مجله دانشکده پزشکی اصفهان
پیاپی 90 (پاییز 1387)

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. This seems to cause changes in brain chemistry that can alleviate symptoms of certain mental illnesses ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), catatonia, schizophrenia and other disorders.

The rupture of hydatid cyst into the intra-hepatic bile ducts is considered as one of the problematic and important hydatid side effects. Considering the fact that this parasite is endemic in Iran, detection and treatment of hydatid cyst ruptured into the biliary system is crucial for any surgeon. Failure in detecting and predicting this complication can result in irremediable consequences.This study was retrospective and included 196 patients with liver hydatid cyst who were surgically operated (1994-2005) in hospitals of Isfahan University of Medical Sciences (Kashani Hospital, Isabne Maryam hospital and Al-Zahra Hospital) by the researcher, and among them, 22 patients were excluded because of incomplete records or lack of the conditions required for entering the study, and finally 174 patients were selected for the study. The quantitative and qualitative data were analyzed by t-test and Fisher's exact test respectively, also with Pearson test when necessary, at the statistical significant level of P< 0.05 in SPSS-10 software.Laboratory findings in patients with liver hydatid rupture was as follows: total bilirubin more than 1 mg/dl (p < 0.05), direct bilirubin more than 0.4 mg/dl (p < 0.05), alanine aminotransferase more than 31.5 u/l (p < 0.05), aspartate aminotransferase more than 29.5 u/l (p < 0.05), jaundice in last two weeks (p < 0.05), cyst size more than 14.5 cm (p < 0.05) and alkaline phosphatase more than 275.5 u/l (p < 0.05). Age, gender, white cell count, and cyst size smaller than 10 cm were insignificant and non helpful in making the diagnosis.In cases that rupture of liver hydatid cyst cannot be detected by ultra-sonography, surgeon must be careful during the operation in exploration for detection of probable rupture of liver hydatid cyst to provide the necessary treatments during the cyst operation and to prevent further operations and side effects.

Proteinuria is the main sign of preeclampsia. The gold standard test for quantitative evaluation of proteinuria in patients with suspected preeclampsia is the 24-hour urine analysis. Howewer, the collection of 24 hour urine specimens is time consuming, cumbersome, costly and unreliable procedure. The purpose of this study was to determine the diagnostic value of the protein/creatinine ratio in predication of 24-hour urine total protein among women with suspected pre-eclampsia.This study was a cross-section investigation and was performed on 45 hospitalized pregnant women evaluated for suspected pre-eclampsia at > 24 weeks of gestational age and a BP > 140/90 mmHg at 22-Bahman hospital between Dec 2006 and Jan 2008. For each patient, a random morning urine sample was obtained for the calculation of the protein/creatinine ratio then a 24-hour urine collection for determination of urinary protein excretion was collectedFrom 45 patients, 67 percent of the study population had significant proteinuria. There was a strong correlation between urine protein/creatinine ratio and 24-hour urine protein excretion. Pearson's correlation coefficient was 84% and p = 0.0001. The best cut off point for the random urine protein/creatinine ratio was 0.23 with sensitivity, specifity, positive predictive value and Negative predictive value 81%, 77%, 89%, 63%, respectively.With further studies the random urinary protein/creatinine ratio could replace the 24-hour urine collections as an easier, faster, more useful screening test for ruling out significant proteinuria in suspected patients.

24-h urinary pr is a standard way to diagnose lupus nephritis. Assessment of Pr/Cr ratio in morning spot urine is a valuable method in diabetic patients but it has no use in SLE patients routinely. In this study Pr/Cr ratio in spot urine was compared with 24-h urine Pr. If they have valuable correlation, we can use this test instead of 24-h urinary Pr. The aim of this study was to evaluate the correlation of spot urine protein-creatinine ratio for prediction of significant proteinuria (> or = 300 mg/24 h) in patients with systemic lupus erythematous.A cross-section study was conducted in 74 hospitalized women with systemic lupus erythematous. The correlation between Prot/Cr in first morning urine specimens and urinary protein excretion were analyzed in 24-h collections.zorrelation between Prot/Cr ratio in spot morning urine specimens and urinary protein excretion in 24-h collections was significant.A high correlation and precision of agreement were demonstrated between the two methods of assessment proteinuria in lupus patients. The difference between the two methods was less than the biological variability in the protein excretion and its measurement, enabling the methods to be used interchangeably creatinine ratio in spot morning urine samples is a precise indicator of proteinuria in patients with lupus nephritis and represents a simple and inexpensive procedure in establishing severity of proteinuria in patients with systemic lupus erythematous.

