MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2000 | Volume:43 | Issue:67|Papers Count:20

This study was done by the vice chancellor for research of health and educational ministry of Iran.The prevalence of RHD was studied among 1054385 school children, age 6-19 years old, since November 1990 until September 1993.All 1054385 students were examined by trained medical students in their schools.The students who were suspected to have heart problems, referred to rheumatic clinic which located at central outpatient clinic, Imam Reza hospital.After physical examination by a cardiologist and also ECG; chest X-ray and sometimes echocardiography and in a few cases catheterization was done.Of 1054385, only 1654 students were found to have heart diseases (219 with RHD i.e. 2/10000, and 1435 with CHD i.e. 13/10000).Of 219 cases with RHD, 88 were female (40%) and 131 were male (60%). Among 219 patients with RHD the incidence of valve involvement respectively was mitral and aortic valve.There was no report about tricuspid and pulmonic valve. It is necessary to mentioned that valve involvements were more common in older children and teenagers than that of young children.Second point was that RHD is far less common in South of Khorasan than North areas. Third: the results were unexpected to us, because before the study we supposed that RHD is more common than that of congenital heart diseases.Fourth: in our study CHD was significantly more common in relative marriages (especially close relatives).

To Identify Incidence of pulmonary Insufficiency; we evaluated prospectively 200 patients who had reffered to Echocardiographic Center of Ghaem hospital. 134 cases (67%) had PI. 48 cases (35.5%) with PI had pulmonary Arterial Hypertension and 86 cases (64.5%) with PI had normal PAP. 146 cases (73%) had Normal PAP & 58.9 % (86 cases) from this group had PI, therefore, incidence of physiologic PI In this study was 58.9%.

Background: Doppler echocardiography is an acceptable and useful method in evaluation of pulmonary artery pressure (PAP).Methods and results: 46 patient with both clearly detectable tricuspid regurgitation and pulmonary velocity profiles in doppler study were selected> pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (MPAP) was measured in every patient by adding 10 mmHg to doppler derived TR pressure gradient.Regression analysis between measured PAPs and ACT showed a moderately good negative relationship, with best for log MPAP and ACT (r=-0.69, P<0.0001) and then for log PASP (r=- 0.67), MPAP (r=-0.64), PASP (r=-0.62) respectively. Finally by using ASP > 60 mmHg and MPAP > 40 mmHg as cut points for severe pulmonary hypertension (PHT), sensitivity and Specificity of ACT for detecting the severity of PHT were tested.Conclusion: ACT method cannot precisely measure PAP but may be useful in patients who have not an easily obtainable TR signal. It was found that ACT≤42 ms is 100% specific sign for severe PHT.

One of the most welknown causes of Thyroid Cancer is believed to be radiation.This research was carried out to increase our knowledge about this subject in Khorasan province. During the period 1372-1374 (1993-1995), cancer patients at the Depts of Nuclear medicine and Pathology in Ghaem and amid hospitals at Mashad were asked to fill the prepared questionnaire. The history of each of these patients specially in relation with Radiation in head and neck was carefully studied.At the same time four normal persons (with no thyroid disorder) of the same age and sex filled the questionnaire as the control group.Statistical analysis of the results showed that a considerable number of thyroid cancer patients had undergone radiotherapy of head and neck.Among the patients those with the history of Tinea Capitis were more carefully investigated. These investigations included probable relationship between parameters such as age, sex, residential area, nutrition, being exposed to high voltage electric fields and, Thyroid cancer, but no significant relationship was found. Using statistical tests the following conclusions were obtained:A significant difference was found between patients with and without head and neck radiotherapy background. 26% of patients had undergone radiotherapy. (84% of which had received X-ray therapy for Tinea Capitis.)A considerable increase was found in the number of patients for the age group 30-39 and 40-49 years. From histopathological point of view, 80% of the patients had papillary cancer.An increase was found between the numbers of female patients in comparison with the male patients. Considering the fact that more than one hundred thousand people have received X-ray therapy for Tinea Capitis, a comprehensive study is required to follow the history of these people and to investigate the effects of ionizing radiation on them.

