Studies in Medical Sciences
Year:2007 | Volume:18 | Issue:3|Papers Count:17

Backgraund & Aims: Polycystic ovary is not a disease but a syndrome and clinical findings, lab techniques, and sonographic methods help to diagnose it. In the past, extendive studies were carried out to determine the best criterion of diagnosing polyeystic ovary syndrome. This study aims at surveying the validity of vaginal sonographic criteria in diagnosis of Pcos compared to indea group and multifollicular ovary (Mfo).Materials and Methods: In this study, ovary volume, surface and stroma surface and ratio of the storma to total surface of the ovary were measured in 60 amenoria and oligomenoria females afflicted with Pcos. Ten women with multifollicular ovary and 30 normal women in the second or third day of the vaginal bleeding were measured through vaginal sonograpy. Then sensitivity and particularity of these criteria were determined in the Pcos patients compared to the index and multifollicular group.Also, using the independent “T-test” the mean of ovary surface, stroma surface, and ratio of stroma surface to ovary surface was compared in the Pcos group to Mfo group.Results: Generally speaking in the patients afflicted with Pcos, ovary volume and surface, surface of stroma and ratio of stroma surface to the surface of the ovary was higher than the index group and Mfo. Sensitivity of these radiologic criteria in diagnosis of Pcos compared to index group and Mfo, 70.13%, and 73.85%, 72.29%, and 69.77%, respectively, and their particularity in diagnosis of Pcos was 73.91%, 65.71%, 100%, and 100%, respectively. Carrying out the independent T-test, for comparing the mean size of the ovary surface, there was no significant difference between Pcos and Mfo groups (P>0.05) while for the variables of stroma surface and ratio of stroma surface to the ovary surface, there was a significant difference between the two groups (P 0.05).Conclusion: Measurement of the stroma surface and ratio of stroma surface to the ovary surface is of a higher credit in diagnosis of Pcos compared to the index and Mfo groups.

Background & Aims: In this study, we evaluate the results of urethroplasty with buccal mucosal graft (BMG) in urethral strictures of anterior urethra longer than 4cm in adult patients.Material & Methods: Over a period of 3 years (2001 - 2004) a total of 12 patients (from 18 to 60 years old) with urethral stricture (8 cases of bulbar urethra and 4 cases of pendolous urethra) longer than 4cm underwent dorsal onlay BMG urethroplasty (Babagli technique) in our center. We performed retrograde urethrography (RUG) and VCUG, and up and down cystourethroscopy for all patients preoperatively and then followed them for obstructive urinary symptoms and with retrograde urethrography and VCUG, postoperatively.Results: Mean follow-up period was 22 months. All 12 patients became asymptomatic and had normal imaging studies, postoperatively. After primary improvement one patient (8 months after the operation) became restenotic due to STD urethritis for whom internal urethrotomy was performed. No major complication was seen.Conclusion: Dorsal onlay urethroplasty (Barbagli procedure) using BMG has a high success rate with no complication for long urethral strictures.

Background & Aims: Intracranial Hemorrhage (ICH) is one of the major causes of the neonatal mortality and morbidity. The aim of this study is to determine the prevalence and role of various factors in developing ICH in neonates hospitalized in newborn ward and NICU of Imam Khomeinie Educating Hospital, Urmia-IRAN.Materials & Methods: It is a retrospective and descriptive study that was done on all neonates who were admitted in the neonatal and NICU ward from April 2001 to March 2003. ICH was diagnosed by cranial sonography, brain CT scan or at autopsy. After having their questionnaires filled, results were analyzed with SPSS software.Results: Fifty-two newborns had ICH (1.38% of hospitalized newborns) and propotion of different types of ICH was: subaracnoid hemorrhage (40%), intraventricular hemorrhage (36%), intra parenchymal hemorrhage (21%), and subdural hematoma (3%). Proprtion of sepsis was 36%, asphyxia 14.5% and respiratory distress syndrome 11.5%. The commonest symptoms and signs of patients were hyporeflexia (75%), convulsion (60%), respiratory distress (40%), apnea (32%) and hypotonia (25%). The most important Para clinical finding other than imaging was bloody CSF (36%).Conclusion: The close prevalence of subaracnoid and intra ventricular hemorrhage may be the result of lower survival chance of prematures and not doing portable ultrasonography. The most common associated disease was sepsis. The commonest presentations of patients were hyporeflexia, convulsion, respiratory distress, and apnea. We recommend cranial sonography for intranial hemorrhage bedsides cranial ultrasonography in all neonates with disease states, risk factors or clinical presentations.

