MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:44 | Issue:74|Papers Count:31

Laparoscopy is a safe and accurate procedure in assesment of various liver and peritoneal disorders, staging of cancers, cirrhosis and hepatitis, differentiaon of ascites, splenomegaly and portal Hypertension. This study shows that the sensitivity of laparoscopy together with biopsy to diagnose the liver and peritoneal disorders, is about 86.8%. This sensitivity can be added by taking more samples from involved tissues or from the liver, peritoneum, round ligament and mesenter that probably involved with, if the appearance of abdomen is normal or non specific, specially when biopsy are taken from the tissues under the fibrin deposition. The existence of special appearance such as milliary granules on peritoneum particulary on intestine, adhesion of abdomen and fibrin deposition has 98% specificity and 91.7% sensitivity to diagnose abdominal tuberculosis.Large nodules with different size (usually larger than 4 millmeter) on the surface of liver can greatly exclude abdominal tuberculosis, but if such nodules have white yellowish color with thin bloody vessles in their surface specially with depression on their center, will be highly specific for metastatic cancer of liver or peritoneum (94.2%). General change of liver color that may be with nodulation on its surface and presence of many tortuous veins in round ligament, is specific for diagnosis of cirrhosis (97.3%). In this study the diagnostic accuracy of abdominal tuberculosis is 98.1 %, metastatic cancer of liver and peritoneum is 86.2% and cirrhosis is 94%.

Imaging specially sonography is an Important technique in diagnosis of transplanted kidneys failuring.Sonography is noninvasive method and is inexpensive and available for the physicians. In order to study the failuring of transplanted kidneys a retrospective study was performed on the records of 300 patients in Imam Reza Hospital.We demonstrated that the accuracy of sonography in diagnosis of obstructive uropathy was 100% and in acute rejection was high (86%) and some sonographic features such as increased cortical echogenicity, decreased sinus echogenicity, enhanced medulary pyramids and indistinct corticomedulary junction, in diagnosis of acute rejection have high sensitivity. Other causes of renal failure can be assessed by sonography as well, to obtain the definite results it is concluded that complementary studies are requried.

Introduction and objective: Pityriasis versicolor is a common superficial fungal infection of the skin caused by malassezia furfur which is a part of normal skin flora. This organism is a lipophilic and lipid dependent yeast which transforms into pathogenically mycelial form under specific conditions. On the basis of the hypothesis that there may be a relation between blood lipids and pityriasis versicolor, we decided to perform this investigation.Methods and Materials: In a prospective study of 50 female patients with pityriasis versicolor, we compared plasma levels of total cholestrol and triglyceride in patients with a healthy sex and age matched control group of 50 persons. In addition an evaluation of pityriasis versicolor was performed in a third group of 50 persons with higher levels of cholestrol and triglyceride than normal and their control group. Results: The main results were as follows: In 22% of patients with pityriasis versicolor, total cholestrol levels were higher than normal which showed a significant difference in comparison with their control group. In 24% of patients triglyceride levels were higher than normal which showed a significant difference in comparison with the control group. There was no significant relationship with pityriasis versicolor in the group with hyperlipidemia. Conclusion: On the basis of statistical analysis, it revealed that there is a relation between pityriasis versicolor and blood levels of total cholestrol and triglyceride, there fore, control of blood levels of lipids possibly can be effective in treatment of this disease.

There has been a great deal of research on the prevalence rate and correlates of childhood depression in different countries. However the number of local researches in Iran has been scanty. In a cross sectional study in the 1999-2000, children's of forth and fifth grade (10-12yr) with CD inventory questionare (M.kovacs) in all Training - educational regions in the city of Mashhad were assesed. An overal 2071 children (1022 female, 1049 male) were randomly assesed. Data analysis was done using in the klomagrov - smirneov, monn whiteney - wilcaxon, kruskal - wallis, correlation coeficent. Data indicated that the prevalence of depression in the city of Mashhad with cut point of 20 was 10/3%, (P<0.0001), male/female ratio was nearly 1/2 (female 13.1%, male 7.6%). This assessment indicate that the factors such as divorce, changes of house, changes of school, socioeconomic class, the number of family, history of neuropsychiatric disorders in the family and death of relatives, in the incidence of childhood depression is effective. Meanwhile, our data suggests that future preventive programs should be directed toward the children as the target group. Besides, using the screening test for eliciting depressed children may be useful for the health workers in order to do the proper secondary preventive activities.

