSAFP were determined at 14-18 weeks of gestation, and were considered as one multiple of the mean (MOM).Discussion: Since MOM in range of 0.5-2.5 is considered as normal, the normal range of MSAFP was determined. These data could be used in prenatal diagnosis in Isfahan population.

Introduction: Low back pains cause the unpleasant memory and important effects such as: reduction of activity, disability, job changing, irregular usage of oral and injection drugs, allocating a perceptible fund of the family income and finally changing the mental images. The study has been done to determine the effect of low level laser therapy on the intensity of low back pack pains.Methods: This double blind clinical trial has been done in 2004 at medical laser center of Pastor-Nov Hospital in Tehran. 30patients with chronic low back pain (because of lumbago) in the range of 30-60 years old were randomly divided to the case and control groups. Data was analyzed with Chi 2and T-Test statistically.Results: The Case group patients have significant symptomatic relief without any side effect. Due to the pain questionnaire and thermograph, in first and second week, there wasn't any significant difference between two groups (P>0.05) and from the third week, in regard to the pain questionnaire and thermograph a significant difference between two groups was found (p<0.05).Discussion: Based on the findings, if low level laser is irradiated on the mentioned area with appropriate dose, wavelength and exposure time, it

Introduction: Sudden sensorineural hearing loss (SSNHL) is one of the most controversial subjects in domain of otolaryngology. In this prospective study, we have analyzed clinical features, audiological characteristics, and results of treatment with two routine treatment modalities(oral steroid + acyclovir vs intravenous urografin) in 53 cases with SSNHL.Methods: In 53 patients with chief complaint of SSNHL, after physical examination and audiological evaluation(PTA ,OAE,ABR) ,each patient were included randomly and alternately in one of two treatment modalities and data were analyzed by SPSS software.Results: From 53 cases (M:29 ,F:24) with mean age of 40.9(+/-15.9) years, left ear was involved in 28 cases (52.83%), and right ear in 21 cases (39.62%), and in 4 cases (7.54%) both sides were involved. The severity of hearing loss was "subjectively" high in 78% of patients, and the mean threshold of hearing had been calculated as 69 dB. The most common pattern in pure tone audiometry curves, was flat pattern (75%), and then, downsloping pattern (16%). There were no any difference in response to each of two treatment groups, and 18% of patients responded completely to our treatment, and good response and partial response rate was 12% and 36%, respectively. In 34% of patients, there were no response ,of whom number of cases treated with steroid+acyclovir was more than other modality (11 cases vs. 7). There were no difference in initiating treatment in first 72 hours, before, or after the first week. Patients age and ESR had no significant prognostic role. All patients in whom overall correlation in transient evoked otoacoustic emission (TEOAE), performed before treatment, were more than 50% responded to our treatments. Discussion: SSNHL is one of controversial topics in otolaryngology, and in nearly all of its aspects there are some mysteries to be cleared and perhaps would be necessary to perform a multicenteric study on this subject. Our study results were similar with other studies, although we recommended performing a TEOAE, that would help in determining prognosis of response to treatment.

Introduction: Low back Pain (LBP) is one of the most common problems among people of any age. More than 80% of people have some experiences with LBP and ridiculer leg pain (R.L.P). Most of these pains can be treated with medical therapy and 2 to 3 weeks of complete bed rest and less than 10% of the patients need operation. More than 70% to 80% of lumbar disk herniation occurs in L4-L5 and L5-S1 levels and less than 20% to 30% occur at lower level (that is L1-L2, L2-L3 and L3-L4).Methods: In a cross-sectional study on 100 consecutive patients, the role of medical therapy with Baclofen (10-20 mg/day), Dexamethazone (4-8 mg/day), (Indomethasine 50-100 mg/kg) and-bed rest on non-operative treatment of disk herniation of lumbar region was studied. Three groups of patients with L4-L5, L5-S1 and L1-L2, L2-L3 and L3-L4 disk herniation were selected. The signs of the patients were analysed with Schober, Moll and Laseque tests (or Femoral traction test for upper lumbar disk) in two steps, first at the time of first visit and then after 2 to 3 weeks of medical therapy and complete bed rest.Results: In 100 patients with LBP and RLP 68% were male and 32% female. The range of age was 22 to 73 years. The results show that patients with L4-L5had less chance of cure (42.2%) than patients with L5-S1 herniation (87.1%) and patients with L1-L2, L2-L3 and L3-L4 had the worse prognosis (34.3%).Discussion: Patients with upper lumbar disk herniation and those with L4-L5 discopathy should have complete bed rest and the possibilities of failure of treatment for them is more than those with L5-S1 disk herniation.