Proton pomp inhibitor drugs are used in the patients presenting gastrointestinal (GI) bleeding as adjuvant to endoscopic treatment. Proton Pomp Inhibitor (PPI) therapy is used via IV or oral route, with significant difference in cost and convenience. The aim of this study was the evaluation of outcomes in PPI therapy via IV or oral rout in high risk patients (i.e. active bleeding, adherent clot and non bleeding visible vessel).After endoscopic treatment, high risk patients presenting with upper gastrointestinal bleeding were randomly divided into two groups. Group one including 45 patients who received IV pantoprazole (80 mg stat, and 8 mg/h for 48 hours) and group two 48 patients received omeprazole (40 mg bid for 48 hours).The mean age of pantoprazole group was 45 ± 18 years (45 patients, Male (28)/Female (17) = 1.6) compared to omeprazole group 42 ± 15 years (48 patients Male (30)/Female (18) = 1.7). The two groups were matched for site of ulcer, age, rate of H. pylroi infection and type of bleeding stigmata. There were no differences between two groups in regards to transfusion units, death, surgery and rebleeding.High dose oral omeprazole is as effective as intravenous pantoprazole in high risk GI bleeding patients treated with endoscopic treatment.

The MR venography is used to examine the intracranial venous system. However, little information is available about the age and sex-related variation in intracranial veins and (venous system) sinuses. We evaluated the normal intracranial venous anatomy in different age and sex groups by MRV.

742 patients with normal brain Magnetic Resonance Imaging (MRI) were studied by MRV. Patients categorized into the three groups (Age < 15, 15-55, Age > 55). All the patients who have a history of brain tumor, vasculitis and anticoagulant therapy were excluded from the study.

The transverse sinus distribution was %51.9 bilaterally, %12.2 only on the left side and %35.8 only on the right side. Only in one patient this sinus was not visible (0.1%).The occipital sinus was seen in 69/1% (224 patients) and the sigmoid sinus was visualized in 67.7% (490 patients). The Galen's vein was visualized in 72.8% and Rosenthal's vein was visualized in 66.6%. The superior sagittal sinus was visualized in all patients. There was a statistically significant difference in intracranial venous anatomy between three age groups but not in different sex groups.

The MRV is a valuable non-invasive imaging modality in the assessment of intracranial venous anatomy and its age related variation.

ARG is a proto-oncogene and a member of a tyrosine kinase proteins family. It has great importance in many cancers, but there is no conclusive evidence on its role in DLBCL staging. The aim of this study was to evaluate importance of ARG, in this cancer's staging.Sixteen DLBCL and 4 reactive lymph node (as control group) samples, after staging using Ann Arbor staging system, were used in this study. Formaldehyde fixed paraffin embedded blocks were prepared from the samples. After the sectioning, all samples were hybridized with primary antibodies against ARG and GAPDH (as control house keep keeping gene). The slides were then washed and hybridized with fluorescently labeled secondary antibodies (ARG, green labeled and GAPDH, red). After capturing the pictures using CCD camera, the intensity of green and red colures was measured and the ratio between green/red, that demonstrate changes in ARG expression, were calculated.The mean ratio of green/red (ARG expression) was significantly different between reactive lymph node, stage I, II and III of DLBCL. ARG expression was different between all groups except for between stage III and VI of DLBCL.The observed changes in ARG expression is a potential biomarker for DLBCL staging. In addition specific inhibitors of ARG can be considered as new chemotherapy agents in the DLBCL treatment.

Manganese (Mn) is one the more important trace elements in the humans. Mn plays an important role in antioxidant defences and it is an essential cofactor for a number of enzymes. Some studies have revealed that Mn deficiency is teratogenic. The relationship of Mn deficiency and cancer induction also has been studied in some studies. We evaluated the serum Mn concentration in patients with bladder cancer in comparison with healthy individuals.

During this cross sectional study, 51 patients with bladder cancer and 58 normal subjects were selected regarding the inclusion and exclusion criteria. Blood samples were collected after 8 hours of fasting. The Mn serum concentration was measured in all samples and copamared between two groups.

Mean of serum Mn concentration was 1.3 ± 0.39 µg/l in bladder cancer patients and 1.87 ± 0.84 µg/l in control group. There was a significant difference between two groups (p < 0.001).

According to the results of this study Mn serum concentration had significant decrease in bladder cancer patients in comparison with normal subjects. This result is similar to the other researches done in different cancers. Regarding the high Mn level in fresh foods and vegetables, consumption of these nutrients, is recommended in high risk individuals for bladder cancer.

Viral co-infection is a major cause of human mortality and morbidity and diagnosis of infected patients can lead to prevalence reduction.In a cross-sectional study, 106 HIV positive patients with a history of IVDA, addmitted among 2000-2007 to Navab-Safavi curing center in Isfahan, were studied. HBs Ag and HCV-Ab were carried on by ELISA method and check-list of related risk factors was completed for each patient. The prevalence of hepatitis B and C and related risk factors were analyzed using Odds Ratio (95% CIs) and logistic Regression tests.Our result showed that 2 patients (1.8%) had hepatitis B, 80 patients (75.5%) had hepatitis C and 10 patients (9.4%) had both of them. History of imprisonment and unemployment were independent risk factors for IVDA [OR (95% CIs): 18.27 (5.9-56.5) and 8 (2.4-26.1) respectively] but marital status, education and age have not any correlation with neither IVDA nor hepatitis.Our results indicated high prevalence of hepatitis B and C in HIV positive patients with IVDA history. Unemployment and low hygiene in prisons must be mentioned to reduce IVDA in our society.