The most important complications after extubation are stridor and laryngospasm, and without correct management they can lead to hypoxia. This controled, study was designed to investigate the effects of topical beclomethasone on stridor and laryngospasm. A total of 200 children aged 1-10 years old and ASA physical status 1 were randomly divided into two groups. In the topical beclomethasone group 2 puff spray of beclomethasone was applied to subglottic, glottic and supraglottic areas before endotracheal intubation and then postoperative stridor and laryngospasm were recorded. The groups were well matched for their demographic data (sex, age, weight and tracheal tube size). The incidence of stridor in beclomethasone group was 8% and in the control group was 29%. On the other hand the incidence of laryngospasm in the beclomethasone group was 0% and in the control group was 5%. It is concluded that beclomethasone administered topically at the time of intubation helps to prevent postoperative stridor and laryngospasm.

Aims: The aim of this research was study the production of Beta-Lactamaze enzyme in hospital's resistant Staphylococcus aureus to Ampicillin.Methods: This research was done in two methods, tube method and capilary tube method. Then the results of these two methods were compared. Among the specimens that had been received from the different departments of Ghaem Hospital (Mashhad), 50 specimens of Staphylococcus aureuses, which was resistant to Ampicillin, (after culturing and antibiogram tests), were selected. The solutions that were used for this study contained Potassium. Penicillin-G with pH around 8.5.Phenol red was used as an indicator.Then the study was done through two methods; tube method and capilary tube method. Results: The results, showed that the majority (96%) of Staphylococcus Aureuses had resistance to Ampicillin had capability of producing Beta-Lactamaze enzyme.Conclusion: Both of two methods with high sensitivities had not any difference. Suggestion: In order to inhibit the effect of Beta-Lactamaze, it's suggested to use Sulbactam or Clavulanic Acid together with Beta-Lactamaze.

ACUTE RENAL FAILURE IN THE NEONATE   Acute renal failure is defined as an abrupt severe decrease in glomerular filtration rate. 412 babies admitted in NICU for 6 month since 8.96. 67 of all NICU admissions (16.3%) met the initial criteria, which were azotemia defined as blood urea more than 40 mg/dl and oliguria defined as urin output < 1cc/kg/hr. 59 of the 67 (88%) were prerenal in etiology and responded to a trial volume expansion and furosemid with immediate and sustained improvment in urin output and resolution azotemia. This study suggest that acute renal failure has an incidence as high as 16.3% in all NICU admissions. Prerenal failure occurs in 88% of these cases which makes it the most common cause of acute renal failure in the neonate. Sepsis and asphyxia were the most common cause of renal failure (P<0.01).22 of 67 (33%) died. Sepsis, hemorrhage and asphyxia were the most common cause of death.  

There is no consensus on the treatment of acute ruptures of the Achilles tendon. We have chosen surgical technique with early muscle stimulation. This study analyses possibility of functional recovery and complications in athletes. During 1986 to 1996 we treated surgically 59 patients who had Achilles tendons ruptures with early musculotendinous Stimulation. Among the patients 45 male and 14 female had a mean age of 25 years. We have used Bosworth's technique with gastrecenemius nap procedure.Immediately after surgery, weight bearing with below-the-knee cast was initiated for 6 weeks followed by rehabilitation. There was no local major complication deep vein thrombosis or pulmonary embolism. Only one patient suffered from a traumatic rerupture one month after surgery. Mean value of the calf atrophy was less than 1 cm. 93% of patients returned to previous activity levels and 78% of patients returned to their usual sport activity. Like this study recent results confirm the low complication and recurrence rate of the surgical treatment. Percutaneous technique and conservative treatments seem to be worse for rerupture and sportive functional recovery. It is concluded that early muscle stimulation decrease morbidity and calf atrophy. Our protocol with weight bearing in ankle neutral position reduces calf atrophy. A rigid and stable reconstruction allowing early weight bearing without equinus position seems to be a rational treatment for Achilles tendon rupture in athletes.

Subacute sclerosing panencepha litis (SSPE) is a wry rare disease and late sequela of measles. The incidence of SSPE has declined since the introduction of measles vaccine and only a few cases were reported in developed coumtries. Since 1983 - 2001 in Ghaem Hospital 34 patinets with SS PE has been studied. Among them 23 patients were male and 11 female with mean age of 10/89 years. They lived maninly in rural area and except 3 that had only history of vaccinatien alone, other patients had history of measles (about 55% at age 1). 90% of patients succumbed (8/8% with fulminant cours) and in 11% stabilization and regression of disease were reported. Typical findings of EEG were considered in 90% of patients. Atypical findings of EEG included focal abnormality especially in frontal and frontotemporal area, abscence like pattern and unilateral slowing. Treatment of SSPE is not succesful and the best prophylaxis is preventive measusre and compelet vaccination of childeren. 

