Journal of Isfahan Medical School
Year:2002 | Volume:19 | Issue:61|Papers Count:19

Pulmonary AV fistula is an abnormal connection between pulmonary arteries and veins. This abnormality causes right to left shunt and so arterial 02 desaturation. Pulmonary capillary system is bypassed and arteries are connected directly to the veins. This abnormal connection is single or multiple, unilateral or bilateral localized or diffuse. Association of this lesion and vascular telangiectasia (Osler-Weber-Rendu Syndrome) suggests abnormal vascular tissue structure. Complications of this disease are multiple hemorrhage, rupture of fistula and aneurysm, paradoxical emboli, infective endocarditis. Electerocardiogram and echocardiography are of little diagnostic value and physical examination, Chest X ray, pulmonary angiography have highest benefits for diagnosis. The Patient is a 26 years old male that complained from dyspnea on exertion, cyanosis and clubbing. In the physical examination, except above history and continuous murmur on the back of the chest, rest of physical examinations were within normal limits. On CXR (PA) a suspicious shadow on the lower part of left lung was seen. On perfusion lung scan decreased left pulmonary blood flow was seen. On chest CT-Scan, a large mass on left lung was demonstrated. On left PA angiography right to left shunt with large fistula and aneurysm was seen. The patient was operated successfully and complete improvement occured.

For evaluation of patients with angina pectoris and normal coronary angiography (CA), the hospital chart and the results of CA of 700 patients who have been hospitalizd in Noor and Chamran hospitals from Isfahan Medical School were studied.Out of these patients 139 patients had normal CA, which 24 patients with cardiomyopathy pulmonary hypertentsion and valvular disease were excluded. %55.6 of them were female who were 51 ±7.39 years old, while %44.4 were male with 49.85±9.92 years old C.C.U admission were %71.4 in female versus %28.6 in male. The ischemic changes in eletrocardiogram were found in %36.5 while the positive exercise test (ET) were found in %71.4 of patients.In our study, the numbers of patients with angina and normal C.A and also the age and sex distribution are the same as in most reported studies.The frequency of positive ET and abnormal electrocardiograms are also similar to other reported studies, female with average age of 51 years and history of repeated attacks of angina, which needs frequent hospitalization are the victim of this syndrom.

Recurrent abortion is the commonest complication of pregnancy which cause severe sadness for couples who are waiting for newborns.Abortion happens in about 1/300 of all pregranceis. Immunologic factors are between 50-60 percent.During of clinical action and simple sampling to women with recurrent abortion and positive test for autoimmune factors patients were selected in two regimen groups: Heparin plus Aspirin (40 women) and Prednizolone plus Aspirin (30 women). Data were collected in prenatal care profiles, observation and physical examination.Heparin plus Aspirin regimen was more effective than prednizolone plus Aspirin regimen (P<0.05).Birth rate in Heparin plus Aspirin was 95 percent and in prednizolone plus Aspirin was 76.6 percent.It is concluded that Heparin plus Aspirin regimen is better than prednizolone plus Aspirin because paraclinic tests were expensive we had afew patients. However another study with large sample is recommended.

Urinary tract infection (UTI) is one of the common and important infectious diseases in pediatrics, which should be treated promptly with appropriate drug, because of potential sequel and subsequent complication. but usually we don't know the bactrial suseptibility at the beginning of the treatment. It has been recommended to begin with a broad spectrum antibiotic including Cefotaxim or Gentamycin. We were going to know the escope of efficacy of these drugs and compare them together, and this would help to choose an appropriate selection of drugs for primary treatment of children's pyelonephritis.In a randomized clinical trial we evaluated the efficacy of cefotaxim versus Gentamycin in all 77 hospitalized children with UTI and fever in Isfahan-Alzahra Hospital during two years (1999-2000). The Criteria for efficacy of treatment were urine sterilization, and be afebrile after 48 hours, and negative serum CRP after 96 hours of treatment. Fisher Exact test was used for difference exposure.Treatment were effective in 97% of patients treated with Gentamycin and 100% of those treated with Cefotaxim. Using Fisher Exact test, made no difference between these two groups. (P=0.5)Cefotaxim or Gentamycin could be recommended as an effective treatment for children's pyelonephritis in our situation but because of low cost and high accessibility sometimes Gentamycin is better than the other.

