فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال چهارم شماره 2 (پیاپی 14، تابستان 1387)

Doppler ultrasound of umbilical vessels is a method of evaluating fetoplacental blood flow which is very important in high risk pregnancies and can predict both the duration of maternal hospitalization and fetal mortality rates in IUGR. Pregnancy induced hypertension is one of the most important causes of high-risk pregnancies. In this study,the rate of blood flow through umbilical artery as well as its degree of resistance were measured, using Doppler ultrasound in the patients with pregnancy induced hypertension.This is a cross-sectional study which was carried out on 35 pregnant women with pregnancy induced hypertension in the year of 2004. All of the cases were studied during their third trimester. 61 pregnant women in their third trimester were selected as the control group. They all had normal blood pressure. Doppler ultrasound of umbilical artery was performed for both the case and the control groups. Then, Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV) and mean velocity were measured, based of which Resistive Index (RI), Pulsatility Index (PI) and Systolic to Diastolic ratio (S/D ratio) were calculated. Finally the statistical analysis was performed on the obtained recorded data, using SPSS software.The results indicate a measure of 0.77 for RI; 1.39 for PI and 4.88 for S/D ratio in the case group while in the control group,such measurements were calculated as 0.64; 1.08 and 2.97, respectively. As a whole, the comparison of the mean values of the mentioned indices revealed a significant difference between the two groups (P<0.01). The case group were significantly rated higher in terms of the above mentioned indices.In patients with pregnancy induced hypertension without having other risk factors (such as diabetes, mellitus and IUGR), Doppler ultrasound should be used for evaluating the degree of fetoplacental blood flow in order to decrease the risk of pregnancy complications.

Coronary artery disease (CAD) is the most common cause of death in the world. Finding an accurate way to detect the CAD in early stages is important. In this study, our aim was to assess the rates of accuracy, sensitivity and specificity of history taking, exercise test and myocardial scan with drug or exercise, in the diagnosis of CAD in the patients who undergo angiography. In a cross-sectional study, 420 female patients who referred to Razavi and Javad-AL-Aeme Hospitals for angiography during 2007 to 2008, were studied. Having done the angiography, we came to determine which method (history, exercise test or scan) was the most appropriate for preparing the patient for angiography. To do so, their rates of accuracy, sensitivity and specificity were calculated. Sixty five percent of the subjects were suffering from CAD. The mean age of the patients was 58 years. Hypertension, hyperlipidemia, diabetes and smoking were detected in 39%, 42%, 24% and 5% of the cases, respectively. The rates of accuracy, sensitivity and specificity were respectively calculated as 3%, 78.1%,47.2% for history taking; 57.1%, 80%,26.1% for exercise test and 73.1%,90.9%,15.3% for myocardial scan with drug. According to the results of this study and with regard to the relatively high cost of perfusion scan and exercise test, it seems that history taking has a high rate of accuracy in predicting and diagnosing CAD. Exercise test, in comparison with myocardial scan, has lower rates of accuracy, sensitivity and specificity in women.

A decrease in serum iron is considered the first phenomenon emerging in the process of Iron deficiency anemia (IDA).In advanced phases of IDA various degrees of anemia occur. Regarding the importance of IDA and its consequences especially on individual’s health, we performed a survey on the female students of medicine to compare the prevalence of IDA between them and female students majoring in other fields. The present study hypothesizes that education level; particularly college education has some effects on the prevention of this disease. This cross-sectional descriptive study was performed in Mashhad Islamic Azad University during the years of 2005 to 2007.189 female students (91 students of medicine and 98 students of other majors) volunteerly participated in the study. Cell blood count, serum ferritin concentration, serum iron test, hemoglobin, Hct, TIBC, were administered for all the students. Then, the subjects’ individual data and the results of their blood tests completed a questionnaire and were analyzed for descriptive statistic,One-way and two-way ANOVA and tooky test, using SPSS software.Among 189 students, 166(88.44%) were found to be normal and 23(11.5%) were detected for iron deficient anemia. In the infected individuals, 9 (39.13%) were students of medicine while the other 14 (60.9%) persons were students of other majors. Also, it was found out that 60 (31.74%) were affected by iron deficiency and 78 (41.26%) had disorders of blood indexes.Statistical findings of this study revealed that the prevalence rate of IDA was lower in the students of higher education in medical sciences in comparison with those of lower levels of medical knowledge. IDA was even higher in extern and intern of medicine in comparison with students of basic science.

