Armaghane Danesh
Year:2005 | Volume:10 | Issue:38|Papers Count:12

Introduction & Objective: Epidural anesthesia is an appropriate approach for surgical operations on lower limbs, abdomen region and painless delivery. Since the application of epidural anesthesia is time-consuming and the onset of the effects of injected anesthetic drugs in epidural space is slow (about 20 minutes), therefore, the time of occupying the operating room is prolonged and this results in wasting of time of the surgeon and staff in the operating room. This study was  conducted to assess the effect of bupivacaine while used with ketamine on shortening the onset time. Materials & Methods: This double blind study was done on 40 patients. All the patients were physically ASA I, II and they underwent orthopedic: and urologic surgical operations. The patients were randomly divided : into two groups of 20 individuals, receiving the drugs as follows: study   group: bupivacaine 0.5%- 20 ml + ketamine 25mg (0.5ml)+ adrenaline  1/200000, control group: bupivacaine 0.5%, 20ml + ketamine  25mg (0.5ml) + saline 0.9%, 0.5ml+ adrenaline 1/200000. After injecting: the drug in epidural space in L3-L4 or L4-L5 regions, blood pressure, heartbeat, onset of anesthesia and the level of anesthesia were evaluated in all patients. Results: Patients in both groups were compared with regard to their height, weight, sex, age and systolic blood pressure before the injection of the drugs and no significant difference was noted among them. The systolic blood pressure and heartbeat of patients in both groups were   checked in 200, 5th, 10th, 15th, 20th, 25th and 30th minutes after drug injection and no significant differences w re found in both groups  compared to pre-anesthesia status. However, the onset and level of anesthesia was statistically significant in the two groups. The onset of i anesthesia in study group was 3.5 to 4 minutes faster and the anesthesia level was two segments higher than that of the control group. Conclusion: Results of this study demonstrated that the addition of 25mg of ketamine to bupivacaine resulted in the acceleration of the onset as well the increase the level of anesthesia in extradural  bupivacaine-induced anesthesia and this might be a useful approach in emergency surgical procedures.    

Introduction & Objective: Succinylcholine is a depolarizing muscle relaxant that is widely used by anesthesiologists especially at induction time to facilitate intubations. Fasciculation is common after intravenous injection of succinylcholine and preceding relaxation may cause myalgia, rhabdomyolysis and increase in blood level of myoglobulin. On the other hand, narcotics are the main components of induction protocols and alfentanil as a short acting narcotic is widely used. Decreasing fasciculation can be achieved probably by use of alfentanil. Alfentanil and sufentanil were used in our study to evaluate this proposal. Materials & Methods: Patients were selected randomly (female aged 20- 50, ASA I). Induction of anesthesia was done by thiopental Na (4mg/kg) and relaxation for intubation reached by succinylcholine (1mg/kg). Premedication was as follows: in the 1st group alfentanil (10µg/kg, 2minutes before succinylcholine injection); in the 2nd group sufentanil; (0.1µg/kg, 4 minutes before succinylcholine injection) and in the 3rd group: (control group) normal saline (0.5-2 ml, 2 minutes before succinylcholine injection). Results: The zero score was 64%, 12% and 8% in groups 1 to 3 respectively while the three scores were 15%, 50% and 57% in groups 1 to 3 respectively. Conclusion: Statistical analysis revealed that alfentanil induced more fasciculation suppression than sufentanil (p<0.0001).    

Introduction & Objective: The age related cataract surgery is most common ophthalmic surgery. Today the method of choice for cataract surgery is phacoemulsification. This study was conducted to compare the visual acuity, pre-operation and post operation ECCE & Phacemulsification complication in patients referring to Khalili & Oastgheib Hospital in Shiraz during 1380-1381. Materials & Methods: This prospective non randomized concurrent Control study was conducted on 100cases (52 case of ECCE and 48 case Pre-operative evaluation included age, sex, visual acuity, astigmatism according to keratometry difference and type of cataract. The patients were evaluated during the operation for size, site of incision, posterior capsular rupture, vitreous loss and nucleus dropped in vitreous. Then in 1, 5, 14, 90,180 days post operation, they were examined for BCVA, UNCVA, astigmatism (keratometry and refraction), Inflammation, Comeal edema, posterior capsular opacity and clinical CME. Results: In this study 100 cases (48 phacemulsification, 52 ECCE) aged 48-76 for cataract surgery were included. Patients were followed for 6 months after operation. Mean age in phacemulsification was 58.27 ±7.26 was 64.71±6.84. On the fifth day after ECCE, UNCVA≥30.60 was 15.3% and in phaco was 62.5%. On the fifth day mean UNCVA in phaco was 30.60 and in ECCE, 20.60. Mean astigmatism on the first day post-operation according to keratometry difference in ECCE was 4.84±2.08D and in phaco was 2.27±1.67D and according to refraction in ECCE was 3.62±2.08D and in phaco was1.91±1.34D. Posterior capsular rupture in ECCE was 7.6% and in phacor was 12.5%. Vitreous loss in ECCE was 5.7% and in phaco was 0.7%.Cornealedema in the first day post-operation in ECCE was 19.2% and in phaco was 43.8%. Two weeks after operation in all patients who underwent phacoemulsification, corneal edema was cleared but in ECCE 3.8% corneal edema continued for 6 months after operation. Nucleus dropped in vitreous occurred only in phaco (2.1%). lOL dislocation after  phacoemulsification was 4.1% and 2.1%(1 case) need to lOL removal but this complication was not visible in  ECCE. Conclusion: Success rate, Intra operative& post-operative complications in phacoemulsification in comparison to other studies were in an acceptable range. We recommend further study In this case for more documented results.      

