MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:47 | Issue:85|Papers Count:24

Introduction: Diagnosis of choledocholithiasis (CDL) is very difficult and in some cases it is only possible with laparotomy. On the other hand diagnosis of cholelithiasis is easily made via ultra sonogeraphy (US). Endoscopic Retrograde Cholangiopancreatography (ERCP) and computerizing tomography (CT) are also used in CDL diagnosis. In this study the investigators compared the sensitivy and specificity of ERCP, US and CT procedures.Material and Methodes: patients suffering from incomplete obstructive jaundice, biliary colic and cholangitis with or without history of previous cholecystectomy underwent US and CT scan after performing liver function tests and after bile duct lesion was confirmed ERCP was conducted. Results: A total of268 cases of ERCP was conducted. Among them 140 (52.2%) patients had either single or multiple common bile duct (CBD) stones.The youngest patient was a 17 year old girl and the oldest one an 85 years old man. The mean age of the patients was 61.7±19.1 years. US was conducted in all patients and in 23 (16.4%) cases showed the stone exactly, but in 36 (25.7%) cases showed only dilation of intrahepatic bile duct without signs of stone in CBD, this was due to air accumulation in C-Ioop of the duodenum, also 81(57.8%) had normal US. If we concider dianosis of stone in CBD as the gold standard than the sensitiviy of US would be 16.4%, tut if we consider both dilation of bile duct and presence of stone as diagnostic indications than the sensitivity would rise to 65.5%, at the same time the specificity for US would be 63.3%. CT was done in 12 cases and in 5 showed a mass or tumor which was proven by ERCP to be stone there for giving a sensitivity of 41.6%. In 3 cases CT showed only dilation of intrahepatic ducts without any mass or tumor in CBD, therefore considering both conditions the sensitivity rise to 66.6%. In 4 cases CT showed nothing. The specificity for CT in CBD stonediagnosis was 28.5%. sensitivity and was calculated 28.5%. Sensitivity and specificity for ERCP in our study were 87.8% and 75% respectivelyConclusion: In our study both US and CT had less sensitivity and specificity in comparisson with ERCP.

Introduction: Wilson disease or hepatolenticular degeneration is a genetic disorder with an autosomal recessive pattern of inheritance. It is due to an error of copper metabolism. The major presentations are changes in liver, central nervous system, eyes and occasionally other organs. Eary diagnosis is very important, because of its known treatment, in addition late diagnosis is associated with irreversible changes. Our purpose was study of clinical presentations and neuroimaging findingsof wilson disease.Material and Methods: This was a descriptive study in the neurology department OfGhaemhospitalsinceautumn2000to winter2004.This study included patients with primary presentation of neurologic and psychiatric symptoms or who were diagnosed by casefinding in family.Results: There were 23 cases and 15 of them were men. Chief complaints were: movement disorder, psychiatric disorders, speech disorder and slowing of movement in order. Seizure, amenorrhea and esophagial varicose had high prevalance among our cases. Brain MRI disorders were seen in 95.3% of cases.Conclusion: The incidence of seizure and amenorrhea among our cases was more than previous studies. Because of high incidence of esophagial varicose in patients with primary symptoms of nervous system we recommend esophagoscopy for all patients should be done. This study showed there was no relationship between severity of symptoms and brain MRI disorders.MRI disorders may be seen in patients in presymptomatic stage. According to this we recommend brain MRI can be used as an ancillary diagnostic test.

Introduction: liver is one of the most injured organs in trauma. We evaluated and grouped the degree of liver trauma and management of each group.Material and Methods: 73 patients with liver trauma admitted in sugery departement from 1992-2002.The patients informations were written in special forms.Results: 58 male and 15 female, mean age of 30 years. (6-68 years) presenting from 1992- 2002 were reviewed. There were 29 cases of penetrating injury and 44 cases of blunt trauma. 7 patient were successfully managed without operation (5 with blunt injury) and were discharged after a mean hospital stay of 7 days. 51 cases were classified as group A (grade I and 2) and were managed by suture (with or without drainage), with 3 deaths. 15 cases were classified as group B (grade 3 and 4) and underwent one or more of the following: peri hepatic packing, resectional debridement and hepatotomy with direct suture ligature. 6 of these died from uncontrolled hemorrhage.Conclusion: Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparatomies.