Bronchial ruptures are rare but potentially life threatening events. Blunt thoracic injuries in children are unique because the pliability of the chest wall allows transmission of massive external force directly into the mediastinum.Children presenting after blunt chest trauma may have complete disruption of the airway with little external sign of injury.Without prompt diagnosis and appropriate treatment, the risk for progressive respiratory failure is high.We report on the case of a 16 year old car accident boy, who developed subcutaneous emphysema and bilateral pneumothorax following blunt thoracic trauma. He was discharged from the ICU two weeks after the trauma.The clinical sign of bronchial raptures and the surgical and anesthesiological approach to the management of bronchial ruptures is discribed.

Acid Azelaic reduces the inflammation and clonization of propiony bacterium keratinization of pilosebaceous unit. The main aim of this study is evaluation of it's efficacy (Gel 20%) in the treatment of acne.This was a randomized double blind clinical trial study performed on sixty patients with mild to moderate acne They divided into 2 groups randomly and these groups received 20 percent topical gel (n=30) and placebo (n=30) . They were followed every 15 days in a period of 45 days. The number of lesions were recorded and compaired with t-student test.The effect of Acid Azelaic in reduction of the acne severity index more than 60% but placebo reduced it 21% the efficacy of drug on comdones was more than inflammatory lesions.Acid Azelaic gel can be used in mild and moderate acne as the effective treatment it's complication was mild.

Fetal Macrosomia was defined as birth weight greater than 4000g. Perinatal mortality and morbidity is increased in fetal macrosomia.If we predict of fetal macrosomia, prevention of its complications are possible. In a prospective study 3oo full term fetus among pregnant women that refered to the radiology department of AL-Zahra hospital for pregnancy sonography was sekcted. Fetal abdominal subcutaneous tissue thickness was meassured in the anterior third of the abdominal circumference.There were 294 normal size and 6 macrosomic fentses. The fetal abdominal subcutaneous tissue thickness ranged between 3 and 14 mm. in all fetuses with a mean measurement of 6.68 mm ± 1.77 S.D. The mean soft tissue thickness differed significantly between normal and macrosomic fetuses (6.57 mm ± 1.6 S.D verS1LS 12mm ± 1.41 S.D). The pearson correlation coefficient was cakulated (r=0.863 P<0.0001). The results of this study show, presence of direct relationship between the thickness of fetal subcutanous tissue and fetal weight, and measurement of this thickness in the full term pregnant woman could be used as a sonographic parameter for intrauterine diagnosis of macrosomia.

In some cases differentiation between Gliosis and Astrocytoma, on the basis & routin staining is difficult. Therefore we have used another compelementary technique. 88 brain biopsy, Includ: 14 cases Gliosis, 25 cases Astrocytoma, 15 cases anaplastic astrocytoma and 34 cases Glioblastoma multifrom were studied with use silver coloid for detennination argyrophilia of protein related to nuclear organizer regions (AgNOR). Mean AgNOR was in: Gliosis 1.76±0.13 (SD), Astrocytoma 228±0.33 (SD).anaplastic astrocytoma 258±0.41(SD) and in Glioblastoma multi from 2,94±0.58(SD). The result was shown significant difference between means. AgNOR technique can be used as a clue for differentiation between Gliosis and Astrocytoma but can't be use as a clue for grading of various degree of astrocytoma.