Introduction: Thumb sucking and nail biting are among the disorders that can indicate child has need to confidence and security and have somatic and psychological consequences. Identification of factors related to these disorders is important. The aim of this research is identifying a relation between feeding and oral habits.Methods: This descriptive- analytic study performed on 200 preschool children (100 cases- 100 controls) in Isfahan, Iran. The tools of research were self-developed questionnaire and clinical interview according to DSM IV TR. Data were analyzed by using SPSS software.Results: The findings indicated that factors such as duration of feeding, breast or bottle feeding, use of pacifier are not related to oral habits. But the age at which child is stopped sucking mothers milk is important (P=0.01).Discussion: Appropriate feeding is a response to oral needs of children. If this need does not response completely, some form of oral habits appeared.

Introduction: Hypertension is one of the most common human disease and a major risk factor for cardiovascular disease. Angiotensin converting enzyme inhibitor (ACE!) drugs, including captopril, is used for treatment of hypertension frequently. In this study blood pressure control parameters of captopril was compared between Iranian and foreign types by 24-hours ambulatory blood pressure monitoring.Methods: Onehundred and twenty five patients with mild to moderate primary hypertension were included in a randomized double blind clinical trial. After a wash out period, patients performed a 24-hours ambulatory blood pressure monitoring, and then treated by one of the three Iranian-types (Iran Dam, Lorestan and Dam Paksh), foreign type captopril and placebo randomly. After Four weeks treatment, blood pressure monitoring was performed again. Statistical analysis was done with ANOVA and T-Student test.Results: The study showed that all types of these drugs reduced blood pressure significantly related to placebo (P<0.05). No significant difference was detected in magnitude, duration and maximum effect between them (Except for non-statistically significant longer effect in foreign type). In foreign type, time to reaching maximum effect was shorter significantly than Iranian types.Discussion: This study showed that all types of Iranian captopril have similar anti-hypertensive quality, and according to no greater effect in foreign type, so it's not logical to use it because of greater cost to patient and community.

Introduction: A number of studies have shown that orally administered sweet tasting solutions reduce signs of pain during painful procedures. Oral glucose was effective in reducing symptoms associated with pain from venipuncture in term neonates, but such effect has not yet been reported in premature infants. The aim of this study was to compare the pain reducing effect of orally administered glucose with that of sterile water during venipuncture in premature newborns.Methods: Randomized, double- blind, placebo controlled trial included 32 preterm newborns undergoing venipuncture for clinical purposes. Each infant was assessed two times receiving 1 ml of 30% glucose or 1ml sterile water by syringe, 2 minutes before venipuncture. Results: The Premature pain profile (PIPP) scores was significantly lower in the glucose group as compared with placebo group respectively, 3.42±11.44013 vs, 0/3±8.94 (P<0.001).Ranges for gestational age, birth weight, and 5 minute Apgar score were 28-34 weeks, 950-2000 gram and 6-10 respectively. The duration of crying during the first 3 minutes was significantly shorter in the glucose group than in the placebo group 24.1±18.4 vs 39.6±26.8 respectively; (P=0.002).Discussion: We found that 30% glucose is effective in reducing symptoms associated with pain from venipuncture in premature infants.