Ataxia is disorder of gait and a clinical neurologic sign that presents a wide range of diseases for the physician. This is a retrospective study on 23 children with acute ataxia who were admitted to the pediatric ward of Emam Reza Hospital from 1370-1375. The goal of this study is to elucidate the various etiologies of gait disturbances among this group, thus fascilitating correct and timely diagnosis is of importance. With regard to that, we need an exact history and a complete physical exam to diagnose ataxia, it is essential to perform the needed investigations in case we have excluded infections and toxicities. Also, in case of exclusion of infections and toxicities, it is necessary to perform skull CT. It is concluded that the most common causes of acute ataxia were infection (encephalitis, cerebellitis), intoxications, acute cerebellar ataxia and Guillain-Barre syndrome respectively. The mentioned etiologies accounted for 82.8% of the causes and the remaining 17.2% were due to kawasaki disease and brain stem tumors. In this series ataxia predominated among boys (56.5%) and also among the 1-6 years-old children (78.2%).

Objective: Increasing T.B. disease in world Specially MDR- TB is due to unstandard regimen. So we studied the treatment strategy in this region with high incidence smear + T.B. Patients & Methods: A retrospective non DOTS study of 406 cases with Pulmonary Tuberculosis Was done in 1376 & 77. According to WHO recommendation, they were visited in clinic as out-patients every two month for treatment. Results: The total number of patients were 912, 316 extra pulmonary TB, 596, Pul- TB. 190 smear negative and 406 smear positive Pul-TB. From those, cured 32.5%, complete treatment 33%, suceess rate 65.5%, faild 4.1%, defaulted 9.6%, prolong treatment 14.3%, referred to hospital 1.8%, chronic case 0.2%, and 0.5%, were died, conversion rate 67%.Conclusions: Observations supported that cure rate was low so DOTS strategy and education of medical staff may improve treatment out come.

Developmental Displasy of Hip (DDH) known as, congenital Dislocation of Hip (CDH) is one of the most common congenital anomalies.Delay in diagnosis and treatment causes secondary musculotendinous coptractures which ends up to arthrosis of the, hip and lumbosacral joints.Early diagnosis and treatment of this anomaly is very important for prevention of the secondary changes.In order to obtain reliable data for the incidence and early treatment of this anomaly, a study was undertaken over a period of one year in Gynecology Department of Imam Reza Hospital at Mashhad University of Medical Sciences (1989-1990) and 1611 newborns were examined by clinical and paraclinical methods.Each newborns was evaluated at first 24 hours after bearth.Dislocation and dislocatable hips were seen in %0.25 and %2 respectively. The treatment was started soon after the diagnosis for all of the cases, and controlled for at least 6 months and all cases were follow up for 10 years. Two cases were treated by hip spica cast, and 17 cases by pavlik harness, and others by triple diaper. After 6 months after treatment all causes had stable hips in imaging and clinical exams.It is concluded that early diagnosis and treatment of DDH (CDH) is very valuable to obtain the best results.

Mediterranean lymphoma is one of the primary Lymphoproliferative small intestinal disorder (lPSID) in which proliferation of plasma cell in the proximal small intestine leads to overproduction of IgA heavy chain, with their sequestration into the blood stream. There appears to be a spectrum of disease, varying from simple plasma cell infiltration to frank lymphoma, predominantly of immunoblastic type.Mediterranean lymphoma most commonly affects young adults from poor socioeconomic background.This study was performed to describ clinicopathologic feature of 45 patients with histologicaly confirmed disease, (26 male, 19 female). Median age of the patients were 27±11.5 years. Patients were predominantly of poor socioeconomic class. Main presenting feature were chronic diarrhea and the main involved location in small intestine were jejunum. According to the WHO classification 40 of the patients had stage A disease and remainder had stage B disease. In Conclusion we suggesed IPSID should be considered in differential diagnosis of the patient that present with malabsorpation and sever weight loss.

Upper gastrointestinal endoscopy was done for 396 patients with chronic renal. failure undergoing long - term hemodialysis as a part of routine evaluation before kidney transplantion over a 10 years period (1990-1999). Accepted endoscopic criterias for diagnosis of lesions were used. There were 251 (63.38%) men, mean age (33 yrs) and 145 (36.62%) women, mean age (35.7 yrs). 57.58% of patients had abnormal findings. Main endoscopic findings in order of decreasing frequency were as follow: erosive duodenitis and/or gastritis, esophagitis, angiodysplasia, hemorrhagic gastritis, gastric ulcer, duodenal ulcer.Since the incidence of upper (GI) complications (mainaly hemorrhage) increases markedly after transplantaion, and one could not predict these problems by looking at the symptoms in the dialytic stage, It is recommend that all kidney tranplant candidates have routine upper (GI) endoscopy before transplanation.