Background and Aims: Violence against women is any act of gender-based violence that results or is likely to result, in physical, sexual, or psychological harms or suffering to women, whether occurring in public or private life. Our study was designed to a) identify demographic and socioeconomic risk factors associated with physical domestic violence among women attending the legal medicine center, and b) offer strategies for decreasing its incidences and outcomes.Materials and Methods: This case-control study recruited participants from Urmia City Legal Medicine Center. Socio-demographic characteristics were analyzed for physically abused cases (n = 133) and controls (n = 133, women referred to legal medicine center without physical abuse history).Multivariate logistic regression models were used to examine associations between physical violence against women and the factors of interest.Results: Significant risk factors for physical violence against women resulted to administer justice includeing women's higher literacy (adjusted odds ratio (AOR) 3.54, p=.000), husbands higher literacy (AOR 2.56, p=.000), women's occupying (AOR 2.70, p=.000), husbands unemployment (AOR 3.70, p=.010), husbands membership of staff (AOR 5.37, p=.000), first years of married life (AOR 2.17, p=.010), and engagement times (AOR 4.65, p=.010).Conclusion: This study demonstrates some previously dentified domestic violence risk factors, but there were strong evidences of socioeconomic factors variability in violence against women.Significant associations between physical violence against women showed that justice and women's higher literacy and women's occupying is probably due to acquaintance of educated victims with their legal and human rights.

Background & Aims: This study aims at comparing intracervical Foley catheter and low dose oxytocin infusion for ripening of cervix in term pregnancies with an indication for termination.Materials & Methods: A randomized controlled trial was performed in Akbarabadi Teaching Hospital for six months, 2001-2002. Eighty four patients who had at least 37 weeks gestation or more and cervical Bishop score of £4 were randomly assigned in two groups.In 42 patients (foley catheter group) a Foley catheter was inserted into the cervical canal and the balloon of catheter was filled with 30cc distilled water and fixed just behind the internal cervical ostium, and in the other 42 patients (oxytocin group) oxytocin was infused at a rate of 2.5 mu/min (16 drop/min of a solution of 2.5 U oxytosin in 1000 cc Ringer), and two protocols were continued for 12 hours in both groups. After 12 hours of performing each protocole, final Bishop score and also each parts of Bishop score were compared separately with the first ones.Results: In Foley group, the mean Bishop score was 1.33± 0.75 and 5.33±2.12 before and after the protocol (P<0.005, Pair T Test) and in oxytocin group it was 1.42±0.7 and 5.1±2.82 before and after the protocol (P<0.005, Pair T Test) which showed statistically significant difference, but the final Bishop score (5.33±2.12 versus 5.1±2.82) in both groups did not have statistically significant difference which meant the effect of both methods are equal. In Foley group, the score for dilatation of cervix was 0.92± 0.26 and 2±0.38 before and after the protocol and in oxytocin group, it was 0.95±0.21 and 1.21± 0.6 before and after the treatment, and the increase in dilatation score showed a statistically significant difference (P<0.005) between the two group which meant that Foley catheter can improve the dilatation score better than oxytocin.In contrast, cervical effacement score in Foley group was 0.28±0.45 and 1.04±0.69 and in oxytocin group was 0.4±0.49 and 1.59±0.73 before and after the procedures, and increase of the score showed a statistically significant difference between the two groups (P<0.005) which meant oxytocin improved the effacement score better than Foley catheter. Improvement of other parts of Bishop score did not show significant differences between the two groups.Conclusion: Both methods are suitable, safe and inexpensive methods for ripening cervix. As Foley catheter improves cervical dilatation and oxytocin improves cervical effacement, it is better to use both methods simultaneously.

