Medical Journal of Mashhad University of Medical Sciences
Year:2001 | Volume:44 | Issue:73|Papers Count:32

Objectives: To assess the IOP lowering effect of timolol and dorzolamide in contralateral, untreated eye. Methods: A randomized, double - masked, placebo controlled study of 182 normal human volunteers was undertaken in Ghaem Hospital, Mashhad. Subjects were randomized to three groups and recieve a single drop of timolol in first group, dorzolamide in second group and palcebo in third group in an eye and applanation tonometry was performed before and one hour after topical instillation of the drug.Results: One hour after topical timolol adminstration, the mean lOP reduction in the treated eye and untreated fellow eye was 4.6 mmHg (31.4%) and 2.6 mmHg (17.8%) respectively (P=0.000). The IOP was reduced by a mean of 2.3 mmHg (15.7%) in the treated eye and 1.1 mmHg (7.3%) in the fellow eye after dorzolamide instillation-(P=0.057).The mean IOP reduction in the treated eye and untreated fellow eye was OS mmHg (3.6%) and 0.3 mmHg (1.5%) respectively in placebo group (P=0.28). Conclusions: Instillation of topical timolol in one eye is associated with a decrease in the IOP of the contralateral eye that is generally about one half of the IOP decrease of the treated eye. IOP lowering effect of timolol in treated eye is two times of Trusopt. Instillation of topical Trusopt in one eye is associated with a decrease in the IOP of the contralateral eye but this effect is borderline. Further investigations is required to assess the contralateral effect of topical dorzolamide.

Objective: Rheumatoid arthritis is a chronic inflammatory systemic disease that certain Major Histocompatibility Complex (MHC) class 11 alle1es especially HLADR B1 epitopes occur with increased frequency in affected individuals.Method: In this study HLA class 11 typing (HLADR) was done in one hundred and twenty patients with rheumatoid arthritis and one hundred normal individuals as a control group by microcytotoxicity.All patients according to American College of Rheumatology (ACR) criterias were diagnosed. Cell blood count and sedimentation rate were also done.Results: HLADR1 was the most frequent HLA in rheumatoid Arthritis, in this study (40%), Compared with normal individuals (12%).The least frequent HLA were HLADR3 and HLADR4 (16%).Conclusion: In this study we find out the relationship between rheumatoid arthritis and HLADR for the first time. Increased genetic susceptibility to rheumatoid arthritis was seen more in individuals with positive HLADR1 and HLADR7, but HLADR2, HLADR3 and HLADRw52 may play a protective role in rheumatoid arthritis patients.

Toxoplasmosis is one of the common parasitic infections of human and warm blooded animals. Clinical diagnosis is very difficult, therefore, diagnosis is based on measuring antibody titer by different laboratory methods.In order to investigate the incidence & prevalence of toxoplasma infection among pregnant women in Mashhad, a study was undertaken over a 6 months period in Emam Reza Hospital. Sera samples of 200 pregnant women who reffered to University Hospital Labs were collected for detection of IgG and IgM by ImmunoFlouresence Antibody (IF A) and Immuno - Peroxidase (IP) tests.Simultaneously, a questionnaire was completed for each woman.The results showed that among 200 sera samples, 108 cases (54%) were IgG positive for toxoplasma (from 1:20 to 1:1600) by IF A and IP techniques. In 92 case (46%) the results of tests were negative. It is concluded that: I-However toxoplasma infection is almost common but the disease is rare in pregnant- women. 2-There is no significant difference between IFA & IP test for diagnosis of toxoplasma infection.

Sensitivty of rectum tissue is an important factor when decission is made for choosing a technique to treat cancers of cervix, bladder or prostate.In this research different techniques, applied at the second stage of treatment, have been examined and the resulting rectum dose have been compared. In this study the dose to pelvical lymphatic glands has also been assessed.For every one of the twenty patients, 38 different treatment plans were proposed. These are as follows:L Three fields technique, one anterior and two posterior - obilque.2. Three wedge fieldes, one anterior and two lateral wedge.3. Four fields (A), (tumor dose contributions by different fields are different).4. Four fields (B), equal tumor dose contributions by four fields.Rectum dose incurred by three fields wedge technique is always less than doses delivered to rectum by other techniques; but when three fields technique is compared with four fields, the results depends on the field's dimentions. three fields technique, smaller target volume and narrow fields releases smaller dose to rectum. On the other hand wider field produces larger target volume which reduces the dose difference. If Posterior - Oblique fields are taken wider than lateral fields three fields technique would give rise to a higher rectume dose. Four fields technique (B) delivers a smaller dose to rectum than four fields technique (A).Three fileds (wedge) and four fields (A) technique produce sufficient dose to pelivical lymphatic glands; but three fields is not capable of delivering sufficient dose to these glands.