Hemoptysis is an important pulmonary symptom, because massive hemoptysis can represent an acutely life threatening problem, also it can be a marker for potentially serious disease such as bronchogenic carcinoma. In this study 92 patients with hemoptysis were avaluated. Among 92 patients, 77 (83.6%) were with mild hemoptysis and 15 (16.4%) with massive hemoptysis. Most common causes of hemoptysis in this study consist of Bronchiectasis 25%, active tubercolosis 21.7% and bronchogenic carcinoma 15%. In 7.6% had no Identify etiology for hemoptysis (unknown). Most common causes of massive hemoptysis were active tubercolosis 46.6% and bronchiectasis 26.6%.

Structural and functional changes of the brain are very common findings in heart diseases but there has been very little studies on the effect of different pathologies of the brain on functional and structural changes of heart rhythm.This paper briefly reviews the heart abnormalities in diverse intracranial pathologies. Including strokes, subarachnoid hemorrhages, brain tumors, spontaneous and traumatic intracranial hemorrhages, braib contusion or laceration and presents result of a one year retrospective and prospective study of heart abnormalities in patients with moderate to severe head injury. Different abnormalities such as: QT - interval, T-waves, U-waves, Q-waves, QRS - complex, ST-segment, atrial and ventrigular flutter and fibrillation, PVC, PAS, heart arrhythmias anginal pain myocardial infarctions and blood pressure change were recorded and analysed.This reports tries to deduce a rational relationship between the severity of a head injury, site of lesion and level of consciousness at time of addmission and cardiac abnormalities, different surgical procedures, site of operatton and prognosis.Also discussed is the preseces of the complete pathway for sympathetic outflow from the orbital - frontal cortex to limbic system via stellate ganglia to the heart. In conclusion, since cardiac abnormalities can greatly increase morbidity and mortality of patients with intracranial pathologies, emphysis is made on timely prevention and treatment of cardiac abnormalities prefereably by stabilization of homeostasis of the brain condition by medical and surgical techniques and anti- arrhythmic drugs should be avoided unless they are strongly indicated. Obviously ventricular flutter and fibrilation must be treated with counter shock and antiarrythmic drugs.

Background: Short stature is the most common clinical feature in Turner's syndrome. There are several conflicting reports regarding the growth in Turner/s syndrome. Patients and Methods: In this study, we compaired basal growth hormone (OH) and GH secretory respons to clonidine adaminestration after 1 hour in patient with Turner's syndrome (TS. No: 10) and normal short children (NSC. girls, No: 12).Results: The mean basal GH value were not significantly different between NSC (1.37±0.85) and Turner's syndrome (1.23±0.6). GH secretory response to clonidine adminstration after one hour were different between these two groups (NSC VS turner: 10.94±3.5 VS 2.21±1.6).Conclusion: Maximal growth hormone response to clonidine was significantly lower in Turner's syndrome in comparison with NSC.We concluded that hypotalamic somatostatin tone is impaired in Turner's syndrome.In recent studies normalization of height was done by GH treatment.We suggest GH therapy before beginning of estrogen replacement therapy.

In this study we tried to find risk factors of Acute Myocardial Infarction (AMI) in 100 patients under the age of 40 years in Imam Reza and Mosabn Jafar hospitals. All of the patients were hospitalized in CCU due to MI during Apr 1999 to Sep 2000.We studied influence of hypertension, hyper cholestrolemia and Low Density Lipoproteinemia (LDL), hypertriglyceridemia, diabetes mellitus, family history of Coronary Artery Diseases (CAD), and smoking, type of personality and physical inactivity in appearance of AMI under the age of 40 years.It was predominantly a disease of men. Unlike in old men, the main predisposing factor was smoking.According to this study, AMI could be prevented by controling the risk factors such as Smoking, physical in activity, hyperlipidemea especialy in young persons with positive family history of CAD, and type a personality.

