مجله دانشکده پزشکی اصفهان
پیاپی 83 (زمستان 1385)

Tissue trauma, pain and surgical stress can increase coagulability in perioperative period. Tourniquet application can increase DVT by blood stasis and releasing tromboxane, but some studies concluded that tourniquet will increase fibrinolysis. In this study, the changes in coagulability and fibrinolysis due to tourniquet application were evaluated by thrombelastograph during knee arthroscopy. In this clinical trial, 30 patients without known risk factors of coagulopathies were studied. Blood sampling were done immediately before tourniquet inflation (TI) as well as 2 and 30 minutes after tourniquet deflation (TD). Thrombelasthographic parameters including R-time, K-time, α angle, MA, LY30 and LY60 were measured and analyzed by t-paired test and ANOVA in SPSS software. The mean of R-time at 2 and 30 minutes after TD decreased and the mean of α increased in comparison with before TI (p

Several studies have assessed the association between chlamydia pneumoniae infection and thrombotic ischemic strokes. This study was designed to investigate the association between this organism and ischemic strokes in Iranian patients. Antibodies to Chlamydia pneumoniae(CP IgA and IgG) were measured in 81 patients with stroke and 43 controls. CP IgG and CP IgA titers more than 1.1 Immune Status Response (ISR) were considered as positive. We found that 9.3% of controls and 13.6% of cases were CP IgA seropositive. Although the difference between these two groups was prominent but it was not statistically significant (p=0.25). The mean CP IgA titer was significantly higher in the case than in the control group (0.6 ± 0.3 vs. 0.47 ± 0.3 ISR, respectively, p=0.03). This difference was not significant for CP IgG titer. The higher titer of CP IgA in patients with ischemic stroke than in controls might suggest the co-existence of this infection with ischemic stroke. Assessment of this association needs longitudinal studies.

Intraventricular hemorrhage (IVH) is an important cause of mortality and morbidity in premature infants. IVH can cause motor deficit, cerebral palsy, behavioral and intellectual disability in preterm newborns. The aim of this study was to assess the prevalence and risk factors of IVH in premature infants with a gestational of less than 35 weeks. From 2003-2005 we prospectively studied 167 preterm newborns less than 35 weeks at Alzahra and Shahid beheshti hospitals- Isfahan- Iran. Skull sonography performed at 7th day of life and IVH graded from grade 1-4. The exclusion criterion was neonatal death before the 7th day of life. Brain sonography was conducted at day 7 after birth, and IVH was categorized to four degrees. The association of maternal and neonatal characteristics with IVH was evaluated. The prevalence of IVH was 19.5% in newborns < 35 weeks and 25% in newborns < 1500 grams. The prevalence of IVH significantly correlated with gestational age (p=0.005) and low birth weight (p= 0.002). From 167 infants, 9(5.3%) had grade 1 IVH, 14(8.3%) had grade 2 IVH, 9(5.3%) had grade 3 IVH and 1(0.5%) infant had grade 4 IVH. The other important risk factors for IVH were low 5-minute apgar score, duration of mechanical ventilation, vaginal delivery, duration of oxygen therapy, endotracheal suctioning, low platelet count and surfactant use. The protecting factors included maternal steroids therapy, higher birth weight and higher gestational age. This study emphasizes on the importance of recognizing the risk factors of IVH. With reduction of these risk factors, the incidence of this critical disease can be reduced in newborns.

MDM2 is a protein factor that plays an improtant role in inhibition of P53 and P73 related apoptosis. The aim of this study was to investigate the correlation between MDM2 expression and histologic grading of cerebral astrocytomas in order to reduce misdiagnosis of this tumor in controversial cases. In this study, 104 cases of astrocytic tumors including 4 different grades were selected randomly. We prepared 4µm sections of paraffin blocks of tumors. Then the slides were stained by anti MDM2 antibody. The intensity of nuclear staining for MDM2 marker had a statistically significant correlation with histologic grading. There was no significant correlation between percentage of nuclear staining for MDM2 and histologic grading. The positivity of MDM2 marker, as well as the multiplication of intensity and percentage of nuclear staining in S.Score had a significant correlation with histologic grading. The S.Score correlation with grading of astrocytic tumors was analysed by ROC Cure analysis method and showed that at the cut off point of 6, this score can be indicative for differentiation of Glioblastom multiform from other grades with specificity of 95.3%. Our results confirm the role of the MDM2 protein as a oncogenic factor in progression of astrosytic tumors.Evaluation the MDM2 experession in astrocytic cerebral tumors can be specifically indicative for distinction of glioblastom multiform from other grades of astrocytic tumors.

