MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2000 | Volume:43 | Issue:68|Papers Count:21

Objectives: Our aim was to evaluate the efficacy of short & long term botulinum toxin therapy in Iranian patients with achalasia.Methods:' In a randomized, double blind trial, 20 patients with achalasia, referred to Imam khomeini hospital, received either 80 units of Batulinum toxin (BT) or Placebo (PL) from 1995 to 1998. Two weeks later, the response to treatment was assessed on the basis of changes in the symptom score (measured on a scale from 0 to 9). Patients who received PL initially were subsequently treated with BT. After two weeks and six months, assessment was repeated.Results: Two weeks after treatment, clinical evaluation revealed that in BT group all clinical sytmptoms were improved and clinical score had significantly decreased from 6.2±1.4 to 1.9±1.66 (P<0.05) and no significant changes were seen in clinical score of PL group. Tow weeks after first injection, patients who did not show clinical improvement. Received toxin with the same previous dose and reevaluation was performed two weeks after second injection and six monthsafter first injections.No significant differences were seen in both groups comparing thoracic pain after two First weeks. After six month total mean clinical score was 3.4±1.9 (P<0.005) in BT group and 2.4±1.51 (P<0.005) in PL group. At this time clinical responses persisted in 12 patients (60 %).Conclusion: Injection of Botulinum toxin into lower esophageal sphincter is an effective, safe and simple method of treatment for Achalasia especially in patients who can not use other methods.

As a complimentary technique for physical dosimetry, biological dosimetry has been used in recent years by many researchers.In this research, chromosomal aberrations observed in peripheral blood lymphocytes of 44 radiation workers (based on duration of work and sex) and the control group were analysed.Chromosomal aberrations observed in male and female radiation workers were respectively: 3.151% ±0.399, and 2.364% ±0.576; and in control group was (irrespective of sex): 0.722±0.091, which shows a significant difference (at 95% confidence limit) between the average chromosomal aberrations of radiation workers and control group.Using the method of regression line, it was proved that there is a linear relationship between the number of chromosomal aberrations and duration of work.

Rickets and osteomalacia are characterized by impaired mineralization of bony matrix. In some Asians countries they are common disorders and they may represent a health problem. So we decided to study clinical, biochemical and radiologic features of these disorders in our patients.Methods; In a prospective study during 10 years (1989-1998) we studied all cases of osteomalacia and rickets in the rheumatology center of Imam Reza Hospital. Diagnosis was based on the clinical, laboratory and radiographic findings. All patients were treated with Vit D and calcium.Results: We had 797 patients (795 female, 2 male). Their age was between 8-74 years. Most cases were in a second decade. Clinical findings were: bone pain 96.4%, (most common in knee, back and pelvis), muscle weakness 81%, abnormal gait 43%, and bone deformity 19.6% (often genuvalgus and genuvarus). Laboratory findings were: osteopenia 63%, epiphyseal growth plate alterations 74.4%, ground glass appearance 26.8% and looser's zones 26.5%. The response to treatment with Vit. D and calcium was significant. Only four patients were Vit. D resistant.Conclusion: Rickets and osteomalacia are common disorders in our region. Females especially in growing age are often involved. The most common cause is Vit. D deficiency probably due to inadequate sun exposure. For prevention we suggest that women should be educated for taking adequate sun exposure and Vit. D should be added to dairy products.

For the analysis of elements in a sample, several techniques including: Atomic Absorbtion Spectroscopy (AAS), Atomic Emission Spectroscopy (ABS), Nutron Activation Analysis (NAA) and Radio Immuno Assay (RIA) are widely used. These techniques are specially suitable for the determination of trace elements in natural and biological samples. But, when radioactive elements are to be measured, g -spectrometery is one of the most suitable techniques, as, qualitative and quantitave analysis is possible. In this method, elements are identified and quantified by studying the g - spectrum emmitted by the sample. Samples of interest in this study were natural samples which by the method of environmental radiation detection their radioactivities were assured.This study showed that the concentration of radioactive series: 232Th, 40K and to a certain degree 226Ra in soil and plant samples are higher than International values, but, in some other samples are lower or equal to normal values. We also found that the activity of 232Th in one of the soil samples was as high as 814Bq. This concentration of 232Th is much higher than the estimated iI1ternational normal value by UNSCEAR (52.85Bq)."

