مجله دانشکده پزشکی اصفهان
پیاپی 96 (امرداد 1388)

Bispectral Index is one of the qualitative methods of measuring of sedation and depth of anesthesia. In a few studies appeared a paradoxical effect of N2O on BIS in adults. In this study, the paradoxical effects of N2O during inhalation induction of anesthesia in pediatrics by halothane and isoflorane were evaluated. In a clinical trial study, eighty 1-6 year old age, ASA I and II pediatrics who candidate for abdominal and extremities elective surgeries were evaluated in 4 groups (Halothane, Isoflorane, Halothane plus N2O and Isoflorane plus N2O). Anesthesia was induced by gradual increase of vapor gas in 100% of O2 in groups 1 and 2 and in 50% of N2O in O2 in groups 3 and 4. BIS and other variables were measured before and after of laryngoscopy and surgical incision. The mean of percent changes of BIS after the laryngoscopy in comparison to pre-laryngoscopy in 4 groups were: 0.15 ± 13.95,16.57 ± 19.49, 4.90 ± 42.68, and 31.22 ± 28.19 (P = 0.287). The pre and after surgical incision BIS were: -3.88±23.30, 19.36 ± 9.17, 16.73 ± 2.33, and 7.75 ± 13.3 (P = 0.121). This study could not confirm appearance of paradoxical effects of N2O on BIS during inhalation induction of anesthesia in pediatrics.

Studies of the association between the plasma concentration of lipoprotein (a) and coronary heart disease (CHD) have reported apparently conflicting finding. The objective of the present study is to evaluate the association between serum levels of LP (a) and ischemic heart disease as well as other cardiovascular risk factors in a population – based study conducted on local cross sectional. LP (a) serum was measured in 142 patients with chronic stable angina who were under going clinically indicated coronary angiography. Lipid profilefasting blood glucose, anthropometric and clinical parameters were analyzed. LP (a) levels were significantly associated with numbers of coronary artery stenosis (CAD) in men, but no in women. Also, an direct association between mean levels of LP (a) and number of CAD in men younger than 55 years old inverse association in men older than 55years old were observed. Our multivariate analysis found that LP (a) was considered an independent predictor for severity of CHD in men, especially in younger individuals.

Metabolic syndrome is one of the risk factors of cardiovascular diseases. This study was designed to determine the prevalence of metabolic syndrome in survivor of childhood acute lymphoblastic leukemia. In a descriptive cross-sectional study fifty-five acute lymphoblastic leukemia cases younger than 21 years-old (the mean age: 10.4 years) were selected randomly from those who referred to Al-Zahra and Seyedolshohada hospitals in Isfahan from Aug to Feb 2007. The metabolic syndrome was defined based on criteria analogous to those of the modified adult treatment III (ATP III). We measured body mass index, blood pressure, fasting blood sugar, serum lipoproteins and insulin levels in subjects with metabolic syndrome. 20% (11/55) of participants had metabolic syndrome. 91% (10/11) of affected subjects were male (P = 0.025) and the prevalence of metabolic syndrome (MS) was more in males compare to the females (30% versus 4.5%, P = 0.019). 25% (14/55) of cases were obese while 71% (10/14) of them had metabolic syndrome (P 0.05). Survivors of childhood acute lymphoblastic leukemia are at risk for metabolic syndrome and its complications. The most prevalent risk factor in our study was obesity. Therefore close follow up in acute lymphoblastic leukemia treated patients is highly recommended.

Early treatment with exogenous surfactant is associated with better outcome in neonates with Hyaline membrane disease (HMD), but diagnosis may only become clear late in the course of the disease. In order to rapidly and reliably identify such neonates, we have evaluated the Gastric aspirate shake test (GAST). Eighty one neonates with gestational age less than 34 weeks enrolled to this study (51 newborns without pulmonary diseases and 31 newborns with HMD). The clinical characteristics of HMD considered as the gold standard of diagnosis. About 1 ml mixture of normal saline (0.5ml) and stomach contents were collected within 30 minutes of birth (0.5ml) were shaking for 15 seconds into a glass test tube. Then 1 ml of 95% ethanol was injected into the test tube and the 2 ml mixture of gastric aspirate, saline and alcohol agitated for a further 15 seconds. After a waiting time of 15 min, the surface of fluid was examined for bubbles to decide the result of shake test. If no bubbles were present then the test was NEGATIVE (very little surfactant). If bubbles were seen around the top of the fluid but not enough bubbles were present to completely cover the surface, then the test was INTERMEDIATE (only some surfactant). If bubbles were present right across the surface of the fluid, then the test was POSITIVE (adequate amounts of surfactant). All infants who developed HMD had negative or intermediate test results. The GAST had a specificity of 66%, sensitivity of 100%, positive predictive value of 64.5% and negative predictive value of 100% for developing HMD. The sensitivity and specificity of the GAST for prediction of surfactant requirement in HMD patients were 100% and 64.8%, respectively, with a positive and negative predictive value of 62.5% and 100%, respectively. We conclude that the GAST on gastric aspirates obtained within 0.5 hour of delivery is a rapid and simple procedure for rule out of HMD and surfactant requirement.

By the increasing of surgeons experience in the transhiatal esophagectomy, the mortality rate of this procedure is markedly reduced. Therefor we should consider to the quality of life the patients after the operation. The aim of this study was to determine the incidence of anastomotic stricture and predictive factors contributed to this complication after transhiatal esophagectomy.

