Internal Medicine Today
Year:2005 | Volume:10 | Issue:4|Papers Count:14

Background and Aim: Coronary artery bypass graft surgery is accomplished without cardiopulmonary pump in many centers. As these kinds of operations are associated with massive bleeding, transfusion of allogenic blood is a necessary component of maintaining hemodynamic stability. Transfusion of allogenic blood has many complications, so autologous transfusion has gained widespread notice. Acute normovolemic hemodilution (ANH) is one of the methods of autologous transfusion, which is simply performed in the operating room. This study was accomplished to investigate the effects of ANH in Off- Pump coronary artery bypass graft surgery.Materials and Methods: In this case-control study, 50 patients undergoing Off-Pump coronary aliery bypass graft with hemoglobin level more than 11 gr/dl were divided into two groups of 25 patients randomly. In one group, ANH was performed and the other group was as the control group. The necessary data were recorded in a questionnaire, and were analyzed by the appropriate statistic tests.Results: The average of hemoglobin level was similar in both groups, pre and post-operation. The amount of bleeding in case group was less than the control group. Transfusion of allogenic blood in control group was 100% while in case group it was 36%. The amount of allogenic blood transfused to case group was severely less than the control group.Conclusion: The beneficial effects of ANH in reducing the transfusion of allogenic blood in patients undergoing coronary artery bypass graft was determined. As performance of ANH is easy and has low cost. it is recommended in all patients with hemoglobin level more than 11 gr/dl.

Background and Aim: Light microscopic investigations relative to destructive effects of hydrocortisone are scanty. Using laboratory animals, we evaluated the effects of extensive consumption of hydrocortisone on tissues by light microscopy.Materials and Methods: In this case-control study, 40 Balb/c strain mice, 20 males and 20 females were selected and divided in two case and control groups randomly. So there were] 0 males and 10 females in each group. Mice of case group were injected intraperitonealy 5 micrograms hydrocortisone for each gram body weight every day. Control mice were injected normal saline parallel to experimental group. 15 and 30 days after the beginning of hydrocortisone injection, mice were anesthetized and killed. Suprarenal glands were removed and washed in normal saline. They were put in formalin for 48 hours. Remainder of tissue preparation and hematoxylin-eosin staining were done. Then couple were examined by light microscopy and photographs obtained.Results: There were tissue destruction in the cortex and medulla of the suprarenal glands of the experimental mice with 5 days hydrocortisone consumption. Excessive cortical and medullary destruction were observed in suprarenal glands of mice with 30 days hydrocortisone consumption. In control group which normal saline had been injected, no change was observed.Conclusion: According to these results, we suggest that overdose injection of hydrocortisone in mouse has progressive destructive effects both on cortex and medulla of suprarenal glands. Longer time of hydrocortisone consumption will be pursued with more destruction.  

Background and Aim: In community health nursing enough information from people needs and problems has a significant importance. The first measure in nursing process in the society is need assessment and knowing the society-Then the research has been done for knowing the Felt needs of Gonabad pop. lab limitations in 2002.Materials and Methods: At first some representatives form different groups of people in pop. lab. Area such as: school students, college students, clergymen, businessmen, adults, youths, women, health workers, teachers, NGOs and... 86 persons were selected. At first the reason and the aims of the research was introduce to them. The incited people were divided in 5 groups for focus group discussion (FGO) containing between 15to 20 people with two collegiate facilators. At least 3 sessions were selected for brain storming to say the Felt problems and needs, the said matters were written down by an editor in each group.Results: The said Felt needs and problems of the people were as the following:1- Life style problem such as: using less than fruits and vegetables.2- Educational and cultural affairs such as: low information about social health and safety and... 3- Health. health and treatment services such as: ask for illegal money (under table) by physicians and self treatment ...4- Economic and job problems such as: youths unsmiling, economic problems, poorness, banks high benefits...5- Social, recreation and welfare matters as: absence of happiness in the society, less care about physical activities...6- Traffics and driving affairs such as: old traffic conveniences, poor driving culture and increasing of accident...7- Social and personal immunity such as: old and poor buildings against earthquakes, neglecting of safety affaire, rubbery...8- Religion and morals such as: belief on superstitions, misuse of foods in Islamic ceremonies, immorality increase...9- City cleanliness and domestic services such as: keeping animal in the city at homes, suburb life...10- Family problems such as divorce increase, men leadership culture at homes, unwanted pregnancies...Conclusion: Participation is a means for population empowerment and from the other side it is the final aim of development plan.  