Endoscopic sphincterotomy (EST) was done in 27 patients with bile duct diseases. 11 were female and 16 male. The mean age was 60.6±13.2 years. The least age was a 24 year old female and the oldest one a 76 year old male. In ERCP 26 (96.2%) had choledocholithiasis with the numbers of stones between 1 to more than 15.The symptoms of the patients were: RUQ pain in 23, jaundice in 16, cholangitis in 12 and pancreatitis in 4 patients. 21 patients had history of cholecyctectomysince 1 week to 9 years ago. T-Tube in 9 patients during operation was created. All of the patients underwent EST. In those with the stones less than 15 mm in diameter Dormia basket were used and the stones removed immediately.In those with the bigger stones only EST was done. Some of the stones which were removed endoscopicallyand also some of the stones excreted in the feces collected for analysis. One patient had oddi dysfunctionand in whom EST was done. 16 patients had very ill condition, cholangitis and sepsis (12 cases) and pancreatitis (4 cases). The analysis of stones showed different amount of cholesterol and bile pigments. No mortality was seen in our patients.

Alopecia areata is a rather common type of hair loss that may cause severe psychological problems especially in the young and women.There are multiple topical and systemic agents, some of which have significantly side effects and there is no good evidence that therapy alters the natural course of the disease. Our purpose was to determine whether cryotherapy is effective in alopecia areata. One hundred patients with alopecia areata were included in an open clinical trial from 1375 to 1377. The contact method of cryotherapy was performed once a week for 10 successive weeks. The efficacy was assessed by clinical response.The results were composed of: Good response 22%Moderate response 28%Poor response 42% &No response 8%In this study the contact method of cryotherapy was found effective and safe for alopecia areata.There were no significant adverse events.

Since Nov. 1990 to Nov. 2000, 200 live donor have undergone nephrectomy via an, extraperitoneal flank approach. Over - all hospital stay was short and mortality and major complication was negative. Early graft Function was excellent as determined by urinary output in the first 24 hours postoperatively (6100-39100 ml.). Follow-up of kidney donors show no evidence of progressive renal deterioration or hypertentioh. We conclude that an extraperitoneal flank approach is the safest for the live donor nephrectomy and provides an optimal allograft for the recipient.

Fractures of femur (especially) are one of the most common fractures in children. Every year it causes a lot of psychological and financial problems for the patient and his or her family, so we have studied and compared two main methods of treatment (conservative and surgery).In our study 34 patients between 10 to 14 years old children during a 4 years period (1371-1374) were followed up In Imam Reza Hospital. These children had a closed fracture of shaft of femur. Some of them were treated by surgery and some by traction and casting. During a 18-36 months of follow up, they were re examined, and control X-Rays were taken. (AV. 27 month).In the patients who had been treated by surgery there was one case of 1 cm overgrowth. Average hospitalization times for conservative methods were 20 days and 8 days for surgical method. The cost of conservative method was much less than surgical method. It seems that (OR & IF) - because of less time spent in hospital (despite higher costs) -is a pramising alternative for conservative method even in the absence of definitive indications.

The advent and development of ESWL has revolutionized threatment of Renal and ureteral colculie. However some patients remain who are managed most effectively by ISWL. Here in we describe the use of penumatic Lithoclast in 57 Patient who had unsuccessfully ESWL of lower ureteral calculie and penumatic Lithoclats successt1ly fragmented 100% of them. We describe the cases of ureteral stones who are better managed with ISWL than ESWL.