We present a prospective study carried out on 61 patients with esophageal cancer from 2000 to 2007 in Isfahan Al-Zahra hospital. The data of anastomotic leak, respiratory complication, reoperation, other complication, operation time, intraoperative bleeding and anastomotic stenos is evaluated.

Leak of anastomosis, respiratory complication, reoperation, and overall complication were significantly correlated with anastomotic stenosis.

In order to reduce the incidence of anastomosis stricture after transhiatal esophagectomy improvement of respiratory conditions as well as decreasing risk factors of anastomosis leak must be considered.

This research has been done with awareness of both positives effect of green tea, which is approved by researchers and the importance of treatment of opened skin wound. 32 male mice were divided into 4 different groups. First group was control and the others were experimental groups. Different dose of alcohol (50, 150 and 300 µl) were injected in experimental groups. After anaesthetizing the mice, skin wound is created on the back of the mice by a 6 mm punch. While the mice in observer group were treated by physiology serum, around the wound of the back of other mice was injected alcohol of green tea. The recovery progress of the wound (wound size and healing time) was measured in the 1st, 3rd, 7th and 15th days of study. Fibroblasts, macrophages, neutrophils and endothelial cells were evaluated in wound specimen in 3rd, 7th and 15th days of the study. There were no significant differences among these groups on 4th day of study. The degree of recovery on 7th day for observer group was (19.2 ± 10.2) for 2nd groups were (38.8 ± 17.9), for 3rd groups were (48.3 ± 17.7), for 4th were (60 ± 17.8) (P < 0.04). The degree of wound healing recovery at 15th day of the study was significantly different, in different groups: 25 8.2 (group 1), 47.8 ± 17.5, (group 2), 66.5 18.1 (group 3) and 76.5 18.4 (group 4), (P < 0.01). The degrees of fibroblasts in different groups were as the following: group 1 (observer) (106 ± 13.8, 185.8 ± 12.1, 90 ± 10.5), group 2 (84 ± 19.7, 158.1 ± 14.8, 103.3 ± 12.9), group 3 (96.8 ± 22.9, 169.2 ± 16.5, 109.8 ± 10.8), and group 4 (99.8 ± 20.8, 173. 8 ± 12, 125 ± 11.9). Alcohol of green tea extracts speed up the wound healing process. We recommend more researches in the field of content enrichment, roots of administration and the effect of them. Examine the water and alcohol of green tea extract on different animals (chronic wounds and burnt) and finally on sick persons.

Low back pain causes disuse and physical deconditioning, and increases disability, and may turn simple low back pain into a chronic low back pain. Twenty subjects who suffered from low back pain entered to the study and were randomly divided in Case (low back pain group) and control group. Also 10 healthy subjects were entered to the study as a sham group. After ten minutes rest and recording of rest, cardiovascular responses of studied subjects in two exercises: Straight Partial Sit-Up (SPSU) and Oblique Partial Sit-Up (OPSU) were studied. Then the case group went through a four week regime of the exercises and cardiovascular responses of the exercises were recorded in three groups. Systolic and diastolic blood pressure changes of LBP subjects in comparison to healthy people (p < 0.05) but heart rate changes of LBP subjects are not significantly different (p > 0.05). After the 4 weeks of training period, cardiovascular responses in low back pain test group in comparison to the beginning of the study reduced. It seems that the differences between cardiovascular responses of low back pain patients and healthy subjects are due to deconditioning theory. These patients during the same exercise activity like healthy peoples use more efforts that lead to more cardiovascular responses. The reduction of exercise cardiovascular responses after the training period in the case group indicates an increase of muscle strength and decrease in central comments for motor unit's recruitments, which show cardiovascular adaptation and conditioning procedure in these subjects.

Drivers have a higher risk of cardiovascular disease and the frequencies of risk factors and IHD is prevalent among them. 176 bus drivers were participated in the study. Frequency of risk factors and Positive exercise stress test were evaluated. The average age of studied subjects was 47.47 years. The waist circumference in 23.19% of them was more than 102cm. The prevalence of obesity and overweight in drivers were 75.5% and 30.7% of them had hypertension and 60.2% were smoker. Exercise stress test was positive in 9.7% of drivers. Frequency of cardiovascular risk factors in drivers was considerably high. However, frequency of positive exercise stress test was not higher than other population in similar study. The reason of normal incidence of positive exercise stress test in drivers, despite the poorer risk profile, may be due to overall lower ischemic heart disease in Iranian population.

Ormandibular Dystonia is a kind of focal dystonia in later adult life with a peak age of onset in decade. Women are affected more frequently than men. The most common type is characterized by forceful opening of the jaw, retraction of the lips, spasm of the platisma; also protrusion of the tongue jaw may be clamped shut and the lips may purse. Other patterns include lateral jaw deviation and bruxism. Blepharospasm may be accompanied by oromandibular dystonia that called cranial dystonia or Meige syndrome. Because the act of speaking and eating can activate the dystonia, patients may have dysarthria and dysphagia. Injection of Botulism toxin is very helpful treatment for focal dystonia like oromandibular dystonia.Toxin is injected in maseter, petyrigoid and other overactive muscles in lower face region.Oromandibular dystonia may have a genetic basis or hyper metabolism of the basal ganglia, cerebellum and supplementary motor area.