MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:47 | Issue:84|Papers Count:21

Introduction: Mitral stenosis is one of the most common causes of valvular heart disease in developing countries. Until the first publication by Inoue and Co-workers on percutaneous mitral commissurotomy (PMC) in 1984, surgery was the only satisfactory treatment for patients with mitral stenosis. Despite worldwide use, this technique has recently been started in Mashhad and its immediate and midterm results of the first 218 patients are going to be reported.Method and Material: Form 1988 to 2003, this descriptive study was done in Ghaem Hospital of Mashhad.The intervention was performed on fasting 218 patients with light sedation. After left and right heart catheterization, interatrial septostomy, septostomy and PMC was done via right femoral vein, by using a standard brockenbrough needle, a mullin sheat, dilator, spiral guide wire and Inoue balloon.Result: PMC was successfully performed on 213 (97.76%) of 218 cases with severe MS.The mean left atrial pressure decreased from 24.3±6.5 mmHg to 12.1±5.4 mmHg.The mean gradient at the mitral valve level also decreased from 15.9±5 mmHg to 2.4±2.1 mmHg.The mean mitral valve area increased from 0.88± 0.17cm2 to 1.99 ±0.25cm2. Mitral regurgitation increased by 1 grade in 56 cases and 2 grades in 11patients. 3 patients developed 3 grades of mitral regurgitation. No patient showed 4 grades of mitral regurgitation.One direction variance analysis showed that there is a statistically significant reverse relationship between age (P<0.0001) of patients and increment of mitral valve area after PMC.In addition, this study showed a significant relationship between functional class of patients (P<0.001) and increment of mitral valve area after using this Procedure.There were not any relationships between age (P=0.06), sex (P=0.890), cardiac rhythm (P=0.632), functional class (P=0.458) of these patients, and the induction or changes in severity of mitral regurgitation after PMC.Conclusion: In spite of some limitations in using the devices, the immediate and midterm results obtained from this study like other researches shows that PMC is a safe, effective and choice method in the treatment of the patients with mitral stenosis. In contrary to the other reports, thise study has also suggested that, there is a significant relationship between functional class of patients and in increment of mitral valve area after PMC.

Introduction: Breast cancer in women is second only to lung cancer with respect to cancer deaths. Early detection of this cancer is believed to improve patient survival and to prevent metastasis.Material and Method: This descriptive study was designed to evaluate the value of 99mTC-MIBIbreast scintigraphy in differential diagnosis of breast masses. A total of 20 patients during a 12- months period (from March 2003 to March 2004) in Imam Reza Hospital evaluated. After clinical examinations and breast MIBI scan, excisional biopsy was done.Result: we studied 21 breast masses. 14 masses were malignant tumours and 7 masses were benign tumours. The mean value of MIBI uptake in malignant masses of breast was significantly greater than benign masses (P<0.05).The sensitivity and specifity of breast scan with 99mTC-MIBIusing qualitative interpretation was 78.5% and 85.7% respectively.The sensitivity and specifity of 99mTC-MIBIusing tumour / background ratio in detection of malignancy was 92.3% and 71.4% respectively.Conclusion: In this study it was found that quantitative interpretation of 99mTC-MIBI scintimammography considering tumour/background uptake ratio (>1.3) is highly sensitive for detection of breast cancer.

Introduction: Previos studies indicated that generally after acute myocardial infarction women have a poorer outcome thane men. Further studies with complete adjustements for coexisting condition are needed to determin whether the older age of the women who studied or the presence of other unfavorable prognostic factors or both explains this difference?Material and Method: we studied 817 consecutive patients (556 men & 261 women) hospitalized in all CCUs in city of Yazd due to acute myocardial infarction from May 2000 to October 2001.Results: In this survey, women were older than men (67.5?±11 Vs 60±13) and had higher prevalence of hypertension, diabetes, dyslipidemia and in-hospital mortalities. The unadjusted odds ratio for death among women compared to men was 2.7 (95 percent confidence interval, 1.79 to 4.28). After adjustment for age the odd ratio reduced to 2.03 (95 percent confidence interval, 1.3 to 3.1). Adjustmen for other differences in the base line characteristics reduced the odds ratio to 1.91 (95 percent confidece interval, 1.03 to 3.5). These differences were significat, but after adjustment for treatment the odds ratio reduced to 1.51 (95 percent confidence interval, 0.6 to 3.7), and it wasn't Statistically significant.Conclusin: Women have worse prognosis after acute myocardial infarction and on the treatment may be contributing to this, and for correct judgement the difference of mortality after acute myocardial infarction, both sexes should under go the same approach for treatment.

