مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال سیزدهم شماره 3 (پیاپی 52، پاییز 1384)

Preoperative psycho emotional preparation of patients is one of the principle purposes of anesthesia which can be achieved by administration of premedications. Children should receive premedication before entering the operating room due to their dependence on parents and the fear and anxiety of separation from parents. Different drugs are administered for this purpose, but considering children's sensitivity, it is wise to use the most effective and comfortable medication with least side effects. Midazolam is a rapid onset, short acting and water soluble benzodiazapine which can be administered by oral, intravenous, intramuscular, rectal or intranasal routes. The purpose of this study was to evaluate the result of intranasal midazolam administration (0.2 mg/kg ) as a premedication in children aged 2-6 years.( Min dose and enough time )

In this randomized prospective study, 100 children aged between 2-6 years old in class ASA 1 and candidates of surgery were divided into two groups case and control. The control group received several nasal drops of normal saline, while the case group received 0.2 mg/kg nasal midazolam 20 minutes before anesthesia induction.

Twenty minutes after administration of the nasal drops, 14% in the control group and 68% in the case group were alert and calm. (P value=0.0) . Mask acceptance during induction of anesthesia in control and case group was 14%and 72%, respectively (P value >0.00) The recovery time in the case group was longer (P value >0.5), but no complications (nausea, vomiting, respiratory and cardiovascular problems) were seen in either group.

Nasal midazolam with its anxiolytic, tranquilizing effects and no respiratory or cardiovascular complications is a safe drug and being better than parenteral drugs is acceptable by children.

Cardiovascular abnormalities have been reported in liver cirrhosis (LC). In these patients, cardiac symptoms and physical signs occur as the liver functions worsen. Cirrhosis is associated with hyper dynamic circulation and beta-adrenergic system changes responsible for the cardiovascular abnormalities. The purpose of the present study was to explore the echocardiographic findings in cirrhotic patients.

A total of 90 patients (63 men, 27 women) with imaging or biopsy-proven cirrhosis of various etiologies without any known cardiac dysfunction were included in the study. Ninety healthy persons of the same age and sex were enrolled as the control group. Cirrhotic patients and controls were investigated by echocardiography. Left ventricle diastolic function (E/A ratio), systolic function (ejection fraction), and wall thickness (left ventricle posterior wall thickness + interventricular septum thickness) along with left and right ventricular dimensions were evaluated.

Right & left atrium and ventricle diameters were enlarged in 3 cirrhotic patients and the E/A ratio was decreased in class C patients (0.9 ± 0.2) as compared to class B and A (1.3 ± 0.4) and controls (1.3± 1) (P value < 0.05). The left ventricular end diastolic volumes were increased in 3 cirrhotic patients(5.9+/- 0.3)(normal 3.5-4.7 cm). The estimated ejection fraction was decreased in39 cirrhotic patients 28 patients with ascites (35 -47%) as compared to 11 patients without ascites (40-48%) and controls (50-75%) (P < 0.05).

Liver cirrhosis is associated with enlarged left cardiac chambers, but wall thickness and right ventricle functions and diameters are normal. LV Diastolic dysfunction and decreased ejection fraction are evident in cirrhotic patients with ascites in class C children. This demonstration of diastolic dysfunction together with the dilated left cardiac chambers suggests that the patients indeed have cardiac abnormalities. Cardiovascular status should therefore be carefully monitored, especially in class C children when patients have ascites.

Renal length as measured on sonography is fundamental in diagnosis & follow up of renal diseases, and there’s increasing use of this kind of examination nowadays. Some radiologists believe in the effect of position on renal measurements. Regarding the above mentioned facts and in order to compare effect of patient position on sonographic measurement of renal length, this study was performed on children (under 18 years old) referred to Taleghani and Shohadaie Tajrish hospitals from October 2001 through October 2002. Methods and Materials: In this clinical trial ,one hundred children were sequentially selected. All of them (or their parents) announced their agreement for sonographic examination. The observer measured the largest longitudinal renal diameter in three positions Supine, Coronal and Prone. Two measurements were obtained in each position and the larger one was recorded. If it wasn’t possible to get the desirable measurement in one position, it was also taken into consideration. The results were judged with Anova tests.

