Journal of Isfahan Medical School
Year:2001 | Volume:19 | Issue:62|Papers Count:17

The aim of this study was to determine the time of engagement in term mulliparous with vertex presentation and its relation to the cesarean section rate. Engagement of the fetal head at the onset of active phase of labor in this population seems to be less common than what has been published in textbooks. As the time of engagement seems to be related to the route of termination, it is necessary to do an observational study for proving its relationship. For this descriptive study, 533 mulliparous term women with singleton and vertex presentation who were admitted to Alzahra and Beheshti Hospitals with labor pain between Ian. 2000 to Feb. 2oo1 were randomly chosen. The patients were all examined weekly in outpatient obstetric clinic since 37 weeks of gestation and then through their course of labor.Engagement was considered to be at station 0 or below. Of 533 patients, only 45 (8.44%) had engaged head at the onset of active labor. Most of the deliveries and engagement were at 39.40 weeks of gestation. 488 patients has unengaged vertex presentation at the onset of active labor (91.56%). Of these two groups with engaged and unengaged fetal head, vaginal delivery occurred in 30 (66.6%) and 236 (48.8%) respectively. Cesarean section for CPD was done in] (2.2%) and 27 (5.5%) as well The rest of patients in each group had abdominal delivery for other reasons except CPD.The observed differences in the route of delivery in these groups were not statistically significant (P=0.175). The mean duration of active phase was significantly .shorter in the first group, but there was not any obvious difference in the second stage of labor.Most of these population had engaged vertex at the onset of active labor and only 5.5% of them delivered by cesarean section as the result of CPD.

Abortion is the commonest complication of pregnancy. Recurrent abortion occurs in 1.300 of pregnancies and immunologic causes responsible for 50-60% of recurrent abortions. In our study, patients with habitual abortion with causing by alloimmune defect were treated by leukocyte immunotherapy. General purpose of this study is determination of leukocyte immunotherapy efficacy rate in treatment of patients with recurrent abortion causing by immune disorders.This study is performed as clinical trial method. Patients with recurrent abortion were ,underwent the several laboratory tests for establishing of alloimmune disorder. Finally 45 samples were selected and candidated for "Leukocyte Immunotherapy with Paternal leukocyte". Subsequent pregnancy of leukocyte immunotherapy with recurrent abortion result in 80% live birth and 20% of abortion. No side effect was seen in mothers or their babies. No one of babies has intrauterine growth retardation.Thus, the leukocyte immunotherapy by paternal leukocyte is a successful therapy method for patients with alloimmune disorder origin. The future pregnancy rate improves by this method.

Dietary sodium restriction - enhances the antiproteinuric and blood pressure lowering effect of ACE inhibition. In clinical practice, however, long term compliance to a low sodium diet may be difficult to obtain. We therefore investigated whether the blunting of the antiproteinuric effect of ACE inhibition by high sodium intake can be restored by the addition of a diuretic.This study is a clinical trial It was been in Ali Asghar and Noor Hospitals during 3 months from July 2000 to October 2000. All of patients had none diabetic renal disease with proteinuria more than 1 g/d Mean 5.6 g.d (3.4 . Z4) & creatinine clearance> 30 cc/min/ 1.73M2. They were 30 patients who were studied during three consecutive 1 month period: low sodium diet (50 mmol/d), high sodium diet (200 mmol/d) & a high sodium diet Plus hydrochlorothiazide (50 mg QD). At the end of the study all of results were exmnined by Friedman two - way analysis variance & were registered to EPSS.During low sodium intake proteinuria wa.v 26 (1.6-3.6) g/day (P<0.001), during high sodiun intake proteinuria increased to 3.8 (3-5.4) glday (P<0.00l). Interestingly, addition of hydrochlorothiazide again reduced proteinuria to 22 (1.4-3.4) g/day (P<0.00l).This study showed reduction in proteinuria from 3.8 to 22 g/day.So addition of hydrochlorothiazide can overcome the blunting of the therapeutic efficacy of ACE inhibition on proteinuria by a high sodium intake.

Preterm delivery is one of the principal causes of perinatal morbidity and mortality in industrialized countries. In more than 50% of all preterm deliveries the etiology is unknown. Evidence has been gathering over the past 20 years that infection-inflammation may cause from 20-40% of pretem births. Thus antibiotic therapy may be useful in preterm labour.Eighty women with singleton pregnancy with threatened idiopathic preterm labour and intact memberan at 26-34 weeks of gestation in two Uniwrsity Hospitals of Esfahan were recroited. 40 wonen treated with metronidazol, ampicillin and Magnesium sulfat and 40 women treated just with Magnesium sulfat.Treatment with ampicllin-metronidazole and Magnesium sulfat was associated with significant prolongation of pregnancy decreased incidence of preterm labour and lower rate of admission to neonatal intensive care unit in the first group was 12 neonates and in the another was 26 neonates P=0.000172.Treatment with Ampicillin metronidazol in women with threatened idiopathic preterm labour significantly prolonged the gestational age (delay in delivery in the first group was 34.33±18.36 versus 25.88±13.9 P=0.023).