Introduction: Despite the dramatic improvement in the short-term outcome of kidney transplantation 30% or more of patients will lose their allograft before the fifth transplant anniversary.Second renal allograft survival rates are lower than those of primary allograft in many studies. This study is carried out to identify risk factors associated with decreased second regraft survival.Material and Method: from 1989 through 2002, 650 primary and 37 first repeat transplans were performed on Imam Reza hospital. Graft survival rates for primary transplants at 12, 36 and 60 months after transplantation were 93%, 89%, 76% respectively, compared with 87%, 79%, 68%, for transplants at the same time periods.Result: we observed no effect of recipient age and sex, time interval between primary graft loss and second transplantation or allograft nephrectomy on outcome for patients who had undergone retransplantation or allograft nephrectomy on outcome for patients who had undergone retransplantation.Causes of the first graft failure were analyzed. Regraft failure is more common in patients who lost their first graft because of acute rejection than patients who had chronic rejection.Conclusion: The result showed a significant relationship between primary allograft survival, PRA and PPRA level and retransplant outcome.

Introduction: Delayed intracranial hematoma after head trauma is an important complication that must be considered much more in our neurosurgical departments. These hematomas may be intra. Or extraaxial.The purpose of this study is to determine the incidence, Complications and mortality rates of delayed intracranial hemorrhages and describe there. pathophysiology, clinical & radiological presentations.Material and Methods: Prospectively from March 2000 to February 2002, 1806 patients with posttraumatic intracranial hemorrhages were admitted at neurosurgical department of Shahid Kamyab Hospital. Many of them underwent operation.Results: 1308 cases of the 1806 patients underwent craniotomy and hematoma removal.Among these cases 247 patients (about 13.6% of cases) had delayed intracranial hematoma (EDH, SDH or ICH).Delayed intracranial hematoma after head injury is a frequent and potentially devastating problem.Conclusion: Few clinical studies showed the effects of vascular disorders and blood dyscrasias in higher incidence of delayed intracranial hematomas. Identification of patients at aricular risk for delayed intracranial hematoma, use of ICP monitoring in selected patients and prompt application of CTScan all can improve the early recognition of this complication of head injury. Early recognition and prompt treatment are both essential for optimal Management.

 Introduction: More than 50 percent of hydatid cysts of man are seen in the liver and ultrasonography is considered to be one of the primary diagnostic examinations in the evaluation of hydatid cysts, especially when the disease affects the liver or other abdominal viscera. In order to study the sonographic feature of hepatic hydatid cyst a study was undertaken over a period of 8 years on eighty patients and the sensitivity of sonography in the diagnosis of hydatid cysts was 83%. The females were predominant 66.11%, and the average age was 40.22±10.25 years.Six different types of sonographic images of hydatid cysts were characterized in the study:multiloculated cysts, Calcified cysts, Cysts with collapsed membranes, unilocular cysts, pseudotumoral types and cysts with absorption of sound. The three first types of sonographic images of the cyst can suggest the correct diagnosis, but the other types usually produce diagnostic problems.In our study hepatic hydatid cysts were unilocular in 46.2% of the cases, with predominance in the right lobe (65%). The complication rate was of 14.80%, with predominance of the supuration (10.12%).

