مجله دانشگاه علوم پزشکی مازندران
پیاپی 39 (تابستان 1382)

Background and Despite extensive investigations, application of surface electromyography (SËMG) in the evaluation of rehabilitation programme for the patients suffering from chronic low back pain (ÇLBP) has yet to be conclusively demonstrated. Ïn a randomised controlled trial, effectiveness of spinal manipulation therapy (SMT) compared with therapeutic ultrasound (ÜS) in the treatment of ÇLBP was investigated using SËMG. Ône of the purposes of this study was to assess the short and long-term effectiveness of SMT and ÜS on ÇLBP and also to identify the effect of SMT on lumbar muscle endurance. Âfter ethical approval, 120 patients with ÇLBP were randomly divided in two experimental and control groups. Pain intensity, functional disability and back muscle endurance using SËMG were measured shortly before treatment, at the end of the treatment and six months after randomisation. Following treatment, significant changes (P<0.01) have been recorded for both groups, statistical analysis of the data obtained from this study in order to determine the difference between these two groups has shown that the rate of improvement in the experimental groups was more than control group (P<0.01) and this difference was significant in multifidus muscle. Both groups benefited from the treatment interventions at six months follow up and the patients in the experimental group showed greater improvement. Çonclusion: This study shows that SËMG approach as a non-invasive tool can be used in evaluating treatment technique. Âlso it has been proved that, both of these treatment techniques have been useful in the patients with chronic back pain, and the patients who received SMT technique showed more improvement.

Background and Bone changes are secondary to chronic anemia, hypertrophy, enlargement of skull and also due to therapeutic agents such as desferal. Ât present in developed counties there is reduction of bone deformity as a result of proper treatment and management of the disease. The present study has been conducted in order to evaluate the type and severity of bone changes in thalassemic patients referring to Boali sina hospital of sari. Thalassemic patients with pain complaint, bone fracture or deformity were selected. Purpose of the study was explained to the patients and their parents, then agreement of parents was obtained, radiography was done for each patient. Bone age was measured based on Greulish-pile criteria. This study was done on 60 patients, (40% females and 60 males). Patients’ mean age was 15 ± 6. Bone pain complaint, history of bone fracture and apparent deformity on face were observed in 53%, 45% and 20% respectively. X-ray image indicated osteoprosis in all of the patients under study. Desferal related toxicity was observed in 13% of the patients. There was relationship between symptoms of toxicity and duration of using desferal for more than 2 years (P<0.05). Various other bone defects were also observed. Çonclusion: Bone changes and osteoprosis are prevalent in these patients. Bone deformities are abandoned indicating improper treatment and blood transfussion in such patients. Probable desferal related toxicity must be considered.

Background and Dysentry is one of the acute intestinal diseases with different etiological agents. Due to emergence of drug resistant strains, treatment of this disease is difficult. This study is conducted in order to determine the relative frequency of dysentry causing agents in children living in Zahedan city of Ïran and to evaluate the drug sensitivity pattern of dysentry causing agents. Ïn this study, which was started from the beginning of 1998 till the mid 1999, 155 stool samples were collected from children of 6 months to one year of age, referring to Hazrat Âli asghar hospital due to dysentry, and the collected samples were investigated for bacteriology, serology and parasitology. Shigella, ËÏËÇ and Ë. histolytica were isolated in 43 (98%), 20 (13%) and 2 cases respectively. Ôut of 43 shigella cases, in 35 (81%) and 8(19%) cases, S. flexneri and S. dysenteriae (Serotype 1) were isolated respectively. Nalidixic acid was the most effective tested antibiotics and only in one case of shigella, resistant to nalidixic acid was observed. Çonclusion: Since significant resistant to antibiotics such as, amoxycillin, cotrimoxazole, furazolidone, ciprofloxacin and cephalexin was observed, it is recommended to avoid their empirical administration and also due to less prevalence of Ë. histolytica empirical use of amebecidal drugs is advised in case of laboratory identification.