Epilepsy is a prevalent disease in all countries. It's prevalence is about 6-10/1000 & in some studies 0.5-2 percent. In this study we demonstrated the prevalence of epilepsy in elementary students of Isfahan.In this descriptive study with multisystem & randomely sampling, we studied the prevalence of epilepsy in 10000 persons population in elementary student in Isfahan and the results are as follow. The prevalence of epilepsy 19.8 in 1000 population or 0.89 percent. The prevalence of febrile convulsion were 19.8 in 1000 or 1.98 percent. The prevalence of epilepsy in student's with febrile convulsion were 125 percent. The history of epilepsy were positive in 5.6% fathers and 3.3% mothers of student's with epilepsy .This study demonstrated that the prevalence of epilepsy in elementary students in Isfahan are similar to other countries. The prevalence of epilepsy in student of fathers with epilepsy is more than those of mothers with epilepsy. This is opposite to results of other studies.

Neglected femorl neck fracture have several complications including non- union and avascular necrosis. In some types of fractures, the rate of avascular necrosis can be 100% after one week.In this study, a 15 year old girl with neglected femoral neck fracture was treated by muscle pedicle bone graft and followed for three years. In this period, there was no symptoms or radiographic signs of non - union or gross avascular necrosis.Therefore, our findings suggest that muscle pedicle bone graft can be used affectively for treatment of neglected femoral neck fractures.

The aim of this study is to evaluate the results of limb salvage operation in patients with bone tumors.Thirty - four patiants with bone tumor were selected and operated by limb salvage method. Results of operation and complications were analysed. The follow up period of these patients was 6 to 30 months.6Z6% of patients were male. The mean age of patients was 20.4±8.7 years old. 55.7% of patients had osteosarcoma and distal of femur was involved in half of patients. The most common stage of tumors were IIB (50%). Preoperative chemotherapy was taken in 76.4%, post operative chemotherapy was performed in 73.5% (100% of patients with osteosarcoma had recieved chemotherapy. Artrodesis was the most method of reconstruction (31.3%) and the most common materials was autogenous bone graft (3Z2%). 26.6% of patients had developed complications, five patients were died because of respiratory metastasis.In 50% of patients, fanctional results was good and excellent in 1 Z6%. Local recurrence was lower than other studies but mortality was the same. limb salvage procedures was proposed for bone tumors.

This investigation was performed on 31 Iranian chemical casualities sufferring from the delayed-hazards of sulfur mustard gas used in Iran-Iraq conflict (1980-1988). The aim of this investigation was to determine the white blood cell and their surface molecule changes after 8 years of exposure, and also to evaluate the origin of persistent atypical lymphocytes in their blood compared to control group.CBC was performed by HI automatic system. The antigenic markers CD45, CD13, CD14, CD33, also T cell CD markers (CD3, CD5, CD7, CD2), B Cell markers (CD19 and CD20) were analysed by flowcytometric method, using congugated monoclonal antibodies.CBC analysis indicated the significant decrease of absolute neutrophil and monocyte, and increase of lymphocyte counts, compared to control groups (P<0.05). In flowcytometric analysis T cell markers (CD5 and CD3) were decreased (P<0.05), wherase CD19 and CD20 B cell markers were increased significantly (P< 0. 05), CD33 (marker of myelomonocytic lineage and immature myeloid cells) was increased in patients compared to control group (P<0.05).The presence of persistent atypical lymphocytes is an unpleasant finding, which seems to be due to B lymphocyte changes. More detailed investigations should be done on B lymphocyte and their surface markers.

A study was made of 64 patients who presented with gastrointestinal lymphoma, seen at the Department of Hematology and Oncology, Esfahan Medical School during the period 1985-1996. The occurence was 25 cases in the stomach, 23 in the small intestine, 7 in the ileocecal region, 4 in the rectosigmoid and in the five cases, multiple sites in the gastro-intestinal tract were involved.All patients had laparotomy, and biopsy from the site. Histopathological subtypes were done in the International Working Formulation. Stage groupings were done applying the Crowther and Black/edge staging system. Post-laparotomy chemotherapy was made depending on the patient's general condition ,completeness of surgery and histological subtype.The overall survival rate was 47.8% at 5 years. Early stage disease and high-grade lymphoma have a better prognosis if treated adequately. The patients that had an adequate resection on laparotomy with a 5 years survival about 67%.