Introduction: Human breast milk is the only and important milk for newborns especially low birth weight newborns. In this cross - sectional study mothers of low birth weight babies with successfull breast feeding. Were observed before and after discharge from hospital during 9 months from May 2000 to March 2001, In Imam Reza Medical Center NICU. 100 mothers entered this study. 84% of them were successful breast feeders. 15% of mothers fed their preterm babies with own and other mothers milk, but less than one percent didn't breast feed their babies.This study showed that mother age, parity, number of babies, type of delivery and education werent statistically significant and the only important factor was economic level (P=0.02).

Introduction: The aims of this study was to estimate prevalence, Clinical finding and results of operation and long term outcome of lumber intervertebral disc herniation in children less than 15 years of age.Method of study and Results: Out of 1232 patients with Lumber Disc Herniation (L.D.H.) admitted Ghaem Hospital since 1985 to 1999.Ten children (8-15 years) underwent surgery for L.D.H. Six patients were female and four were male. The chief complaints were low back pain, lower limb pain, or both. The most common evolved intervertebral disc was L4-L5.The results of operation were favorable and the patients became symptom free. They were followed for 1-13 years, no recurrence was observed.Conclusion: The conservative treatment in H.L.D. in children is not satisfactory and surgery preferable.

Introduction: Attention-Deficit Hyperactivity disorder (ADHD) is one of the most common disorders of childhood and if not treated can produce server complications such as decreased educational function and self esteem, disrupted peer relationship, anxiety.depression and substance abuse. According to its importance, the study has planned to evaluate the prevalence of ADHD in Young children of preschool age in Mashhad kindergartens and evaluation of the relevance to birth season, rank of birth, type of delivery and child gender.Material and Methods: Conners 10 steps questionnaire with the cut off line 15 was chosen as the instrument. 34 kindergartens (20% of all) were selected randomly and from 1275 children, 1089entered the study. SPSS software was used for data analysis.Results: In 1089 children, 133 gained the least 15 score needed for the study and the prevalence was obtained as 12.3±2.12 percent (P=0.05). Prevalence was 18.1% in boys and 6.7% among girls.There was no relationship between ADHD and the birth season. There was also no relationship between the type of delivery and birth rank with the ADHD prevalence. ADHD was significantly more prevalent in boys than girls (M/F=3/1).Conclusion: ADHD total prevalence rate was12.3±2.12 which has a significant statistical correlation with gender of the cases only.

Introduction: pediculosis capitis persists as a health problem in many countries and children are the mostly involved group. There are few studies about its prevalence and distribution in our community.Our aim was to evaluate the prevalence of pediculosis capitis in a part of society and to detect its relation with age and socio- economic level.Material and Methods: This study was done in primary schools of different areas of Mashhad in 2001-2002.769 girls between 7 to 12 years of age were examined with random sampling method. The results of examination and information about the age, socio-economic level and clinical signs and symptoms were recorded by use of a questionaire , then our collected data were analysed by using statistical tables.Results: 59 cases of 769 students had pediculosis capitis (Prevalence = 7.6%). The most common age of infestation was 8 and it was significantly more common in low socio-economic classes than high socio- economic classes.(72/88%, 1/6% respectively). Most of the cases were in the group of moderate severity (49.2%). Occiput was the most commonly infested area, and itching was seen in 39% of cases as a major symptom.Conclution: pediculosis capitis is an important health problem in our primary school students specially in low social classes. it seems necessany to examine students by trained peopJe tQ find infested students.

