Journal of Kerman University of Medical Sciences
Year:2005 | Volume:12 | Issue:3|Papers Count:11

Background: Cancer as the second leading cause of death following cardiovascular diseases has always been a threat to human life and due to its peculiar nature and lack of a favorable treatment, it is considered as a research priority in all communities. Understanding the geographical distribution of the incidence of various tumors, constitutes the first step in health and treatment planning. This study was carried out to review the incidence rate of gastrointestinal cancers in Kerman province and estimate disease load in this geographical area. Methods: Through a community-based registration system, all the documents related to cancer diagnosis in Kerman province from 1996 to 2000 were investigated.Results: Among 5867 registered cases of cancer with an average age of 51.5±20.6 years, men composed 55.5% and women 44.5% of the cases and 1303 ones (22.2%) had gastrointestinal tract cancers among them gastric tumors (39%) had the highest incidence rate. Following gastric tumors, tumors of colon (29.4), esophagus (12.5%), liver (5.83%) gallbladder (5.3%), and pancreas (2.84%) acquired the next ranks in regard to the incidence rate. The incidence pattern of aforementioned cancers in men showed the same pattern as the general population, but in women, colon tumors with the incidence rate of 35% have the highest incidence rate while tumors of the stomach (29.71%), esophagus (10.15%), gallbladder (9.8%), liver (5.26%) and pancreas (4.32%) were the next. Conclusion: Although, various GI malignancies have a lower incidence rate in Kerman province compared with other countries, the fact that these malignancies account for 22.4% of all malignancies, greatly enhances the need for serious planning for prevention, early diagnosis and correction of improper dietary habbits in the province. Moreover development of a versatile cancer registration system to evaluate the domestic comparisons seems essential.

Background: Internal medicine consultants are frequently asked to evaluate patients' tolerance against the stress of an intended surgical operation. Classification of surgical operations to mild, moderate and major is based on the morbidity and mortality rates due to the procedure, duration of procedure and underlying risk factors of the patient.Body response to surgical stress is via some hormonal alterations following the activation of hypothalamo pituarity adrenal axis (HPA) and hormonal changes reflect the degree of surgical stress. Due to high prevalence of addict patients operated in our surgery center and the established effect of opioid agents on HPA, this case-control study designed to detect the effect of chronic opioid usage on body response to major operation stress.Method: Twenty six patients selected for laparatomy, thoracotomy or thyroiedectomy in two equal and matched groups of opium-addict and nonaddict were studied for alterations in serum cortical, CRP, Glucose and interleukin-6 immediately after the induction of anesthesia and 4 and 24 hours postoperatively. The obtained results were analyzed by t-test.Results: Serum cortical level of addict group 24 hours after operation (288ng/dl) showed significant increase comparing to that of non-addict group (195ng/dl).Conclusion: The obtained result show more severs response of opium addicts to major surgery stress comparing to non addicts.

Background: Nowadays the main problem in transplantation is the complexity of host immune system protection against the immunological and destructive reactions of the transplanted organ. High serum level of the immunosuppressive drug may cause toxicity and low serum level leads to the rejection of the transplanted organ. Cyclosporine has been known as the most effective immunosuppressive drug. Our goal in this study was to determine the relationship between cyclosporine serum level and administered dose in renal transplant recipients in order to find the optimum cyclosporine dose in Kermanshah kidney transplantation center.Methods: This descriptive-analytical study with simple sampling was done on 80 renal transplant recipients (51 males and 29 females) in Kermanshah transplantation center. At least 6 months after transplantation. In patients with stable conditions, cyclosporine peak and trough levels were measured by specific monoclonal, Radio Immuno Assay (RIA) method over a period of 3 months. Other biochemical parameters were measured too. Data were analyzed by X2 and ANOVA tests.Results: Mean cyclosporine Trough and Peak levels were 271.9±85.2 and 904.5±414.2ng/ml respectively, for the treatment dose of 3.25±1.46mg/kg B.W. There was no significant difference between trough and peak levels in all three administered doses and the range of administered dose was 1.79-4.71mg/kg B.W. According to the findings, cyclosporine serum concentrations and the administered dose range differed from other studies. This may be due to pharmacologic and pharmacokinetic differences of the drug and individual physiological characteristics of patients. The minimum dose of 1.79 and maximum dose of 4.71 led to optimum treatment in stable patients and could prevent rejection or toxic effects. Cyclosporine peak level was obviously different from other studies; however it showed better relationship with clinical status.Conclusion: Conversion from the routine cyclosporine Ctrough monitoring to Cpeak monitoring is recommended in Kermanshah kidney transplantation center.