Introduction: Single fiber electromyography (SFEMG) is the most efficient way of neuromuscular junction disorders diagnosis. By this method action potentials of two adjacent fibers from the same motor unit can be recorded by using a bipolar electrode after voluntary activation or electrical stimulation of the nerve. The variability of the interpotential interval (IPI) between two single muscle fiber action potentials belonging to the same motor unit during successive discharge is referred to JITTER, that is expressed by the mean value of consecutive difference (MCD) quantity.The fiber density of each motor unit is also measure by same electrode.Material and Method: In this study that was carried out on 25 patients referred to mashhad ghaem Hospital with suspected diagnosis of myasthenia gravis (MG), SFEMG Test accomplished by voluntary contraction of extensor digitorum communis (EDC) and frontalis muscles. tensilon test and repetetive stimulation test (RST) was done simultaneously.Result: 10 patients (40%) had generalized, 5 patients (20%) had bulbar and 10 patients (40%) had ocular symptoms of myasthenia gravis. SFEMG results in 3 patients, suspected to ocular form, was negative. In these patients, myasthenia was also excluded in later evaluationes. SFEMG test was positive in the other patients (100%).Conclusion: These results suggest that SFEMG for the diagnosis of myasthenia gravis, especially ocular type has more sensitivity and higher reliability than the other diagnostic methodes.It has not yet been feasible to use SFEMG as routine test for diagnosis of myasthenia gravis disease when other diagnostic tests were positive specially in generalized form, considering it is time consuming, costly and not having enough experience.

Introduction: Malnutrition is one of the important causes of mortality and morbidity in chronic renal failure. In this study we assessed the Prevalence of malnutrition in patients with chronic hemodialysis and CAPD.Material and Method: In this study we assessed 22 patients on hemodialysis (11 male, 11 female) and 20 patients on CAPD (11 male and 9 female) and in total 42 patients for clinical evidence of malnutrition. Four Subjective parameters including loss of body weight, Anorexia, loss of muscle mass and loss of subcutaneus fat pad were used. Every parameter was scored from 1 to 7 and then total score from 4 parameters concluded. If the total score were 7 or less than 7 the diagnosis of malnutrition was made.Results: 20% patients on CAPD and 13.2% patients on hemodialysis in Ghaem hospital of Mashhad were suffered from mild malnutrition. We did not have any cases of moderate or severe malnutrition. Prevalence of malnutrition in patients on hemodialysis or CAPD did not have any significant differences (P>0/05), and also six of patients had no effects on prevalence of malnutrition (P>0/05). All cases of malnutrition in CAPD were seen in patients which dialysed for more than one year where as in patients with hemodialysis all cases of malnutrition were seen in the first year of dialysis (P<0/02). Patients with recurrent peritonitis in CAPD patients had more malnutrition (P<0/005).Conclusion: prevalence of malnutrition in our chronic dialysis patients is less than from majority of other studies but because of increasing of mortality and morbidity rate in patients with malnutrition we must sopport these patients with suitable diet. Early referral the patients with CRF to nephrologist and proper initation of dialysis will decrease prevalence of malnutrition. In other hand with prolongation of dialysis treatment in patient with CAPD and decrease of residual renal function and recurrent peritonitis the prevalence of malnutrition will increase.

ntroduction: Half of the patients with type 2 diabetes have secondary failure to sulfonylurea compounds by 5 years. Emphasis on diet and adding a second drug is not usually effective and Insulin therapy is necessary. This may induce weight gain that is not desirable.Material and Method: 200 cases of type 2 diabetes with sulfonylurea failure were evaluated at least every 3 months for more than 2 years after insulin therapy. FBS, weight and Body Mass Index (BMI) was measured. This study included 160 female and 40 male patients.Results: The age of starting sulfonylurea compound was 43±8.9 years. Duration of effectiveness was 9.3±4.4 years. Interval of unresponsiveness to insulin therapy was 16.9±13.9 months. One year after insulin therapy 32% (64 patients) had acceptable fasting blood glucose (60- 139 mg/dl) but they had weight gain of 5±3.5 Kg. 45 % (90 patients) had intermediate control (FBS of 140-199 mg/dl) They had 4.9±3.4 Kg weight gain. 23% (46 patients) remained in poor control state (>200 mg/dl). They had 3.5±3.1 Kg weight gain. 2 years after starting insulin therapy, fasting blood sugar was like the first year but weight gain was more increased.Conclusion: Sulfonylurea compounds usually lose their effectiveness in few years (in our study 9 years). It is not good to delay insulin therapy (in our study 16.9 months). In spite of near normalization of blood glucose there will be weight gain (more than with ideal control) which is not desirable and should be considered in management of diabetic patients.