Background and Aim: Asthma is the most common cause of pediatric admission. Its incidence is 7.4%. Since this disorder is due to type one hyper sensitivity reaction related to IgE, this study focused on the relationship between total lgE and eosinophils in pediatric asthmatic patients.Materials and Methods: This study was performed on asthmatic patients age 1-12 years old who admitted in hospital during one year. Diagnosis was made based on questionnaire, clinical findings including personal history and radiological findings. After selection of patients, the questionnaire was filled and data was analyzed based on t student and Mann- Whitney tests.Results: The most common physical sign was wheezing (98.6%) and tachypnea was the next one (96.1 %) The average of total serum IgE was (175.8±198.6) and blood eosinophils was (403.1±300) There was a significant relation between total serum IgE and blood eosinophils (p: 0.01, r: 0.32) According to our findings the level of total serum IgE was above the normal limit in all age groups.Conclusion: The level of total serum IgE and blood eosinophils, in pediatric asthmatic cases were above normal range, since there is an increase in total serum IgE in critical asthmatics, and it can be a predictive factor for severity of asthma.  

Background and Aim: Childbirth is a turning point in couple's life. Husband's presence during delivery not only strengthens the relationship between partners but also is very important in accepting paternal responsibility. The aim of this study was to evaluate couples' attitude about husband's presence during childbirth.Materials and Methods: This descriptive study was undertaken on 150 couples in the summer of 2002. Data were collected by means of questionnaires. The data were evaluated and compared using one way ANOV A test with P<0.05 as the limit of significance.Results: Results were as follows: The mean and standard deviation of age was 26:1:4 years at the range of 17-40 for women and 30±5 at the range of 21-45 was for men. The majority of our objectives were high school or university graduated that was 90.2% for men and 87.3% for women. Most of women were employed (58%) and most of men had noneducational jobs (77.6%). The mean and standard deviation of attitude score was 100±15 at the range of 49-134 in women and 97±16 at the range of 56-131 in men. We found a statistical significant relationship between age, job and education of our objectives and their attitude score. 88.4% of women (n=130) and 82.1% of men (n=119) had positive attitude toward husband's presence during labor. In most of the couples (76.9%, n= 110) both of the partners had positive attitude.Conclusion: As a whole this study indicated that most of the couples have positive attitude about husband's presence in delivery room. Facilities for husband's attendance during delivery must be provided and appropriate training should be given to the couples during pregnancy.

Background and Aim: Today arthroscopy is the best method of knee surgery for both diagnosis and treatment. Among joints, knee althroscopy is more familiar than other joint to the orthopedic surgeons. Arthroscopy is a minimal invasive technique with low complication. The aim of this study was to determine of knee diagnostic althroscopy evaluation and its comparison with other clinical diagnosis.Materials and Methods: This study was a prospective type consisting of 290 patients, who under went knee arthroscopy at Ghaem Hospital Medical School, from 2000-2003.Results: From 290 patients, 81.6% were men and 18.4% were women. Symptoms complied by patients were including; knee pain, locking, instability, click, limited range of motion and effusion.Our clinical diagnosis prior to arthroscopy consisted of; 45% meniscus tears, 20% ACL tears. 16% both ACL and meniscus tears, 4% posterior instability, 5% chondoral lesions and others remained with undefined diagnosis. Althroscopic findings were including; 58% meniscus tears, 49% ACL tears, 20% both ACL and meniscus tears, 5% PCL tears, 14% chondoral lesions and in 15% more than two internal disarrangements.Conclusions: The Study showed despite our clinical experience in knee surgery, aIihroscopy increased or changed our findings more than 90%.  

Background and Aim: Alcohol is a substance that its uncontrolled consumption has destructive effects on different organs of the body. Negative effects have investigated on esophagus, stomach, liver, heart, nervous system and some other organs. These investigations are continuous. Reports of pancreatic side effects of ethanol are scanty. This study was programmed for defining the destructive effects of ethanol on pancreatic cells.Materials and Methods: In this interfered laboratory study 20 Balb/c male mice were selected and divided in two 10 members case and control groups randomly. 15 mg ethanol for each gram body weight intraperitonealy injected two times a day at 8Am and 4Pm. This process continued for 3 weeks. Control group received normal saline parallel and similar to case group. After 3 weeks, pancreas of all case and control groups' mice were removed and washed by normal saline. Then they were fixed by 10% formalin solution for 48 hours. Xylene and paraffin were used for defined periods of time. 5 micrometer thick sections were prepared by microtome. Prepared couples were stained by hematoxylin-eosin (H&E). So they were prepared for light microscopy.Results: No changes were seen on exocrine and endocrine tissues of pancreas in control group. They had normal appearance. Local fatty changes in different area of both exocrine and endocrine parts of pancreas, as vacuoles in different sizes were seen in case group. Around the vessels and connective tissues inside the exocrine and endocrine parts, inflammation and dilated vessels with lymphocyte and plasmocytic infiltration were seen.Conclusion: This study showed that ethanol can damages pancreas alike the liver, and produces steatose, acute pancreatitis, blockage the ducts by protein clots, fibrosis and chronic pancreatitis.