Post operative infection; especially in bone surgery since along time "ago has been one of the complicating agents, necessary measures such as disinfection of operative field, disinfecting of operative room & closed ventillation of operative room has been done. As a prophilactic action, patient dependent & surgeon dependent risk factores should be eliminated. In a prospective study of 53 patients with colsed fracture of the hip, femoral neck and proximal part of the femur we compared the results of three groups of high risk patients recived 3-days, 2-days and 24 hrs courses of intraoperative and postoperative Antibiotic (cephazolin) with each other.Low risk patients also recived 24 hrs course of intraoperative and postoperative antibiotic as a fourth group. Postoperative infection rate was 1.89%.By statistical methods, no significant difference was seen in the infection rates after administration of the various regims. Therefore 24 hours course of antibiotic for all patients was adequate (P=0.1). Since there was not any statistical data available, our recommendation in closed fractures of hip and femur would be to administerate a broad spectrum antibiotic (cephalosporin) 20 minutes before surgery, to be continued during surgery, and to be discontinued maximaly after 3-days in high risk patients and 1 day in low risk patients.Concerning malnutrition in 64% of the patients and wound contamination in 23% of them due to operative field, it is recommended to add supplemental nutritional support, ultra clean air units, whole body exhaust suits, and rigid restriction of movements.) In the operating room (especially exclusion of unnecessary visitors) and prophylactic antibiotic therapy are very important in prevention of infection after orthopaedic surgery.

Cutaneous Leishmaniasis (CL) is a Zoonotic skin disease which is endemic in many parts of Iran, including Khorasan.2 different clinical forms of CL including dry form and wet form are present in the northern part of Khorasan province.In order to investigate the prevalence and incidence of CL among the students of primary schools of Mashhad a study was undertaken over a 6 month period (October 1999 - March 2000).According to recent regulations of teaching and education office in Mashhad and due to limitation of personnel and facilities only the male students of primary schools of 2 different regions of Mashhad were included in this project.The results showed that among 34065 male students 425 boys had suscepected lesions on their bodies (scars 76.2% and active ulcers 26.6%).The common sites of lesions for scars were: face (70%) and upper extrimities (17%) and for active lesions: face (84%) and upper extrimities (29%). The highest no of scars and active lesions were 14 and 9 respectively.Among different routes of diagnosis, "direct smear" test was the best method. It is concluded that CL is endemic all around the city with higher incidence in west-southern area, and direct smear is the best route of diagnosis.

Shigella is one of the etiologic agents of infectious colitis.The worldwide prevalence of shigellosis has been 14×107 cases per year.The important problem about it's causative agent is resistance to antibiotics.Martality rate due to shigellosis is almost high in young children, specially in developing countries. In addition, to WHO wright about anually determination of drug resistancy has been a strong motive in performing this study.The results showed that among 4042 cases suffering from acute diarrhea, 366 cases were culture positive for shigella, antimicrobial susceptibility test for 348 cases was performed and serotyping test for 366 cases showed that: 1 - The prevalent serotypes were I - Flexneri (56.55%) II - Dysenteria (42.36%).2 - 96.5% of cases were resistant to Ampicillin and 100% of cases, were sensitive to Cefixim. Otherwise the resistance to Co-Trimoxazole 63.7%, to Nalidixic acid 7.4% and to ciprofloxacin, 5.7%.It is concluded that the empirical use of Co-Trimoxazole and Ampicillin for severe cases not recommended, but Quinolones are the suitable drugs in Mashhad.

The open lower limb fractures are still problems of orthopaedic in present time. Because tibia bone is located beneath the skin, it is susceptible to opening, cruhing of skin, post accidental skin necrosis and therefore infections and delay in healing, not healing and some times amputation. In recent years with progress of orthopaedic art use of UTN method has fully shown its superiority to other methods by investigation of 2200 cases of patients Hospitalized in Emdadi Hospital from 1995-2000, 268 cases of fractures were extracted (12% of total). 183 cases of these were closed fractures (68%) and 52 cases were open fractures (19.4%) and 33 cases were of unknown type (12.4%). 11 cases of open fractures were treated by UTN method. In this method patients were more comfortable and weight bearing had stared faster and union had occurred earlier and the complications of bone and flesh tissues like nonunion and infection were less than the other methods.

