پژوهش در علوم پزشکی
سال:1385 | دوره: | شماره: |تعداد مقالات:14

BACKGROUND: Low back pain (LBP) and radicular leg pain (RLP) are among the most common types of pain in human beings. Although magnetic resonance imaging (MRI) is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan (CTS) in patients with disc herniation in each level of lumbar spine versus MRI findings at the same level.METHODS: In a prospective trial, 100 consecutive patients with LBP and RLP and signs and symptoms of discopathy referred to our private clinic from September 2004 to April 2005 were studied. CTS and MRI and their data were compared level by level; i.e. CTS of the patients analyzed according to clinical signs and symptoms and compared with MRI at the same level in axial view.RESULTS: Thirty-two patients had clinically S1 root signs and symptoms, in all of them CTS and MRI showed disc herniation at L5/S1 level in axial view. For L5/S1 level, positive predictive value (PPV) of CTS was 100%. In upper lumbar region, CTS findings were less reliable than MRI. CTS showed the pathology at 14.2% of upper lumbar, 27.2% at L3/L4 and 46.3% at L4/L5. In nine cases with more than one level involved, CTS confirmed the diagnosis in 11.1% of the cases.CONCLUSIONS: MRI is the gold standard for diagnosis of lumbar disc herniation, but CTS is sensitive in 100% for L5/S1, 68% for L4/L5, 60% for L3/L4, 0% for upper lumbar discopathies and finally 78% for multilevel involvement. Therefore, the higher the level of disc herniation is, the lower the sensitivity of CTS.

BACKGROUND: Vagina like all other mucosal organs owns its especial bacterial/microbial flora. Though may be pathogen in other circumstances, members of vaginal normal flora do not cause disease on healthy vaginal mucosa. In this study, we tried to determine the relationship between microscopic findings on Methenamine silver stained cervicovaginal smears and clinical symptoms.METHODS: A total of 389 cervicovaginal smears were examined cytologically from April to August 2005, among which 103 satisfactory smears of patients who were normally menstruating were subsequently selected. The originally Papanicolaou– stained smears were stained with Methenamine silver method. The cervicovaginal flora in symptomatic and asymptomatic patients was classified into four groups. The relationship between the type of genital flora and the presence of Candida or Actinomyces spp was also determined. Data were analyzed with SPSS software using Chi–square test.RESULTS: In 103 evaluated patients, 46 (44.7%) were symptomatic and the rest were asymptomatic. The most prevalent genital microbial flora in both symptomatic (21.7%) and asymptomatic (37.9%) patients was type II (Lactobacilli). Microbial frequency differences were significant for types II (P=0.034) and III (P=0.039) in both groups. Coexistence of microbial flora of type I (P = 0.02) and type IV (P=0.033) with Candida was statistically significant. Coexistence of all types of microbial flora with Actinomyces was not proved significant.CONCLUSIONS: Symptomatic women, except those with potential pathogens, tend to have Lactobacillus flora. Therefore, it is advisable that all Lactobacilli types be investigated through microbiological methods in symptomatic patients. In silver stained slides, there was a clear relationship between the type of vaginal microbial flora and the presence of Candida spp.

BACKGROUND: Stress urinary incontinence (SUI) is a prevalent medical problem for women especially through escalation of age. Many conservative nonsurgical therapies have been used for management of this problem which will usually be followed by high relapse rates or frequent side effects. Evaluation of the efficacy of transcutaneous electrical nerve stimulation (TENS) in management of genuine SUI has been studied in a few trials. We sought to assess the effectiveness and complications of high frequency TENS in SUI.METHODS: In a clinical trial, 10 sessions of high frequency TENS with 15 minutes duration every other day were applied for 40 women with genuine SUI. Treatment results were evaluated by SUI severity index at the end of first and sixth months after final session of TENS and they were compared with the baseline index. RESULTS: Seven patients (17.5%) were omitted from the study because of intolerance of TENS. In the remaining 33 patients, there was no sign of any complication. In comparison to baseline, severities of SUI showed significant decrements at first and second post-intervention evaluations (P<0.0001). There was a significant increase in SUI index from first month to sixth month (P<0.0001).CONCLUSIONS: TENS is a safe and cost-effective method for SUI management but its effectiveness decreases by time.

BACKGROUND: Colloid Osmotic Pressure (COP) is an important factor in the fluid balance of body compartments. COP is related to Total Protein (TP) concentration and Albumin: Globulin Ratio (A/G). The A/G was not included in pervious empirical models, and therefore the main objective of this study was to develop a mathematical model to determine the COP in terms of TP concentration and A/G.METHODS: Sera with different A/G were prepared in-vitro, and COP was measured directly using colloid osmometer. The relationship between COP, TP concentration and A/G were determined mathematically. The validity of developed empirical models was confirmed by statistical comparison between measured and calculated COP in 122 serum samples obtained from hospitalized patients and healthy individuals. RESULTS: By non-linear regression, the following relationships were found between COP, TP concentration and A/G. All coefficients were statistically significant (p<0.05): COP = (4.0814 A/G TP)/ (A/G + 0.0153 TP); r2 = 0. 91272. COP = [5.3192 A/G -2.2252 (A/G) 2 + 0.2939 (A/G) 3] TP; r2 = 0.94737 No significant differences were indicated between measured COP and calculated one in clinical data. CONCLUSIONS: The variation of A/G may be the most effective factor for the differences between calculated and measured COP. This parameter must be considered when the direct measurement of COP is unavailable.

