Studies in Medical Sciences
Year:2004 | Volume:15 | Issue:3|Papers Count:13

Background & Aim: D & C is a standard method for evaluation of endometrial lesions, which requires hospitalization and anesthesia and may have serious complications in some cases. In contrast, outpatient endometrial sampling is a safe, ambulatory and cost-effective method. The aim of this study was to compare the correspondence between histopathologic diagnosis of D & C and outpatient endometrial biopsy.We wanted to replace the D & C by outpatient endometrial sampling, if correspondence will be acceptable.Materials and Methods: We studied prospectively 100 consecutive patients who admitted at Urmia Kosar Hospital in 2003 for D&C. Outpatient endometrial sampling with pipelle (Endorette) were performed followed immediately by D&C. Statistical analysis were done according to histopathologic findings.Results: In this study overall correspondence was 74.7%. In 71.6% of outpatient biopsies and 85.3% of D&C sample volume were sufficient. In the cases that endometrial thickness was more than 5 m.m., outpatient sample volume adequacy was 71%. but only 29%, when endometrial thickness was less than 5 m.m. The sensitivity and specificity were acceptable in the cases of proliferative and / or secretory endometrium, hyperplasia and endometrial cancer.Discussion: Endometrial thickness can be a criteria for selecting appropritate method of endomtrial sampling. When the result of outpatient biopsy is other than proliferative and/or secretory endometrium, hyperplasia and endometrial carcinoma, confirmation of outpatient sampling with other techniques should be done.

Background & Aim: Knee osteoarthritis is one of the common elderly conditions which irrespective of the causes, has similar pathologic and clinical features. OA can involve three compartments of knee joints, medical and lateral tibiofemoral and patellofemoral compartments. Main clinical findings are pain, swelling and stiffness. No definite treatment and management is based on reduction of symptoms and decreasing disease progress. Analgesic drugs and intraarticular injections cause sedation temporarily so physical therapy is considered as the most effective treatment on knee with OA. Physical therapy aims are:Sedation of pain, stiffness, force, joint biomechanics' condition, reduction of excess load and improvement of range of motion. To reach these aims, heating and electrical stimulation modalities and proper isometric exercises are used.Materials & Methods: Seventy patients with OA of knee who did not use drugs, managed with physiotherapy and evaluated in physical medicine & rehabilitation department. Patients got 10 sessions physiotherapy and pain, quadriceps muscle force graded before & after physical therapy, then all data were assessed with SPSS.Results: Evaluation of data showed: reduction of pain was little at 8.6% of patients, 65.7% moderate & 25.7% high. Quadriceps force improvement was little at 11.4% of patients, 62.8% moderates, 25.7% high. Pain reduction & force improvement also evaluated based on age and gender.Discussion: This research showed, female patients proportion to males was 3.5 which is compatible with references. Pain reduction &force improvement have complete compatibility. AS OA is a senile condition with more prevalence after 50 years, rehabilitation is more effective at these ages.

Background & Aim: Planning for providing essential mental health services to the people requires knowledge about the present status of psychiatric disorders in the society. The objective of this research was to carry out the epidemiological study of the psychiatric disorders in the individuals 18 years and above in urban and rural areas of Ardebil province.Methods & Materials: 394 individuals were selected through randomized systematic and clustered sampling methods from the families of Ardebil province and the Schedule for Affective Disorders and Schizophrenia (SADS) questionnaires were completed by clinical psychologists based on DSMIV classification criteria.Results: The results of the study showed that the prevalence of psychiatric disorders in the province is 12.69 percent (17.11 percent in the women and 8.69 percent in the men). The mood disorders with 4.82 percent had the higher prevalence in the province. The prevalence of psycho tic disorders in this study was 0.25 percent, anxiety disorders were 3.31 percent, neuro-cognitive disorders were 3.56 percent and dissociative disorders were 0.76 percent. In the group of mood disorders, major depression with 4.82 percent and in the group of anxiety disorders, generalized anxiety disorder with 1.27 percent had the higher prevalence. The prevalence of psychiatric disorders in the province among the individuals in the age group of 66 years and above with 16.67 percent, individuals whose spouses had passed away 31.25 percent, the residents of rural area 13 percent, the illiterate individuals 15.56 percent and unemployed individuals 21.05 percent' were more than other individuals in the sample.Discussion: This study also showed that 9.90 percent of the individuals suffered from at least one of the psychiatric disorders. Being aware of this matter reveals the responsibility of the health policy makers and planners about preparing application and executive plans in Ardebil province for mental health.