Introduction: Pityrosporosis is a prevalent superficial fungal infection of the skin caused by Malassezia SPP, which is a part of normal skin flora. This organism is a lipophilic and lipid dependent yeast which transforms in to a pathogenic mycelial form under specific conditions. Considering the previous studies, there may be a relation between blood lipids and pityrosporosis, a prospective study was undertaken over a 12 months period in the Departments of Mycology, Dermatology and Biochemistry, Emam Reza Hospital, Mashhad.Materials and Methods: The population of study was randomly selected as the following groups:Group 1: 50 patients suffering from severe pityrosporosis.Group 2: 50 individuals with negative direct smear for Pityrosporum ovale.Group 3: 50 persons with high level of cholesterol & triglyceride in their blood serum examination.Group 4: 50 individuals with normal level of cholesterol & triglyceride in their blood serum examination.A questionnaire was completed for each individual. Direct stained skin smear (methylen blue) & blood serum examination for cholesterol & triglyceride were performed for all 4 groups by RA -1000 system.Results: The results showed that:1. In 28% of Patients with pityrosporosis, total cholesterol levels were higher than normal which showed a significant difference in comparison with the control group.2. In 22% of patients, triglyceride levels were higher than normal which showed a significant difference in comparison with the control group.3. In 32% of patients, LDL-C levels were higher than normal which showed a significant difference in comparison with the control group.4. There was no significant relationship between HDL-C levels and the group suffering from pityrosporosis .5. In those patients suffering only from hyperlipidemia, pityrosporosis was uncommon.Conclusion: On the basis of statistical analysis. it is concluded that there is a relation between pityrosporosis and blood levels of total cholesterol and triglyceride LDL-C, therefore control of blood levels of lipids possibly can be effective in prophylaxis & treatment of pityrosporosis.

Introduction: The following research intends to determine the effects of a sensory stimulation program and the level of consciousness in patients with sever head injuries. The main hypothesis is these sensory stimulation programs will reduce the (level of consciousness and duration of hospitalization in comparison with those without.Material and methods: this study was conducted in two patient groups (each group consisted of 22 patients) during a 6 month period in the ICD ward of Kamiab Hospital, Mashhad, Iran. Results: there was no statistically significant difference between levels of consciousness in tile two groups; however there was a significant difference in the average duration of hospitalization.

Introduction: The role of glycemia control in reduction of coronary events in diabetic patients with IHD is unknown.Material and Methods: In this study 204 patients with diabetes type 2 and IHD were followed up for 1 year. They were visited every 3 months, observations were obtained and patients were studied, new coronary events assessed and recorded on the base of history, physical exams, ECG, echocardiography and other tests. FBS and HbA1c also were measured each time.Results: We studied 204 patients of whom 85 pts. Were in group of controlled diabetes (HbA1c ≤7) and 119 pts. in group of uncontrolled diabetes.The age and sex distributions were relatively equivalent in both groups. The mean age was 60.4 years. Most of patients used oral hypoglycemic agents in both groups. There were no significant differences in other major risk factors in our studied groups.103 pts. (51%) experionced at least one coronary event, 71 pts. (35%) had recurrent ischemia.Nonfatal MI and mortality occurred in 28 pts (14%) and 4 pts (2%) respectively.Glycemia control caused 7% reduction in recurrent ischemia, 3% reduction in cardiac mortality and 1% reduction in nonfatal MI, but they werent significant statiscally.Conclusion: In this study glycemic control reduced the rate of new coronary events in diabetics with IHD, but this reduction wasnt significant statiscally.

Introduction: Breast cancer is a worldwide burden in both developed and developed countries and unless some action is taken, it will continue to grow for the foreseeable future. Hence, diagnosing its risk factors is of great importance.The aim of this study was to investigate the association between menstrual and reproductive factors with breast cancer.Material and Methods: In a case-control study in Mashad loss patients with confirmed breast cancer were compared with loss healthy women who were patients neighborhood and matched cases by age and interview. A questionnaire including demographic information as well questions regarding reproductive factors emphasizing abortion were used. Data collect was analyzed using SPSS ver 12.Results: The findings indicated Early age at menarche, age at menopause, late age at first term pregnancy and fewer number of full term pregnancy significantly associated with breast Cane risk.The risk of breast cancer showed an increase in women who had a history of abortion (OR=2.09 %95 CI=1.2-3.7). Also women experiencing abortion before their first full term pregnancy showed a higher risk of breast cancer (OR= 5.9 95% CI= 1.8-19.6) Conclusion: Our findings suggest that decreased parity, early Age at menarche, late age menopause and first birth and abortion were the most important determinants of breast cancer risk thus authors purpose health interventions about these mothers.