Introduction: One of the common treatments in patients with RP.H is finasteride (a 5-a reductase inhibitor). This study has been done to find a model for prediction of finasteride efficacy in alleviating symptoms of patients with B.P.H.Methods: In this study, 212 males with B.P.H and indication of drug therapy were put under a clinical trial with finasteride consumption (5mg/d) for 6 months.Severity of symptoms before and after treatment was estimated according to international prostate symptom score (IPSS); P.S.A and prostate volume (measured by transrectal ultrasonography) were also assessed. Before treatment P.S.A density was calculated on the basis of prostate volume and P.S.A.Results: The mean age of patients was 63.62±10.6 years, average of prostate volume was 40.15±12cc and the mean of PSA was 2.98±1.74 ng/ml. On the other hand the average of pretreatment symptom score, post treatment symptom score and symptom score improvement were 18.16±5.07, 13.04±5.46 and 5.12±2.98 respectively. By the analysis of data we could find a regression equation to predict the post treatment symptom score of patients who are treated with finasteride.Conclusion: with the above mentioned regression equation we can predict the post treatment symptom score in BPH patients who are under treatment with finasteride.

Introduction: The aim of this study is evaluation of efficacy of lacrimal sac localization with lacrimal probe without using light pipe. The study was based on nonrandomized prospective clinical trial with one year follow up period.Methods: A group of 40 patients operated since march 2001 to December 2004 The operation was Endoscopic Dacryocystorhynostomy and localization of lacrimal sac, which was performed with a lacrimal probe inserted in lacrimal sac. With pushing the probe inferomedialy pierces lacrimal sac lacrimal bone, and nasal musca over the bone. Follow up includes symptom evaluation such as epiphora and endoscopy. Success was defined as relief of symptoms & duct patancy with irrigation for a 1 year period.Results: 29 patients were male (72.5 %) and 11 were female (27.5 %). Mean age was 37.5 (with SD±12.26) in 20 patients right eye involved, left eye involved in 16 cases and in 4 cases both eyes involved. For 3 patients septoplasty was done besides EDCR. success rate was 82.5% and no complication was seen.Discussion: the use of lacrimal probe for lacrimal sac localization is a safe and easy method and don't have light pipe limitations then can replace light pipe.

Introduction: Autoimmunity in thyroid has important consequences for fertility, the occurrence of pregnancy complications and pregnancy out come. Several studies have shown an association between thyroid autoimmunity and [thyroid peroxidase antibodies (TPO), anti thyreoglobulin antibodies anti TG] and infertility.Methods: We studded two groups of 60 women in winter 1383 to summer 1384, for serum anti TPO and anti TG are involved in this study. One group was infertile women and the other group was normal women with no infertility.Results: 45 percent of infertile women had elevated (75 <Iu/ml) anti TG levels in their serum and 30% had normal anti TG level (50< Iu/ml). 20 percent of infertile women had elevated anti TPO levels (75 < Iu/ml) and 80% had normal anti TPO levels (50< Iu/ml) Any of normal women hadn't elevated levels of anti TG and anti TPO. 91.7% normal women had normal anti TG levels and 95% had anti TPO levels. P-Value between two groups were less of 0.05.Discussion: The results of this study have shown there is an association between the presence of anti TPO and anti TG with infertility in women.In infertile women the anti TPO and anti TG levels must determined.

Introduction: This study was performed to determine value of procalcitonin (PCT) detection by a rapid, no instrument dependent test for differentiation patients with noninfectious systemic inflammatory response syndrome and patients with sepsis, sepsis syndrome and septic shock.Methods: Over a period of one year from February 2004 to February 2005, 50 patients with systemic inflammatory response syndrome (25 coronary care unit (CCU) patients without infection and 25 intensive care unit (ICU) patients with sepsis, sepsis syndrome and septic shock) admitted at St- Zahra hospital, Isfahan, Iran, were tested to detect procalcitonin in their blood.Results: 22 (88%) of those patients with sepsis had positive test (slightly elevated PCT=0.5ng/ml [3 patients (12%)], moderately elevated PCT>0.5ng/ml [5 patients (20%)], markedly elevated PCT≥2ng/ml [11 patients (44%)], severely elevated PCT≥10ng.ml [3 patients (12%)] and 1 (4%) out of those with no sepsis SIRS had moderately elevated level of PCT.Discussion: In this survey PCT shows 88% sensitivity, 96%specificity and clearly discriminates sepsis from nonseptic SIRS.

