مجله علمی دانشگاه علوم پزشکی کردستان
سال هشتم شماره 3 (پیاپی 31، بهار 1383)

Cesarean is one of the most frequent of all surgical procedures in the world and our country. A regional anesthetesia is more often conducted for elective cesarean section particularly when maternal awareness is desirable. However, hypotension occurs frequently during spinal anesthesia. The aim of this study was to evaluate Intramuscular Ephedrine effects in the prevention of hypotension during a cesarean section. In a randomized clinical trial at Besat Hospital 100 patients were selected and divided into two equal groups. One group was given 30 mg of Ephedrine intramuscularly and the other group underwent spinal anesthesia.Systolic blood pressure was measured before and after spinal anesthesia at 2.5, 5, 10, 15, 20, 30 minutes. Demographic and clinical data was assessed and analyzed with Spss-win computer software. Intramuscular Ephedrine significantly reduced the hypotension in the Study group compared with the Control group. Systolic blood pressure at 2.5, 5, 10, 15, 20 and 30 minutes after the injection of Intramuscular Ephedrine and spinal anesthesia was significantly different in the two groups and occurrence of hypotension in the intervention group was lower than the comparison group (p<0.05) Prophylactic intramuscular ephedrine is effective in the prevention of hypotension associated with spinal anesthesia for elective cesarean section.

Reconstruction of the genital area is important for functional, cosmetic, and psychological reasons.Case Reports: Since 1999, nine cases of one stage reconstruction of extensive genital area wounds using gracilis musculocutaneous island flaps have been successfully carried out. All patients were male with an average age of 39. In these patients, the scrotal and perineal skins were lost as a result of either necrotizing fasciitis or trauma. All the patients had exposed testicles. The mean follow-up was 23.6 months and all flaps survived. All wounds healed without complication. Genital area wounds reconstruction with the gracilis musculocutaneous island flap gave an excellent aesthetic and functional result.

Chronic diarrhea is a common problem. The causes of chronic diarrhea are numerous. The subsets of patients are those having chronic non bloody diarrhea with normal colonoscopy. These patients may be challenging for the physicians in respect to diagnosis. Many of these patients might be diagnosed mistakenly as having irritable bowel syndrome. The aim of this study is to determine the causes of chronic diarrhea in this subset of patients. This descriptive study encompassed all patients with chronic non-bloody diarrhea that had referred to Shariati Hospital clinic during an 11 month period (Nov 2003- Oct 2004). Routine laboratory tests, thyroid function test, small bowel transit, HIV test, celiac serology, and colonoscopy with biopsy were performed. Upper endoscopy with biopsy of second portion of the duodenum was performed also. Sixty-five patients (34 males, with an average age of 39.616 Ys) were included in the study. 43 (66.2%) patients had Rome II criteria for irritable bowel syndrome IBS. Of these 43 patients, 38 (88.4%) patients had IBS and 5 (11.6%) patients had organic diseases (including 3 (7%) patients with microscopic colitis (MC) and two (4.6%) patients with malabsorption syndrome). Thirteen (20%) patients had organic diseases including 4 (6.2%) patients with MC, 5 (7.7 %) patients with malabsorption syndrome, and one (3.1%) patient with crohn disease. Seventy five percent of patients with MC also had Rome II criteria for IBS. The causes of diarrhea were not clarified in 14 (21.5%) patients.Overall, the most common organic causes of chronic diarrhea were malabsorption and MC. Prior to the diagnosis of IBS, in patients with chronic non bloody diarrhea who have normal colonoscopy, a colonic biopsy should be performed to rule out MC, and if normal, small bowel diseases should be suspected.

Alpha-fetoprotein (AFP) is a glycoprotein that is synthesized by the fetal yolk sac early in gestation and later via the gastrointestinal tract and liver. It circolates in fetal serum and passes into fetal urine and amniotic fluid. Its concentration increases steadily in both fetal serum and amniotic fluid until 13 weeks, after which these levels decrease.In some of the fetal abnormalities alpha-fetoprotein levels increase. This study was done to survey threatened abortion. This study was cohort and the population under study included 100 women with vaginal bleeding in the first trimester and 100 women without any bleeding.AFP level was measured in the two groups at the 16th and 18th weeks of pregnancy. The data was analyzed with Spss-win software. This study showed that in the case group the AFP level was higher than that in the control group. Moreover, The AFP level at the 18th week of gestation in the case group was higher than in the test control group. There was a significant difference between the two groups. Serum AFP levels in patients who suffered from threatened abortion was more than normal control group. Which may indicate fetal anomaly.

In recent years, repeated cesarean was the most important reason for cesarean surgery in our country. Although a previous cesarean is not a compulsory indication for section, it has been recommended by the Society of Obstetricians and Gynecologists of Canada and the American College of Obstetricians and Gynecologists (ACOG) as a safe and desirable option for the majority of women who have had previous cesarean section All files (a total of 15,073 cases) of the Rafsanjan’s Niknafs Hospital archives dating back to the years 1368 to 1370 were evaluated. 592 cases with a history of previous cesarean section were selected. Then the necessary information was recorded in a research checklist. The prevalence of normal delivery was 26/7%. Despite the significant difference between the bedding time in the hospital of the two groups (p=0/001), there was no significant difference between the maternal and neonatal complications in the two groups. In non of the 154 cases of cephalic deliveries uterine rupture occurred. One case of uterine rupture due to a breech delivery and cephalic dystocia and one case of dehiscence due to a long labor of a fetus with transverse lie occurred at home. Based on global reports the risk of uterine rupture is 0/01 – 0/001 but in this research study out of 154 vaginal cephalic deliveries, there was no uterine rupture. Vaginal delivery after cesarean section in women with access to suitable obstetric facilities, who desire it, and are looked after by experts, is appropriate especially for low-income people.

