Iranian Red Crescent Medical Journal
Volume:9 Issue: 3, 2007

The assessment of family coping patterns and resources will provide a further basisfor helping family''s adaptation. This study was undertaken to assess the coping strategies used byparents of children with cancer in Aliasghar Cancer Hospital affiliated to Shiraz University of MedicalSciences. Data collection was conducted based upon Family Crisis Oriented Personal EvaluationScale (F-COPES) including social and spiritual support, reframing, seeking help and passive appraisal.A total of 72 parents including 28 couples, 8 single mothers and 8 single fathers participatedin this study. The spiritual support ranked the highest and the social help, the lowest strategies usedby the parents. Seeking help, reframing and passive appraisal were the remaining strategies.Statistically significant differences were found between the age of participants and reframing andseeking help strategies. A significant difference was also observed between the level of parent’seducation and reframing strategy but not between gender and coping strategies. Familiarity with coping strategies and the method to use them could balance theemotional, psychological and social consequences of parents who have a child with cancer.

Metronidazole has been reported to reduce postoperative anaerobic infectionsfollowing surgical procedures. Because of high cost and poor availability of intravenous metronidazolecompared with that of oral preparation, we decided to measure the serum level of metronidazoleafter oral administration in patients during postoperative ileus, and to evaluate thesubstitution of intravenous metronidazole for the oral product. The present study comprised 45 adult patients undergoing major abdominal surgeryvia long laparatomy incision from Aug to Nov 2003.(500 mg of Metronidazole was administered as a single dose orally to each patient twice, one inileus condition and the other in nonileus condition. Blood sampling was done 1 hour after eachepisode of the drug administration). A significant reduction (P<0.001) was found between the mean serum metronidazoleconcentration (2.90 ± 2.29 SD g/ml) during postoperative ileus, and that of controls(11.07±6.72 SD g/ml). In majority of patients (62.5%), the serum level of metronidazole in ileusdid not reach its minimum inhibitory concentration (3 µg/ml) for the most clinically importantanaerobic bacteria. Postoperative ileus significantly affected the oral absorption of metronidazole. As aresult, if we want to control an active anaerobic infection with a prompt antibiotic therapy, it seemsthat initiating of the therapeutic regimen with oral Metronidazole postoperatively is not justified

Traditionally, pain has been thought to be an unfortunate but inevitable part ofdisease and its treatment. Pain associated with medical procedures was ignored because it wasthought to be unavoidable. The question of why physicians should treat pain is as important asthe knowledge of preventing it, since it is a right measure to take. This study was conducted to compare the effectiveness of lidocaine iontophoresiswith that of local infiltration of lidocaine for the prevention and reduction of pain during radialartery cannulation, in patients undergoing open heart surgery. The present study comprised 60 adult patients, 36 males and 24 females, aged from29 to 84 years with a median age of 63.8 (±10.35 SD) and 65.4 (10.48±SD) for groups 1 and 2,respectively. The patients underwent elective open-heart surgery in Nemazee Hospital affiliatedto Shiraz University of Medical Sciences. Prior to induction of general anesthesia, patients wererandomly allocated to one of two groups for analgesia prior to radial artery cannulation on analternate week basis. Group 1 (n=30) patients received one-week analgesia using lidocaine iontophoresis,and analgesia in Group 2 (n=30) was performed using lidocaine infiltration the followingweek. Both groups were similar in terms of gender distribution. The VAS scores in group 1 were significantly lower than group 2 with no significantdifference in the difficulty of cannulations between the two groups. There was no complaint ofpain from patients during iontophoresis, and no report of any significant side effects. Slight skinerythma was noted after removal of the iontophoretic anode patch in 4 patients, which lasted forabout 0.5-4 hours. This study has demonstrated that lidocaine iontophoresis is a useful, non-invasive,rapid, painless alternative to lidocaine infiltration for dermal analgesia for radial ar

