مجله دانشگاه علوم پزشکی اراک
سال نهم شماره 4 (پیاپی 37، زمستان 1385)

Oxidative stress may play a critical role in neurodegenerative disorders but the relation between oxidative stress and learning ability in normal rats is not investigated, so the aim of this study was to investigate the correlation between oxidative stress and two way active avoidance learning in Wistar rats. This is an experimental research. 14 Wistar rats were assigned for assessed learning ability in shuttle box. One day after shuttle box learning, cerebrospinal fluid (CSF) and blood samples were obtained. Concentration of Nitric Oxide and Ferric reduction/antioxidant power were assessed. Data was analyzed using Pearson correlation test. The results of the present study demonstrate that there are positive correlation between shuttle box learning ability and Ferric reduction/antioxidant power (p<0.001, r =0.66 4) and Nitric Oxide concentration (p<0.001, r = 0.724) in serum, but not in CSF. The results of this study suggest that high concentration of antioxidant power and Nitric Oxide concentration in blood can improve shuttle box learning in rats.

Irritable bowel syndrome (IBS) is the most common functional bowel disorder. Stress triggers or aggravates it's symptoms. This investigation is carried out to determine the effect of Benson relaxation therapy on anxiety level and severity of symptoms in patients with irritable bowel syndrome. In this clinical trial 30 patients with irritable bowel syndrom were randomly divided into case and control groups. The control group was treated by only usual medical therapy but the case group was treated by combined medical- relaxational therapy. The two groups continued therapy for three months. Anxiety level and gastrointestinal symptoms of case and control groups were compared at three different times (two weeks before intervention and one week and three months after intervention). Also, patients were asked to document 6 common gastrointestinal symptoms in their daily symptom diaries, 2 weeks before intervention to 3 months after intervention. At the end of each week, these symptoms were compared in the two groups. Data was analyzed using chi square, Man - Whitney U and Wilcoxon tests. Mean state and trait anxiety of the case and control groups two weeks before and one week after intervention did not show significant difference. But the results after 3 months showed a significant difference (p<0.001).The mean severity of gastrointestinal symptoms, 2 weeks before intervention, was significantly higher in case group, but the comparison of gastrointestinal symptoms severity, 1 week after intervention, did not show any significant difference between the two groups, and 3 months after intervention a significant difference was observed in the two groups (the control group had more severe symptoms than the case group). The comparison of 6 common gastrointestinal symptoms based on weekly self-report showed that abdominal pain, eructation and distention were significantly lower in case group, but there was no significant difference between diarrhea and constipation. Three months Benson relaxation therapy significantly decreased the state and trait anxiety level and severity of symptoms in patients with irritable bowel syndrome.

Flexor tendon entrapment of the digits (FTED) is a disorder characterized by snapping or locking of the thumb or fingers (with or without pain) and called trigger finger. Corticosteroid injections are one of the most commonly used treatments for chronic tendon disorders. Despite their popularity, the systematic evidence for their benefits are largely lacking. This study tries to determine the efficacy of local corticosteroid injection in treatment of trigger finger. This is a clinical trial research. Variables including local tenderness, trigerring stage, pain during isometric flexion and passive stretching of the tendon (based on VAS) were evaluated before local injection of corticosteroid and then 3 weeks, 3 months and 6 months after the injection. Data was collected by special forms and analyzed using Chi square and ANOVA Tests. The difference between persence of A1 pulley tenderness in 4 examinations was significant (p<0.0001). The difference between pain induced by isometric flexion and pain induced by stretching the tendon passively in extension was also significant (both p<0.0001). The difference between frequency distribution of triggering was significant (p<0.0001). Patients satisfaction was 90%. The rate of success in local corticosteroid injection was 90% (only with one injection). The high rate of success and low side effects, make this method a suitable treatment for trigger finger.