Introduction: According to high prevalence of cervical spondylosis and many questions about indications of surgery we decided to sudy its signs and symptoms especially those that lead to surgery.Material and method: This is a desciptive study on 54 patients that operated on in Qaem Hospital between 1991-2001. Special data collection sheets that included personal informations, signs and symptoms, evolution, neuro-imaging findings and indications of surgery. All data were analyzed using statistical tests.Results: In 54 patients who were studied, the results were as follows: male was predominant significantly (81.5% versus 18.5%), all patients age was above 40 years (average 58.9 years), the course of disorder was slowly progressive in 89% and acute in 11%.Hyperreflexia 92.5% Babinski sign 70%, Hoffmann sign 52%, clonus 41%, fasciculation 11%, paresthesia 63%, vague sensory level 44.5% proprioceptive sensory loss 22%, cervical dermatome sensory loss 52%, gait disorder 85%, motor weakness 85%(tetraparesis was the most common), neck pain 63%, Radicular pain 40.5%. hand atrophy 37% and sphincteric disorder 33%.MRI findings Was: 96% of patients had canal stenosis (12.5% of them had one level stenosis and 87.5% had multiple level stenosis). The most common level of stenosis was C5-C6, C6-C7, C4-C5, and C3-C4 respectively.Indications of surgery were as follows; progressive motor weakness 96%, intractable pain 56% and sphincteric disorders 33%.Some of patients had more than one indication.Conclusion: male to female ratio was more than4, the most common level of compression were C5-C6, C6-C7, and in comparison with other data, we had a higher incidence of neck pain, spastic tetraparesis , Hoffmann sign, hand atrophy and spastic gait.

Introduction: Intralesional instillation of steroids (methyl prednisolon) is currently one of the accepted methods of treatment for simple bone cysts. The purpose for this study was to find an answer for this question: Why some S.B.Cs. do not completely answer to the injections?Our primary hypothesis was multiloculation of the cysts as an important cause of incomplete healing. So we decided to inject opaque fluid (such as urograffin) into the cysts (cystography).Material and Methods: This study was due in Private hospitals and Emam Reza Medical centers. Between (1995-2002). 50 patient with simple bone cyst and without any previous treatment have been studied. In operating room, under general anesthesia with biopsy needle and after removal of the cyst fluid, cystography was done. All of the patients controlled for one day in the hospital and followed upto 2 years after treatment. Chi-square test was used for interpretation of the results.Results: Sixteen (32%) patients were detected to have cysts with two separated cavities in radiography, and thirty-four (68%) patients had a cyst with one cavity (unicameral). No one of our patients had cyst with more than two cavities. Injection of methyl prednisolon was done for each cavity of the cyst by a separate portal: two portals for the patients with two cavitated cysts. The results were 94% cure in contrast to the 80% cure after injection of the drug without cystography, and 80% cure after curettage and grafting.Conclusion: We concluded that cystography is a acceptable method for detecting the cavities of bone cysts before injection of methyl prednisolon Therefore installation of steroid into the cavities via more than one portal for multiloculated cysts will result more persentages of cure for simple bone cysts.

Malignancy is the leading cause of chronic pericardial effusion. Although maybe not life threatening as the acute tamponade, by compressing cardiac cavities and adjacent organs, causes significant morbidity and discomfort for the patient. Its early diagnosis and effective and safe treatment would have significant role in improving the patints quality of life and his life expectancy.There are various treament modalities with different success rate including, pericardiocentesis alone (average success rate of 47%) or with indwelling catheter drainage(78%), sclerotherapy (83%), external radiotherapy (69%) , and surgery (success rete of 48-92% for different techniques), and Percutaneous balloon pericardiotomy (96%).Percutaneous balloon pericardiotomy is a promising nonsurgical therapy, especially in malignant recurrent tamponade, in which after drainage of pericardial fluid through subxiphoid pericardiotomy, using a balloon catheter, a window is created in parietal pericardium.Generally it has the same early and late results as surgical Pericardiotomy, especially in malignancies, with less morbidity. But it's role in the management of nonmalignant pericardial effusionis not clear.Here, in addition to introducing this method, we report successful treatment of a case of recurrent temponade with past history of treated gastric cancer.

