Journal of Research in Medical Sciences
Volume:12 Issue: 1, Jan & Feb 2007

The aim of this study was to determine if preemptive local anesthesia yields better postoperative pain control than infiltration of local anesthesia at the time of wound closure. Forty patients aged between 1 and 10 years were randomly allocated to one of the two groups by using a sealed envelope technique. Group 1 received 0.5 mg/kg bupivacaine 20 minutes before the incision of skin and the same volume of normal saline at the end of skin suture. Group 2 received 0.5 mg /kg bupivacaine at the end of skin suture and the same volume of normal saline 20 minutes before the incision of skin. Pain scores of patients in the recovery room, 6, 12 and 24 hours after surgery were measured. If patients complained of post surgical wound pain, 30 mg/kg of acetaminophen was administered by rectal suppository. Data were analyzed by chi-square test, t -test and ANOVA. There were no statistical significance between the two groups for age, weight and sex. The overall mean of pain was 4.6 ± 2.6 for group 1 and 18.6 ± 8.7 for group 2 and the difference between the two groups was statistically significant (P<0.001). The mean dosage of acetaminophen administration was significantly higher in group 2 compared with group 1 (P<0.05). Pre-surgical infiltration of bupivacaine in the surgical field is a useful method in decreasing both post-surgical wound pain for up to 24 hours and analgesic consumption after inguinal hernia repair.

Cutaneous leishmaniasis (CL) with diverse clinical manifestations is prevalent and remains a major public health problem in Iran and its incidence has been doubled over the last decade. The present study is about the potential role of rodents in the epidemiology of CL in Kharameh district in Shiraz, Southern Iran. From April 2004 to April 2005, a total of sixteen rodents were collected in live traps from the endemic area of CL in Kharameh district in Shiraz. Evans medium was used for culture. Specific polymerase chain reaction and isoenzyme electrophoresis methods were performed to characterize the parasite. The rodent species were Tatera indica. Three samples from Tatera indica were found positive (2 males and 1 female in Kafdehak and Sejel-Abad villages) for L. major. Macrophages in the bone marrow of femoral bone were infected with the amastigote form of the parasite. It seems that T. indica is the reservoir host for CL in Kharameh (a district in Shiraz, Southern Iran). It was shown that the bone marrow of the rodents is the tissue of choice for light and ultrastructural studies of L. major.

Femoral shaft fractures are major causes of mortality and morbidity and are managed with intramedullary nailing (IMN). In this study we compared the results of open and closed nailing in femoral shaft fractures. Between 1993 and 2001 we managed 136 femoral shaft fractures by IMN (81 closed and 55 open nailings) in 120 patients with mean age of 36.2 years. The mean time of follow up was two years. Radiologic and clinical results were analyzed with SPSS software using student-t and Fisher test. 93.2% healed within six months. 2.9% required dynamization; total union rate was 96%. Full weight bearing was permitted between 5-16 weeks (mean of 10.62 weeks) in the closed method, and 10-20 weeks (mean of 12.83 weeks) in the open method (P<0.001). Complications included 4.41% nonunions, 2.9% shortening, 10.8% limited range of movement, 1.47% deep infection, and 6.6% malunion. Nonunion was observed in 2 cases in closed and in 4 patients in open method (P = 0.039). Closed series showed higher rate of malunion (P = 0.181, P = 0.221). In closed method attention should be paid to malalignment while locking the nail.

Pancreas as the insulin-producing gland is subjected to destruction and change in the diabetes-producing process. Realtime sonography can assess the gland in 95% of cases and its accuracy in diagnosis of pancreatic disease matches that of CT-scan. The purpose of this study was to evaluate pancreatic diameter and echogenicity by sonography and to examine the correlation of these two factors with duration of disease in diabetes types I and II in comparison with controls. In two groups of 60 diabetic patients and healthy controls, diameter and echogenicity of pancreas was determined. Diameter of pancreas was significantly different in diabetic patients and correlated with duration of disease. In type I diabetes, decrease in the size of pancreas was more prevalent than in type II diabetes and thesechanges become more prominent over time.

Tibial avulsion fractures of the posterior cruciate ligament are not infrequent. However, controversies exist between the fixation of the fragments and their reconstruction in the cases with small bony fragments. This prospective study was undertaken to study the results after fixation of the fragments by the malleolar screw and the pull through suture techniques. From June 2003 to March 2005, 26 patients with acute isolated posterior cruciate ligament avulsion fracture of the tibial attachment were treated surgically at Qhaem and Emam Reza hospitals at Mashhad University of Medical Sciences. The screw fixation was used in 18 cases with large bony fragments and the suturing method for other cases who had small or comminuted fragments. The patients were followed for an average of 14 months; and according to The International Knee Documentation Committee the results were evaluated. All our patients were men and all the avulsion fractures achieved union at an average of 4.8 months (range, 3-8 months). All the patients had sever posterior instability (>10mm) pre-operatively. However, when the union of the fracture was achieved, no one suffered severe instability. Both of these two techniques (especially screw fixation) had satisfactory results. Although the number of our cases was not high enough, it can be claimed that when the bony fragment is small and the screw fixation increases the risk of fragment breakage, the double bundles pull-through suture technique is an effective alternative choice.