Background & Aims: Erectile dysfunction (ED) is a highly prevalent problem among hemodialysed patients that is often under-diagnosed and under-estimated.Materials & Methods: A prospective clinical trial was conducted to determine the prevalence of ED in hemodialysed (HD) patients and the effect of successful renal transplantation (RT) on improvement of erectile dysfunction. Eighty eligible HD men assessed by international index of erectile function version 5 (IIEF-5) and then 6 months later 64 available patients with successful RT were reassessed by IIEF-5.Results: The prevalence of ED in HD patients was 87.5%. Although there were some differences in the prevalence of ED between patients older and younger than 50 years old, this difference was not statistically significant. There was no relationship between the duration of dialysis and severity of ED in HD group. Compared to pre-RT IIEF-5 score (13.59), this score showed significant improvement (19.16). In an attempt to find predictors of improvement of ED after RT, linear regression analysis with backward method was used. Pre-RT IIEF-5 score, age at the time of RT, and anastomosis to the common iliac artery had statistically significant association with the chance of improvement, but the duration of dialysis and anastomosis to internal iliac or external iliac artery did not.Conclusion: Prevalence of ED in HD patients is exceedingly high and has profound negative impact on their quality of life. So with respect to the development of effective oral therapies for ED, urologists should include ED assessment when evaluating HD and RT patients. At last it is better to perform RT at lower age in respect to improvement of ED.

Background & Aims: Colon adenocarcinoma is a prevalent cancer throughout the world. The incidence of this cancer is 3.39% of all malignant tumors in Khorasan province (North-East of Iran).Although the surgical removal of the adenocarcinoma is the main route of treatment at present, the survival is not so good in most patients. It seems that any other approach for the treatment of this cancer with possible eradication of tumor or improvement of survival rate and duration is of great interest.Alpinia galanga L is a medicinal plant. Various therapeutic effects such as antibacterial, analgesic and anti- inflammatory, vasodilatory, neuronal protective and hypoglycemic effects have been reported about this plat. Several studies have also demonstrated anticancer effects, growth inhibitory, and cytotoxic effects for Alpinia galanga or its different components. The anticancer effects of these components are due to scavenging of free radicals, inhibition of enzyme activities and inhibition of cytotoxicity. The aim of this study was to investigate the possible effects of ethanolic extract of Alpinia galanga on proliferation and growth of HT-29 (human adenocarcinoma of colon) as case and L929 (normal mouse fibroblast) cell lines as control.Materials & Methods: Ethanolic extract of rhizemes from Alpinia galanga were prepared by soxhelet and both cell lines were studied by morphological and MTT assays. Both HT-29 and L929 cell lines were treated with equivalent of 250, 500, 750, 1000 and 1500 mg/ml of Alpinia galanga from the ethanolic extract in culture medium for intervals of 24,48 and 72 hours. Both cell lines were studied under light inverted microscopes for shape, granulation, and anchorage independency. At the same time anti-proliferative properties of the extract were determined for both cell lines by MTT colorimetric assay. The results were compared by one-way ANOVA followed by Tukey-Kramer and when P-values were less than 0.05, the differences were considered to be significant.Results: The data demonstrated that ethanolic extract of the plant had inhibitory effects on HT-29 cell line but no inhibitory effects were seen for L929 cell line. The IC50 for HT-29 cell line with ethanolic extract at 72 hour was 250 mg/ml.Conclusion: In conclusion, these data demonstrate that ethanolic extract is effective and exert inhibitory effects on growth of HT-29 cell line. Therefore, it may be suggested that the ethanolic extract of Alpinia galanga L. would have inhibitory and protective effects on human colon adenocarcinoma and may be used in treatment of adenocarcinoma of colone in man. Keywords: Alpinia galanga L, Ethanolic extract, Colon adenocarcinoma, HT- 29 cells, L929 cells.

Background & Aims: Hemoglobin (Hb) concentration may or may not be decreased by blockade of renin-angiotensin system (RAS) after renal transplantation. In this study, Hb concentration secondary to enalapril (E) and /or losartan (L) is evaluated with respect to RAS polymorphisms.Materials & Methods: After determination of RAS polymorphisms consist of ACE (DD, non-DD), angiotensinogen (TT, non-TT) and angiotensin receptor (CC, non-CC) by polymerase chain reaction, seventy renal transplant recipients were recruited to four groups randomly; first and second groups were treated with E (10mg/d, 15 patients) and L (50mg/d, 20 patients) alone, respectively. The third group received E+L (10mg/d + 50 mg/d, 13 patients) and the forth group (22 patients) received no medication. The treatment protocol was followed for 16 weeks. Complete blood counts were checked before treatment and every 2 months. Values were expressed as mean±SD; P<0.05 was considered to indicate statistical significance.Results: Treatment for 4 months decreased the Hb level in the E+L (14.15±0.94 to 12.06±0.66 g/dl, P=0.000); E (14.00±0.86 to 13.11±0.82 g/dl, P=0.02) and L (14.12±0.90 to 12.10±3.25 g/dl, P=0.01) groups, but not in the control group (13.55±0.70 to 13.36±0.69 g/dl, P=0.22). None of the above regimens was more Hb reducer than the others (P=0.21). DD genotype of ACE was the only genotype among the RAS polymorphisms, which associated with higher Hb concentration. (14.29±0.41 vs. 13.44±0.76, P=0.04) but none of the RAS polymorphisms could predict the intensity of the reduced Hb according to the type of treatment. Any other sets for RAS (alone or together) did not impact on Hb levels in pre and post intervention.Conclusion: Our findings suggest that low dosage of E and/or L in RTRs can decrease Hb levels regardless of the RAS polymorphisms. DD genotype of ACE polymorphism was associated with higher Hb concentration.