Of the 100 patients investigated, 52 were boys & 48 were girls. In sagittal view, the left kidney was not measurable in 33.3 % of girls & 38.5% of boys. The maximum difference in renal measurements in the three procedures and accordingly, right and lsft kidneys as well as boys and girls was 3.7%, which was not statistically significant.

Patient’s position has no effect on renal length. It may not be possible to measure the renal diameter in the supine position of all patients. It seems that coronal position is more suitable than the others.

This study was aimed to asses the rate of recurrence after the first unprovoked seizure in children. Methods and Materials: In a prospective study, we recruited 145 children who presented with primary unprovoked seizure and were followed for at least 12 months after the first seizure.

Seventy five children (51.7%) experienced subsequent seizures. The cumulative risk of seizure recurrence following the first seizure was 16.5%, 35%, 47% and 51.7% at 1, 6, 12, 24 months, respectively. The median time for repeated seizure was 5.4 months with 67% of recurrences occurring within the initial 6 months, 92% within 1 year and 100% before the end of two years. On multivariable analysis, risk factors for resumption of seizure comprised of abnormal electroencephalography (EEG) and age greater than ten years at the time of occurrence of the first seizure. On unvariable analysis, etiology of seizure, history of neonatal problems and lack of AED (Antiepileptic drugs) usage increased risk of recurrence.

This study revealed that the risk of seizure recurrence in our patients was relatively high. Those with abnormal electroencephalography and age greater than ten years at the time of occurrence of the first seizure were at greater risk for recurrence of seizures.

Post operative pain is an unpleasant experience following various stimuli resulting in a response by the body. This process causes physiological disturbances in all of the systems of the body. Methods and Materials: In this clinical trial , 60 upper abdominal surgery patients were selected post operatively and divided into two groups of 30 patients each. In one group, bupivacaine intrapleural injection and in the other group, opioid injections were administered in the recovery room. Pain intensity with visual analogous scale was measured 6 hours after the operation.

There was no difference in VAS according to patient's age, sex, and type of operation, but in the Bupivacaine injected group, VAS score was significantly lower.

Intrapleural injection of bupivacaine is more useful and reliable than opioids for controlling post operative pain.

Acute mania is a psychiatric emergency state that often requires rapid management. There are many different therapeutic protocols for this emergent situation. One of them is combination of moodstabilizers and antipsychotics. Olanzapine which is now available in our country can be used for this purpose. Methods and Materials: In this study, we compared the effectiveness, rapidity of response and side effects of sodium valproate plus olanzapine (group I) with sodium valproate plus lithium (group II) in acutely manic or mixed bipolar patients. In this randomized, double blind, parallel group study, 44 acutely manic or mixed patients according to DSM IV-TR criteria were randomly assigned to receive combinations of sodium valproate (20mg/kg per day) with either olanzapine (5-15mg/day) or lithium (900mg/day) during a ten-day course. Efficacy was measured with Young Mania Rating Scale (YMRS). Effectiveness measures included YMRS response (YMRS reduction ³ 50%) and YMRS remission (YMRS<=12). Data was entered in SPSS11 software program and analyzed by Mann-Whitney, Fisher exact test and Wilcoxon tests (P-values < 0.05 were significant).

Total number of patients were 44 (mean age 27.18±7.34), 21 in group I and 23 in group II. Response rate was 85.7% (18 patients) and 73.9% (17 patients) in group I and II, respectively with no significant differences between the two groups(P=0.33). Remission rate was 42.9 %(9 patients) and 43.5% (10 patients) in group I and II, respectively with no significant differences between two groups(P=0.97). The reduction in total scores in YMRS on the 2nd, 7th and 10th days of study were significant in both groups (P<0.05), but the rapidity of response was similar. The rates of adverse effects between two groups were not statistically significant.

Both combinations of drugs were effective in acutely manic or mixed patients. Both treatments were safe and well tolerated

As monoclonal antibodies are potential tools for characterization of soluble or cellular surface antigens, use of these proteins has always been considered in infertility and reproduction research. Therefore, in this study, monoclonal antibodies against human sperm surface antigens were produced.

To produce specific clones against human sperm surface antigens, proteins were extracted using solubilization methods. Balb/c mice were immunized intraperitoneally with the proteins using complete Freund’s adjuvant in the first injection and incomplete Adjuvant in the following booster injections. Hybridoma cells producing ASA were cloned by limiting dilution.