Rapid growth of populations, urbanization, and working in confined spaces has led to an increasing demand for healthy recreations such as swimming in public pools. In view of the fact that contaminated pools could transmit a number of contagious diseases, their sanitation is considered as top priority in environmental health programs. The aims of the investigations described in this study were two fold: (1) Firstly, to evaluate the degree of microbial contamination of the open and covered pools with selected groups of bacteria (major indices of water contamination) (2) Secondly, to assess the relationships between the degree of contamination and variables such as the mean value of residual chlorine, pH, temperature, etc in the pools. Using standard methods, numerous samples were collected from all of the active pools at different times in Shiraz during the summer season of 2000. Relationships between the degree of contamination and variables such as the mean value of residual chlorine, pH, temperature, etc in the pools were evaluated. The data indicates that 51.3% of the total samples were contaminated with pseudomonas. Furthermore, 16.6%, 11.1% and 7% of the total samples were contaminated with E.coli, fecal coliforms and streptococcus, respectively. The mean value of residual chlorine in pseudomonas contaminated samples was 0.445 mg/l. However, the corresponding value for non-contaminated samples was 1.052 mg/l, and the difference was statistically significant (P<0.02). Similarly, 26.3% of the samples collected from the covered pools and 53.9% of those collected from open pools were contaminated with pseudomonas. Statistical analysis of the data revealed a significant difference (P<0.02) between the degree of contamination in open pools of pseudomonas as compared to that in covered pools. Additionally, our data shows that the source of water supply is also a major determinant of the degree of contamination. Surprisingly, public pools filled with well water were found to be less contaminated with different germs as compared to those filled with normal tap water. Moreover, the mean value of residual chlorine in E.coli contaminated samples was significantly different (P<0.0008) from that of non-contaminated samples. Open pools were found to be more contaminated with E.coli than covered pools. However, this difference could be attributed to a significant difference between the mean values of residual chlorine in these two different types of pools. Similar observations were made for contaminated and non-contaminated samples with fecal streptococcus and coliforms. There was an inverse relationship between the number of coliforms and the mean value of residual chlorine in the pools. Collectively and in conclusion, the observation that public pools in Shiraz, as demonstrated in this study, with a few exceptions, were generally contaminated with different germs, calls for a more strict supervision on the pools by the health authorities. In the absence of such supervision, contaminated pools continue to pose a significant risk to the health of swimmers.

Ticks are the main arthropods that play an important role in disease transmission to human beings. They are also important in zoonosis. One of the most important diseases transmitted by soft ticks is relapsing fever and its causative agent, Borrelia persica, could be transmitted by O.tholozani. The disease transmission routes are mainly through tick bites, as well as coxal fluids. In the year 2003 a total of 36 Borreliasis cases were reported in Kurdistan Province, from which 95% were from Bijar Town. In the study area a total of 20 villages were selected randomly. The study was conducted between winter 2002 and autumn 2003. Ticks were collected in each season once. In each village 5 sites were chosen randomly as representatives of resting places of ticks. In each place ticks were collected by the hand collection method for a standard 20 minutes. All required information about the specimens was recorded in holding tubes of the ticks. Subsequently ticks were identified using the national systematic key. In order to find the infectivity of O.tholozani to B.persica, the ticks were smashed in a proper way and then suspensions were injected into Guiana pigs and mice. From day 4 onwards for 10 days the animal's blood were examined under microscope for presence of Borrelia in the blood smear. All the information was subjected to the statistical analysis and results were then interpreted. During the entire period of the study a total of 8,537 soft ticks were collected. The ticks were identified in two genera, Argas (45.7%) and Ornithodoros (54.3%). Ornithodorus comprises of two species: Ornithodoros lahorenis with a maximum of 47.6% and Ornithodoros tholozani with a maximum of 6.7%. Argas includes Argas persicus (45.7%) and Argas refelxus with a minimum of 0.07%. Collected O.tholozani was tested for their infection with Borrelia persica. Among all the specimens tested only 3% were shown to be infected with this agent. This infection was only found in spring and summer. Our findings support the presence of disease in the study area. It should be emphasized that the peak of tick activity is synchronized with disease burden. The disease is found in Golbalagh village, Siah Mansoor region. This region is situated in vicinity of Takab City which was previously reported as an endemic area of Borreliasis.

In spite of developments in all aspects of treatment of lung cancer, surgery is still the most effective treatment provided that the tumor could be resected completely. Although radiotherapy with or without chemotherapy effective in palliation or occasionally in curative treatment of lung cancer, it is less effective than surgery. Chemotherapy as a primary treatment is indicated only for palliation of advanced disease. Unfortunately only small numbers of patients are good candidates for surgical treatment. The goal of the surgical resection is to cure the patients, however, it is used occasionally just for palliation of symptoms such as hemoptysis, infection or intractable effusions. These symptoms could also be palliated with less invasive methods like laser therapy or radiation therapy. Most of the surgical procedures are lobectomy and pneumonectomy, sampling or complete resection of mediastinal lymph nodes which is an obligatory part of the surgery. More complex procedures like sleeve pneumonectomy and resection-reconstruction of the chest wall are used in some patients. Non anatomic resections like wedge resection are not standard forms of resection as they frequently result in a local recurrence, therefore, thoracoscopy is also not widely used for resection of lung cancer.Surgical resection is usually the only primary treatment for stage I & II, although some advise chemotherapy with surgery even at these stages. For stage IIIA, adjuvant or neo-adjuvant treatments are commonly advised. For stage IIIB or IV surgery has been used very occasionally in the form of multimodality treatments, although the results are poor.