ntroduction:Purpose : unengaged vertex in nulliparous in active labor , as confirmed by some studies is considered as a risk factor in cesarean section Considering the increasing rate of cesarean section in recent years and higher marbidity of cesarean section compared to vaginal delivery we tried to verify the relation between unengaged in vertex nulliparous in active labor and methods of delivery. Material and Methodes: This research was conducted between june 22 1999 to oct 22 2000 in delivery ward in IMAM Reza and HAZRAT ZAYNAB hospital. 100 nulliparous patient with unengaged vertex at the biginning of active labor were considered as the case group 100 other nulliparous patient with engaged vertex were chosen as control group. All the patient were s:ngletons with the fetus between 37 to 42 week. They did not have pelvic contraction and the fetuses were not macrosomic for every patient was filled a questionnaire from the biginning of the active labor to the time of the delivery. The data obtained were analyzed using the fisher test and T test. Results: of 100 cases of engaged vertex, there were 8 cases of cesarean section and 92 cases of vaginal delivery ( Five cases due to fetal distress and three cases due to arrest and protraction disorders). , Of 100 cases of unengaged vertex there were 21 cases of cesarean section and 7 cases of vaginal delivery (9 cases due to fetal distress and 12 cases due to arrest and protraction disorders). Conclusion: In nulliparous with unengaged vertex the risk of cesarean section increases. In such cases, therefore the need for conscious seach is clearly felt.

EVALUATION OF SURGICAL TREATMENT OF OPEN TIBIA SHAFT FRACTURES WITH UNREAMED TIBIA NAIL (UTN)     ntroduction: The goal of treatment of open tibia fracture is to prevent infection. fracture healing and restore normal limb function. Unreamed tibia nail (UTN. Synthese) is now replaced with external fixation for treatment of open tibia fracture because of easy insertion and low complications. The purpose of this study is to evaluate union rate with this device in open tibia fracture and compare complications with other studies.Material and Methodes: From 1998 to 2001, sixty-eight patients with open grade I to grade IIIa tibia fracture were treated with unreamed tibia nailing and evaluated to find results and complications of this fixing tool. Of this group 46 patients were available for follow up at an average of 6 months after surgery. 31 patients were type IIIa, 9 patients, type II and 6 patients had type I Gastilo open tibia fracture. Operation was performed at a mean of 6 days after fracture.Results: Union occurred at a mean of 18/66 weeks for type I, 20/8 weeks for type II and 26/2 weeks for type IIIa open tibia fracture. Superficial and deep infection occurred in 10%, malunion in 4/35%, delayed union in 2/17%, nonunion in 2/17%, ankle joint stiffness in 6/52%, knee joint stiffness occurred in 2/17%, locking screw failure in 6/25 % and nail failure occurred in 4/35% of patients.Conclusion: The advantages of the UTN is less infection rate incontrast to external fixators, lesser need for secondary operation and greater patient comfort. Therefore, we find UTN to be a good alternative in companissan with other fixation devices in the treatment of open fractures of the tibia.  

A 20 year-old unmarried woman was evaluated in the hospital because of fever and progressive Icterus.The patient had been well until 45 days earlier when malaise, anoreia, cervical lymphnodes and weight loss developed.Two weeks before admission laboratory tests were ordered by her phcysician.There was no cough, diarrhea, disuria or rash, but she complained of light stool, dark urine and vomiting.Tests for viral hepatitis A.B and C were negative but aminotransfrases were more than 1000 Iu and total bilirubine 6 mgldl with hematologic tests about normal ranges. There after she vomited as often as 4 times daily. The pulse was 85 beats/minute and respiratory rate 16 beaths/minute.Hetrophil antibadies test was requerted and because of high prothrombine time (19 seconds) and progressive jaundice the patient hospitalized and serum infusion with vitamine K1 10 mg daily was adminstred subcutaneusly. On the second hospital day, laboratory tests were performed and an ultrasonographic examination of the abdomen performed, revealed mild heterogenous echogenecity.No fluid was present in the subhepatic space. On eyes, examination, kayser fleische rings were not found and urine copper was in a normal limit.Reticulocyte count was normal and coombs test was negative. Plateletes were normal (shape and number) and WBC did not show atipycal lymphocytes.In her medical history she did not state consumption of herbal and illegal drugs, but sugar, creatinine, uric acid, LDL. HDL, and urinalysis were normal and two blood cultures were negative.Anti HIV-1 test was non reactive and febrile agglutination tests were negative too.On the fifth hospital day no petechiae, conjuctival injection were seen. Chest.X.Ray was clear.The liver descended two cm below the righ costal margin and spleen was just felt. The patient was alert and there was no signs and symptoms of hepatic encephalopathy. The patient had no clinical appearances of chronic liver disease like spider angiomas, ascitis and clubbing .