Five stable ASA producing hybridoma clones were achieved and their antibody isotypes were determined by ELISA. All the isotypes were of IgG class. Their cross reactivity with rat and mice spermatozoa was examined but they did not have any cross reactivity.

The produced antibodies can be used in further studies to characterize and evaluate each of the antigens present on human sperm surface and determining their role in fertilization.

Patients suffering from epilepsy have to take antiepileptic drugs forever. It has been suggested that epilepsy itself and antiepileptic drugs are teratogenic. All aspects of the abnormalities that are induced by these drugs are unclear. Therefore, the objectives of this study were to determine the effects of two routine antiepileptic drugs on ossification. Besides, there was an attempt to decrease their teratogenic effects by using folic acid.

81 female mice (BALB/c) were selected and divided into six groups. Pregnant mice were fed with phenytoin (45mg/kg), Phenobarbital (30mg/kg), phenytoin and folic acid (15􀈝g), Phenobarbital and folic acid, folic acid and water. The embryos were removed and stained with Alizarin red S/ Alcian blue. Total length of tibia and femur, length of ossified parts of tibia and femur and ossification index were calculated. The data was analysed statistically by ANOVA, LSD and Duncan test.

Ossification index in the group treated with Phenobarbital was decreased significantly in femur. Phenytoin had no effects on ossification index. Ossification index in tibia was affected by both antiepileptic drugs. Taking folic acid improved the indices. The impact of these drugs on the tibia was more than femur.

It seems that phenytoin decreases the total length of the ossified part of the femur and therefore, has no effect on the ossification index. But phenobarbital affects the length of ossified tissue but not the total length of the femur, so it could change the ossification rate. The drugs affect the tibia and femur differently. It may be because of the different times of appearance and ossification of upper and lower limbs in the fetus

Considering the importance of co-culture in differentiation of embryonic stem cells, the aim of this study was evaluation of the effect of co-culturing fetal liver stroma cells with P19 cells on the line of differentiation.

For this purpose, P19 cells were cultured directly in semisolid medium. These cells proliferated and primarily differentiated to colonies know as embryoid bodies (EBs) after 8-12 days. The Ebs cells were trypsinized and dissociated to single or double cells. Then these cells were co-cultured on the mouse fetal liver feeder layer in the absence of exogenous factors. After 14-18 days, the colonies were studied morphologically by benzidine and giemsa staining and also counted under invert microscope.

The percentages of benzidine positive (or erythroid) and negative colonies were 94% and 6% respectively and also the cells of colonies were studied by Giemsa staining. Results showed that they were myeloid or lymphoid type cells. Thus, the results show that in the presence of mouse fetal liver feeder layer, the number of erythroid colonies was increased.

Therefore, this technique may be effective for differentiation of stem cells from different sources into hematopoietic cells and can be used in future for human cell therapy.

Hearing loss is the most common sensory neural defect in humans, affecting 1 in 1000 neonates, with over half of these cases predicted to be hereditary in nature. Most hereditary hearing loss is inherited in a recessive fashion, accounting for approximately 80 % of non-syndromic hearing loss (NSHL). Mutations in GJB2 gene are major cause of inherited deafness in the European and American populations. To date, more than 90 mutations have been reported in this gene. Although most of these mutations are rare but 35delG mutation is the most common deafness causing allelic variant of GJB2 in most parts of the world.

In this project, 120 probands from 120 families with ARNSHL in Yazd Province were studied. Mutations Screening of GJB2 was performed by Amplification Refractory Mutation System (ARMS)-PCR for detection of 35delG and then all samples excluding 35delG homozygote were analyzed by DHPLC and Direct Sequencing.

GJB2-related deafness was present in 7.5% of this population. We identified 4 mutations (35delG, 312del14, 314del14 and 167delT) and 4 polymorphisms (V153I, V27I, E114G and R127H) in this study.

Prevalence of GJB2 mutations in this population was lower than American and European populations, and also other provinces of Iran. Interestingly, 312del14 rather than 35delG was the most common mutation found in the population under study. 56.25 % of GJB2 mutant alleles carried 312del14 mutation. To date, this frequency has not been reported in any of the world populations.