Introduction & Objective: Hyperinsulinemia is related to obesity, diabetes and hypertension, but its relation to coronary artery disease, as an independent risk factor, is questionable. This study was conducted to compare the insulin level in patients with acute coronary and non coronary diseases. Materials & Methods: This is a cross-sectional study in which two groups of hospitalized patients in emergency department, 32 patients in each group (acute coronary and non coronary disease) were evaluated for fasting insulin level. Diabetes or a family history of it, previous history of coronary artery disease or family history of it, pancreatic origin of abdominal pain, hypertension, overweight or obesity, or using steroids were exclusion criteria for this study. Collected data were analyzed using Mann-Withney test. Results: There was not any statistical difference in age and sex of both groups. No significant difference was noted in insulin level of coronary and non coronary patients in this study. Conclusion: Having these results, we can not include hyperinsulinemia as an independent risk factor for CVD.  

Introduction & Objective: Several studies have been performed about the association between Helicobacter pylori and gastric carcinoma some of which have confirmed while others have excluded this link. The aim of this study was to evaluate a possible connection of gastric carcinoma with Helicobacter pylori infection. Materials & Methods: We evaluated 70 gastric carcinoma and 70 age and sex matched control subjects (without any mass or ulcer) for H. pylori infection by Geimsa staining of the samples obtained from the subjects. Results: The prevalence of H. pylori infection was 37.14% in control subjects, 44.44% in intestinal type and 40% in diffuse type of gastric carcinoma. Conclusion: Statistical analysis did not reveal any meaningful difference between the prevalence of H. pylori in case and control group in this study. Therefore, the relationship between H. pylori and gastric carcinoma was excluded in our study. Atrophy and metaplasia intestine which result in reduction of colonization of bacteria and also bias in sampling might account for the findings of the present study.  

Introduction & Objective: Atrial septal defect (ASD) closure by surgery is a standard method with low mortality and complication rate. Nowadays, surgeons prefer to use less invasive methods including interventional and limited thoracotomy. The aim of this study was to compare the post surgical results in two groups underwent ASD surgery, by sternotomy or thoracotomy method. Materials & Methods: This retrospective study was performed in Shahid Madani heart hospital from 1998-2003 on 73 patients who underwent ASD surgery. Data were collected by filling out a questionnaire. Results: Group I (thoracotomy) included 38 patients with mean age of 23.84±3.2 years and group 11(complete sternotomy) included 35 patients with mean age of 21.82±2.3 years. The results were almost the same in: both groups except for longer operation time (p=0.01) and shorter hospitalization period (p=0.01) in group I. Conclusion: Considering lower injury by surgery and better cosmetic results, ASD repair by thoracotomy seems to be a suitable method.    

Introduction & Objective: Thalassemia major is the most sever identified hemolytic anemia and the most common single gene abnormality. This disease is very common in Iran and that is why there should be a careful investigation into it. Not treated properly, growth failure is one of the most important complications of this disease. This study was designed to evaluate the growth parameters in thalassemic children and to compare the obtained data with normal children. Material & Methods: This cross-sectional, descriptive and analytical study was carried out on 121 thalassemic patients who received blood transfusion therapy in Yasuj, with respect to the physical growth parameters such as height, weight, sitting height, and arm circumference. Collected data were compared with data from normal children (who were chosen from the same sex, age and socioeconomic groups). Result: According to statistical analysis, weight of 53.7% of thalassemics and 17.1% of non-thalassemics, for the same age group, was under 5 percentile (p<0.0001).These measurements for height and mid arm circumference were 66.9% v/s 17.1%, and 72.7% v/s 32.5% under percentile respectively (p<0.0001). Conclusion: Considering the growth retardation of thalassemic patients, we recommend regular follow-up for confirming the blood transfusion and desferal injection with exact interval.  

Introduction & Objective: Positioning is an important part of perioperative care that optimal respiratory function is a main purpose. Thus oxygen saturation measurement in routine surgical positions could be a proper index of respiratory function. Material & Methods: To determine effects of supine, prone and litatomy positions on arterial oxygen saturation, 31 healthy volunteer were positioned in each three position for ten minutes periods. Oxygen saturation was measured by pulse oximeter. Results: there was no significant difference between 3 positions in oxygen saturation. Conclusion: Absent of prone and lithotomy positions effect on oxygenation in this study may be attributed to the short time that the subjects were in each position (ten minutes). we suggest that evaluation of position effect on oxygenation require further investigation.  