One of the causes of pulmonary artery hypertension (PAH) is mustard gas poisoning. Mustard gas is a destroying factor in chemical Bumps that contaminated Iranian soldiers in the war between Iran and Iraq. This study was designed for evaluating the effect of sildenafil, (one of the effective drug in PAH) on the PAH caused by Mustard gas.In a quasi experimental study on 20 patients poisoned with mustard gas and symptomatic PAH, pulmonary artery pressure (PAP) was measured with transthorasic echocardiography (TTE). Patients did 6 minutes walking test (6 MWT); then, they were treated for 12 weeks with 50 mg sildenafil, daily. At the end, echocardiography and 6 MWT were repeated.All the patients were men with mean age 42.89 ± 3.91 years old. Mean pressure of pulmonary artery at the beginning of the study was 37.75 ± 8.21 mmHg and walked distance at 6 MWT was 263.35 ± 2.28 meter. These values after 12 weeks treatment were 29.10 ± 6.55 mmHg and 291.35 ± 82.39 meter, that wee statistically meaningful improvement.There are studies demonstrate the effect of sildenafil in improving PAH. This study also reveals that sildenafil improves mustard gas PAH. According to the results, even single daily dose of sildenafil can has good effect on these patients.

The role of prenatal restraint stress on the immune function of male rats has been studied previously. In this study we evaluated the effect of this stress on some of the blood cells.To study of the prenatal restraint stresses effect on the immune system, pregnant rats were divided into four groups including one control group and three experimental groups. The control group did not receive any stress during the gestation period. In the experimental groups (1, 2 and 3) the pregnant rats were subjected to the restraint stress respectively from 8 to 21, 8 to17, and 17 to 21 days of gestation Offspring were housed in laboratory conditions with their mothers until 40 days of age. At the age of 60 days the blood samples were taken from the male rats.Prenatal stress markedly decreased the total number of white blood cells (WBC) in groups 1 and 3, and the percent of granulocyte cells in groups 1, 2 and 3 decreased. The percent of lymphocyte cells in the groups 1, 2 and 3 compared with control group increased significantly. The number of red blood cells (RBC) significantly increased in group 1 and 2 compared to control group. The number of platelet cells also increased in group 1.Our data support that prenatal restraint stresses alter the function of immune and hemopoietic system. Further studies needed to evaluate these effects precisely.

Tuberculosis infects one third of the world population and the leading of death worldwide. Lymphadenitis is the most frequent form of extra pulmonary tuberculosis. Breast tuberculosis is an extremely rare form of extra pulmonary tuberculosis. We introduced a case of breast tuberculosis that presented with axillary sinus tract, left supraclavicular lymph node and left breast edema. Case Report:A 15 year-old girl with a history of left breast swelling and left axillary sinus tract discharge from 2 months ago was admitted to our hospital. The physical examination showed left supraclavicular lymphadenopathy (size=1×0.5, fixed, firm with mild tenderness), left breast mass (size=2×2, firm, mild tenderness) with normal overlying skin, left axillary sinus tract with large mass (size=8×8, tender, erythematous and firm). She has also edema of the chest wall especially in the left hemi thorax. Chest X-Ray was normal and ultrasonographic study of breast showed an ovaloid mass (13×29) with cystic structure and multiple septations. Abdominopelvic sonography was normal and PPD was negative. Excisional biopsy of left axillary lesion showed granuloma and caseous necrosis compatible with tuberculosis. Within 2 weeks of anti-TB medication, the patient developed with left breast discharge. After 6 weeks of anti-TB therapy discharge from this site and left axillary sinus tract was stopped. The tuberculosis of breast is a disease of younger age group and the younger patients usually manifests sign of a pyogenic breast abscess. In our case left breast swelling and left axillary sinus tract discharge were the first presentation of disease.

Entrapment of the suprascapular nerve may causes pain in the shoulder which may be attributing wrongly to the other shoulder disorders and the treatment often delayed. Many authors believed that the treatment of this disease is conservative. This study was conducted to assess the effect of surgical release of the suprascapular nerve on the improvement of the patient's functional score.Operative release for the entrapment of the suprascapular nerve was carried out in 5 patients. All patients were followed for 16 months (between 12-20 months). They finally were assessed by the functional shoulder score devised by constant and murley. The average score before the operative release was 40 ± 17. The diagnosis was confirmed with electrophysiologic studies and MRI. The average time from the onset of symptoms to operation was 7.8 ± 3.2 months. All patients were followed for an average of 16 months after operative release. Final constant score was 75.8 ± 26.2. There was an excellent result in all patients, except one who obliged to change his job (case 1). All patients were pain free after operation and had full recovery of muscle bulk except for case 1.The symptomatic and functional outcome in our study showed that operative decompression and entrapment of the suprascapular nerve improved the patient's functional score. It seems that, if conservative treatments such as physiotherapy failed, it is better to do operative release as soon as possible, because the delayed operation has negative effect on final outcome.