Background & aim: Electroconvulsive therapy consists of electrical stimulation of the CNS that initiate seizure activity is believed effective treatment of major depression in patients unresponsive to medical therapy. Generally believed that overall seizure duration is a primary determinant of treatment efficacy. Ketamine can reduce seizure threshold theorically. Regarding to this effect, we hope induction of anesthesia for ECT with ketamine, can result more effective electroconvulsive therapy.Materials &methods: 40 patients selected for this prospective clinical trial, were suffered from major depression and candidated for ECT. Physical status of patients was class I, II and aged between 20 - 50 years old.After admission, patients divided into two group (each consists of 20 patient) .At first group received thiopental (3mg / kg) and second one received ketamine (I mg / kg) plus midazolam (1mg/70kg). Succinylcholine (0.5mg/kg) provides muscle relaxation and patients received standard shock by psychiatrist. Convulsion time and hallucination recorded in two group and tram/erred them to PACU after respiratory support. Regarding to vital signs stability, including regular breathing, awareness and responsiveness, recovery time recorded.Results: Average seizure time was 28.2 sec in first group and 35.6 sec in second group, with significant difference (P=0.004).Mean recovery time in thiopental group was 21.82 min, compared with 23.24min in ketamine group with insignificant difference (p=0.225). Average hallucination incidence was 5% in each group.Discussion: Study showed that Ketamine can increase seizure duration with little change on recovery time. Simultaneous administration of midazolam, Decreases hallucination rate with minimal effect on seizure threshold.

Background & Aim: The study of spermatid chromatin can show the quality of spermato-genesis. In this paper, the ultra structure of elongated spermatid nuclear chromatin (nuclear maturity) in testicular tissues has been investigated.Materials and Methods: 12 biopsies of testicular tissues from patients with non – obstructive azoospermia as a patients group, and 5 biopsies from person with normal spermatogenesis as a control group were selected. The samples were fixed and processed for electron microscopy (EM), and elongated spermatid chromatin examined.Results: In control group, the spermatids have a condensed chromatin. But in patients, the mentioned cells had not matured, So, the chromatin condensation was less than normal, and also, the chromatin has a coarse granular pattern.Discussion: Results showed that maturity of spermatids in patients was incomplete. This immaturity may be one of the cause for the failure in normal spermatogenesis.

Introduction: Microscopic evaluation of cervicovaginal smears (Pap smear) plays an essential role in detection of the preneoplastic and neoplastic lesions of uterine cervix. A wide spectrum of changes are seen in Pap smears. Interpretation of intermediate changes which resulting in observation of so-called ASCUS is difficult. ASCUS is defined as a cellular change that is more marked than typical reactive change but lack features diagnostic of intraepithelial neoplasia. Different studies revealed that in 30%-40% of cases with ASCUS in Pap smear, dysplasia was seen in biopsy sample.The aim of this study was determination of reliable cytologic parameters to identifying real nature of ASCUS.Methods: In this near 4 years investigation, all Pap smears with presence of ASCUS which followed by biopsy samples were reviewed. In this regard 17 parameters of cytoplasm, nuclei and smear background were considered and the datas analysed by SPSS and Chi Square test.Results: After statistical evaluation, we found that 4 parameters of irregular nuclear contour, increased nucleo-cytoplasmic ratio, cytoplasmic vacuolization and dirty background are highly suggestive of dysplasia.Discussion: It is important to consider that to find out the real nature of ASCUS a group of parameters are more helpful than a single one. Also, a single Pap smear is not enough for this purpose and further investigation is required.