Introduction &Objective: Vaccination of children under 1 year of age is j one of the most important programs of the country at all levels of the health and treatment organization. Due to geographical dispersion and movement during different seasons of the year, tribal societies are the most vulnerable communities in the field of health services and vaccination. This study aimed at determining the vaccination coverage of children under one year of age in the tribal society of kohgiloyeh and BoyrAhmad Province. Materials & Methods: This descriptive cross-sectional study was performed on all the newborns from the tribal society of kohkiloyeh and BoyrAhmad province, who were under the age of one, born between 1.1.81 and 29.12.81. For data collection, a questionnaire was used which contained individual characteristics, types of routine vaccines, the data regarding the injections, and the possible reasons for delay in receiving vaccines. The questionnaire was tested for its content-validity. Results: The total coverage of B.C.G vaccine was 97%1. The total coverage of polio vaccine was 98.4%, 98.2% and 97.7% for the first, second and third doses, respectively, but it was the same for DPT vaccine. The coverage of hepatitis for the first, second, and third doses was 98.6%, 95.2% and 95%, respectively. The total coverage of polio vaccine at birth was 85.5%. All the vaccines were received with delay. The highest delay was related to first dose (27.6 days) and second dose of hepatitis B (74.3 days), first dose of measles (295.4days) and the least delay was found in polio (10.9 days) and third dose of hepatitis (272.4 days). The main reasons for delay were distance from vaccination station (27.3%), unavailability of health staff (262%) and the mother's lack of knowledge (14.2%). Conclusion: Revision of the programs related to the monitoring of mobile teams of vaccination is necessary to improve the vaccination coverage in tribal communities. Moreover, more health staff is required in order to improve the present status of vaccination in tribal societies.  

Introduction & Objective: Life expectancy at birth and longevity are important indices and represent social, economical, cultural and hygienic status of every society. This index can be used in evaluating any planning. WHO uses this index along with indexes of annual income, per capita income and literacy rate of women to estimate human development Index Yasuj University  witch is one of the most important indices in estimation of todays communities. Estimation of the above index in Kohgiloyeh and Boyer Ahmad province and comparing it with nearby provinces or countries could show feature horizon of this province compared to other regions. These data are essential for evaluating the implemented programs, knowing the position of province and future planning. Material and Methods: Having the population size and the dead number: in different age groups in each year, life expectancy was estimated. Yasuj Collected and registered data with an acceptable precision for rural regions were used for estimation of life expectancy in Kohgiloyeh and Yasuj Boyer Ahmad province and its townships. Results: Life expectancy for men in rural area of the province was 70.8 years and the highest rate belonged to Kohgiloye and Boyer Ahmad townships, with 72.4 years and the lowest rate belonged to Gachsaran with 69.2 years. Also life expectancy of women in the rural areas of the province was estimated to be 73.8 years and the highest rate belonged to Gachsaran with 75.5 years and the lowest rate belonged to BoyerAhmad Township with 72.9 years. Conclusion: Comparing the results of this study with previous estimates of the region and latest estimates of the life expectancy in the country, a slight increase in life expectancy of the province was noted. This decrease has been more in female than male. Also difference in life expectancy in urban and rural areas is about seven years which calls for immediate attention to; the rural regions of the province.  

Introduction & Objective: Thyroid nodule is a risk factor in thyroid carcinoma. So proper awareness, evaluation and appropriate management of these nodules can result in early diagnosis and treatment of thyroid cancer which can lead to better prognosis. Materials & Methods: In this study we evaluated 100 patients with Thyroid nodules who referred to Imam Khomeini hospital of Ahvaz during 11370-79. Results: Findings showed that 18% of the subjects were diagnosed as thyroid cancer after operation and 89% were those who had solitary and cold nodule. Conclusion: It is believed that medical suppression therapy is a treatment of choice in these patients but we believe this can induce delay in diagnosis and appropriate treatment. So, obectomy and isthmectomy appear to be the management of choice in thyroid nodules especially in solitary and cold nodule in males.  

Introduction & Objective: Acute puerperal uterine inversion is a rare but life threatening complication in which the uterine fundus collapses within the endometrial cavity. The rate of uterine inversion is estimated from one in 2000 to one in several hundred thousand labors. Although the cause of uterine inversion is unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is immediately recognized and corrected. Case: The patient was a pregnant woman (G2P1), 27 years old, admitted in Yasuj Imam Sadjad Hospital due to onset of labor pains. The patient had history of cesarean section in first pregnancy and the indication of cesarean was unclear. She wanted to have vaginal delivery. Delivery was taken normally. Placenta exited the vagina together with dark-red mass attached to it. Placenta was detached simply from the mass. The mass did not have massive bleeding. With diagnosis of uterine inversion manual correction of inversion was begun. The inversion was converted from complete to incomplete inversion. The correction was not completely successful. The patient's condition was poor and went to shock. Because of these reason's the patient undergone manual reinsertion of the uterus under general anesthesia and then prepared for surgical correction. Conclusion: Although the uterine inversion is not very common, it will result in severe hemorrhage and shock, if left unrecognized, and leads to maternal death.