JOURNAL OF RAFSANJAN UNIVERSITY OF MEDICAL SCIENCES AND HEALTH SERVICES
Year:2005 | Volume:4 | Issue:1 (13)|Papers Count:8

Background: The selective treatment of internal mammary chain (IMC) in breast cancer is controversial. Previous randomized trials have not shown a benefit to IMC irradiation. The recent positive trials testing post mastectomy radiation that had included IMC irradiation has renewed interest in their irradiation. The purpose of this retrospective survey was to evaluate outcome as a function of IMC in a cohort of breast cancer patients treated with modified radical mastectomy (MRM) and radiation therapy (RT).Materials and Methods: From 1987 to 2001, the files of 215 patients with invasive breast cancer that were treated with MRM+RT were reviewed. The mean time of follow up was 74 months. All of the patients received chemotherapy and regional radiation (supraclavicular, axillary with or without IMC). The decision to use or not use a separate IMC field was the result of change in treatment policy over time. To evaluate the results, patients were divided into two groups: those who received IMC radiation (IMC group, 120 patients), and those without IMC radiation therapy (control group, 95 patients). Five years disease free survival rate, metastasis and loco regional recurrence was calculated in two groups. To determine the patients who can benefit from radiotherapy the metastasis in two groups was analyzed according to age, the location of tumor, the stage of disease and the situation of axillary lynph nodes.Results: Distant metastasis and loco regional recurrence occurred in 42(35%) and 10(8.3%) patients in IMC group and 37 (38.94%) and 7 (7.3%) patients in control group, respectively. These differences were not significant between 2 groups. Subset analysis showed that distant metastasis occurred less frequently in IMC group when the location of tumor was inner quadrant (42.85% vs 75%) and stage ?a was (38.2% vs 84.6%) (p<0.001). Five years disease free survival rate was 57% and 50% in IMC and control group respectively.Conclusion: Regards to the results of this retrospective analysis, it could be concluded that IMC radiation in breast cancer patients is not beneficial. This treatment should be considered only for those with inner quadrants and stage IIIa tumors.

Background: Intravenous heparin is an effective treatment in patients with acute coronary syndrome, and administered either by 6 hours bolus intravenous injection or continuous in fusion. Thrombocytopenia induced by heparin injection have been reported 0-30%, that is variable by different methods of heparin administration. This study was carried out to determine the incidence of thrombocytopenia in both methods of intravenous heparin administration in patients referred to CCU of Aliebn Abitaleb Hospital, Rafsanjan.Materials and Methods: This clinical trial was carried out in 64 patient (35male and 29 female) with mean age of 52±6 years who admitted in CCU with acute coronary syndrome.32 patients received continuous infusion (group A) and 32 patients received intermittent intravenous bolus injection of heparin every six hours (group B). Because of hospitalization duration of shorter than 24 hours, 4 patients (2 males and 2 females) from group B and 1 (male) from group A excluded from the study. Dosage of heparin adjusted based on body weight and Aptt measurement of 1.5-2 times of control levels. CBC and platelet count was done on the day of admission, 3 and 7 days after heparin administration.Results: There were not significant differences between two groups for age, sex and total amounts of prescribed heparin. There were 4 (14.8%) cases with thrombocytopenia in-group B, and one cases (3.1%) in group A, this difference was significant statistically (p<0.05). There was no significant difference in platelet count in group A (210000±20000/mm3) compare to group B (208000±18000/mm3).Conclusion: Thrombocytopenia induced by heparin, was significantly lower in continuous infusion of heparin compare to intermittent intravenous bolus injection. Therefore continuous infusion of heparin is recommended for patients with acute coronary syndrome who needs heparin therapy.