Background and Âmong rheumatic inflammatory diseases, rheumatoid arthritis has the highest rate of prevalence (1% in majority of the societies and as well as in Ïran). This is a chronic disease, followed by multiple- system involvement of unknown etiology. Major sing is inflammation of sinovial joints. Ïn addition to pain, inflammation, restriction and joints deformity the patients experience mental disorder, stress, anxiety and depression resulting from disease condition is associated with disease which provid defective cycle between mental and physical signs, as a result, the disease is activated by stress and nervous stimulants. Therefore control of the disease is difficult sometimes, hence, in this study, medication was followed along with benson relaxation in order to control the disease activity. This clinical trial study was performed in rheumatology research clinic of Ïmam khomeini hospital in Tehran during 2000-2001. Fifty patients were selected as non probable samples from the society under investigation, and on the basis of age and sex, randomly were divided in two case (26 patients) and Çontrol (26patients) groups. Patients of the case group individually were trained for benson relaxation with tape. This interferance was followed for 8 weeks. Ïn order to evalute benson relaxation effects, clinical symptoms, laboratory findings, anxiety, depression and feeling of well being before and after interferance were measured. Statistical tests showed no significant difference in variable of pre and post intervention in two groups. Mean variables of anxiety, depression and feeling of well being in two groups in post intervention were as follow: P=0.0001, P= 0.0001 and P=0.001 respectively which indicated significant difference. Most variable of clinical symptoms and laboratory findings showed decline in disease progress. But no significant statistical difference was observed. Çonclusion: Hypothesis of this study emphasizing that, benson relaxation declines disease progress, was confirmed for anxiety, depression and feeling of well being. Referring to the other variables related to clinical symptoms and laboratory findings, and in order to obtain more accurate statistical results, study with more sample size and performing of interferance in more than 8 weeks period is necessary.

Background and Hypertension during pregnancy is one of the three main causes of maternal mortality which is followed by bleeding and infection. Ïn an effort to prevent pre-eclampsia, different ways are used. The drugs which are used are aspirin and antioxidants. Âim of this study has been to evaluate the role of administration of aspirin in preventing pre-eclampsia in the patients referring to hazrat fatemeh zahra prenatal clinic from oct. 2001 to the end of may 2002. This study is a randomised double blind clinical trial done on two groups: primiparas and single para on their 13th to 32th weeks of gestational period. None of the individuals had any history of asthma, blood pressure, diabetes, peptic ulcer and sensitivity to aspirin. Âll of 537 persons under study, excluding 48, had complete cooperation. Full time participants that is, 489 persons were randomly divided in two groups. Çase group (252 persons) received placebo and the control group (237 persons) were given aspirin. Âll participants of two groups on their routine referring to the prenatal clinic were tested for blood pressure, protein uria and edema. Both groups were matched for age. For statistical analysis, X2, ÇL and ÔDDS ratio were performed. Ôccurrence of pre-eclampsia was not significant between these two groups. No case of eclampsia was observed in two groups, and prenatal mortality was not observed in any group. Çonclusion: Ït seems that, low dose administration of antibiotic in primipara females will be effective in preventing pre-eclampsia, eclampsia, preterm delivery, under 2500 grams birth weight and prenatal mortality. Study on the use of other prophylactic drugs and study on the exact pharmacokinetic effect of aspirin is recommended

Background and The common method of stabilization in noncancerous lesions of anterior cervical vertebrae is the use of interbody bone graft and instulation of caspar plate and screws which is followed by several complications, breaking or loosing of screw, damage to esophagus and improper fusion of bone graft, as a result, damage to spinal cord during fixing the screw and also expouser of the patient and operation team members to radiation when using fluroscope. Ïn order to overcome these problems, a new method is proposed, that is, use of methyl meta crylate as a bone cement plate system. Main objective of this research is the elimination of screw and plate system in order to study the fusion of vertebraes in control radio graphy after operation. Ïn this prospective study, the patients who were operated due to cervical disc or disc herniation and canal stenosis by anterior cervical approach at shafa and Ïmam hospitals in sari were selected. The patients were 5 men and 5 women with age range of 36 to 77 years. Ïn order to create bone cement plate, methyl metha crylate which is used for cranioplasty was used. This study was done from 1998 to 2001. This method was used for 10 patients. Ïn the follow up using control radiography during maximum 25 months and minimum 8 months. No complication such as infection, sensitivity and fusion disorder were observed, and in no case there was need of reoperation. Çlinical outcomes of operation were statisfactory. Çonclusion: Âdvantages of performing this method are as follow: easy doing, no risk for spinal cord,no need of special equipment, availability of needed equipments, cost efficiency, MRÏ compatibility, no need for flouroscope and creation of immediate suitable stabilization. Ëlimination of screw and plate in this technique would lead to elimination of consequent device related complications. Ïn this method, rigid post operative external immobilization is not required and philadelphia collar is enough.

Background and Since Çystoid Macular Ëdema (ÇMË) is caused by ocular inflammation after cataract surgery. Ït’s control with suitable medication is reasonable. Âim of this study was to compare a nonsteroidal topical solution (0.1 % diclofenac) to a steroidal topical solution (0.1 % betamethasone) in preventing ÇMË after extra capsular cataract surgery. Â prospective randomised double blind clinical trial was performed on patients undergoing extra capsular cataract surgery with posterior chamber lens implantation. By simple randoming method, patients were divided in two groups on the basis of diclofenac 0.1 % and betamethasone 0.1 %. Âll patients had similar condition of ocular background (cataract) surgical procedures and inter ocular implantation in two groups. The presence and degree of ÇMË were determined by fluorescin angiography. Â breakdown of the blood-aqueous barrier was determined by anterior chamber cells and flare biomicroscopy. Six weeks after surgery, ÇMË was present in 2 of 47 eyes (4.25 %) receiving diclofenac and in 12 of 50 eyes (24 %) receiving betamethasone. There was no significant difference in cellular reaction in the anterior chamber at 3 days, 1 and 6 weeks after surgery between two groups (P<0.01). The amount of flare in the anterior chamber at 3 days, 1 and 6 weeks after surgery was also significantly lower (P<0.001) in diclofenac group. Âlso extra ocular inflammation declined in diclofenac group (P<0.001). Çonclusion: These finding shows that diclofenac effectively prevents ÇMË following cataract surgery and indicating that, ÇMË is closely related to the post surgical intra ocular inflammation, also diclofenac can effectively reduces ocular inflammation and the occurrence of ÇMË.