Background & Aims: Turner syndrome (TS) is a sex chromosome disorder which is related to the loss of X chromosome material. The Turner patients’ phenotype is always female. Approximately half of TS female have a karyotpe 45, X. Since the disease has variable phenotypes, in this study it was aimed to assess the relationship between patients’ clinical findings and their karyotypes.Materials & Methods:Clinical examination and paraclinical investigation were carried out in all suspected cases by gynaecologist. The sixty candidate patients were sent for chromosomal study using GTG banded karyotype.Results: The karyotype analysis of the patients were as follows: Karyotypes of 41.7% (25) of the patients were 45, XO and 58.3% (35) karyotypes’ of the patients were: 45, XO/46, XX, 45, XO/46, X i(Xq), 45, XO/46, X i(Xq)/47, X 2i(Xq), 45, XO/47, XXX; 45, XO/46, XX/46, X i(Xq), 46,XX, del(Xp), 46, X+ mar, 46 X i(Xp). Major clinical findings include: cubitus valgus, shield chest, low hair line, abnormal ear, microgenatia, webbed neck, abnormal nails, lymphedema, and ptosis. The frequency of the clinical symptoms differs in two classic turner and mosaics groups.Conclusion: Combination of clinical and paraclinical findings such as chromosome typing could help for better diagnosis and analysis of clinical manifestation in the patients.

Precocious puberty is defined as true puberty with onset before 8 years in girls and 9 years old in boys.In some cases, central precocious puberty (CPP) may be the only manifestation of a CNS tumor.Hypothalamic hamartoma (HH) is a congenital malformation consisting of a heterotopic mass of nervous tissue that contains Gonadotropin Releasing Hormone (GnRH) neurosecretory neurons attached to the floor of third ventricle. It is a well recognized cause of CPP and in some cases gelastic seizure. The diagnosis of CPP due to HH is suggested by early onset of sexual precocity, generally before 2 years of age. MRI is the imaging method of choice in the diagnosis of CPP. HH should not be approached surgically except in unusual circumstances such as intractable seizures. The precocious sexual development can be controlled by treatment with Luteinizing Hormone- Releasing Hormone (LHRH) agonist therapy. Here is a case report of an 18 month-old girl with complaint of vaginal bleeding who had CPP due to HH.

Penetrating head injuries are most commonly due to traffic accidents. Attempting suicide by nail is very rarely reported. We report a 50 year-old man who attempted suicide by a 20 cm nail. Using a brick, he pushed the nail from midline of skull into his superior sagital sinus and brain. We are reporting peninsular like craniotomy for the first time in the world. This approach shows a safe way to extract the nail.

Spinal cord injury is a severe and complicated injury that primarily affects young people. One of the most important disabilities of these patients is inability of ambulation. So standing and walking ability is an important goal for rehabilitation program. One of the newly developed orthosis used in patients with upper level of injury such as thoracic or upper lumber is ARGO. This orthosis is a kind of THKAFO orthosis. This is a case report of a 36 year-old women with spinal cord injury at L2 level since 20 years ago. For this patient, an ARGO was implemented and after complete rehabilitating program, including education and gait training in a 9 month follow-up, she achieved household ambulation using 2 crutch.

We report extensive necrotizing fasciitis and septic shock following extraction of tooth in a 43 yearold male with history of diabetes. Necrotizing fasciitis is a fatal, life threatening, and rapidly progressive and prompt and multidisciplinary treatment including surgery, bord spectrum antibiotics, and hyperbaric oxygen therapy after early disgnosis can be useful.