This Retrograde investigation which has been done by the study of 100 which has been done by the study of 100 files of corneal grafting show kcn with 38.2%, corneal opacity with 31.37% corneal ulcer with 11.76% Bulus kera topathy 6.86% graft rejection with 5.88% , CHED 2.94% and Miscellaneous 2.94% in the above studded 100 cases 68% were males and 32% were females the maximum signet observed was 1 mcf in patient in 36% right eye was effected 27% left and 37% both eyes were effected. The surgical operation has been done in 59% in right eye and 41% in left eye on the whole grafting was more in males despite congenital dystrophy and opacity followed by the congenital glaucoma which was more in females. The most common range was 10-19 years and the lowest range was infants and the highest was 89 years. PK (OD) the most common operation has been dove and after it PK (OS) has been done.The most common case of corneal grafting observed in this centre was in order KCN, Opacity of corneal, corneal scar and at the last (ABK + PBK) in the above cases corneal scar and opacity was preventable which need the eye Hyiegn.

Purpose: Transcutaneous Electrical Nerve Stimulation (TENS) has been widely used to relieve pain but its effects on pain of labor are controversial, this study examined the efficacy of TENS for pain relief during labor in mothers who hospitalized Mashhad, Imam Reza Hospital between 1376 and 1377.Method: In this double-blind, clinical trial study, 100 laboring mothers were selected and randomly divided into two groups: TENS and placebo-TENS, the first group received electrical stimulation and the second group had the TENS machine connected, but with no current. Pain of the mother was assessed by visual analogue scale of pain intensity (VAS-I) in two groups.Result: There was significant difference of pain between two groups, TENS treatment was superior to placebo on intensity and duration of pain reduction (P<0.001 for inten sity and P<0.02 for duration). There were no adverse effects on mother or newborns. Conclusion: These findings show that TENS is an effective non-pharmacological, non-invasive adjuvant pain relief modality for use in labor.

Background: Pancreatic cancer study.Objective: A retrospective review of 25 patients with pancreatic carcinoma (PC) during 15 years.Design: retrospective analysisSetting: Inpatient and out patient GI Dept. Of Mashhad Ghaem Hospital.Methods: Patients with severe obstructive jaundice (OJ) or epigoastric mass were included.Liver function tests (LFT) and pancreatic function tests (PFT), ultrasonography (US) and endoscope (EGD) were done in all. In some Computed Tomography (CT) was also done. All upper or lower GI tumors with liver metastasis and OJ were excluded. ERCP was done or attempted in nearly all. All patients with the diagnoses of Cholangiocarcinoma, Ampullary carcinoma or duodenal tumors were also excluded. Only PC were chosen.Results: Of the 25 patients 60% were male and 40% female. The peak age incidence was the seventh decade. Only an 18 year old girl was in the second decade. US and CT in OJ patients showed dilatation of intra and extrahepatic bile ducts. ERCP was successful in 17 of the 25 patients, in 7 was not feasible and one patient refused. The "Double Duct Sign" was seen in 4 patients and in others the other signs of PC were seen. Of the 16 operated patients 11 were in head and 5 body and tail of the pancreas. In 5 whipple Operation was done. Of these only 2 had 5-year survival. Of the biopsied patient most were adenocarcinoma and only one was islet cell carcinoma.Conclusion: In suspected PC patients ERCP can define the anatomic place of involvement and like any tumor. The earlier the diagnosis is, the better the prognosis will be.

Following on Spinal Cord Injury, SCI, the patients encounter a variety of complains (more than 80%), including as ejaculation disorder that, it is one of the important factor for male infertility as in our Janbazan imposed war. So far, different procedures have experienced for treatment of this disorder.Electroejaculation (Transrectal electrical stimulation of ejaculation) techniques have proved capable of causing ejaculation very, few complications and promising outcomes and safe procedures.Electroejaculation offers an encouraging pregnancy opportunity for ejaculatory men particularly, Spinal Cord Injury, who otherwise is considered infertile.We have compared the Janbazan semen's analysis which have been obtained by, EE, with a normal sperm criteria's (in relation with sperm count p>0.05, with morphology P=0.0000 and with motility P<0.05).The result showed the Janbazan semen's parameters are dercreasd in normal values.