Thyroid dysfunctions are common among the elderly, but their clinical manifestations are more vague, subtle and often hidden. The aim of this study was to determine the thyroid functions in people over 55 years old for determining sub clinical thyroid disorders.This investigation was performed on 25 men and 25 women over 55 years old who had referred to the out- patient clinics of Islamic Azad University of Mashhad during the period of 2007-2008. For each patient, a questionnaire was filled out by a physician. The questionnaire contained some information about the patient’s individual data, his/her past record of thyroid dysfunctions, clinical signs and symptoms and the results of thyroid tests. The laboratory tests included TSH and total T4. Also, if required, complement tests for diagnosing the disease and complications were preformed. Finally, the results were compared with those in the reference books and the related articles.The prevalence rate of thyroid dysfunctions was 14% (7 cases). The frequency rate of the identified disorders were as follows: 4 persons (8%) were suffering from clinical hypothyroidism; 2 persons (%4) from subclinical hypothyroidism and one person (2%) from clinical hyperthyroidism. However, no case of subclinical hyperthyroidism was observed. Two persons (4%) had a previous history of clinical hypothyroidism. Among the patients, 20% of the women and 8% of the men were involved in thyroid dysfunctions, but there was no significant correlation between the factor of gender and thyroid dysfunction (P=.417). Also, there was not any significant association between the age group and thyroid dysfunctions (P=0.687). The most frequent symptoms in hypothyroid patients were fatigue (66%) and weakness (50%). The other manifestations were as follows: constipation %33), dry skin (%33) and cold intolerance (%33). Moreover, hypercholesterolemia was observed in 50% of the hypothyroid patients and there was a significant relationship between hypothyroidism and hypercholesterolemia. (P=0.0186)For senile subjects complaining about fatigue, a test of thyroid function is recommended. Hypercholesterolemia was significantly higher among hypothyroid patients.

Multiple sclerosis (MS) is one of the most common neurological disorders in young adults.Mitoxantrone, as an immunosuppressant and cytotoxic drug has shown a slight beneficial effect on the progressive form of the disease. However, it has been experienced that in cancer treatment this drug has caused cardiologic side effects such as congestive heart failure and decrease in ejection fraction. The aim of this study is to investigate the left ventricular ejection fraction changes induced by Mitoxantrone as administered in patients with secondary progressive form of multiple sclerosis.During the years of 2005-2007, the patients with secondary progressive MS who referred to the Neurological Clinic of Aria General Hospital in Mashhad were included in our cross-sectional study. These patients had no history of hematological, cardiac or hepatic disorders. Neither they had ever used immunosuppressant drugs. They were prescribed to intravenously take 12 mg/m2 of Mitoxantrone every 3 months for at least 2 years. Before each infusion of Mitxantrone, the left ventricular ejection fraction (EF) was measured by echocardiography. After the treatment (8 infusions), the results of echocardiography were compared and analyzed through statistical methods using SPSS and Excel soft wares.Forty four patients with secondary progressive -MS were included in our study (24 females and 20 males). Five of the subjects were younger than 30 year old, 27 patients were between 30 and 40, and 12 patients were above 40. The data was analyzed using the method of repeated measures. The results demonstrate that Mitoxantrone had no significant effect on the left ventricular ejection fraction. Also, the trend mean of EF during 8 months showed no significant drop. The mean of EF between sexes was not significant, either. As a whole, ten percent of the subjects treated with Mitoxanterone showed a decrease of EF which returned to its normal stage once the treatment was stopped.The benefit from using Mitoxanterone in multiple sclerosis was more than the complication caused by its usage.