Nucleolar Organizer Regions are evaluated by AgNOR staining which is a valuable method indicating proliferative activity of the cell population. In this method ribosomal proteins of active nucleoli appear as black dots.Quantitative assay of AgNOR can help us to distinguish benign lesion from maligant. It is also valuable method in the predication of outcome.In this study 100 cases of prostatic diseases, including; Benign prostatic hyperplasis (6 cases) and prostatic adenocarinmoa (40 cases), were obtained.After reevaluation of sections of prostatic adenocarcinoma they classified (on Gleason grading system) to: Well differentiated adenocarcinoma or Gleason grade, I, II (15 cases), moderately differentiated adenocarcinoma or Gleason grade III, IV (10 cases), and poorly differentiated adenocarcinoma or Gleason grade V (15 cases).These specimens were stained with both hematoxylin eosin and AgNOR stainings. In the sections of prostatic diseases, the mean silver stained NOR (AgNOR) Counts were as follow; benign prostatic hyperplasia (1.68) , atypical adenomatous hyperplasia (5.03) and prostatic adenocarinoma (9.46) well differentiated adenocarcinoma (7.08) , moderately differentiated adenocarcinoma (8.40) and poorly differebtiated adenocarcinoma (13.02).The range of AgNOR counts in these sections were as following; Benign hyperplasia (1-3), Atypical adenomatous hyperplasia (4-6), well differntiated adenocarcinoma (6-9) moderately differentiated adenocarcinoma (7-10) and poorly differntitaed adenocarinoma (11-15).Statistical analysis showed significant differnce between these groups. (P value < 0.001). This study, showed that AgNOR stain can be used for differntation between bengin and malignant lesions, bengin hyperplasia and atypical adenomatous hyperplasia and finally between atypical adenomatous hyperlasia and adenocaecinoma.It is also used for grading of prostatic adenocinoma and determining its prognosis.

ST elevation on right ventricular lead (V3R-V4R) in patients with acute anterior wall myocardial infarction (AMI) and high occurance of hemodynamic and cardiovascular complications in these patients necessitates accurate diagnosis and management of this complication. The aim of this study is to show the frequency distribution of ST elevation on right ventricular lead (V3R-V4R) in association with anterior wall Ml.This study is a cross sectional study in which there are 176 patients with acute anterior wall MI who referred to Isfahan Nour and Al-Zahra Hospitals and were selected in a one - year period. The subjects underwent electrocardiography with leads of V3R and V4R in addition to the standard 12-lead electrocardiogram. The presence of MI was also confirmed by CPK and LDH enzymes measurement. After performing appropriate physical examination, data collection through a checklist was performed.In this study frequency of associated ST elevation on right ventricular lead (V3R-V4R) was 15% and 8% respectively. In comparison with the patients with anterior wall MI without ST elevation on right ventricular lead (V3R-V4R), patients with anterior wall MI and ST elevation on V3R and V4R, increased jugular venous pressure (JVP) and limb edema, increased 3 and 6 fold respectively.The presence of ST elevation on right ventricular lead (V3R-V4R) with anterior wall MI is a significant problem on diagnosis and management of these patients. Therefore the accurate diagnosis and management of this disorder is very important. Standard electerocardiogram in addition to V3R and V4R leads are important diagnostic tools.

Diagnosis of tubal patency is important step in evalution of infertiliy. Common method in our country is Hysterosalpangography (by X-Ray and Contrast Media). Uterine tube can be evaluated by sonography if there is liquid in or around it.This study accomplished in Isfahan shahid Beheshti Hospital on 42 infertile women whose uterine tubal patency condition was unknow. Neonatal NG tube number 0.8 was cause to pass via cervix at the moment of vaginal songraphy by 6.5 MHZ probe concept/me dynamic imaging EHS49DR system. Passing of liquid through uterine tubes and abnormalities in line of movement were observed. Then laparoscopy with passing dye (Methylen blue) was performed up to 8 weeks later. Results and side effects of two methods were written down.Compatibility of SHT and laparoscopy finding were 88.2% in bilateral patency, 55.6% in unilateral patency and 61.3% in bilateral occlusion. SHT sensitivity was 89.6% its specifity was 81.3% and ppv =100%.SHT side effects was 12% (anxiety, vaginismus, slight pain) laparoscopy side effects was 28.6% (nausea and vomiting, abdominal pain, overt abdominal distention, dyspenea) mean price was accounted 65000 rials in SHT and 600.000 rials in laparoscopy.Because of low-priced method, simplicity, low side effects, suitable for outpatients and acceptable results (in comparison with laparoscopy), we can use SHT as the first step in diagnosing of tubal patency.