Lpomeningioma is a rare benign tumor of meninges that contains mature adipose tissue. The heterogeneous enhancement visualized on CTscan. mimic necrotic malignant tumors. In this article a patient that presented with a frontoparietal mass lesion and in histopathologic examination revealed a benign meningothelial neoplasia with adipose differentiation. characterizing a lipoblastic meningioma, is described.

Rhabdomyosarcoma of biliary tract system (RMS/BT) is a very rare form of RMS that usually presents with jaundice in young children. In some rane cases icter disappears transiently and causes delay in diagnosis, there fore this condition must be included in differential diagnosis of obstructive jaundice in infants and children.Ultrasonography is very useful for diagnosis of abdominal mass and clarifying its relationship with the biliary tract system. Surgery is critical for estabilishing accurate diagnosis and determining the extent of regional disease, but aggressive surgery is not recommended because, despite gross residual mass after surgery the outcome of chemotherapy +/- radiotherapy is sufficient. Because this tumor is very rare and its treatment has improved in recent years we report a case of RMS/BT in a I5-month girl who presented with abdominal mass and history of obstructive jaundice

Tumoral calcinosis is a rare clinical and histologic entity that is chracterized by a deposition of calcium in the periarticular soft tissue of large joints and is found predominantly in otherwise healty adolescents and young adults.Tumoral calcinosis can be mistaken with malignant neoplasms.A report a case of tumoral cacinosis in 8-year-old girl in gluteal region without underlying disease.

Metabolic and genetic hepatitis may be manifested initially as acute hepatitis and wilson disease is more likely to present with chronic liver disease or a neuropsychiatric disorder and a normal urinary copper excretion effectively rules out the diagnosis of acute hepato - lentricular degeneration. In fulminant hepatitis B in less than 5% in the beginning of disease. HBsAg marker may be negative but other HBV infection markers will be positive. Herbalism in Iran especially in liver diseases is a common problem of physicians and swallow of alive, river fishes is an ancient behaviour in managing icteric patients. Fortunately the patient had done none of them. A serum protein electerophoresis performed and revealed high gamma globulin. In a yaung female patient with paranchymal hepatitis and hypergammaglobulinemia with negative viral markers for hepatitis and normal urinary copper excretion, autoimmune liver disorders will be in suspicion. These disorders are chronic but occasionally have no overt manifestation, until an overlap syndrome develops that is indistinguishable from acute hepatitis. The most common of these disorders, is type I autoimmune hepatitis, it is more common in females than in males and its peak incidence is in young peoples. This form of autoimmune hepatitis characterized by hypergammaglobulinemia and a positive test for antinuclear antibodies or antismooth muscle antibodies or both of them. Type II. Characterized by presence of anti-liver-kidney-microsmal antibody and in type III autoimmune hepatitis, antibodies to soluble liver antigen is positive. Type IV autoimmune hepatitis is a-seronegative autoimmune hepatitis and only in liver biopsy diagnosis confirms. In this patient both of antinuclear antibodies and anti-smooth muscle antibodies were positive. Because of bleeding processes with unresponsiveness to vit k and FFP; liver biopsy did not perform and prednisolone plus Imuran started, jaundice and fever disappeared there after, and prothrombine time (pt) became normal.