Hypertension is still an important cause of mortality in mother, fetus and neonate. Up to 25% of perinatal mortality in developing countries is due to hypertension. The role of immunologic factors in development of pre-eclampsia is increasing. Decreased level of C3 & C4 complements in pre-eclamptic patients has been documented in some studies. The goal of this study is to compare the level of C3 & C4 in patients with normal pregnancy versus those with pre-eclampsia. This cross-sectional study was performed during one year, among pregnant women with a gestational age of more than 20 weeks and blood pressure over 140/90 mmHg plus proteinuria over 300 mg in 24h-urine or over 30 mg/dl in random urine. We selected 23 pre-eclamptic cases and 34 controls. Mean level of C3 in pre-eclamptic patients was 98.8±25.82 mg/dl and 112.5±29.03 mg/dl in controls (p

The use of narcotics leads to immunodeficiency and infection these patients. Hence, recognition of common germs and appropriate antibiotics is of special importance.

This cross-sectional study was performed among all patients hospitalized within 2002-2005, in the ward of infectious diseases, in Alzahra hospital. First, the patients were divided into 4 groups of skin, limb, heart and lung involvement, then microbial culture was obtained and type of bacterium and effective drug.

Overall, 493 patients with a mean age of 27.75 years, and a minimum of 15 years. The mumber of deaths was 59 (11.96), of which, more than half have been affected by infective endocarditis. The most common complication (58.6%) was related to injection site complications. The lung was second (19%) followed by cardiac involvement equivalent to 13.8%. 60% of existing scopes were on tricuspid valve.The most common bacterium, staphylococcus aureus was obtained at a rate of 82.8% from these patients, which responded mostly to cefazolin and gentamicin. The need for vancomycin was present in 2% of patients, which were all hospitalized in the last year of the study (2005), and cefepime was used in only one case.

Considering that the most common bacterium was Staphylococcus aureus, whith a remarkable majority of patients has given appropriate response to simple and inexpensive drugs cefazolin, gentamicin, ceftriaxone and cloxacillin which are first line of treatment against this bacterium, therefore vancomilyn should be kept for special cases.

The aim of this study was to evaluate the pathologic findings in patients with sinonasal polyposis after functional endoscopic sinus surgery, and to assess the relationship between these findings and the predisposing factors of polyposis. This prospective study was conducted from March 2004 to November 2006 among 30 patients. All patients underwent endoscopic sinus surgery after a detailed history and physical examination. The biopsy specimen were evaluated in two groups of eosinophilic and neutrophilic polyposis; then pathologic findings were compared with other findings. Overall, 20 patients (66.67%) were male and 10 (23.33%) were female. The highest frequency was seen in the 50-60-year age group. Allergic rhinitis and septal deviation were the most co-existing conditions. Eosinophilic polyposis was more prevalent than neutrophilic polyposis (18% vs. 12%, respectively, p=0. 04). Eosinophilic polyposis was more common than neutrophilic type. Males are more frequently affected than females. Allergic diseases and nasal structural abnormalities were the most important factors associated with nasal polyposis.

CD44 is a cell surface glycoprotein which its expression on the surface of neoplastic cells in breast invasive ductal carcinoma seems to be associated with increased aggressive potential of tumor. The aim of this study was to determine the prevalence of this antigen on neoplastic cells in this type of cancer according to the metastasis to axillary lymph nodes. This study was performed on 80 cases of breast invasive ductal carcinoma treated by mastectomy with documented status of axilliary lymph nodes metastasis. Slides prepared from formalin-fixed and paraffin-embedded tumoral tissue were stained for CD44 immunohistochemically, and the frequency of CD44 immunoreactivity in two groups (with and without axilliary lymph node metastasis) was assessed by chi-square test. Mean number of metastatic lymph nodes in two groups (with and without CD44) was assessed by t-student test. The significance level was set at p

Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection that, formerly several cases has been reported in Iran. During recent years some outbreaks has been reported in different parts of country including Isfahan. The purpose of this study was to determine the seroprevalence of CCHF according to finding of IgG among butchers and slaughters of Isfahan province. In this cross-sectional study, conducted as a joint research with Arbovirus Laboratory in Pasteur Institute, IgG antibody against CCHF was assessed among 80 individuals. The study was conducted as a joint research with Arbovirus laboratory in Pasteur Institute of Iran on 2004. Overall, 4 (5%) persons were seropositive and 2 cases had borderline results. There was no statistically significant difference between butchers & slaughters. Positive cases were detected mainly in the Isfahan slaughterhouse. The findings of the current study show that although CCHF is endemic among domestic animals in Isfahan province, but seropositivity in high risk groups, e.g. butchers and slaughters is not so high. More serious measures should be considered for prevention of CCHF in high risk groups.