BACKGROUND: Preeclampsia is a common complication of pregnancy often leading to significant maternal and fetal complications Preeclampsia occurs more frequently in primigravidae and in multigravidae who have a change in paternity. Length of sperm exposure has been proposed to influence the risk of preeclampsia. The aim of this study was to assess the relationship between unprotected coitus and preeclampsia.METHODS: A case-control design was used to compare 91 women with preeclampsia (cases) with 91 matched ones in control group. The age range was from 20 to 35 years. Subjects were selected from mothers referred to Mahdieh and Akbar-Abadi hospitals. Data were gathered by interview method and were analyzed by independent t-test, Mann- Whitney, chi-square, and logistic regression using SPSS software.RESULTS: Women with a short period of co-habitation (<4 months) or the ones who used barrier methods for contraception had a substantially higher risk for development of preeclampsia compared with women with more than 4 months of cohabitation before conception (P = 0.0001). Oral contraceptive users had a lower preeclampsia rate than women who used no oral contraceptive (P = 0.003). No relationship was observed between coital rate before and during pregnancy and the risk of preeclampsia.CONCLUSIONS: This study suggests that the risk of developing preeclampsia in primigravidae is inversely proportional to the duration of sexual co-habitation.

BACKGROUND: This study aimed at presenting the updated growth reference data for height and weight of healthy school children aged 6.5-11.5 years in Shiraz (Iran).METHODS: A total of 2397 healthy school children (1268 boys,1129 girls) aged 6.5-11.5 years were sampled from four educational districts of Shiraz (Iran) using a multistage random systematic sampling scheme. Their heights and weights were measured using a SECA stadiometer and recorded to the nearest 0.1 cm and 0.1 kg, respectively. Healy-Rasbash- Yang (HRY) distribution free method was applied to estimate aged related centiles of height and weight of children. Then, they were compared with CDC (Centers for Disease Control and prevention) growth charts and the smoothed curves of the previous study in Shiraz carried out 15 years ago, when our country was faced with the imposed war of Iraq against Iran during 1980-1988.RESULTS: Our school children are now significantly taller and heavier for age than their peers born 15 years earlier. However, the statistical models for estimating the age-related centiles were consistent. A comparison of our data with the centers for disease control growth charts CDC 2000 shows that our height and weight medians correspond almost to the 40th centile of the latter, indicating less deficit than the previous growth study in Shiraz.CONCLUSIONS: The paper concludes that the CDC 2000 growth charts seem inadequate and inappropriate for our subjects and supports the previous studies findings for using local growth standards for clinical work in Iran, which should be updated periodically due to changes and developments taking place. These charts are likely to be applied in school children of urban population of Iran.

BACKGROUND: This study was conducted to compare the success rate of daily administration of aromatase inhibitor letrozole at a dose of 5 mg when administrating clomiphene citrate (CC) 100 mg daily in women undergoing superovulation and IUI.METHODS: This prospective randomized trial was done in Research and Clinical Center for Infertility (Shahid Sadoughi University), Yazd, Iran. Ninety-five patients with unexplained and mild male factor infertility were studied. Using a computer-generated random table, the patients were randomized into two groups, which were treated with 5 mg of letrozole daily (42 patients, 42 cycles) or 100 mg of CC daily (53 patients, 53 cycles). The data were analyzed using Student's t-test and chi square test.RESULTS: The mean age and duration of infertility in both groups were similar. There was a significant difference between the two groups in the total numbers of follicles during stimulation (5.45 ± 4.2 in CC group vs. 3.07 ± 2.1 in letrozole group) (P = 0.01). No significant difference in the endometrial thickness was found between the two groups (letrozole group = 6.9 ± 2.2, CC group = 7.8 ± 1.8). The mean levels of LH and FSH in both groups were similar. P value of difference in hormone levels between two groups were 0.33 and 0.47, respectively, but there was a significant difference in mean E2 levels between the two groups (241.28 ± 167.537 in letrozole group vs. 867.34 ± 296.689 in CC group) (P = 0.018). The mean number of gonadotropin ampules used in both groups was the same. Pregnancy rate per cycle was 9.5% in the letrozole group and 5.7% in the CC group (P = 0.6). Two out of the three pregnancies in the CC group (66.6%) and one out of the four pregnancies in the letrozole group resulted in a miscarriage (25%). One twin pregnancy (33%) occurred in the letrozole group and none in the CC group. Ovarian hyperstimulation syndrome (OHSS) did not occur in either of the two groups.CONCLUSIONS: In IUI, superovulation with clomiphene citrate and letrozole was associated with similar pregnancy rates, but the miscarriage rate was higher with clomiphene citrate.