Radiotherapy after breast cancer surgery will increase local control of the disease and also increase overall survival. Radiation have some side effects on lung function. In different radiotherapy techniques, these side effects are different. Pulmonary function tests and oxygen saturation are methods for evaluation of these complications. In this study we decide to campare pulmonary complications in two radiotherapy methods. In this clinical trial study fifty one patients with breast cancer in stage II and III according to TNM staging system, which were under modified radical mastectomy in Imam Hosein hospital and refered for adjuvant radiotherapy, randomly divided in two groups. In one group patients were treated with three field technique and in others with four field technique. All patients received total dose of 48-50 Gy. For patients, pulmonary function test and pulse oxymetery were done once before initiation of radiotherapy and then one and three months after radiotherapy. Measurement of FEV1, FVC and show that no significant statistical difference was present between the two groups one month and three months after radiotherapy, also in each of the two groups the amount of FEV1, FVC and one month after radiotherapy had no significant statistical difference in comparison to baseline tests but FEV1 and FVC after three months was decreased and had significant statistical difference respectively (p<0.001, p<0.006). SO2 had no significant defference between the two groups and also in each group after one and three month of radiotherapy. Locoregional radiotherapy of breast and lymph nodes areas causes a decrease in some parameter of pulmonary function tests but no difference was present between three field and four field techniques.

Kalleh-Pacheh is an Iranian food used in many part of Iran and many other countries such as Afghanistan, Pakistan and India. We found no information regarding the effect of this food on acute myocardial infarction. The aim of this study was to assess the effect of this food, together with diabetes and smoking on myocardial infarction in Arak district. This was a case-cohort study which was performed in Arak district. In this study the data of Arak sub-cohort was taken from Isfahan healthy heart project which was performed in 2001. Cases were myocardial infracted hospitalized patients who were resident in Arak at the time of study. We showed the effect of different exposure, on myocardial infarction by estimating relative risk and population attributable fraction and 95% confidence interval. In this study 150 cases were compared with 6339 sub-cohorts. The population attributable fraction for Kalleh-Pacheh was 19% (95% CI, 6 to 30%). This measure for diabetes and smoking was 31% (95% CI, 23 to 39%) and 41% (95% CI, 31 to 49%) respectively. According to the results of our study smoking, diabetes and using Kalleh-Pacheh has significant effect on myocardial infarction.

There are a few clinical trials on human that show the effect of topical vitamin E on keloid and hypertrophic scars. In this investigation we try to study this effect and also show the effect of the concentrations which have not been considered yet in improving hypertrophic scar and keloid healing. In a double-blind randomized clinical trial, 32 patients who had hypertrophic scar from 12 weeks ago were given three ointments including placebo and ointments contaning injectional vitamin E (d-α tocopheryl) with different concentrations (300Iu/mg and 600Iu/mg). The scars size, erythema and hardness were evaluated by patients and physicians after 1, 4 and 12 weeks. Data was analyzed using ANOVA and Kruskal Walis tests. After 12 weeks there were no signs or symptoms of dermatitis and rash. Comparison of the scar size after 1 week showed difference between the high concentrated ointment with the others and in the 12th week all of the ointments were different (p<0.001). Evaluation of the scar erythema, in the 1th, 4th and 12th week showed significant difference between vitamin ointments and placebo (p<0.001), also scar hardness in the 12th week was significantly different between groups(p<0.001), but in the first and 4th week no difference was detected in hardness. This study shows that topical vitamin E has good effects on keloid and hypertropic scars. Their effect in decreasing size and erythema is more considerable than scar hardness.

