MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2009 | Volume:51 | Issue:4|Papers Count:13

Introduction: Type1 diabetes is the most common endocrine disorder in children. The disease is associated with a variety of complications including growth abnormalities. The aim of this study was to evaluate the role of diabetes and blood sugar control on physical growth (height and weight), growth parameters and lipid profile.Materials and Methods: This descriptive cross - sectional study took place from July 2006 to July 2007. A total of 154 children and adolescents with diabetes type 1, evaluated for their growth parameters, lipid profile٫ and its correlation with duration of diabetes and mean HbA1C.Results: The mean age of diabetes diagnosis recorded 6.2±3.1 year. The mean height growth velocity was 4.8±1.48 cm and the mean weight growth velocity 3±1.5 kg in one year. In the first group with HbA1c< 8 (mean±1sd) height and weight growth velocities were 4.8±1.3 cm and 3.03±1.6 kg in a year respectively. In the second group with HbA1c > 8 (mean±1SD), yearly height and weight growth velocities measured 3.2±1.22 cm and 3.03±1.2 kg in turn. Moreover, in the first group TC, LDL, HDL and TG were 163.1±34 mg/dl, 109.3±22 mg/dl, 49.5±1 mg/dl, 116.3±55 mg/dl and in the second group 172.6±46 mg/dl, 122.4±80 mg/dl, 48.5±1 mg/dl, 153.3±1.5 mg/dl in the order mentioned. In the group with disease duration less than 5 years, height and weight growth velocities were 5.7±1.4 cm and 3.3±1.6 kg and in group with disease duration more than 5 years, height and weight velocities reported 3.74±1.2 cm and 3.3±1.2 kg annually respectively.Conclusion: According to this study, there was no correlation between the mean of height, weight growth velocities and metabolic control in both groups. However, the high growth disorder and increase in the level of TG were correlated with the duration of disease. Also, lipid profile (dislipidemia) was associated with the lack of metabolic control.

Introduction: Multiple Sclerosis is one of the commonest neurological disorders that because of its different clinical presentation, recurrent and progressive attacks, and age spectrum of patients who are usually young, has particular importance. Optic neuritis is common in MS patients and VEP is abnormal in most of the patients with optic neuritis. VEP is also abnormal in most of the MS patients who do not have the history of optic neuritis. The aim of this study was to compare the incidence of VEP in MS patients with and without the history of optic neuritis.Materials and Methods: This study included 80 patients with definite MS diagnosis who referred to the MS Clinic Ghaem Hospital. A questionnaire used to collect the patients demographic and illness history. Patients were divided into two groups based on the history of optic neuritis. The full neurological examination including VEP carried out for the patients. Collected data analyzed with SPSS and statistical tests.Results: The abnormal VEP found in 92.2% of patients with the history of optic neuritis. The incidence of VEP in patients without the history of optic neuritis was 57.5%. The VEP abnormality recorded 40.5% unilateral and 59.5% bilateral in the first group of patients. In the second group the VEP was 87% unilateral and 13% bilateral.Conclusion: Many MS patients without the history of optic neuritis, had abnormal VEP, therefore VEP can be used for the early diagnosis of MS. Although, patients with the history of optic neuritis will have significant improvement with the time, but many cases with increased P100 latency is persistence, and can be used as a marker of the pervious optic neuritis attack.

Introduction: Complications like chronic diaphragmatic hernia thoracoabdominal stab wound following conservative treatment, make it necessary to find a safe and exact diagnostic method. The aim of this work was to assess, accurate diagnostic value of thoracoscopy in occult diaphragmatic injuries in penetrating thoracoabdominal stab wound.Materials and Methods: In the present prospective study, from March 2005 to October 2007 at Ghaem, Emam Reza and Shahid Kamyab Hospitals of Mashhad University of Medical Sciences, thirty patients with penetrating thoracoabdominal injuries, with stable hemodynamic and no need to emergent exploration were evaluated. They underwent thoracoscopy to evaluate probable diaphragmatic injuries, which were repaired via thoracoscopy or laparatomy and all patients evaluated for chronic diaphragmatic hernia by CT-scan, 6 months later.Results: Mean age was 26.2 years and M/F ratio was 5:1. In thoracoscopic evaluations five hidden diaphragmatic injuries (16.7%) were observed, that 3 cases (9.9%) were repaired through thoracoscopic approach and laparatomy was inevitable in 2 (6.6%) patients. Lung paranchymal laceration was seen in 2 patients (6.6%), repaired with thoracoscopy and intra abdominal injury was seen in 1 patient (3.3%), repaired with loparatomy. No complication reported after thoracoscopy and there was no evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scan performed 6 months later. In this study, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries was 100%.Conclusion: Because of high diagnostic accuracy rate, and minimal invasively diagnostic and treatment ability of thoracoscopy, this diagnostic method in all clinically stable patients with penetrating thoracoabdominal stab wound is recommended.