Background: Opioids may affect hypothalamic GnRH secretion and Hypothalamic-Pituitary-Gonad axis, resulting in reproductive disturbances. Current study investigates the effects of morphine on structure of ovary following superovulalion through morphologic/morphometric studies.Methods: Twelve young female NMRl mice were allocated into treatment and control groups. Treatment group received oral morphine at final dose of 0.4mg/ml for 21 days. Physical dependency was proved by injection of naloxone (2mg/kg ip). The mice were super ovulated by 10 iu PMSG (ip) and 48 hours later were sacrificed by cervical dislocation. Ovaries were removed and H&E staining was done. Every 10th serial section, which represents nonrandom 10 percent sample was counted. Follicles were classified into small, growing, antral and atretic according to the diameter and number of follicular cell layers surrounding oocytes. The volume and the weight of ovaries were recorded. In addition, the diameter of the antral follicles and oocytes was carefully measured by a calibrated oculometer.Results: The volume and the weight of ovaries showed no significant alterations in the two groups. The proportion of small and atretic follicles was statistically different in treatment and control groups (P<0.001).Conclusion: According to our data, oral morphine did not alter the volume and the weight of the ovary. However, folliculogenesis was moderately affected by morphine and following superovulation the behavior of ovaries in the treatment group is comparable to the control group.

Background: The value of CA 15-3 (cancer antigen 15-3) marker in early detection of breast cancer recurrence has been studied in several prospective trials. But the results of these studies are different. This may he due to variahle cutoff points used for analysis, different intervals' between CA 15-3 measurements and the differences between patients population. This study was done to examine the predictive value, semitivity and specificity if CA15-3 in detection of breast cancer recurrence in Iranian patients, using a commercial available ELISA assay with a cut-off value of 30u/ml. Methods: For this purpose serial blood samples and clinical data of 133 female patients with breast cancer referring for adjuvant treatment to Radiation Oncology Department of Shiraz University of Medical Sciences from 1379 to 1382 were collected and for all cases of clinically suspected recurrence, routine methods were used for documentation.Results: Mean age of patients was 45.6 years (SD 11) and mean time of Follow up was 17.5 months. Recurrence was documented in 39 patients who were classified into 4 groups: patients with documented recurrence and early elevated marker (true positive, 32 patients), patients with documented recurrence but no elevated marker(false negative, 7 patients), those without recurrence and normal marker (true negative, 76 patients) and those without recurrence but elevated marker (false positive, 18 patients). According to these data sensitivity, specificity and positive and negative predictive values of CA15-3 were 82, 80.85,64 and 91.5 percent respectively.Conclusion: CA15-3 with cut-off point of 30u/ml has an adequate sensitivity and specificity for early detection of breast cancer recurrence in Iranian patients.

Aim: This study was done to evaluate the rate of microleakage in class V amalgam restorations in which the dental bonding agent (DBA) Excite was used as a sealer beneath the restorations.Methods: four amalgam restorative materials with commercial names of Dentam, Cinalux, Tytin and SDI (GS-80) were used. Seventy sound human premolars were selected and randomly divided into 4 groups of 15 teeth and 2 groups of 5 teeth as negative and positive control groups). Clays V cavities were prepared on the buccal surface of each tooth. Excite was applied on the surface of all cavities and then teeth were cured and restored with four selected amalgam restorative materials. Then teeth were thermocycled (500 cycle) and immersed in 2% methylen blue solution for 24 hours. After immersion, teeth were thoroughly washed with tap's water, and sectioned using a diamond disk. Conclusion: Based on microscopic evaluation and Kruskal-wallis test, Cinalux (An amalgam filling material manufactured in Iran) showed maximum of microleakage in comparison to other amalgam filling materials used in this study, however it's value was not significant.