Background and Aim: Idiopathic scoliosis is one of the most common orthopaedic disorders that may progress to a severe musculo skeletal problem if is not treated. Discussion about the treatment of idiopathic scoliosis has been in the history of orthopaedia since a long time ago. The purpose of this study is finding of an appropriate device for spine instrumentation.Materials and Methods: In this study, 28 patients, 8 male (28.5%) and 20 female (71.5%) with idiopathic scoliosis were studied between 1999 and 2002 in Shahid Kamiab hospital of Mashhad. The mean age was 16.95 years (from 12-33 years). Follow up time was 1.5- 4 year. Nine patients (32.1%) had posterior spinal fusion (PSF) and 19 patients (67.2%) had anterior spinal fusion (ASF) and PSF. In 14 (50%) patients Cotrel- Dubousset (CD) system and in 14 (50%) patients Harrington distraction+ sub laminar wiring system (HD+SLW) were used for instrumentation.Results: Bleeding during operation was 455.5±84.5 cc in CD system and 438.5±61.75 cc in HD+SL W system duration of operation was 4.26±0.56 hours in CD system and 4.22±0.33 hours in HD+SL W system.Curve correction was 63.3% in CD system and 64.15% in HD+SL W system. There was not a significant difference between tow systems (X2=95%). Loss of correction was 10% in tow systems.Conclusion: The results in tow systems are the same with no significant difference, but the HD+SLW system is ideal because of lower price and simple application.

Background and Aim: Industrial and workplace wounds due to corrosive substances such as acids and bases encompass the majority of wounds in the community. In this study, the effect of topical application of bovine vitreous humor, as a biomaterial containing Hyaluronan, on the healing of second degree burns in the skin of rabbits was investigated.Materials and Methods: The study was carried out using 5 adult male white Dutch rabbits, in the same age and weight range of 2-2.4 kg. Animals were shaved at both sides the back and anesthetized with lidocaine (10%). Using nitric acid solution (65%) second-degree burns with a diameter of approximately 10 mm in both sides of animals were produced on shaved areas. Wounds on the right side (30 wounds) were treated with topical application of bovine vitreous humor and left side wounds were considered negative controls (30 wounds). During the experimental period, the diameters of the wounds were measured as an index of healing process. For microscopic examination, samples were prepared from both types of wounds (test and control), stained with H & E, Periodic Acid Shift (PAS) and Peacindigo and were evaluated under light microscope for their cellular layers and epithelium formation. Data were analyzed using t-student test and p<0.05 was considered significant.Results: At day 8 of experiment, the percent of wound healing was 30% and 50% in test and control groups, respectively. At day 16, 65% and 85% wound healing were achieved for the same groups, respectively. Microscopic observation showed less epithelial layers and more cellular differentiation in control group than test group.Conclusion: In this study, topical application of bovine vitreous humor negatively influenced the wound healing process of second-degree burns. This might be due to inter-species differences in proteins attached to hyaluronan in bovine vitreous humor and in rabbit skin or due to molecular weight of hyaluronan in bovine vitreous humor.

One of the most important challenges in the twenty first century is population transition and aging.Various disease incidences in elderly people is a cause for using more drugs than youths and average adults and then show more side effects. pharmacokinetic changes and pharmacy dynamic in adulthood cause cardiac output decrease ,liver, kidneys, haemostatic changes, drug interventions and using OTC drugs case increasing drugs side effect in adults. Since drug use is different with other people, then Cockeroft-Gault method is a proper method for measuring drug dose and administration interval in adults. According to this formula at first we should evaluate the ideal IBW to height for both men and women and then certify adult creatinine clearance based on age, weight and serum creatinine concentration and then will certify dose fraction (DF) considering regression line, drug dose use level is made from DF into drug use in a usual state. Drug interval usage is certified from division of drug interval on DF in a usual state. This formula is a proper method for drug prescription in adults. Formulas, tables, and charts used are available in the context.