The thoracic sympathectomy is traditionally performed through open surgical thoracotomy.It is an extensive procedure associated with an unacceptable inconvenience. The presentstudy describes a less morbid and minimally invasive thoracoscopy as the procedure ofchoice for thoracic sympathectomy. The present study, carried out during 2001 to 2005, was performed on 33 patientsaged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females. Theysuffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitablefor revascularization. Of 33 patients, 15 had Buerger’s disease, 3 emboli, 5 essential hyperhidrosis,3 Raynaud’s syndrome, 3 intra-arterial injections, 2 advanced arthrosclerosis, 1 acutethrombosis, and 1 patient post-traumatic ischemia. The patients were indicated to undergo aprobable emergency thoracotomy. They were anaesthetized using one lung endobronchial intubationsand underwent a two-port videothoracoscopy. Sympathetic chain resection was limited toT2–T3 and lower third of the stellate ganglion. The patients were kept under careful observationand comparisons were made between their preoperative and postoperative symptoms. Moreover,the early and late complications were carefully documented and analyzed. The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, restpain, cyanosis and cold extremities, as well as excessive hand sweat respectively. The foregoingthoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients. Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapywith surprisingly good results and low complications in patients with primary hyperhidrosis aswell as limb threatening upper extremity ischemia, an entity unsuitable for revascularization.Additionally, the results of sympathectomy

Controversy still exists about the best surgical method for the treatment ofpilonidal sinus. The aim of this study was to compare two methods of excision and primaryclosure. One hundred and seventy-three patients with pilonidal sinus, 119 (69%) men and 54(31%) women, and a mean age of 23.3±7.5 yrs and divided into two Groups of A (electrocautery)and B (excision) for the removal of pilonidal sinus. Wound complications, hospital stay,times to heal, return to work, patient’s comfort and recurrence rate were recorded for the twogroups. The postoperative follow-up was 6 months. All patients were able to resume their normal lives and activities 7-9 days after theoperation. Wound infection and recurrence rate were significantly (P<0.05) less prevalent inGroup A (5% and 3.8%) than in Group B (1% and 0%). There was no significant differencebetween two groups in regard to hospital stay, time to heal, time to return to work and patients’comfort after 6 months of follow-up. The use of electrocautery at the base of the wound is not recommended because itmay obscure the exact extent of the pilonidal sinus and increase the rate of recurrences.

Open lung biopsy may be required in the patients with parenchymal lung diseasewho do not have a clearly defined diagnosis. There is no doubt thoracotomy with general anesthesiais preferable to local anesthesia; but it is associated with high risks in the severally ill patients.The aim of this study is to review our experience and compare the efficacy and complications ofusing local anesthesia versus general anesthesia for open lung biopsies in high risk patients. From January 2002 to September 2004, Twenty five patients (18 males, 7 females)underwent open lung biopsy using minithoracotomy in the Baqiyatallah hospital in Tehran. 14(56%) of them had open lung biopsy using general anesthesia (GA) and 11 (44%) selected forthis procedure with local anesthesia (LA), all of LA group were excluded from GA because of theirpoor condition. we reviewed effectiveness of LA for minithoracotomy and also compared the safety,accuracy and various complications of this procedure between the two methods of anesthesia. The mean age in the first (GA) group was 42.5 (±14.7) years and in the second (LA)group was 49.6 (±12.2) years (NS). The average length of hospital stay, postoperative air leak,and the diagnostic accuracy was not significantly different between the two groups. There wasone operative-related mortality in the second group (NS). In selected patients with diffuse lung disease or peripheral lesions Local anesthesiais an acceptable substitute to general anesthesia for minithoracotomy to obtain adequate lungtissue for accurate diagnosis.