Background: Previous studies have shown that morphine administration could produced behavioral defects in human and also animal. In the present study, the effects of maternal morphine consumption on neural tube development in rats has been investigated. Material and Methods: Female wister rats (250-300g body weight) were crossed with male rats. Experimental groups were received 0.1, 0.05 and 0.01 mg/ml of morphine in drinking water daily (14 ml water for each rat). Control group received tap water. 9 days and 12 h after the onset of pregnancy, the animals were anesthetized by chloroform and the embryos were taken out surgically. Weight of embryos were determined by a digital balance and their length (Antero-Posterior axis-[AP]) as a criterion for embryos length were determined by a caliper. Then embryos were fixed in 10% formalin and tissues were processed, sectioned and stained by H&E staining. These sections were investigated for neural tube development by light microscope. Results: Decrease in "AP" length and embryonic weight in group that received 0.01 mg/ml of morphine was significant. Neural tube was observed in control group. Daily consumption of morphine sulfate in dosage 0.1, 0.05 and 0.01 mg/ml could delay the neural tube development. In addition, dose 0.01 mg/ml of morphine lead to damaged in regulated neuro-ectoderm layer and its thickness. Conclusion: This study showed that oral morphine consumption lead to neural tube defects.

Background: Some of plants are used as analgesic in traditional medicine. The aim of this investigation was to evaluate the analgesic effects of colchicum szovitsii Fisch and C.A. Mey that has been used traditionally to relieve the pain. Materials and Methods: The plant specimen was collected from Jupar, and then identified and nominated by a botanist. The dried bulbs of the plant was powdered and extracted by Percolated method and then concentrated by rotatory evaporator and oven. Different doses of methanolic extract of the plant was injected into male albino mice (20-25g) and its analgesic effect was evaluated by Hot-plate and formalin test.Results: The results showed that all doses of extract, induce significant analgesia (p<0.01) in Hot plate test. The dose of 200 mg/kg of extract, induced toxic effect such as diarrhea and lethargy in mice. The results showed that, the doses of 50 and 100 mg/kg of extract, induced significant antinociception compared to the control group in all time intervals after 10-15 minutes in formalin test (p<0.05, p<0.01). There was not significant differences between the analgesic effect of the most effective dose of extract (100 mg/kg), ASA(300 mg/kg) and morphine (2.5 mg/kg), in second phase of formalin test. The analgesic effect of the extract was lower than morphine (p<0.01) 15 am 30 min after injection in Hot plate test. The analgesic effect of extract was lower than ASA 15 min after injection (p<0.01) but was higher than ASA 60 min after injection(p<0.05). Pretreatment of animals with naloxone 4mg/kg, subcutaneously, five minute before extract injection, decreased the analgesia induced by extract in all times of hot-plate test (p<0.01) except 15 min. Naloxone decreased the analgesic effect of extract in formalin test(p<0.01), except in time intervals between 5-10, 10-15 and 25-30 min.Conclusion: The results show that, the methanolic extract of colchicum szovitsii has a significant analgesic effect in formalin and Hot plate test and the opioid receptor may be involved in the analgesic effect of this plant. The results of this investigation could be used for more studies to access a better results.

Background: Alpha-1-antitrypsin (AAT) has many different genetic variants but the most prevalent alleles that cause AAT deficiency are S and Z variants. The allele frequencies of AAT variants, have been identified in many countries but there were not any statistical reports on Iranian population. Therefore, the aim of this study was to investigate the frequency of M1, M2, M3, S and Z variants in Iran.Materials and Methods: In this study 318 sera were obtained from healthy volunteer students of Tehran universities dormitories using ethnic stratified sampling. Then phenotyping was carried out by isoelectric focusing (IEF) with pharmalite pH= 4.2-4.9 in comparison with standard phenotypes. Results: From 318 normal sera, 201 had M1, 55M2, 41M3, 8MS, and 6 MZ phenotypes, 7 sera had other phenotypes.Conclusion: Allele frequency of M1, M2, M3, S, Z and other variants of AAT in the population of Iran were 0.6477, 0.1776, 0.1305, 0.0126, 0.0094 and 0.0220 respectively.