Introduction: Renal artery atherosclerosis is the most common cause of renovascular hypertension and ischemic nephropathy which is potentially a correctable problem by surgery or intravascular intervention. The prevalence of Renal Artery Disease (RAD) in hypertensive patients evaluated for Coronary Artery Disease (CAD) as the main symptom of atherosclerosis, in our population is unknown; we began evaluation of renal artery stenosis in these patients.Materials and Methods: A prospective cross-sectional study carried out from March 2004 through January 2005 in cardiology department of Emam Reza Hospital, Mashhed University of Medical Sciences, Mashhad, Iran. Over all 255 of patients suspicious of CAD included in this study. Coronary angiography performed by femoral artery approach followed by renal artery angiography. Artery' involvement with more than 50% of the lumen (renal arteries or coronaries) classified as significant stenosis. Coronary stenosis divided into 1-, 2- or 3-vessel involvement. Collected data analyzed by SPSS.Results: The patients were 129 males and 126 females, with the mean age of 58.5%+10.6. A total of 200 patients (mean age of 59.7±10.5) had CAD and the reminders had normal coronary arteries (mean age 61.5±10.3). The Prevalence of RAD in patients with CAD was 31% (63 patients; 19 bilateral and 44 unilateral stenosis), of significant RAD in 1-, 2-, or 3-vessel involvement were as follow respectively 24.27%, 35.7% and 36.5 %. In 55 patients with normal coronary arteries, the prevalence of RAD was 3.6% (p<0.001).Conclusion: Many studies have shown the progressive nature of renal artery stenosis; therefore, early diagnosis will prevent its progression and other consequences. Our results suggest that CAD, especially when more arteries are involved, is a predictor of renal artery stenosis. Since 31% of our hypertensive patients with CAD had significant renal artery stenosis, we recommend that renal artery angiography be performed following coronary angiography for those patients with significant stenosis.

Introduction: Hirschsprung's disease is a developmental disorder of the enteric nervous system, characterized by functional obstruction. Absence of ganglion cells in the distal colon resulting in a functional obstruction. The aim of this study was to evaluate the results and complications of one-stage transanal endorectal pull-through (OTEPT) in the management of patients with Hirschsprung's disease.Materials and Methods: A total of 40 children (31 boys and 9 girls) aged 3 days to 60 months underwent OTEPT procedure over a period of two-years at Dr. Sheikh pediatric Hospital. This study was approved by the local committee of Medical Ethics. Median follow up period was 9.10 months (range, 3 to 33 months).Results: Mean operation time recorded 101.60 mins (range, 25 to 270 minutes). Hirschsprung's disease developed conventional in 55% (short segment in 30%), Ultra-short in 32.5% and long segment in 12.5%. Mean length of resected bowel measured 17.31 cm, 2 patients underwent laparatomy because of extension of aganglionic segment beyond the sigmoid colon. Mean NPO time and need to rectal tube after the operation were 4.35 and 4.41 days, respectively. 8 patients required urinary catheters after the operation with the mean remaining time of 3.30 days, 20% needed ICU care after surgery and mean hospital stay was 5.76 days. Post-operative complications included entrocolitis (n=2) and abdominal distension (n=1). One patient expired due to non surgical reason (heart failure).Conclusion: OTEPT procedure is a safe method with low incidence of postoperative complications. In Hirschsprung's disease confined to the rectosigmoid region, the hazard and morbidities associated with laparatomy and colostomy are avoided with this technique.

Introduction: Application of off-pump technique for reoperative coronary artery bypass grafting (Redo CABG) has been limited by technical difficulties, potentiation for embolism of athermanous debris from the involved grafts, resulting in myocardial infarction, and rapid hemodynamic deterioration.Materials and Methods: In this descriptive study from 2002, at Cardiac surgery Department of Emam Reza Hospital, a total of 77 consecutive patients underwent redo CABG (64 ONCAB and 13 OPCAB) The outcomes of off-pump (OPCAB) and on-pump (ONCAB) redo CABG were compared. Surgical technique in 2 patients (%11) was converted from OPCAB to ONCAB due to hemodynamic instability, severe adhesion or graft injury; and in one patient (%7) the conversion from ONCAB to OPCAB was for severe aorta calcification.Conclusion: Propensity matched comparison of the outcome of OPCAB with ONCAB for redo CABG showed that OPCAB was associated with significant reduction in postoperative complications, volume of blood transfusion and hospitalization length. OPCAB can be safely and effectively applied for reoperative CABG, in selected cases.