The use of stereological methods in evaluation of volume changes in vital organs such as kidney is very important. In this study, the volume of glomeruli in glycerol-induced acute renal failure in rats was determined.

48 Sprague-Dawley male rats were divided into 2 groups (1control, 1experiment). Experimental group was injected 10ml/kg of 50% glycerol intramuscularly, while the same volume of saline was injected in the control group. After 48h, animals were dissected under deep anesthesia, and right kidneys were fixed by vascular perfusion. Microscopic slides were stained with H-E. Glomerular volumes were calculated using projecting microscope, point counting and cavalieri principal.

The results indicated that renal failure induced-glycerol didn’t affect the glomerular volume

It seems that estimation of glomerular volume can not be a useful variable in identification of acute renal failure induced glycerol, but further investigations are needed to clarify the issue

It is well known that one of the powerful sperm function tests is the acrosome reaction (AR), which is a prerequisite in the fertilization process. The predictability of sperm fertilizing ability using AR has been suggested for IVF treatment cycles. The aim of study was to assess the power of AR using human follicular fluid (hFF) to predict the fertilization rate (FR) in IVF cycles.

This investigation was experimental. During 9 month, 54 different semen samples were collected from infertile men exactly before insemination of retrieved oocytes. Each sample was divided into 4 aliquots and semen analysis (SA) was done on the first aliquot. For Acrosomal reaction, the sperm samples were washed with Ham'sf10 culture media and after 2 hours in 37C􀃛 incubator, the samples were divided into 3 tubes. The first tube was control, DMSO 1mg/ml was added to the second tube and follicular fluid was added to the third one. The acrosome was stained by double staining method and acrosomal status was examined.

The data analysis showed that there are no significant relationships between fertilization, sperm count, fast moving sperms, slow moving sperms, overall sperm motility and morphology. The results also showed that the mean of acrosome reactions in groups with rate 􀂔50 and > 50% were significant (p<0.05). In addition, using ROC analysis, with cut-off value of 45% for fertilization, a cut-off value of 10.5% was achieved.

In order to have a more accurate selection of the method of fertilization, predict the success rate of IVF and prevent possible complications, it is advisable to use acrosome reaction test

A four month old male infant was referred to the pediatric clinic of Afshar Hospital in Yazd city because of cyanosis. On physical examination, patient had central cyanosis, single second heart sound, A grade III/VI continuous murmur in left clavicular area, abdominal distension and large sized smooth and movable abdominal mass in right upper quadrant of abdomen. Transthoracic echocardiography showed VSDpulmonary atresia and small patent ductus arteriosis. Plain abdominal X Ray showed right sided abdominal mass. Ultra sonography showed a mass lesion in RT upper quadrant of abdomen with diameters of 5cmX12cm that was suggestive of fecaloma. Soap enema was performed and after that abdominal mass disappeared and abdominal distension was improved. Rectal biopsy 5cm from anal verge showed absence of ganglion cells in the intramural and sub mucosal plexuses. Ten day later, barium enema was performed. Barium enema showed dilated descending, transverse ascending colon and transition zone in recto sigmoid area. Therefore, definite diagnosis of the case was Hirschsprung disease with VSD- Pul. Atresia and small PDA. At first the patient underwent Right modified Blalock Taussig shunt (systemic to pulmonary shunt) and one month later underwent temporary colostomy. As no case of Hirschsprung disease with pulmonary Atresia- VSD and PDA has been reported to date, the above case has been reported.

In any patient with a history of penetrating thoracic trauma, cardiac injury must be kept in mind. Here, we describe a 36 years-old female referred to this hospital with severe chest pain and hypotension. After primary evaluation and suggestion of AMI, streptokinase was started for the patient and because of deterioration of vital signs, cardiac surgery consultation was requested. After performing urgent echocardiography, massive pericardial tamponade was detected. Visualization of a knife blade on C.X.R and past medical history of thoracic stab injury led to a diagnosis of delayed cardiac tamponade and urgent sternotomy was performed. The blade that had penetrated the right ventricular chamber was extracted. Six days after operation, patient was discharged without any problem. This case study suggests the importance of high suspicion to cardiac injury in any patient with chest pain and a history of chest trauma.