Background: After 16 years from the end of "Holy Defense" we are still confronted with physical and mental ailments of "Janbazan" (devoted combatants) and "Azadegan" (captives).Regarding the pivotal role of clients" perspectives on health services quality this study was conducted to assess the level of satisfaction of Janbazan and Azadegan who referred to Bonyad Janbazan in Kerman city, from the health services quality. Materials and Methods: In this cross-sectional study during a 4 months period in 2004, 384 individuals of Janbazan and Azadegan were randomly selected (one from every ten clients) and were interviewed by a questionnaire consisting baseline questions and also 31 questions requesting the clients" level of satisfaction using Likert scale ranging from highly unsatisfied (score 1) to highly satisfied (score 5). Content validity of the questionnaire was established by an extensive literature review and an experts panel. To examine the internal consistency Cronbach's alpha was calculated as 0.97.Results: The mean (±SD) of age of the sample was 39.2 ±5.8 and 99.7% were male. The highest mean satisfaction score (3.5) was to the question asking "How were the behavior of physician in out patient services and the highest unsatisfaction rate (41.7%) was related to the results of therapeutic interventions offered by the physicians. Conclusion: The result clarifies the need for promotion in provision of health services to these brave individuals.

Background: Chronic otitis media (COM) is one of the most common otolaryngologic diseases that can involve patients in every age group. The aim of this study was to evaluate the prevalence of cholesteatoma in COM patients and compare the postoperative results in COM patients with and without cholesteatoma.Materials and Methods: This clinical trial was a descriptive cross sectional study that was conducted on 80 patients with COM in otolaryngology ward of Yazd Shahid Rahnemoon Hospital who underwent surgical operation and post surgical results investigated in 6-24 months follow up period.Results: Cholesteatoma prevalence was 22.5% that higher in men (26.4%) compared to women (14.8%) and was more common in the first two decades of life. Graft insertion success rate was 85.5% in patients without cholesteatoma and in all of patients with cholesteatoma. The average improvement of hearing threshold in patients without cholesteatoma was + 7.9 dB and in cases with cholesteatoma -1.1 dB. Post operative air-bone gap in patients with cholesteatoma increased 6.4dB and in cases without cholesteatoma decreased 5.3 dB .Conclusion: Results of this study showed, if before occurrence of cholesteatoma, surgical treatment for COM was done, better post surgical hearing status will expect.

Background: Renal colic due to urinary tract calculus is one of the urology emergencies. However The traditional and standard treatment of renal colic is first narcotics and then non steroid anti inflammatory drugs (NSAIDs) drugs, but studies have shown that other drugs such as decompressing are used with different effectiveness. This study assessed the efficacy of decompressing nasal spray compared to sodium diclofenac in treatment of renal colic caused by calculous.Materials and Methods: In this clinical trial study, 90 patients with renal colic due to urinary stones referred to the emergency department of Rafsanjan Ali Ebn Abitaleb Hospital were divided randomly into three groups. Group 1 received 40µg of desmopressin nasal spray, group 2, 75 mg of sodium diclofenac intramuscularly and group 3, both desmopressin and diclofenac. Using a visual analogue scale at 10, 20 and 30 min after administering the treatments assessed pain relief that were classified to complete, Moderate, and no pain relief, respectively. The results were analyzed by X2 and Fisher test. Results: In this study 70% of samples were male with mean age 33.6±10.5. At the end of study, 34% of patients reported complete relief, 23% moderate and, the remainders reported no Pain relief. The best response to the treatment was observed in group 3 (decompressing + diclofenac) (96.7%) which pain relief at 10, 20, 30 min after administration was significantly higher than groups 1 and 2 (p<0.05). The pain relief was same in groups 1 and 2 after 10, 20 minutes, however the effect of decompressing was more than diclofenac after 10 minutes but after 30 minutes pain relief in group 1 was reduced significant compare to group 2 (p=0.016). Conclusion: It seems that nasal spray decompressing alone has a rapid but transient on renal colic pain relief but if it is combined with sodium diclofenac, increases the sedation effect.