Background & Aim: The age at menarche verifies among various populations, and it is affected by different factors such as genetic, body weight, psychological state and geographic Site. The aim of this study was to evaluate the correlation of menorcheal age to body mass Index (BMI) and fatness Index of girl students in midschools of Urmia.Materials & Methods: We conducted this cross sectional study on 485 girls. Subjects were selected randomizely from twelve midschools of city. All subjects seemed healthy, were requested to co-operate with a nurse who filled out the questionnaires. The questionnaires included data of age, family members, information about the date of first menarche, height and weight: 124 students who had their first menarche in the last three months compared with 361girls without any history of menarche.Results: The mean menarcheal age of subjects was 13.12 ±0.82 and the mean age of students with no menarche was 12.53±0.85. BMI of first group was 18.90±2.27 and in second group was 17.58±2.69. T test analysis showed: t=4.8, df= 483 (p<0.001).There were also statistical significance for age at menarche and BMI, when we used pearson's rank correlation. (R=0.18 p<0.04).Discussion: Based on these findings there is significant correlation between menarcheal age and BMI or fatness index, but we didn't obtained significant relation between BMI and socioeconomic class.Our survey showed persistence of BMI more than 50th percentile in most of girls who experienced their first mel1arche before twelve years old. Because of the higher risk of estrogen dependent disease in moderately obese girls we believe it must be considered as a important problem for them.

Introduction: Hemophilia A is an X-linked, recessively inherited bleeding disorder which results from deficiency of procoagulant factor VIII (FVIII). Affected males suffer from joint and muscle bleeding and easy bruising, the severity of which is closely correlated with the level of activity of coagulation factor VIII (FVIII: C) in their blood. Hemophilia severity is defined by FVIII: C level in plasma, where normal individuals have between 0.5-1.5 iu/ml; severely affected individuals have (<0.02-0.10) iu/ml and mild (>0.109) iu/ml. The disease affects approximately 1 in 5,000 males' world wide.Materials & Methods: Blood samples were obtained from patients and their families. DNA was extracted from the whole blood of them.Amplification was carried out using thermocycler and primer designed for two RFLP makers inside the intron 18 and 19. The PCR products were cut with restriction enzymes BCLI and Hind III and were analyzed on 2% agarose gels.Results: From 100 patients and their families in this study, it was revealed that the results were informative in 46% of the cases. In addition it was found about 79.7% of the cases were familial and 20.3% sporadic. 86.1% of cases were male and 13.9% female. Obligatory carriers were 56% of the cases and non obligatory carriers were 44% of the patients.Discussion: Although this method is informative in only 46% of the cases, but because it is the only available and practical method in our country, it should be applied on all our health centers. These markers are useful for prenatal diagnosis of hemophilia A in pregnant women and other people who are at risk.

In this case report management of an extreme externsion contracture of hand of a 14 years old patient 6 months after burn is described After releasing of Contracture, the carpal and metacarpal joints subluxations were corrected The resulted defect was convered with sheet splint thickness skin graft.An exercise program for increasing the strength of flexor muscles and range of movement of joints started to lengthen extensor tendons and prevention of re-contracture. Two years follow up didn't show any re-contracture and the patient was able to perform his ordinary activities.Simple contracture release and a postoperative exercise program were emphasized.

Introduction: Submandibular salivary gland secret into oral cavity by submandibular duct and also it opens by a narrow orifice in the floor of the mouth on the summit of the sublingual papilla at the side of the frenulum of the tongue. Sublingual gland drain its secretion by 8 to 20 ducts. These ducts mostly open separately into the floor of the mouth on the summit of the sublingual fold. From anterior part of the gland sometimes a greater sublingual duct is formed which opens to or near to the submandibular duct. In this case we observed a large wall duct formation on the posterior part of the gland which joins to the one third of posterior part of the submandibular duct. Materials & Methods: We dissect the infratemporl and submandibular and sublingual regions of the cadaver to see submandibular and sublingual glands and their ducts.Results and Discussion: Communication of the sublingual and submandibular ducts at the posterior part of the mouth and neighboring lingual nerve is important in surgery of mouth, salivary glands and their ducts. Also it has to be considered in infection of the glands and sialography methods in radiology.