Introduction: This study was performed to compare safety and efficacy of intracameral lidocaine with placebo during phacoemulsification under topical anesthesia with systemic IV sedation. Methods: 101 consecutive cases undergoing clear corneal phacoemulsification were enrolled in this single surgery, prospective, double blinded control trial. Patients were randomized into two groups, receiving either intracameral lidocaine 1% (0.1 ml) or placebo (BSS). Blood pressure, pulse rate, central corneal thickness, pain, degree of sedation, patient cooperation and satisfaction were assessed and recorded during and after operation. Data were analyzed by T-student and non parametric Mann-Whitney tests.Results: Fifty one cases received intracameral lidocaine and 49 received placebo. There was no statistically difference in order to demographic data, hemodynamics, sedation score, corneal thickness change, patients' cooperation and surgeons satisfaction between two groups. Mean patients satisfaction score in lidocaine and placebo groups was 3.4±0.5 and 3.1±0.7 respectively (p=0.008). Patients in the lidocaine group had significantly less pain score (0.6±1.0 vs. 1.5±1.7 placebo group, p=0.03). Corneal thickness changes in lidocaine and placebo groups were +11.2±8.1 and +9.8±19.8 (micro meter) respectively (p=0.65).Discussion: Intracameral lidocaine (1%) can improve pain relief and patient satisfaction without effect on corneal thickness during phacoemulsification under topical anesthesia and systemic sedation. Thus topical anesthesia supplemented with intracamerallidocaine was effective and safe method for phacoemulsification.

Introduction: Behavioral problems and psychopathology have been widely assessed in patients with epilepsy. However, the issue that whether people with epilepsy are at increased risk for psychological problems remained highly controversial. Psychological and personality profile are not evaluated in Iranian epileptic patients. The aim of this study was to evaluate personality characters and psychopathology in this patients and compare with those with out epilepsy Methods: In this study personality and psychological characters were examined in 40 patients with epilepsy that randomly selected from Alzahra Neurology Clinic. Control group was matched in accordance with age, gender, marital status, educational level, psychiatric history and job. Two groups were assessed by MMPI (Iranian version).Results: The analysis of MMPI profile of two groups revealed that patients with epilepsy have more elevation on some of MMPI scales than those of control group such as depression, Hysteric, Pt and Schiso phereniu. But there was no significant differences except Sc scale (P=0.04).Discussion: Psychological interpretation on patients MMPI profile indicated that they tend to be more neurotic and introversive than control group. The significant higher score on Schizophrenia scale in epileptic patients should not interfere as schizophrenia disorder but it indicates on existence of some characters such as social withdrawal, conceptual distortion, confusion, agitation, restless and nervousness. These results provide information about patients with epilepsy that may be useful in their therapeutic plan.

Introduction: Liposuction is a surgical procedure for body fat reduction that is supposed to be on the increase. Regarding to the effect of weight reduction on cardiovascular risk factors such as body mass index (BMI), hyperlipidemia, hypertension and inflammatory markers (CRP, LPa,...) we investigated the role of liposuction on these indices.Methods: 24 obese (BMI>30) nondiabetic women with average age 51.2 (48.7±7.3) y/o were studied. Before liposuction they completed the questionnaire and for them physical examination and sampling of fasting blood for measurement of glucose, total cholesterol, HDL-C, LDL-C, triglyceride, fibrinogen, CRP, antioxidant capacity, insulin, insulin resistance and LPa were done. 12-14 weeks after surgery the same examinasions and tests were repeated. Then data was evaluated by analytical paired T-test method.Results: BMI, waist-to-hip ratio (WHR) and LDL-C were significantly lower after liposuction (P<0.05) but other parameters were not significantly altered.Discussion: we found, over a 4 months, liposuction would able to decrease BMI, WHR and LDL-C.However these findings may be necessary that been reinforced by larger studies.