Since the establishment of blood transfusion, it freqoently have saved the life of many patients and accident victims. Which for some of them there was no notion for saving the life.But like other therapeutic measores it has some hazards and many benefits, hazards such as fever and simple reactions to even death, related to inappropriate usage.The important role of physician is in recommendation of each therapeutic method regarding to the hazards and benefits and these vary for each patient depending upon underlying factors, but never is really for all the patients. Blood transfusion is not an exception on fortonately we have noticed increasing prescription of blood transfusion in medical centers without respecting to all the necessary criteria. Therefore, we decided to alter the physician's opinion from the term "blood save the life" to more correct term" blood volume save the life". We study during 8 months period in the two Large Medical Centers of Mashhad University.In this study, all the patients which had received blood transfusion doning operating procedures were evaluated for assessment the rate of necessity of blood transfusion. The criteria was from the FDA recommendation that a Hgb>7 is acceptable, and finally as we have supposed and is presented in the table of the results of investigation, the rate of unnecessary transfusions was 82 percent, if we did not respect to the side effects in recipients (which was not neyligible) and with a simple calculation, we can easily obtain the cost which has been lost for preparation and preservation of the blood. Upon this calculation the expense for unnecessary usage of blood in the operating rooms was about 270 Milion Rials/Year in two Medical Centers. If we have added the costs for treatment of the side effects, it would be more than 300 Milion Rials.

Pain of the anterior tibial crest (shin splint) is different from the compartment syndrome. Pain and local tenderness are the only signes and symptoms of this syndrome, and rest and restriction of activities is the best treatment for it. We studied the causes and incidence of this syndrome in 430 university school gitls in three universities in Mashad, the results was analysed by computerised statistical analysis.Shin splint was diagnosed in %19 (82 cases), %95.1 in jumpers, %95 in bad sport shoes with flat heels, and %61.5 in weak tibialis ant muscle. In handballisits and in who with 2 hours sport activities in a week (%56.1), and sporting in 2 cessions (one hours, every cession) %68.3, had shin splint. In %66.7 of the cases all of the clinical signs, and symptomes were regressed with rest, and orthers with NSAIDs. We recommend step by step, forecefull exercises for the trainers on a flat play ground, with rigid shunk, and elastic sole shoes.

In the past 2 years (1999-2000) we have increasingly encountered to some patients who presented with intestinal obstruction or acute opiate intoxication due to smuggling of opium that wrapped in cellophan packages and concealed either by swallowing or by insertion into their rectum.We reviewed 13 cases of such patients who came to the emergency department of surgery at Imam Reza Hospital. The diagnosis of body packing was based on physical examination and questioning of the patient about bodily comcealment & plain abdominal X- ray. There were 12 men and one woman with mean age of 27.2 years (ranged 16-25 years). Their journeys commenced in eastern part of Khorasan province and Zahedan to the destination of Mashhad. 9 cases of body packers presented with clinical evidence of opiate intoxication due to packet rupture and resusciated with Naloxan prior to Laparatomy and four cases presented with symptoms and signs of intestinal obstruction.11 patients concealed the opiate packages by swallowing and 2 cases inserted the packages into their rectum.The procedures that carried out for removal of opiate packages via laparatomy were gastrotomy (7 cases) enterotomy (2 cases) resection and primary anastomosis of ileum (one case), partial resection of duodenum (one case). In 2 cases there were packages in the colon. So they milked gentely to the distal part of rectum and recovered from anus.From one to one hundred packages (mean 27.6) have been recovered from each case. Each package contained between 12-45gr opiate material. The time elapsed between bodily concealment to presentation were 1-5 days (mean 1.7 days). Mean hospital stay was 8.8 days (range 4-23 days) but in one case the hospital stay was a total of 138 days with multiple operations unfortunately this case passed away.