The effect of single dose topical verapamil (0.25%) on IOP was evaluated in non glaucomatous people.The study was prospective, Randomised, cross-sectional and double masked. Intra ocular pressure (IOP) & Heart rate (HR) & Blood pressure (BP) were earwsed before and 90 minutes after drug instillation. IOP in treated eyes were reduced significantly from 15.2 ±3.2 mmHg ta 13.8 + 3.2mmHg (P<0.000) and IOP in the fellow eyes were reduced from 14.8±3.2 mmHg (P<0.002). HR & BP showed no significant changes.So we concluded that administration of a single dose topical verapamil (0.25%) could reduced IOP significantly in treated eyes and slightly in fellow eyes.

Abnormal uterine bleeding (AUB) is one of the most common diseases in OB & Gyn. There are many causes for AUB.Ulterasonography is a simple, noninvasive, and effective metod to use in the evaluation of patients with abnormal uterine bleeding.This study is a comparison of the patologic results with sonographic reports in 100 patients with abnormal uterine bleeding in Ghaem Medical center.Results: The most sensitive and correct sonographic Reports were about Myoma and endometrial hyperplasia (80% - 100), that is the same of other UN papers reported.

Antiversion of femoral neck was measured by computed tomography in 20 pastients (40 Hips) in Radiology department of Imam Reza medical center from Esfand 75 to Ordibehesht 78 (during 26 months). The methods require two scans, one through femoral Neck, an other through the femoral condyles.A specially designed device assures immobilization of legs. Intraobserver & Interaobserver error of this method are low 3.8 & 3.2 respectively, and no-statistically significant differences were observed in two groups of measurements.So the method appears to have sufficient accuracy for clinical purpose.

Surgical intervention is indicated when the lesions are complicated by pathologic fracture or sever pain or significant deformity in affected area. The presence of fibrous dysplasia in a bone is not an indication for operation.In ten patients which we evaluated the surgical method of treatment was in this manner, the lesion are adequately treated by curettage and allograft or autograft bone grafting in upper extremity and without bone grafting in lower extremity. Deformities are corrected by osteotomy and internal fixation, and pathologic fractures are best treated by curettage and bone grafting and internal fixation.The result of this study is as follows.1. In the upper extremity pain and pathologic fracture and sever deformity are indication for surgical intervention.2. Excision of lision and bone grafting and interamedullary fixation is the best treatment for lesions in arm and forame and bone graft for hand lesions.3. In the lower extremity, we use intramedullary fixation without excision of the lesion and without bone graft. The issue of the bone graft, bone inducing agents or synthetic in this condition also awaits definitive data. The result was excellent even after removal of the implant.

Now evidence is mounting that suggests people with periodontal disease a bacterial infection, may be more at risk for heart disease and have nearly twice the risk of having a fatal heart attack, than patients without periodontal disease. It is our central hypothesis that periodontal disease, which are chronic Gram-negative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease-and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotocxin (Lipoplysaccharide) and inflammatory cytokines (especially TXA2, IL-1, PGE2, and TNF-a) which serve to initiate and exacerbate atherogenesis and thromboembolic events. While more research is needed to confirm how periodontal bacteria may affect your heart, one possibility is that periodontal bacteria enter the blood through inflamed gums and cause small blood clots that contribute to clogged arteries.Another possibility is that the inflammation caused by periodontal disease contributes to the buildup of fatty deposits inside heart arteries.

Since 1951 that 14 and 6 positive spike pattern was originally described, controversial reports were published about the significance of the pattern in psychiatric disorders. We designed a controlled retrospective study about the correlation of the positive spikes and psychiatric disorders in children and adolescents.There was not significant correlation between 14 and 6 positive spikes and mood disorders, psychotic disorders, sleep disorders and disruptive behavior disorders.The relative prevalence of ADHD and anxiety disorders were significantly lower in patients with 14-6 positive spikes in EEG (P<0.05).