Introduction: The home visit is a matter of psychiatric services in diverse areas of nursing, psychology and social worker in schizophrenic patients. This method has been shown to be an effective strategic treatment by psychiatries .the aim of this study was to determine the efficacy of home visit in chronic schizophrenia .Methods: This study was a clinical trial performed in Isfahan in 2005. Sixty -three chronic schizophrenic patients that were underpart services of Behzisti were randomly divided to two groups. The experimental group receipted home visit program in a monthly for 6 months. Relapse by psychiatiric visit and admition in hospital global function and quality of life according Global Assessment Function (G.A.F) and W.H.O Quality Of Life Seal compared before and after intervention in both groups. Data was analyzed by t student and SPSS software.Results: Patients in the experimental group relapsed within 6 months with 3 days hospitalization, (3±0) whereas 15 patients relapsed in the contrast group that admitted 20-40 days (285±31) {p<0.001}. In hospital Global function in experimental group increased compare to the control group (p=0.001, t=3.36). Quality of life in experimental group ameliorated than control group (p<0.0001, t=4.75).Discussion: Home visit program can establish positive efficacy in schizophrenic patients by decrease relapse, increase global function and improvement in quality of life.

Introduction: Turner is a clinical syndrome that is usually caused by a complete absence of one of' X chromosomes in females. This syndrome has a vast spectrum of clinical manifestations such as short stature and amenorrhea. Regarding versatility of the clinical pictures, cytogenetic study is important to confirm the clinical diagnosis.Methods: The cytogenetic study was carried out by GTG banding procedure. Percentage of karyotypes of affected persons, accuracy of cytogenetic procedure, accuracy of clinical diagnosis, and also paternal and maternal mean age at delivery, and mean age of patients at the time of clinical diagnosis were determined.Results: The karyotype analysis findings were as follows:30.8% of the patients with karyotypes 45, X; 20.5% with karyotypes 46, XX; 12.8% with mosaic karyotypes 45,) U46,XX; 10.3% with mosaic karyotypes 45, X/46, X i (Xq); 10.3% with mosaic karyotypes 45, X/46,X i (Xq) /47, X 2i (Xq); 5.1% with mosaic karyotypes 45,X/47, XXX; 5.1% with mosaic karyotypes 45, X / 46, XX / 46, X i (Xq), 2.5% with karyotype 46, XX, t (Xq, 6q); and 2.5% with karyotype 46, XX, (delXp).In 94.7% of the cases the patients were over 18years of age at the time of clinical diagnosis and referral. Age of mothers at delivery was under 33 years in 73.7%, and over 33 in 26.3%. ART facilities were not used by any couple. Two of the patients were married without being pregnant.Discussion: Findings of this study represent that karyotyping is a suitable tools to confirm clinical findings. But because of delay in referring the patients it is not possible to choose suitable treatment protocols for them and give them proper reciepe of hormones or treat their short stature.

Introduction: Recurrent brief depressive disorder (RBD) is a well-defined and significantly prevalent affective disorder with an increased risk of suicidal and significant clinical impairment in the community and general practice. RBD is characterized by depressive episodes occurring at least once a month and lasting for only few days and the lack of a successful treatment represents one of the main challenges of this disorder.Method: We report on a 21-years-old married woman who presented a 3 years history of sudden depressive episode with a twenty days recurrences lasting 7-10 days of depressive symptoms such as psychomotor retardation and mutism.Results: The patient was treated with imipramine and fluoxetin for a while and in spite of maintaining the treatment, recurrence of depressive episodes were continued but since sodium Valproate therapy was added, she has remained euthymic without any recurrence of depressive symptoms. Conclusion: The absence of recurrence for a year since sodium Valproate treatment was started, suggest a prophylactic effect of this agent on RBD.