Influenza viruses poses a significant health problem specially in children, elderly and high risk groups as patients with chronic heart and chest disease, patients with renal disfunction, diabetes, and with asthma, therefore immunization is recommended for this groups of patients. The best vaccine for immunization against this disease should stimultaed humoral cell mediated and local immune systems. Although vaccines against this disease have been developed and used for years, but they remain less effective. The role of IgA secretory antibody is very important to prevent the influenza infection, in this study we were decided to measure the level of IgA antibody after given 3 doses of HA subunit influenza vaccine in DTP vaccine in mice.Nasal wash discharge were collected from immunized mice at 10 and 21 days after first and second immunization, and 21 days following third immunization with FlA subunit alone and HA subunit in DTP vaccine. All samples were tested for IgA secretory antibody against influenza viruse, using the EL1SA procedure and compare with positive and negative control.The results of the present experiments showed the incorporation of influenza HA subunit vaccine into DTP failed to produced significant secretory 19A antibody in nasal wash of mice, but DTP is able to stimulat humoral and cell mediated immunity against subunit influenza A vaccine.

Preventing thrombus formation after caustic esophageal ingestion has been proposed to have beneficial effects. Therefore, an experimental study was carried out to investigate the effects of heparin on the esophagus after caustic burns.Caustic esophageal burns were produced in rats by irrigation with 50% NAOH and 0.5% cl (ingredients of whitex). Rats were devided into four groups as follows: group A: Animals with esophageal burns, received subcutaneous heparin treatment and underwent autopsy 48 hour after caustic injury. group C, animals with esophageal burns, received subcutaneous heparin treatment for 7 days and underwent autopsy 28 days after caustic injury. group D, animals with esophageal burns, received placebo and underwent autopsy 28 days after caustic injury. Histopathologic evaluation was performed in all groups and esophageal strictures were evaluated by circumferences diameter of the burned segments.Congestion and inflammation was encounter in all groups of animals. The submucosal venules and arterioles were patent in 30% of group A animals. Submucosal vascular thrombosis was encountered in all group B animals. Esophageal strictures did not develop in any of group C animals, but varying degree 01 esophageal stenosis were encountered in all animals of group D. The circumferences of the burned segment have been narrowed to 8 :t 0.1mm in group D. collagen deposition was obvious in 20% of group D rats.Although heparin has ameliorating effects on preventing thrombus formation. But effect of heparin on stricture formation in this study was not significant in statistical analysis (p>0.05).

After Appendectomy like other abdominal surgeries, patients are traditionally fed when postoperative ileus resolves. The aim of this study was to assess the safety and tolerability of early oral feeding after appendectomy that would lead to a shorter duration of hospitalization.Two hundreds young patients (range 15-45 years) with uncomplicated appendicitis (without phlegmon, Abscess or peritonitis) between January 2000 and August 2000 in Isfahan (AL- Zahra and Kashani Hospitals) were randomized for this clinical trial: 100for early feeding (EF) protocol consisting of clear liquid diet starting at the sixth postoperative hour, then advancing to regular diet in the subsequent six hours and discharging home as tolerated at the 12th postoperative hour, and 100 patients in traditional feeding (TF) group in which the feeding was started after resolution of post- operative ileus. Both groups were similar in type of anesthesia and procedure and postoperative analgesia and were checked for vomiting - abdominal pain or distention and length of hospitalization. The feeding was discontinued if three or more episodes of vomiting of more than 100 mililiters occured.No significant difference was seen in rate of food tolerance (99% in EF- group and 100% in TF- group). (P>0.05) Ten in EF group (10%) and 5 in TF group (5%) developed 2 episodes of vomiting that did not lead to discontinuation of feeding except one in EF group who developed more than 2 episodes of vomiting after starting of diet. Non of the patients in both groups developed complication. The average postoperative hospital stay was 17.6 ± 6.4 hours (range 10-42 hours) in EF- group versus 46:t16.9 hours (range 21-100 hours) in TE group.Neither group had readmission for recurrent nausea or vomiting. Too early postoperative oral feeding after uncomplicated appendicitis is safe and can be tolerated by the majority of patients and significantly reduces post operative hospital stay.