Although appendectomy is the most common emergency abdominal surgery, there is no epidemiologic study on chronic pain after open appendectomy. The aim of this study was to evaluate the incidence and possible risk factors of chronic pain following this common surgical procedure. In this cross-sectional survey, a questionnaire was completed regarding the pain at the surgical site by calling available patients who had undergone open appendectomy from 1999-2004 in a hospital in Fasa. The patients records were checked for the results of pathology. Out of 1130 patients operated by open appendectomy, 155 were available. The mean time left after appendectomy was 28 months. At the time of study, 41 (26%) patients still had pain at the site of operation and 9.85% of them had severe pain at rest and 22% suffered from severe pain during daily activities. Chronic pain was significantly more common among patients who had the memory of severe acute post-operative pain and there was no significant difference in the chronicity of pain according to age, sex and positive appendectomy. Chronic post-appendectomy pain is provalent. It is more common in patients with severe acute post-operative pain but it seems not to be related with age, sex, and positive appendectomy.

Anxiety is a common disease in the society. Several neurotransmitters. The aim of this study was to investigate indirect effect of dopamine on anxiety in rat.

In this experimental study, eight male rats were divided into control and experimental groups. The control group received saline and the tested groups received different IP doses of drugs haloperidol (dopamine receptor antagonist), SKF38393 (dopamineD1 receptor agonist) and quinpirol (dopamine D2receptor agonist). For studying of anxiety-like and antianxiety effects Vogels conflict test and Elevate plus-maze (EP-M) test were used.

Injection of different doses of haloperidol in rats could increase the number of times of passing through place of received shock by apparatus in comparison with control group in Vogels test. In EP-M test, injection of 0.04 mg/kg of haloperidol increased the number of entrance to open arm and time spent on arm comparing to the control group. Quinpirol diminished the number of times of passing through place of receiving shock in comparison with control group in Vogels test. In EP-M test in dose 1 mg/kg number of entrance to open arm and the time spent on arm decreased comparing to the control group.

The findings of this study showed that by increasing the doses of haloperidol, the effect of this antagonist has been significant and diminished anxiety. The SKF38393 and Quinpirol by occupying their own dopamine receptor D1, D2 had an effect like endogenous dopamine and made the rats anxious.

The methods of ammetropia of human eye correction are divided into invasive and non invasive methods. Each method has its own advantages and disadvantages. Each method has limitations due to the type of compensation; therefore it is difficult to make a straight forward decision. In this study we tried to compare the results of methods to find out their predictability, Uncorrected Visual Acuity, safety and stability. We investigated data of 24012 patients of different operation types in published papers by using the following keywords: Conductive Keratoplasty (CK), Hyperopic Thermokeratoplasty (HTK), Diode Laser Thermal Keratoplasty (DTK), Laser Thermal Keratoplasty (LTK), Photorefractive Keratectomy (PRK), Laser In Situ Keratomileusis (LASIK), Laser SubEpithelial Keratomileusis (LASEK). The criteria for selection of papers were safety, predictability, stability and uncorrected visual acuity. Data were analyzed with Chi-square test. For those patients with hypermetropia less than 3.5 diopter, CK and LTK have best correction results, respectively. Then the results of PRK and LASEK were the same. For all range of myopia, LASEK provided the best results and then LASIK was proper for moderate and higher myopia refractive errors, and PRK was useful in low myopia refractive anomalies.

Spontaneous migration of an intrauterine device into the bladder is very rare. Foreign bodies of the urinary bladder may occur by self-insertion or migration from neighbor organs. When ignored for a long time, foreign bodies act as a core for calculus formation. The patient usually present with dysuria and intermittent urinary tract infections.A 42-year-old woman is reported in whom an intrauterine device had been placed 7 years before this report, and complained of chronic pelvic pain, recurrent urinary tract infections and irritative urinany tract symptoms. After observation of stone in the bladder, the intrauterine device and the surrounded stone was removed by suprapubic cystolithotomy.

A huge retroperitoneal malignant fibrohistiocytoma myxoid type, 10.5 kg of weight, with anatomic involvement of left kidney but without metastasis is reported. It is reported because of its size. This 54-year-old patient lived in Austria, and his chief complaint was abdominal obesity that has been resistant to diet therapy. The patient underwent a successful laparatomy and was referred to an oncologist for further follow up.