Streptococcus pneumoniae continues to be a leading cause of morbidity and mortality in persons of all ages. For sensitive strains of pneumococci, penicillin remains the drug of choice for pneumococcal infections. Penicillin resistance occurred soon after the discovery of penicillin. Pneumococcal resistance is now distributed globally. In many countries, penicillin resistance in pneumococci is increasing. Our study carried out over 90 pneumococci isolates from 1997-1998 in Mashad with using MIC method nab agarie diffusion.The prevalance of pencillin susceptible, intermediate resistance and high resistance were 0%, 62.2% and 37.8% respectively. Results of our study denotes that pencillin cannot .be considered as an effective first line antibiotic at least for serious pneumococcal infections in Mashad. As a consequence, a switch of therapy from penicillin to other agents is mandatory in infections caused by penicillin resistant strains.

Objective: Treatment of infertility needs classification of data from different centers. So we have decided to study infertility and its causes in this center.Material and Method: 1846 couples were clinically studied.Design: Retrospective analytic study method of infertile couples from 1998-2000 in Mashhad University.Result: Gaining enough information about infertility and its causes and effects is the first step in programming to cure infertile patients. Studying the infertility causes in the infertility center of Mashhad University was carried on for two years.This retrospective and descriptive study has been conducted on the basis of questionnaires filled out according to collected information from a number of infertile couples.From 1946 infertile couples, 82% of them were suffering from primary infertility while 18% of them had the problem of secondary infertility.In 39% of these couples, female infertility, 35% male infertility, 13% multifactorial causes and in 13% unexplained infertility factors could be seen.In evaluating, different causes of infertility in women in 48.9% of patients ovulatory factors, in 34.2% tubal factors, In 9% cervical factors. in 4.5% pritoneal factors, in 3.3% uterin factors and in 0.2% vaginal factors played the most important role.The same study carried on about male patients proved that, in 67% of them seminal abonormalites, in 30% varicocele, and in 4% retrograde ejaculation could be seen.And infertility with multifactorial causes which can be traced in 13% of patients. 61% of them suffered from ovarian factors, 29% from male and endocrin factors, 6% from male and cervical factors and 3% from male and tubal factors. Conclusion: Primary infertility is more common than secondary infertility P<000. But the rate of infertility between men and women is equal. In female infertility cases ovarian factors form the most common cases while in male infertility cases the rate of varicocele factors is 30% which is the most common. This study showed that in multifactorial cases, ovarian and male factors form the most and male and tubal factors are the least common cases.

Urinary Infection (UI) due to Spinal Cord Injury (SCI) is an important syndrome caused by many infectious agents. The prevalence of UI in patients with SCI is very high compared with other patients. In order to compare the effect of Nalidixic acid & Nitrofurantoin with Aminoglycosides in SCI patients suffering for UI, a study was undertakes in Department of Microbiology, Ghaem Hospital & 947 urine samples of 160 SCI patients were cultured and tested for sensitivity to 2 different antibacterias.The results showed that, proteus mirabilis & E.Coli were the most common etiologic agents and serratia was a rare bacteria in UI. The isolated bacteria were resistant to Nalidixic acid (33.67%), Nitrofurantoin (77%), Tubramicin (65%) and Kanamycin (71%), but their sensitive to Amikacin and Gentamycin were 72.75%, 33.85% respectively.It is concluded that most of the etiologic agents of UI are sensitive to Amikacin, Gentamycin.

Objective: Regarding to variety of socioeconomic, culture, race and epidemiologic factors, reactive arthritis in Iran can be different from other parts of the world Method: In this study one hundred and eighty six known cases with reactive arthritis in Rheumatology Department of Imam Reza Medical Center were evaluated between the years 1991-1996. They were also followed up for 4-6 months.Findings: Gastrointestinal infections as a primary etiologic factor were found in one hundred and eight patients. 83% patients were male and 17% were female. Asymmetrical polyarthritis in lower extrimities was the most frequent clinical symptom. There were a few patients with spondylitis.Conjunctivitis was seen in some patients. It was the only eye complication that we found in our cases.Mucocutaneous symptoms were not frequent compared with other studies in western areas. HLAB27 was positive in 38 cases. Response to treatment was favorable.Conclusion: Reactive arthritis is more frequent following gastrointestinal infection. In this study females are involved more than other studies.The most common finding is polyarthritis. Mucocutaneous and heart involvement as late complications were not common. Neurologic complications were not observed in our patients.