Chest wall in children is more compliant, slow twitch muscle fibers are less than adults and the alveolus are smaller in size and lesser in number. Airways are more expandable and smaller in diameter. In the other hand the inhalational anesthetics can cause respiratory depression and rapid shallow ventilation. These changes can cause microatelectasia, low respiratory system compliance and increase in work of breathing. Controlled ventilation probably will prevent these events. This study is going to compare behaviors of respiratory system under inhalational anesthesia. In a clinical trial, 60 pediatric patients between 6 months to 6 years of age, ASA I & II, who were candidates of elective surgery on extremities and lower abdomen, entered to study. Patients were randomly allocated in two groups of spontaneous and controlled ventilation. In the first group inhalational and in the second group intravenous inductions was performed. Both groups were given halothane (0.8-1%) in a 50% mixture of N2O and O2 for maintenance of anesthesia. HR, RR, BP, SPO2 and T before induction and all of these plus EVT and peak and plateau APs, 5 minutes after induction and every 15 minutes thereafter were measured and dynamic and static compliance were calculated by using measured data. Data was analyzed by ANOVA, T student and Chi square tests. Patients in spontaneous ventilation group had significantly more RR and EtCO2 and less awakening time (p<0.05).Total mean of HR, SBP, DBP, SPO2, T, PIP, PltIP, dynamic and static compliance after induction of anesthesia had no statistical differences between the two groups. There are no constant significant differences between the two groups in respiratory system compliance, airway pressures and T and this study can not prove the development of significant changes in respiratory system indices between the two groups. Thus microatelectasis (if developed) is not clinically important during less than one hour surgeries.

Benign Prostatic Hyperplasia (BPH) is the most common benign tumor in men. Due to the side effects of chemical drugs, phytotherapy has become a treatment method in BPH since 1990s. Prostatan is a plant extract widely available in Iran. In this study, we evaluated the therapeutic effects of Prostatan drop in combination with Prazosin in alleviating BPH symptoms. In a single blind randomized clinical trial, 66 men over 50 years with BPH symptoms who were visited in Vali-e-Asr hospital of Arak were randomly divided in two groups and treated with either Prostatan (40 drop,TDS) plus Prazosin (1mg, BD)or Prazosin (1mg, BD)alone. AUA symptom score, PSA (prostate-specific antigen) levels, Prostate volume, post voidal residue (PVR) by sonograms and uroflowmetry results were determined before and 12 weeks after treatment. Data was analyzed by T and Man- Whithey u tests. Before treatment there were no significant differences in age, PSA, PVR, AUA symptom score, Prostate volume and uroflowmetry between the two groups. After treatment the mean of PSA levels, Prostate volume and PVR did not differ between the two groups. In the Prostatan plus Prazosin group, the mean of AUA symptom score was 3.3 less (p<0.0001) and the mean of maximal urine flow rate was 2.7 ml/s more than the Prazosin group (p<0.0001). Regarding results, it seems that adding Prostatan to Prazosin against Prazosin alone enhances its effects on controlling BPH symptoms and increases urine flow rates.

The membranes used in haemodialysis may be manufactured from cellulose, modified cellulose or synthetic polymers. Such membranes, when in contact with blood will activate the complement system, which entails changes in leukocyte and platelet counts. Polysulfone is a synthetic membrane of high biocompatibility standards, whereas haemophane membranes are modified cellulose-based membranes. The biocompatible profiles of these membranes, has been studied by clinical reactions (i.e. hypotension, nausea, pruritis, …) during dialysis sessions. Both kinds of these membranes are used in Iran. The number and severity of these reactions define the degree of dialysis biocompatibility. In a clinical trial study which was carried out in Imam Khomeini hospital in Tehran, 100 hemodialysis patients were enrolled to this investigation. Their clinical reactions were compared during 3 sessions of hemodialysis with polysulfone and 3 sessions of hemodialysis with hemophan membrane. Each patient was the control of him/herself. Data was analyzed using Chi square test. Mean age of patients was 48.85±17.56 years and 39% of them were female. The most common complications were hypotension and muscle cramps (each 21.5%). Hypotension was higher in sessions of polysulfon versus hemophane (18% versus 25%) but was not significantly different. Also other complications such as muscle cramp, nausea, vomiting, dyspnea, headache, chills and fever had no significant difference. Seizure did not occur in any patient. According to our findings the membrane’s type has no role in acute clinical complications during hemodialysis and in most patients, membranes can be used according to their availability. It seems their biocompatibility has no considerable clinical difference.