Asthma is a life threatening disease which may lead to the death of patient bycausing spasm and airway obstruction. Stress is reported to spark off the disease and anxiety isan accelerating factor. This study was performed to evaluate two training methods in reduction ofanxiety and improving the quality of life in patients suffering from asthma. The present study comprised 84 patients with asthma referred to Shiraz University ofMedical Sciences Clinic. They were divided into two groups of 29 subjects for face-to-face and 26for pamphlete training methods, with 29 individuals considered as controls. In addition to twoquestionnaires relating to demographic information and quality of life,the present study includedKrunbach Alpha, Hamilton anxiety tests and Lickhert classification. The total numbers varied fromzero to 56 and scores of more than 14 indicated anxiety. The mean age of cases and controls were 43 and 52 years respectively. Among the participants,41.8% were males of which 61% held a high school degree or higher with a monthlyincome of more than 110 $. Of these, 34.6% had a disease duration of more than 10 years. Both training methods had significant impact on reducing patient’ anxiety and improvingtheir quality of life. However, no relationship was observed between gender, age, educationand income levels.

Lifetime treatment of persons with hemophilia entails a heavy financial burden. Themain goal of this study was to determine the factors influencing care cost of hemophilia A insouthern Iran. The present study comprised 88 of 170 hemophilia A patients who had been registeredand virtually treated in Fars Hemophilia Treatment Center in southern Iran. The data concerningpatients’ characteristics and medication schedules were collected from their past medical recordsand staff interviews. The scale utilized by the Hemophilia Utilization Group Study (HUGS) was usedto assess the status of patients’ functional health. The severe, moderate and mild deficiencies of factor VIII were found in 43.2%, 21.6%and 35.2% of 88 patients respectively. The mean age in the study group was 21.8 years (±12.2)and 58 (65.9%) enjoyed high health status. In regard to laboratory records, 25 (28.4%) patientswere HCV-positive, 2 (2.3%) HBS-positive and all were HIV negative. The average cost of care fora patient with Hemophilia A was $8,510 (±8,066) and the total annual costs were significantly (p<0.05) associated with: severity of arthropathy, presence of factor VIII inhibitor and its titer, severityof factor VIII deficiency, positive HCV infection and functional health status. Costs unrelated toforegoing factors included only 1% of the total. The total cost of patient care was correlated with severity of factor deficiency, arthropathy,positive HCV infection and functional health status. Financial resources to meet factorunrelatedcosts should increase, in order to provide patients with improved quality of medical care.

Extraadrenal paraganglioma makes up a dispersed neuroendocrine system which extends fromthe base of the skull down to the pelvic floor. Paraganglioma have been found in particularlyevery site in which normal paraganglia are known to occur. Herein, we present a typical caseof carotid body paraganglioma according to both histological and immunohistochemical findings.The presence of a large ribbon-like amphophilic to basophilic amorphous material which,according to the history of angiography, must result from the precipitation of angiographic dyemakes this entity unique and the first to be reported.

The incidence of tuberculosis is high and extrapulmonary tuberculosis is seen more frequently, thethyroid tuberculosis is rare. Thyroid tuberculosis is presented as thyroid nodule, thyroiditis or abscessformation. This condition should therefore be recognized whenever goiter is being treated,because it has an entirely different treatment. The aim of this report is to present thyroid tuberculosisin order to gain a better understanding of its clinical characteristic, diagnosis and treatmentwe present 9 cases of thyroid tuberculosis since 1995-2006 from north of Iran. They comprised 5patients with thyroiditis, 2 cases with abscess formation and 2 with thyroid nodules. All patientswere diagnosed using Fine Needle Aspiration (FNA) and treated by repeated surgery and antituberculosisdrugs. It is concluded that tuberculosis of thyroid should be kept in mind while treatingdiseases of the thyroid such as thyroid nodule, thyroiditis, thyrotoxicosis especially in communitieswith high prevalence of tuberculosis. The diagnosis of thyroid tuberculosis is facilitated byFNA and its treatment is achieved by simple surgery as well as anti-tuberculosis therapy.