Purpose: To evaluate results of Hang-back recession procedure on recti muscles in different strabismus patients.Method: This prospective study was performed on 17 strabismus patients during 6mo in Imam Reza Hospital. The deviations were measured with alternate prism cover test or modified krimsky method.Results: In 12 patients horizontal R & R, in 3 patients bimedial recess and in 1 patient vertical R & R were performed. About 10PD around considered alignment was acceptable. Results in 15 caces were acceptable, in 1 case undercorrected and no overcorrection was seen and in one patient due to slipped muscle reoperation was done and then excluded from this study. Duration of follow-up was between 1WK and 3mo and mean duration was 36.5 days.Conclusion: In comparison with conventional surgery, Hang-back recession is a safe procedure with least complications and in regard to postsurgical good alignments that we abtained in this study, we introduce it as a good alternative EO conventional surgery.

Reactive, non neoplastic fibrous lesions of the bladder that, because of clinical presentation, on gross apearance, growth pattern and light microscopic features, may be mistaken for a malignancy, usually a sarcoma, often are referred to as pseudosarcomas.This lesion can appear spontaneously, subsquent to or simultaneously with various type of bladder mucosal damage, such as chronic cystitis and T.C.C. An awareness of this type of spindle cell proliferation is of importance to avoid an erroneous diagnosis of spindle cell sarcoma or carcinoma.The occasional presence of cytokeratins and possibly EMA, should not lead to an erroneous diagnosis of a spindle cell carcinoma. Needle biopsy can not be considered a reliable diagnostic method.

Bricheteau in 1884 reported a case of air in the pericardium, this rare phenomena was reviewed by shackelford in 1931, and 77 cases were reported in the world literatures.The characteristic sign are pericardial tympany and metallic splashing sounds, chest film provides conclusive evidence.The causes of this phenomena are: penetrating chest trauma, gastric and esophageal rupture, bronchopericardial fistula, gas production from contagious infection.Our patient was a 13 years old gril, that following penetrating chest trauma feel dyspnea, tachycardia and expectoration, with bloody discharge.Chest X.Ray reviewed air in the pericardium, with characteristic sound by auscultation.The prognosis of our patient was good and the air was disappeard after 9 days and she discharged without any complication.

Nevoid basal cell carcinoma syndrome is a rare autosomal dominant disorder that usually characterized by multiple basal cell carcinomas, pits of the palms and soles, jaw cysts, intracranial calcification especially in falx cerebri and skeletal abnormalities., In this case report a male patient is reported with a negative family history.

Convulsion is one of the common neurologic problems in children.Gelastic seizure (laughter epilepsy) is a type of seizure which happens rarely. Althout it may be misdiagnosed as a psychologic problem this condition usually is a sign of CNS disease. Parent & physcians do not pay attention to it until tonic clonic seizure occurs.In this article we represent two cases of gelastic seizure. The first case had temporal lesion in MRI and the second patient had a history of encephalitis. The goal of this presentation is to warn the physician that the inappropriate laugh can be a sign of seizure.

Clozapine is an atypical neuroleptic drug that was initially thought not to cause Neuroleptic Malignant Syndrome (NMS).We report a case of NMS associated with clozapine use developed in a young man without previous history of NMS.Although NMS associated with clozapine treatment is a rare event, NMS should be considered in the differential diagnosis of a februle patient treated with colzapine.

Failure to Thrive (FTT) is one of the most common problems of referring to pediatric clinics.Malnutrition, maternal depriviation and major organ diseases are the main causes of FTT.In our country organic causes are the most common etiologies of FTT. In this article one patient with diencephalic syndrome, a rare condition, that presented with severe FTT is described.

Epithelioid sarcoma is a uncommon malignant slow-growing tumor which differentiates from mesenchymatous cells. The majority occuring in the subcutis as a multinodular mass, usually 3-6 cm in diameter in the distal extremities of young adult males.Histologically, tumor is typically composed of multiple nodules, made up of eosinophilic cells which are epithelioid and spindle shaped that are positive for cytokeratin and vimentin on immunohistochemical staining. The center of the nodules often shows necrosis or myxiod degeneration and the tumor's cells are set in a very dense collagenous stroma.This tumor should be differentiated from benign and malignant lesions. Treatment is wide surgical excision with or whithout radiotherapy. Regional lymph node dissection should be included among the therapeutic modalities. The 5-years survival rate is 70%. Around 75 perecent of cases recure locally, often repeatedly. Tumor size of more than 3cm in diameter, deep location and the presence of necrosis, vascular invasion, and lymph node metastatic lesions have been identified as adverse prognostic signs.