Mycetoma is a subcutaneous mycotic disease, which is sporadic in Iran. The etiologic agents are different species of Actinomycets & Eumycetes.The clinical signs include: Chronic granulomatose lesions with polyfistulizations producing pus & granules.In order to investigate the cases of myctoma during past decade in Emam Reza Hospital a retrospecitve study was undertaken in Departments of Dermatology & Mycology during (1989-1999). The records of apraved cases of mycetoma were studied.The results showed that 66% of cases were male & 33% were female. Most of them were farmers who were inoculated while working in their farms. All of the patients were more the 25 years old.The results showed that only five patients received positive results for the cultures from their lesions.Treatment by dapsone & sterptomycin were performed for 2 patients & both of them obtained their health after 6 months. It is concluded that treatment of mycetoma is possible if exact diagnosis by labratory methodes is preformed & no need for amutation.

Systemic Lupus erythematosus is a relatively common rheumatologic disease. In this article we reviewed all systemic Lupus erythematosus admissions to Imam Reza Hospital during 6 years period. The goal of this study was to determine the rate and nature of disease activity, infection and its association with overall disease activity.Eighty two patients were admitted during 6 years, from 1372 to 1377. Sixty four patients were female and eighteen patients were male.The most common cause of hospitalization was disease activity (67%). The second cause was infection (30%).We found out that disease activity has an important role for hospitalization in systemic Lupus erythematosus patient. Infection is associated with overall disease activity and can be a significant cause of hospitalizaiton. Corticosteroid complication is the other cause of hospitalization too.

From Bahman 1375 to Azar 1376 During 11 months 2550 male newborns, evaluated in aspect of congenital external genitalia anomalies. At all, 2040 (80%) of those newborn were term and 402 (15.8%) were preterm and 108 (4.2%) have clinical signs of postterm. 261 anomalies in 258 neonates (10.11%) established. In this study, fourteen have one of forms of hypospadiasis and formed 5.3% of anomalies. (5.4 cases in every 1000 newborns) Vesical extrophy with epispadiasis found in one. Congenital hydrocele was found in 45 and involved 1.76% of ails. In our study 199 have undescended testes that involved 7.8% of all neonates: 106 (26%) in preterms and 93 (3.6%) in terms. 116 (58.3%) have bilateral cryptorchidism, 44(22.1%) have right and 39 (19.6%) have left. Micropenis found in two and 95% of neonates have physiologic phimosis without pathologic symptoms.

We reviewed the ultrasound scans of 95 patients who underwent cholecystectomy for cholelithiasisand compared the findings. The operative and ultrasound findings were at variance in 12 of the 95 patients (%12.6).Seven were reported as having gallstones on ultrasound but none were found at cholecystectomy, a false positive rate for ultrasound of 7.3%. Five had abnormal gallbladders with no gallstones on ultrasound but gallstones were found at operation, a false negative rate of 5.3%. Some false negative examinations may be avoided by performing repeat examinations if the gallbladder is-thick-walled and tenders.

ORAL Anticuagulant are used in many cardiac diseases in order to prevent thromboembolic process. Warfarin is the most common drugs used for this purpose. Which Inhibits synthesis of vit K dependent coagulant factors, its efficacy is variable in different patients.Warfarin metabolism depends on various concommitant drugs nutrients consumption either on additive or diminutive effect.In patients with hypercoaguable state due to anticuagulan protein's deficiency i.e/protein & S, anti thrombin. III require higher doses of warfarine or heparine.There are some rare cases of resistance to warfarin effect (Who requrie 50mg or more doses daily) persumably due to hereditary back ground, high doses of warfarin in addition to anabolic steroids would be beneficial in this respect.

Hamartomas are nontumoral lesions composed of disordered proliferation of normal and abnormal tissue components.Lung hamartomas are composed of irregular native tissues such as cartilage, fat, smoth muscle and tubules lined by bronchial or bronchiolar Epithelium.These are rare lesions often presenting as a small solitary mass in lung paranchyma of adults discovered radiologically as a coin lesion.They are acquired proliferations although some chromosomal aberrations are observed. This is a report of a lung Hamartoma and review of the recent related literature.