Background: Nowadays, the most important aspect of hemodialysis is the technical method of anticoagulation of extracorporeal circuit. This quasi-experimental study was performed to compare three methods of heparinization in the extracorporeal circulation.Methods: Twenty-seven hemodialysis patients referring to Rafsanjan Hemodialysis Center with the weight range of 50-90 kg and normal Clotting Time and Partial Thromboplastine Time were selected and underwent three methods of anticoagulation rotatively. In the first method, only a single bolus injection of heparin (5000 IU) at the beginning of hemodialysis was applied. In the second method a primary bolus of heparin (2000 IU) followed by heparin infusion (1000 IU/hour) from the beginning of second hour to the end of third hour was used. In the third method, a single bolus injection at the beginning of hemodialysis and another injection (2500 IU) at the end of the second hour were applied. The amount of clot formation was evaluated at the end of the hemodialysis session by visual inspection.Results: The amount of clot formation in the first method (%92.6) was significantly more than those in the second and third methods (P<0.05).Conclusion: Although the first method is currently being used in some hemodialysis centers, it is not safe and accurate in comparison to the other two methods.

Background: Tramadol is an opioid analgesic indicated for the management of moderate and severe pains. Its side effects, in parts are due to the activation of µ receptors and in parts to increasing central catecholamine and serotonin levels. In the case of long administration, tramadol has a potential to cause dependency, tolerance and also drug abuse.After prohibition of injective diclofenac, considering Iranian's tendency for rapid sedation of pain symptoms, tramadol has been prescribed widely. The aim of this study is to determine general practitioners knowledge about this new drug.Method: This cross-sectional study was arranged by collecting data through a self-administrated questionnaire consisted of 25 questions related to different aspects of drug knowledge. Sample consisted of 244 general practitioners in Kerman and data analysis was performed by SPSS.Results: Out of 173 general practitioners, 49.1% worked in clinics, 34.9% in private offices and 16% in Emergency Units. Mean knowledge score was 30.72±0.35 out of the maximum of (50). From all subjects 49.7% had poor knowledge (Z<-1), while 39.3% had moderate knowledge (-1<Z<1) and only 11% were sufficiently informed (Z>1).The poorest information was in regard to drug classification and pharmacokinetics, while in dosage and side effects subjects' knowledge was better. No correlation was observed between mean score and variables of job experience, duration, place and sex of practitioners.Conclusion: Considering serious side effects and drug interactions of tramadol and also the low level of knowledge of general practitioners about this drug, educational programs and limitation of distribution seems to be necessary.

Meningioma is considered as a benign central nervous system tumor that accounts for approximately 18% of all brain tumors. About 5% of meningioma tumors are malignant and have more aggressive clinical signs and worse prognosis compared to benign tumors. Extracranial metastasis of meningioma is rare but in the case of occurrence, it is more prevalent in lung, liver and lymph nodes. Osseous metastasis including vertebra has been reported very rarely. Here we report a young male patient with intracranial malignant meningioma who developed signs of lumbar spinal involvement of metastatic malignant meningioma after one year.

An extremely rare case of floating second metatarsal is reported. The reported case is a young man with simultaneous dislocation of tarsometatarsal and metatarsophalangeal joints of the second metatars following a car accident. Because of patient's discontent for open surgery, blind percutaneus pinning was performed that was not completely successful and in follow up radiography, 18 months later, degenerative joint disease (DJD) signs were observed. In examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the whole foot as the forces acting on it which are axial and compressive can injure the metatarsophalangeal joint (in the same or the adjacent ray) as well. After reporting the case, we will discuss the probable mechanism and different aspects of this rare traumatic injury.