Ultrasound examinations of 278 patients with right upper quadrant pain and a clinical suspicion of acute cholecystitis were reviewed in 14 patients a tender, dilated gall- Bladder with a thick (more than 3mm) partly hypoechoic wall without any detectalle calculi was found on the emergency examination. This was interpreted as due to acute acalculous cholecystitis. But in the follow-up studies with either oral cholcystography, or ultrasound, only three patients had true acalculous cholecystitis.

Hypertention is a common complaint in children (11 percent). Two forms of hypertension primary and secondary are seen. But secondary form is about 80-90 percent. The most common cause of secondary hypertention 60-80 percent is paranchymal. kidney and then the other causes; Heart diseases. Vascular, Renovascular endocrine diseases.Renovascular diseases are more common in neonates and infants. In this study 68 children with hypertension (1-10 years old) who were admitted in pediatric ward of Ghaem Hospital evaluated.62 Patients (91.1%) had kidney diseases. This result is the same as references. The mean age in our patients was 5-10 years (48%). There was no difference between male and female. The most common symtoms were; edema (68%) and hematuria (30.8%).

From 1996-1998 in Imam Reza medical center infants umbilical granuloma treatment with salt and silver nitrate studied prospectively, comparative and unaccidently.20 infants were in salt group and 19 infants were in silver sitrat group.In these two groups the patient's sex, weight-age-pariety-umblicle cord separation age of granuloma presentation were not statically signicant.Response to treatment in salt and silver nitrat groups were 2.1 and 3.36 times respectively (2-taile p=0.0000).This study showed that umbilical granuloma treatment with salt is cheapper, available and more effective than silver nitrat. And treatment complications in silver groop were more than salt group.

Brucellosis has a universal distribution which also has a significant prevalence in Iran.Meningitis is the most common neurological event of the disease, but with regard to the varied clinical pictures of neurobrucellosis, we should list it in the differential diagnosis of each patient with unexplicable neurological manifestations.Among factors which support this diagnosis are:a) Epidemiological data such as positive history of exposure to animals and their products. b) Systemic signs and symptoms of the disease.c) Detection of the brucella agglutinins in serum and/or CSF; and isolation of the organism when possible.d) Acceptable clinical response to treatment with antibrucella agents.Different aspects of neurobrucellosis are presented in 10 uncommon cases in this article.

During the past 10 years (1368-1377) 13 patients (7 male, 6 female) whose ranged from 11 to 54 years (mean 29.5 years) with diagnosis of ulcerative colitis were operated at Ghaem and Omid hospitals. Perforation occurred in 5 patients due to toxic megacolon or toxic colitis so they were operated urgently.The operation carried out in these patietns was total colectomy with end ileostomy and preservation of rectum as the initial treatment with 2 postoperative deaths. At the second stage usually 6-11 months later mucosal proctectomy and construction of S pouch from ileum and ileal pouch-anal anatomists (IPAA) with protective ileostomy was done in 3 survivors. After 2 months the ileostomy was removed as a third stage. Elective surgery was performed in 8 patients due to unresponsiveness to medical therapy. Each patient underwent colectomy and standard IPAA and loop ileostomy, and at a second stage after 8 weeks the ileostomy was closed. In one patient whom ileostomy didn't perform was complicated with a pelvic abscess that drained ransperineally with good result fortunately. No operative death occurred in elective patients.Of 11 patients that have had IPAA (3 survivor of urgent operations and 8 elective series) satisfactory function of the reservoir has been achieved in 10 patients. Dysfunctional of reservoir occurred in one patient. He had to catheterize the reservoir to evacuate faeces and this was attributed to the long efferent ileal limb. In this study we analyzed factors affecting technical and functional outcome.

Tuberous sclerosis is one of the neurocotaneous syndroms. Clinical feature is mental retardation, seizure disorder, adenoma sebaceum (vogt triad). Prevalence is about 1 per 10000.This article presents 5 patient of tuberous sclerosis that 4 cases are accompaind with sub epandymalgiant cell asterocytoma (rare) and another one only with special nodules of tuberous sclerosis.Microscopic diagnosis shows sub epandymal giant cell astrocytoma in 4 cases and latest shows sever gliosis in tuberous sclerosis nodouls.All of clinical and microscopic findings were compatible with other authors.