The concomitance of hypophosphatemic Osteomalacia and polyostotic Fibrous Dysplasia has only been reported to date in a few cases in literature.We have not found any case in medline search in last 7 years. A 22 years old male was admited to the endocrine department because of bone pain. In physical examination typical pigmented cafe-au-Iait lesion of the skin with irregular border was noted only in the left side.Numerous bone cystsand Shepherd's crook deformity of the femur in the radiography and leonine appearance confirmed the diagnosis of polyostotic Fibrous Dysplasia.Persistent low serum phosphate and high urinary excretion of phosphate (in 24 her urine) confirmed concomitanee of hypophosphatenie Osteomalacia.Patients symptoms improved markedly after treatment with calcitriol (Rocaltrol) and phosphate.

We present an infant girl with hyperekplexia, hypertonia, hyperreflexia and a characteristic exaggerated response to nose tap.The genetic basis of recessively inherited and sporadic cases of hyperekplexia is unknown. Familial cases of hyperekplexia appear to be due to mutations in the glycine receptor. This disorder is important to recognize because of the increase risk of apnea and sudden infant death. Most of these infants respond to clonozepam.

Among the patients that referred to Ghaem Medical Hospital duto weakness of lower limbs, we report two cases of myositis.Neurological examination showed proxymal weakness with atrophy in upper and lower limbs without pain and tenderness.Paraclinic investigations showed: Increased CPK in both cases.Electrodignostic searching was compatible with myopathic pattern with mild involvement of anterior horn in one, and peripheral nerve. Damage in other one Serum HTLV1 was positive in both. (Confirmed with western blot).Muscle biopsy showed atrophy with necrosis of muscle fibers (especially type I fibers) with T killers cell lymphocytes and macrophages infiltration in perimyosal and edomysal spaces. That relation with myositis duto HTLV1 confirmed in important myology centers of the world (Prof. Engle U.S.A., Prof. Schroder and Prof. Mehraeen. Germany).Final dignosis was myosistis most probably duto HTLV1.It is interest to say in Khorasan HTLV1 is endemic and many cases of myelopathy duto this virus is reported by other authors. But about myositis with HTLV1 atyet there are no reports in Iran, and even in other countries there is few reports by authors.

Before the introduction of routinely feasible endoscopic gastroscopy, gastric carcinoid was mostly regarded as a pathologic curiosity. In recent studies, however, about 3% of all gastrointestinal carcinoids have reported an incidence of gastric carcinia. Moreover, endoscopic screening may disclose these tumors in up to 9% of patients with pernicious anemia, a condition at risk for the development of such neoplasms. Gastric carcinoid may also arise during long- term treatment with powerful inhibitors of gastric acid secretion, a finding first observed in toxicologicexperiments on rodents and then substantiated in some cases of Zollinger- Ellison Syndrome and multiple endocrine neoplasia type 1. In this report we have performed a histiologic investigation on a patient who presented with a vague abdominal symptom. During gastroscopy, and finally obtaining a biopsy, the diagnosis of gastic carcinoid was made. We reviewed the literature and discussed gastric carcinoids here.

Metaphyseal dysplasiasare a grope of heterogenous and rare disorder, that presented with flaring and irregularity of metaphyses. The radiographic changes of these disorders are similar to rickets, but calcium and phosphorus metabolism is normal. These hereditary diseases presented with bowing of the legs and disproportionate short stature, such as other skeletal dysplasias.Four types of this disorder are schmid, spahr, Mckusik and Jansen which could be differentiated by clinical, radiographic, genetic and biochemical criteria. Here we present two paitents of metaphyseal dysplasia of Mckusick type, whose bone disorder diagnosed as rickets and treated with vitamin D.We suggest that in differential diagnosis of vitamin D resistant rickets and disproportionate short stature metaphyseal dysplasias should be considered.

Kawasaki's Disease is the most common kind of vasculitis in childhood with unknown etiology that primarily affects infants and young children. Diagnosis is based on clinical criteria which were first established by the Japanese in 1979. The most serious manifestation is cardiac involvement. In addition to the classic diagnostic features there are many Reports on other signs and symptom’s associated with the disease. An ulcerated lesion at the BCG vaccination site (or Reactivation of BCG vaccine) is a rare manifestation during the course of the disease and Hydrocele is another sign which only five cases has been described since 1990 by Italians. Here we present a case of Kawasaki's Disease with reactivation of BCG vaccine and hydrocele during the course of the disease.