A 19 - year-old male youth refered to private clinic for jaundice and fever, starting two weeks ago. There was no history of recent jaundice in his family. and no history of blood transfusion and L.V. drug abusing. The patient was unmarried and according to him, there had been a sexual entercouse 3 months before the oncent of jaundice. On clinical examination the liver was tender and palpable two-centimeter bellow the costal bore. Spleen was palpable too. In palpation of inguinal regions numerous enlarged lymphnodes were touched. These lymphnodes were painless and non-ulcerative and without adhesion to surrounding tissues but cervical and axilarry regions contained no adenopathies. Both of palmar skins were erythematous. Skin and sclera were yellow and the patient complained of malaise, anorexia, hotness and dark urine. Laboratory tests requested and these tests demonstrated; WBC=8200 with 71%. Neutrophils 25%. Lymphocytes 4%. Monocytes, AST 1210 IU/L, ALT 2110 IU/L, ALP 710 (normal upto 350), PT 18, PTT 52, Bilirubine total 10 mg/dl and direct Bilirubin 6 mg/dl. IgM anti HAV Negative, HBS Ag and IgM anti HBC Negative, anti HCV Negative, IgM anti CMV and IgM anti EBV were negative. There was no history of herbalism and illegal drug abusing and alcohol consumption. Sonography of liver and spleen revealed nothing. Ceruloplasmine level of plasma was normal and there was No neurologic sign and symptoms. Serum protein electrophoreses except mild elevation of gamma globulin was normal. Serologic assays revealed the ethiologic agent.

Juvenile granulosa cell tumor (JGCT) is one of the rare sex cord-stromal tumours of the ovary occurring in the first two decades of life .It makes less than 5% of ovarian tumours in childhood and adolescence.It is different from adult granulosa cell tumor that is seen in older females with respect to clinical and pathological features as well as biological behaviour.In this article we report a case of juvenile granulosa cell tumor of the right ovary in a 7-month-old infant which was presented with vaginal bleeding.

Introdaction: The incidence of skin cancer in transplant recipient is higher than general population. Therefore, careful phyiscal examination to detect skin malignancies is essential in the long-term prognosis of these patients. This study was carried out to identify risk factors associated with variant of skin tumor from 1989 to 2002.Material and Method: 620 kidney transplants (223 women and 397 men) were performed in Imam Reza hospital. The patients were followed up for one to 14 years. They were treated with cyclosporine, prednisolone, Azathioprine or Mycophenolate Mofetiel.Results: Skin tumor was observed in 12 patients (10 men and 2 women). Diagnosis was based on biopsy.Kaposi sarcoma was occurred earlier than other tumor and accounted for 50% (6 out of 12) of post-transplantation skin tumor. Five patients had SCC and one ofthem had BCC. Kaposi sarcoma on the average appeared 14 months after transplantation. SCC appeared later than other type of cancers occurring after transplantation (90±36 months).All patients who had SCC and BCC were male and they were older than 40 years old, when they received kidney.SCC and BCC occurred on the head and neck in all patients who did have these tumors. All patients with kaposi sarcoma had skin involvement. 33.3 % of these patients had visceral lesions.In our study the incidence of malignancy was observed to be less than those reported in other reports (2% instead of 6 % -24 %) and kaposi sarcoma was the most frequent neoplasm.The result showed a significant relationship between recipient's age and sex with skin tumor. Skin tumor was observed to be more common in men and older patients.Conclusion: In addition to standard established treatment for each malignancy, reduction of immunosuppression was performed. Complete remission was observed in two patients who had kaposi sarcoma and three patients who had SCC while the other patients didn't respond to the treatment.

A ccording to the patient, there had been a sexual encounter 3 months ago and inguinal regions contained numerous enlarged lymphnodes in both sides. But there was no chancre although palmar erythema were seen bilaterally and serum ALP level was high and viral hepatitis markers were all negative. On further examination for hepatitis, R.P.R titer was requested and it was 1/512 and FTA-abs was positive too. Anti HIV 1,2 assay was negative. Syphilitic hepatitis is a safe disease but in a young sexually active man especially if he engage in anal intercourse with high serum ALP (2.5 times) level with negative viral hepatitidis markers, you should think about syphilitic hepatitis. Liver needle biopsy was done, you sometimes can find T.pallidum in the liver biopsy specimen, but in this patient pathologist was unable to find T. pallidum and just infiltration of inflammatory cells and patchy necrosis without cholestasis was reported by pathologist.Anal intercourse is a risk factor for syphilitic hepatitis but the patient denied any anal intercourse. Antibiotic therapy rapidly improved the condition with reducing serum R.P.R titer.