Burn is the main cause of mortalities in children after motor accidents. One of The most important responses of the body to burn is creating changes in metabolic system and food needs. These changes are generally formed in intensive and high degree burns. So, in spite of the existence of just one source ward (Imam Reza burn ward), we decided to accomplish a comprehensive research study on the population of the children who were admitted in this center, consuming the existing facilities.In this descriptive-cross sectional research, 452 burned children aging 1 to 15 years old (268 boys and 184 girls) were surveyed. All the patients were being treated at the burn ward in Imam Reza Hospital for over one year (i.e. from 20/04/2004 to 24/06/2005). Three metabolic criteria including Fasting Blood Sugar, Total Serum Protein and Serum Lipid Profiles (cholesterol and triglycerides) were measured in 3 phases: a) the first day of confining, b) in the first week, c) at the dismissing time. All the patients were revived according to Brooke formula, and some changes were made in the base of clinical situation, patient's responses, and the age groups. NG tube was inserted and food supply was provided for all the patients with more than 15% burn.In this research, 184 girls (40.7%) and 268 boys (59.3%) aging from 1 to 15 years were examined. Regarding the factor of sex between the two groups, the mean age in the boys was 5.89 ±1.3 years, while in girls, it was 2.28  2.1 year. As for the etiology of burn, the degree of prevalence rated as 74.8% with hot liquids; 23.9% with flame; 0.6% with electricity. In terms of the mean percentage of burning, it was 23.2% in the girls and 26.7% in the boys. The mean and standard deviation of the duration of hospitalization was respectively 14.12 and 11.51 days for the girls and 17.97and 14.83 days for the boys. Over the period of hospitalization, 67 patients including 32 girls (17.39%) and 35 boys (13.05%) died because of the intensive burn or its side effects (14.82%). Regarding the metabolic criteria changes, the most changes occurred in the following order: 1) the changes in blood sugar (particularly between the first day and the first week of hospitalization), 2. The rate of serum fats 3.The rate of serum protein (especially, between the first day and the first week of hospitalization).Heat injuries resulted from burns can cause dramatic changes in the patients’ metabolic system and nutrition, particularly for children. Having a good control over these changes, a well-timed treatment and utilizing suitable reviving methods can have vital roles in decreasing the mortalities as well as the duration of hospitalization.

Prolactin in human serum exists in 3 different molecular forms, i.e, monomeric, big and at times big big (Macroprolactin). Macroprolactin is a complex of prolactin and IgG and may account for a significant proportion of idiopathic hyperprolactinemia. Its biological activity is considered low or absent, usually idiopathic and poorly symptomatic. Since its association with a prolactin producing macroadenoma is poorly documented, we performed this study on the patients with Macroprolactinoma for the presence of macroprolactinaemia through its identification with Poly Ethylene Glycol. The study aims is to comparing the clinical (galactorrhea and oligomenorrhea) findings in patients with macroprolactinaemia and those without it.In this study 10 patients with Macroprolactinoma (macroadenoma in MRI of hypophysis, prolactin level more than 100μg/L and clinical and radiological response of tumor to dopamionergic agents after treatment) were evaluated for the presence of Macroprolactinemia, using Poly Ethylene Glycol precipitation test.Doing so, one patient infected by Macroprolactinemia was detected. At the time of reception, the clinical findings in all 10 patients were classic and similar and in the follow ups, both clinical and radiological changes were the same.Our Results suggest that Macroprolactinoma may be associated with Macroprolactinemia

The ultrasonographic findings of urinary obstruction indicate the diagnosis of hydronephrsis. Hydrophrosis is a descriptive term referring to the presence of dilatation of the pelvis and calyces and not to the cause of the dilatation. IVU can provide functional and anatomical details while ultrasonography can only provide anatomical details. There are some different ideas about diagnostic values of each method. The purpose of this study is to evaluate the ultrasonographic sensitivity in detection of hydronephrosis (obstructive or nonobstructive) as compared to IVU.This prospective comparative study was done on 70 patients referring to the radiology department of Bahman 22nd and Arya Hospitals since April 2006 to October 2007. Kidney ultrasonography and IVU were administered for all the patients. Then, the accuracy rate of ultrasonography in diagnosing hydronephrosis was determined comparing with IVU as a gold standard method. Some variables such as age, sex, the size of kidney, kidney parenchymal echo, ureteral stone, bladder condition in IVU and stone in KUB were evaluated in all the patients.Among 70 patients, the mean age was 36±16.3 years ranging from 12 to 72 years. Comparing ultrasonography with IVU, the sensivity of ultrasonography for diagnosing hydronephrosis was 79.41%, the specificity rate of ultrasonography was 55%; the positive predictive value was 62% and the negative predictive value was 74%. Also, the accuracy rate of sonography in diagnosing hydronephrosis was 67%.The results of this study suggest that although ultrasonography is not a substitute for IVU, it can be used as a preliminary tool for detecting hydronephrosis and as a screening diagnostic method for urinary obstruction in azotemic patients. IVU is suggested for acute urinary obstructions and in patients with renal colic and normal sono-findings.

Mesothelioma of pleura is classified as malignant and benign. Benign mesothelioma is less frequent and may diagnose incidentally during routine chest X ray. Symptomatic cases usually show chest pain, dyspnea or cough due to compressive effect of tumor on surrounding tissue. In this article we present a benign fibrous mesothelioma in a female subject with shoulder pain and missed huge pleural mass. She referred because of long lasting dyspnea and chest pain. This subject was operated and complete resection of tumor results in complete resolution of symptoms.