Pain relief has been received the highest level of medical attempts continuously but still many patients suffer from it. Narcotic's side-effects have led investigators to apply other techniques for controling acute postoperative pain to reduce narcotics requirements. Recently, some concepts have been presented implying that Metoclopramide does have analgesic effects and this led us to conduct the present study in order to determine Metoclopramide's effect on alleviating pain after cesarean section. In this clinical trial, 80 patients who were candidates of elective cesarean section were studied in two groups. 10 minutes before the cesarean section's ending time, the control group was given 25 mg Pethidine accompanied by 10 mg Metoclopramide and control group 25 mg Pethidine and distilled water. Then when patients were conscious after cesarean section, for a period of 6 hours received after-care for their vital signs and side-effects of prescribed drugs. Their pain score (VAS) and nausea rate was measured and if necessary, Pethidine was injected with certain dose. Injection time for first dose of Pethidine and its required amount were recorded in a checklist within first 6 hours after cesarean section. Data was analyzed using ANOVA and T tests. Prescription of Metoclopramide inhaunced analgesic effect of narcotics and a meaningful decrease was found in pain score (p=0.002) and nausea rate (p<0.005). Injection time for the first dose of Pethidine was also prolonged in the group who received Metoclopramide compared to control group (p=0.019) and an obvious decrease was occurred in received Pethidine's amount within the first hours after cesarean section (p<0.005). Drugs side-effects were not found in patients. The results indicate that use of Metoclopramide accompanied by Pethidine in ending time of cesarean section, does have considerable effects in controlling acute pain after surgery and increasing analgesic effect of narcotic drugs. Therefore, use of Metoclopramide as a proper supplement drug with low side-effects is recommended.

Hydronephrosis in infancy and childhood is a frequent urinary malformation. We were unable to find any reports concerning rate and causes of hydronephrosis in Iranian children therefore, we decided to evaluate it, in under 12 years old children. This was a descriptive study done in a 9-month period starting from Novemger 2004. All children under 12 years old who had visited Amir Kabir hospital of Arak for UTI or FTT were enlisted and an ultrasonography was requested. If hydronephrosis was detected, then a VCUG was performed. For those with normal VCUG results, if hydronephrosis persisted in the follow up sonography, the next step was an IVP or DTPA scan. 65 patients (39 girls and 26 boys) were evaluated for hydronephrosis. 18.5% presented with FTT, 75.4% with UTI and 6.1% with FTT+UTI. The most prevalent causes of hydronephrosis were VUR (40%) and UPJO (23.5%). Grade I hydronephrosis was the most prevalent form (65%), however when VUR was present, it was mostly grades III or IV (27% and 19% respectively). 70% of girls and 31% of boys had VUR and the average age at the time of diagnosis was 2-3 years. Vesicouretero reflux and UPJO are the most prevalent causes of hydronephrosis and must be evaluated in children with hydronephrosis.

Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare but important etiology of cervical lymphadenopathy in young women. This disease is self limited and improves during 2-8 months. Diagnostic key is the pathology of involved lymphnode. Association of the disease with viral and autoimmune disease is not proved yet. In this article two cases of Kikuchi-Fujimoto disease are reported. Case: The first case was a 31 years old female patient with sever fever and right axillary lymphodenpathy (size: 57cm) in which one month after the disease, diagnosis was proved by pathology studies. This patient has erythematous patches in her face and nose in several times that were improved spontaneously. The second case was a 20 years old female patient with fever, chill, headache, weigh loss and cervical lymphadenopathy (size: 21cm). She received antibiotic at several times without any improvement. Finally after 5 months since the beginning of symptoms, the disease was diagnosed as Kikuchi-Fujimoto disease by surgical excision of lymhnode and pathology studies. After the surgery two small lymphnodes were appeared around the surgical site. In differential diagnosis of lymphadenpathy especially cervical in young women, Kikuchi-Fujimoto should be considered. Consumption of antibiotic in lymphadenopathy without clear diagnosis should be avoided. After diagnosis of Kikuchi-Fujimoto, long term work up for recurrence or the appearance of autoimmune disease symptoms is necessary.