The prevalence of allergy and asthma among children is increasing in many countries. However, such inclination has not been completely cleared in North of Iran. This study was carried out to evaluate the prevalence of asthma and allergic diseases in school children in Gorgan and also to evaluate the association between allergies and sex, family history of atopic disorders, and personal symptomatic atopy. This was a cross-sectional study and the study population included 2800 school children aged 12 to 13 (53% female and 47% male). All participants completed an ISAAC (International Study of Asthma and Allergies in Childhood) written questionnaire. Among the selected children, 7% were asthmatic, 19% had eczema during the last 6 months, and 35.3% had rhinitis. Family history of allergy included 8.4% asthma, 22.1% rhinitis and 12% eczema. The prevalence of asthma is higher in boys compared with girls. There was a strong relation between family history of atopy and allergic diseases and asthma in children.

Complaining of tearing was found in some of our patients after phacoemulsification surgery for senile cataract. Secondary acquired lacrimal drainage obstruction has been proposed to happen due to different causes. This study was performed at Feiz hospital in Isfahan, Iran from September to December of 2004 to evaluate the effects of phacoemulsification surgery on tear drainage in eyes with senile cataract. This cohort study was performed on 110 patients with senile cataract who had phacoemulsification and posterior chamber lens (PCL) implantation surgery under topical anesthesia in one eye. Included patients had fluorescein disappearance and taste test duration of xxx; 5.5 minutes in both eyes before operation. Tear drainage function tests were repeated for one week and one month after surgery in both eyes and obtained data were compared. The incidence of lacrimal drainage impairment in eyes treated for senile cataract was 35% at one week and 20% at one month after phacoemulsification surgery. The mean taste test duration time was 3.84 ± 0.77 minutes before surgery, 7.30 ± 4.80 minutes at one week and 6.31 ± 4.42 minutes at one month after surgery (P < 0.001 and P < 0.001 respectively). No post operation tear drainage impairment was observed in the sound eyes of the patients. Impairment of lacrimal drainage can be predisposed by cataract surgery in eyes with senile cataract. KEY WORDS: Lacrimal drainage, cataract surgery, phacoemulsification

The most common neoplasm of the salivary glands is pleomorphic adenoma and the most common complications of its surgical removal are facial nerve dysfunction (temporary or permanent) and auriculotemporal syndrome (Frey’s syndrome). One of the surgical techniques in pleomorphic adenoma is partial parotidectomy. The whole excised tumor is surrounded by a safety margin of parotid tissue. Several surgical techniques are used for this operation. In the analytical studies published for partial parotidectomy, we searched for the complication rates of this operation. In a cross-sectional study, 59 patients with pleomorphic adenoma who underwent partial parotidectomy from 1994 to 2000 were selected and their clinical examinations and pathological files were evaluated at the Alzahra hospital which is affiliated to Isfahan University of Medical Sciences. From the fifty nine patients, who were studied, 44.06% were male and 55.94% were female. The mean age at the time of the onset of symptoms was 37.18. One of the patients had a history of tumor recurrence. Four patients had temporary facial nerve paresis immediately after the surgery. One patient (1.69%) had a permanent facial nerve paralysis in one of the facial nerve subdivisions. Two patients (3.38%) had Frey’s syndrome. In 1 case (1.69%) there was a history of bleeding after the surgery. Two patients (3.38%) had wound infection. In comparison with the superficial parotidectomy technique, the partial parotidectomy method indicates more satisfying results in regards to recurrence and complications.

Many types of single-use blades are manufactured with different designs and materials. There have been several reports of difficulties in obtaining a view of the glottis with single-use laryngoscopes. The purpose of this prospective study was to compare the quickness and the success rate of endotracheal intubations with two different laryngoscope blades: disposable laryngoscope blades and reusable laryngoscope blades. The study included 200 patients aged 18 to 70 who were admitted to the operating room of the Ali Ebne Abitaleb Hospital in Zahedan. The patients were randomly divided in two groups. Disposable laryngoscope blades were used for the first group and reusable laryngoscope blades were used for the second group. The endotracheal intubation duration and the failure rate of the intubation were assessed in the two groups. No failures and prolongations of intubations were found in the reusable laryngoscope blades group compared with 21% incidence of prolonged intubations and 14% incidence of failed intubations in the prolonged intubations group which led to change of the laryngoscope by the anesthetists (P<0.05). The single-use laryngoscope blades appear to be efficient devices because they do not modify the ease of endotracheal intubation in most cases. Nonetheless, for difficult intubations it is advised to maintain conventional laryngoscopes in reserve.

Septic arthritis with polyarticular presentation is an uncommon clinical entity. A case of complicated staphylococcal infection with purulent and reactive polyarthritis, osteomyelitis, cutaneous and pleuropericardial involvement as well as transient blindness is presented here.

Inguinal hernias sometimes surprise surgeons with unexpected contents. This article reports a 46-year-old male with a painless inguinal mass. Surgical exploration showed three smooth yellowish concretions in the hernia sac. To our knowledge, this is the first report of hernial sac lithiasis.