The patient was a 44 year old woman who was referred to Rheumatology service with chief complain of low back pain. Her illness was begun from two years ago with the most severity in the nights causing somnolence during days. In addition the patient had complaint of night sweating and increasing of skin thickening from six months ago. She also pointed to the past history of dental abcess and it's association with skin problem. The notabel signs in her physical exam were as follows: Obesity, induration of skin and loss of natural wrinkles in the face and upper trunk involving the breasts, upper limbs from shoulder to upper forearm, Albright Sign in hands, decrease ROM of all the spinal movements, positive FABER test in rigth hip and ANTALGIC gait. Differential diagnoses were some disorders which causes skin induration (Scleroderma like skin Syns) without involving the fingers and Raynoud phenomen. After lab test, portein and immunoelectrophoresis of serum, radiological exams, bone marrow aspiration and consultaion with dermatologist, skin biopsy and specially after researching in the last Rheumatologic and Dermatologic references and Medline, the diagnosis become more evident that the patient had a rare illness which was Scleredema Adultrorum of Buschke in association with Multiple Myeloma. the patient was referred to Oncologist for treatment and follow up.

Cardiovascular complications are the most common cause of mortality and morbidity in noninsulin dependent diabetes mellitus (NIDDM).Autonomic neuropathy is one of the complications of NIDDM which may also involve cardiovascular system. Autonomic system abnormality may increase QTc interval On the other hand patients with prolonged QTc interval are prone to ventricular arrhythmia, especially unique torsade-de-point and also sudden cardiac death. This study is aimed to detect the prevalence of QT c prolongation in diabetic and nondiabetic patients as well as its correlation with diabetic autonomic neuropathy.This study includes 200 diabetic (case group) and 200 nondiabetic patients (control group) with comparable age and gender. Evaluation of autonomic nervous system was carried out in all cases with prolonged QT c interval Autonomic nervous system evaluation in control group also was performed. The results of study in the case and the control groups were compared.The prevalance of prolonged QT c interval was significantly higher in the case group in comparison with the control group, 8 percent versus 2 percent respectively.(P value = 0.012, OR=4.3).Sympathetic nervous system evaluation test in cases with QTc Interval prolongation and negative exercise test demonstrates abnormal results in more than 50% of case group (OR=3).Parasympathetic nervous system evaluation test in cases with QTc interval prolongation showed abnormal results in comparison with control group (OR=9).Abnormality of parasympathetic nervous system is more common than (3 fold) abnormality in sympathetic nervous system.With regard to the prolonged QT c interval in the case group in comparison with the control group and abnormal autonomic nervous system function in more than half of the case group, the probability of ventricular arrhythmia, torsade de points, has incresed. The mentioned ones are in increased risk of sudden cardiac death. Rendering approaches for decreasing the risk of sudden cariac death in diabetic patients are seriously recommended.

For a lactation woman who is Looking for contraception, progestron only pills (POP) are the first choice because they do not effect breastfeeding and not harmful for infant growth.This is a prospective, case control study, in each groups 100 fullnursing breastfeeding were selected. In case group 100 women used lynestrenol and in control group also 100 women use none hormonal methods like (condom, IUD m and TI). In This observational descriptive study, all data were collected by questionnaires and were analysed by software systat.Mean age was in case group 23.7±3.7 and in control 25.5±.4.9 years. Mean duration of used lynestrenol 7.3±3 months. There were no significant relationship between lynestrenol and amount of mother"s milk and infant growth rates (P>0.05). The most side effects were Ameorrhea 65%, Anxiety 49%, Headache 27% and Spoting 18%. There was not any relationship between duration of using oral lynestrenol and these side effects.Lynestrenol when started after six weeks postpartum, had no adverse influence on lactation.

Patch or complete Interposition of Prosthetic grafts are the standard procedures in the surgical repair of postductal type of aortic coarctation. Most of the surgeons prefer to use the native vessles as the repair material in children. They believe, the prosthetic grafts during maturation, may be put them on the high risk of aneurysm formation, but this is not going to match with our observation since more than 12 years of experience in coarctation repair surgery.Between 1368-1379, 80 consecutive coarctation patients diagnosed by history & physical examination and con finned by echocardiogaphy and aoric root angiography M/F 27/53, 71 (88.7%) with patch and 9 (11.3%) with other repair procedures: include; native vessele flaps, complete graft and direct aortic anastomosis have been surgically repaired in chamran heart hospital.After 11 years and one month of follow up, Hypertension in 13.6% of cases have completely treated ,and 71.9% with 170± 20 /70±20 mmHg BP are controlled now by antihypertensive drugs. 4.2% Recoarctation is documented by echocardiogaphy with 20±2 echogradiant in operation site. 2 Cases reoperated because of patch infection and aneursmal chages in aorta. No perioprative mortality have repoted.Patch aortoplasty with prosthetic materials in an ideal method in the surgical repair of coarctation in all ages and the aneurysm fomattion rate in our study is considerably acceptable and lesser than the other reports.

Three cases of fungal rhinosinusitis are reported one with invasive and 2 with non-invasive disease. All three patients underwent endoscopic debridement. Direct endoscopic access in these cases facilitated resection of the diseased areas and produced physiologic conditions for sinus drainage.