BACKGROUND: To determine the distribution and severity of extracranial carotid arterial atherosclerosis in Iranian patients with ischemic stroke.METHODS: 328 patients with ischemic stroke were included in this study. Doppler ultrasound was used for evaluation of atherosclerosis in extracranial carotid arteries. The NASCET criteria were used to measure carotid stenosis.RESULTS: Ninety of 328 patients (27.4%) were found to have atherosclerotic plaques; 40 of these patients were women and 50 were men. Sixty-eight patients (20.7%) had artery stenosis <50%, 13 patients (3.95%) had 50-70 % artery stenosis and 6 (1.8%) had >70% artery stenosis.CONCLUSIONS: Extracranial atherosclerosis is not rare in Iranian patients with ischemic stroke, but most carotid artery lesions were plaques with <50% stenosis.

INTRODUCTION: The results of intracranial and extracranial vessel color Doppler sonography, which is now an inseparable part of patient evaluation, vary in different studies. The objective of this study was to evaluate the pattern of vascular involvement in thrombotic stroke and its relationship with risk factors of stroke.METHODS: One-hundred patients (45 males and 55 females) with thrombotic stroke underwent transcranial sonography and color Doppler sonography of extracranial vessels. The pattern of vascular involvement was analyzed. The risk factors of stroke were also evaluated.RESULTS: Forty-seven percent of the studied individuals had some variations in their color Doppler sonography of extracranial vessels, 27% had changes in the intracranial vessels and 26% showed changes in both. The most frequently involved vessels among the intracranial and extracranial vessels were the middle cerebral artery and the internal carotid artery, respectively. The pattern of vascular involvement was unrelated to hypertension, cigarette smoking, diabetes mellitus, dyslipidemia or history of ischemic heart disease. Extracranial involvement in patients with positive history of MI was more prevalent than in those without such history.CONCLUSIONS: Extracranial vessel involvement in thrombotic stroke was found to be more prevalent than intracranial vessel involvement in the city of Rafsanjan; however, intracranial vessel involvement was more prevalent than in western countries.

BACKGROUNDS: This study was conducted to determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis, and to identify independent predictors of anemia in children on hemodialysis.METHODS: This cross-sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7+20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan.RESULTS: A total of 22 (88%) patients had hemoglobin levels of <11 g/dL (anemic) and 12 patients (48%) had hemoglobin levels of <8 g/dL (severe anemia). The mean age of these patients was 15.5 ± 3.7 years. Mean time on chronic dialysis was 20.44 ± 15.25 months. Anemia was more common and more severe among children who were on dialysis for less than 6 months. There was an inverse relationship between the severity of anemia and duration of hemodialysis (P = 0.019, r = – 0.465). Nearly all patients were treated with erythropoietin, Children with more severe anemia received slightly higher dose of erythropoietin (P = 0.09, r = 0.202). There was a significant difference between serum albumin values in anemic patients and patients without anemia (P=0.023). There was a correlation between serum albumin and hemoglobin level (r=0.511, P=0.01). Intact PTH levels were >200 pg/ml in 16 patients (66%) and >400 pg/ml in 9 patients (37. 5%). There was a reverse correlation between intact PTH level >200 pg/ml and hemoglobin level (r=-0.505, P = 0.046).CONCLUSIONS: The prevalence of anemia in hemodialysis children in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months) and in those with low albumin and severe hyperparathyroidism.

Massive pulmonary embolism (MPE) often leads to circulation collapse, a form of shock. The process is set off by thrombus or multiple thrombi dislodgement followed by a rapid perfusion insufficiency of pulmonary arterial system. Patients experience severe hypotension with diastolic and systolic failure with an acute tricuspid regurgitation. On many occasions, release of an obstruction is unattainable and death is occurring frequently within one hour of presentation.A key reported source of MPE is its occurrence as a complication of deep vein thrombosis (DVT). While long-term immobilization and surgery are both directly associated with MPE, others such as previous DVT, malignancy, infectious lung and heart diseases, family thrombophilia, lower limb paralysis and pregnancy have to be considered as risk factors mainly due to its silent nature. Predisposing and complicating risks should be addressed by an early diagnostic physical exam. The clinician might offer a wide variety of diagnostic approaches, combining techniques into algorithms to better deal with the embolism severity. Multiple patient life-style changes and decisions to adhere to the proposed plan should be built up on patient-physician team effort.

Mediastinal lymph node enlargement is an uncommon feature of intrathoracic tuberculosis in adults, whereas it is the rule in primary tuberculosis in children. Herein, we report a 56–year-old female with three-year history of nonproductive cough, which was diagnosed as mediastinal lymph node tuberculosis.

Giant cell tumor of soft tissue is a rare primary soft tissue neoplasm with clinical and histological similarities to giant cell tumor of bone. Most cases arise from superficial soft tissue of extremities and present as painless and well circumscribed masses.Adequate surgical treatment by complete excision is associated with a benign clinical course in most cases. We report a case of primary giant cell tumor of soft tissue in groin region of a young man which was thought to be an inguinal lymphadenopathy in clinical examination.