Accumulation of subcutaneous fluids (Blood, Lymphatic fluid, Interstitial fluid and serum) due to traumatic crush injury was defined by Morell Lavalet at 1853. He published his studies about this problem: During 8 years we studied 8 cases of this syndrome since 1371. Because this syndrome gradually progress first week after trauma, delay in diagnosis is a common problem. Result of treatment is suitable with early diagnosis and appropriate surgical approach. All 8 our cases has traumatic lesions. Most of the patients (75%) were male & 25% were female.The lesion were found on different parts of their bodies imostly on lower extremities. It is suggested that Debridment of necrotic skin, dramage of subcutaneous fluid and if needed skin graft for defects are the routes of treatment. If accumulation of fluids is unique problem, the treatment is suction of fluids, insertion of vacuum drain with compressive dressing for 3 days duration. In the absence of complications prognosis is good.

Spinal cord compression due to extramedullary hematopoiesis is a well - described but rare syndrome in several hematologic disorders, including beta-thalassemia. The literature is not uniform about the optimal treatment of these syndrome and different modes of thrapy have been proposed so far, including surgical exision or decompressing laminectomy, small doses of radiotherapy, hypertransfusion. Three patients with thalassemia intermida, who developed neurological complications, are described. Diagnosis were based on the clinical findings, MRI, Myelography.Two patients were treated with surgery and transfusion and one with radiotherapy and transfusion. All of our patients have made almost complete clinical recoveries from cord compression.

Arsenic, particulary its mineral salts are very toxic and afects most of body organs. Arsenic poisoning cases admitted to the ward of Imam Reza Hospital are usually suicidal patients. Based one prisent, states tics the number of accidental and criminal Arsenic poisoining are seldom.In this report, three patients with criminal arsenic poisoning transferred to the poisoning unit are discussed. One of them who was a 45 your old man deceased right after admission due to the severity of acute As poisoning. The other two, an 8 years old boy and a 16 years old girl were survived after treatment with antidotes (Dimercaprol and Dipenicillamine) and supportive treatments. Following police investgations, the criminal subject was identified and went under trial. Conclusion: Physicians shoud be familiar with diagnosis and treatment of poisonings. The dangerous chemicals and Poisons must be regulated and control by the health authorities.

Calcium ions have a key role in the exitation as well as the contraction of cardiac muscle fibers, but is surprising that clinical evidence of cardiac failure observed infrequently in calcium deficiency stats.We have a few cases in medline search in 10 years ago. Case report: A 16 years old girl was admitted to the emergency ward with signs of CHF. She had past history of convulsion and cataract surgery two years ago. She had no evidience of underlying cardiac disease. Initial laboratory test reveals low level of calcium (6 mg/dl) (normal range 8.5-10.5), phosphor 4.2 mg/dl (normal range 2.5-5) and PTH 14.7 pg/ml (normal range 15-65 pg/ml) then, patient was treated with Calcium, Recaltrol, Digoxin- Hydrocholorothiazid, Captopril, and discharged with a good condition. In serial echocardiographial examination ejection fraction raising from 30% to 58%.

The most commonly employed relaxant for intubation is succinylcholine (sch).The great advantage of Sch is that. it produces excellent intubating conditions. usually within a minute and its rapid offset of action by ester hydrolysis. Several early case reports have suggested that patients with renal failure are susceptible to a hyperkalemic response to Sch.Nevertheless. more controlled studies showed that patients not to be any more suscpetible to an exaggerated response to Schthan are those with normal renal function.In this double - blind clinical trial study 40 patients were allocated randomly to two groups.The aim of the investigation was to determine the effect of schon potassium concentrations in serum during anesthesia in renal transplantation. Potassium values were measured 5 minutes before the induction and again 5 minutes after the induction of anesthesia.The groups were simillar with respect to demographic data and potential confounding variables.The meam change in serum K levels for Sch group was 0.45 mmol/lit (95% CI 0.16 to 0.7 mmol/lit) and 0.2 mmol/lit (95% CI - 0.3 to 0.35 mmol/lit) for control group but there were no statistical differences between the two groups. Our results indicate that the administration of Sch in chronic renal failure might be possible without significant increasing of serum potassium level.

Ataxia-Telangiectasia (A-T) is a inherited multisystem disorder that transmited as autosomal recessive and characterised by oculocutaneous telangiectasia, severe cerebellar ataxia, variable immunodeficiency and a high incidence of multiple infections and malignancy. The neurologic symptoms usually dominate the clinical picture with onset at about the time that child is learning to walk. The disorder frequently results in profound disability, with the patient becoming almost totally dependent on others for care and even feeding.In this paper we report one case from Department of Pediatrics in Imam Reza Hospital that has had total nervous, dermal, occular and infectious symptoms with acute lymphoblastic leuckemia.