Introduction: Absence of one of the pulmonary artery branches is an uncommon congenital defect. Most of these patients have other associated cardiac deficiencies. Early diagnosis and surgical intervention may prevent irreversible pulmonary hypertension and collateral circulation formation.Materials and Methods: A cross-sectional descriptive study was done from 2001 to 2006 on the records of 18 patients with absence of one of the pulmonary artery branches that referred to the EmamReza Hospital, Mashhad University of Medical Sciences (a tertiary referral hospital). Patients’ data including history, physical examination, chest X-Ray, cardiac catheterization and angiography reviewed and analyzed statistically.Results: Among 18 patients, 13 (72.2%) were males; the mean age of those on diagnosis was 11.8±10.8 years (Range 1-38 years). Except one, all of them had associated congenital heart defects. Most of these abnormalities were complex form of CHD, and Tetralogy of Fallo was the highest abnormality (7 cases). Seventeen patients (77.8%) had occult left pulmonary artery (LPA). CXR findings in all patients included heart and mediastinum deviation toward the absent pulmonary artery.Conclusion: Early diagnosis and surgical intervention may allow normal growth of the pulmonary artery and prevent collateral formation and irreversible pulmonary hypertension. Therefore, complete evaluation for the absence of pulmonary artery branch in suspicious infants, especially those with CHD, is mandatory.

Introduction: In vestigating the status of education of Medical students, in different department, is among the objectives of organizers for the educational evaluation, prevention of fall in quality of education and presentation of solutions. Opinion poll of university students and graduates is one of the simplest and most reliable methods to find not the problems and solving them. This study was aimed to determine the educational problems, and to remove them presenting solution.Materials and Methods: Method of this research is descriptional, from simple kinds. Statistical society is among graduates from the last three years and 100 subjects were participated in this opinion poll.For collecting information, one questionnaire including 71 closed questions, type of five choices, was used.Results: Since this research was done for the first time, it will assist the teaching responsible to realize where they are situated, regarding the training goals.Conclusion: Finally, considering and reviewing the obtained results about responses of students to questionnaire, we can conclude that the basic changes for planning of medical education are required to gain desirable goals in educating.

Introduction: Duodenal hematoma occurs rarely due to blunt or penetrating trauma and it may cause intestinal obstruction. Half of the patients with duodenal hematoma show symptoms of obstruction 48 hours after trauma. After ruling out other visceral injuries, treatment is essentially conservative and laparoscopic or surgical drainage is rarely necessary.Case Report: First case was a 16-year-old man who referred to the hospital with abdominal pain, vomiting and tenderness of upper abdominal quadrant, 2 days after blunt abdominal trauma. Diagnosis was made with CT scan and upper GI radiography. After 10 days of conservative treatment, patient was discharged from hospital in a good condition. The second case was a 25-year-old man who referred to the hospital 3 days after blunt abdominal trauma. Patient symptoms were; vomiting, pain and tenderness in upper abdominal regions. Diagnosis was made with ultrasonography, CT scan and upper GI contrast radiography. After 6 days of conservative therapy he tolerated oral diet and was discharged from hospital with good condition.Conclusion: Trauma is not a common cause of alimentary tract occlusion. If obstructive symptoms appear after trauma, the hematoma of intestine particularly duodenum must be considered. The protocol for conservative therapy of hematoma includes: 1) Early diagnosis and ruling out any duodenal leakage through upper GI radiography at admission and 5-7 days later, 2) On time diagnosis of associated injuries like pancreatic injuries, 3) Parenteral nutrition and intravenous hyperalimentation if needed.

Introduction: Leukocyte adhesion deficiency (LAD) is a rare functional leukocyte disorder, which is divided into two separate types: LAD-1 and LAD-2. LAD-1 results from lack of b2 integrin molecules (CD11 & CD18) on the leukocyte cell surface. These molecules are essential for leukocyte adhesion to endothelial cells and chemotaxis.The present case report is about a 42-month-old girl with recurrent otitis, pneumonia and gingivitis. On physical examination, patient was pale and malnourished. Multiple desquamated erythematous plagues were found on her body and extremities. Blood investigations revealed persistent leukocytosis with normal serum Immunoglobulin profile and complement. The diagnosis of LAD1 was made based on Flow cytometry finding; showing decreased in CD11 and CD18 markers of PMN a.Conclusion: When a patient has persistent leukocytosis and recurrent infections, investigation for the primary immune deficiency, specially leukocyte adhesion deficiency must be considered.