Background and Median epidural block is often done with some difficulty due to pain, ossification of interspinous ligament and improper positioning of patient. Ïn addition, back pain is common with median approach, that may be due to puncture of ligaments on the line of epidural needle passage. Ïn paramedian approach needle dose not pass through ligaments, so back pain can be theoretically less. Ïn a single blind clinical trial, pain at needle insertion point, back pain and satisfaction of patient from epidural technique at the time of operation and in ward, in addition, pain score at three phases in median (20 patients) and paramedian (20 patients) groups were studied. Ëpidural block was done at sitting position and hanging drop maneuver was used for all the patients. Severity of pain with the help of pain score and comparison of pain with the pain arised due to insertion of angiocath insertion on the back of hand were evaluated (p<0.05). Ïn this study, it was found that pain at the point of insertion (compared to the pain by angiocath at the back of hand) in paramedian group was less (12 cases of less pain in paramedian group versus 12 cases of severe pain in median group). Ïn paramedian group less back pain was noticed. Âlso statisfaction of patients with epidural approach was more in paramedian group (50% in paramedian group versus 20% in median group). Ïn all of the three cases, there were significant differences between median and paramedian groups. Çonclusion: Referring to the results of this study, it is concluded that comparing to the median paramedian approach is followed with more satisfaction, with less pain approach and is easier too particularly when due to pain or ossification of ligaments proper positioning of the patient for median approach in not possible.

Background and Retinopathy of premature neonates (RÔP) is a lesion in the retina of under weight neonates at birth, which can lead to blindness. Âim of this study is to report the prevalence and severity of this complication in the intensive care unit of sari Boali sina hospital. Ïn this descriptive- cross sectional study which was followed by clinical examinations, laboratory findings and by referring to the filled questionnair, 68 neonates met the necessary criteria, were selected. Neonates under study were under eye examinations at the time of discharge (4 weeks) from hospital, 6 to 8 weeks after brith. Then each 2- week till complete development and vascularization of retina, statistical analysis of the results was done by mean comparison of two societies. Prevalence of RÔP was generally 11.7 % and severity of RÔP at stage 3 or greater was 1.4 %. No case of RÔP at gestational age of more than 34 weeks was observed. Most cases of RÔP were observed in the neonates under 1500 grams weight at birth, but birth cases up to 2500 grams weight were observed too. There was significant statistical difference between duration of phototherapy, high level of Pco2, Severity of respiratory distress and RÔP. Çonclusion: Çonsidering the difference in the rate of prevalence and severity of RÔP as compare with the given reports from the western countries, it seems that national RÔP prediction needs to be evaluated.

Background and Panic disorder (PD) and MVP are relatively Çommon disorders, and the relation between them has been noticed by researchers. The question, weather, MVP is more common in PD patients than the whole non PD population, has not been answered yet. Ïn order to answer the question, this study was designed and performed. This descriptive study, has been done on the patients referring to psychiatric clinic from 1998 to 2001. The patients with confirmed diagnosis of PD according to DSM-ÏV, were under clinical trial and echocardiography by cardiologist for the probable presence of MVP. During this study, 181 patients suffering from PD were under study, of which, 127(70. 2%) were females and 54 (29. 8%) men. Mean age in females was 26 and 32.6 years respectively. Ïn all, 64(38.1%) of the patients had MVP according to perloff criteria. Çonclusion : Ït seems that MVP in the patients suffering from PD has relatively more prevalence as a result, cardiovascular examination in confirmed PD patients would be useful.

Ïntussusception is the most common cause of intestinal obstruction in children. Disease in typic form manifests itself by colic abdominal pain and episodic vomiting with bloody stool. Ïn Ïleoileal types, manifestations may not be typical. Diagnosis is based on clinical finding through barium enema and sonography. Treatment is nonsurgical reduction, and if contraindicated, surgical reduction. Ôur patient was a 3.5 years old girl referred to emergency ward with very bad general condition, and low consiousness. Patient had persistant abdominal pain and vomiting (first non bilus then bilus) four days prior to admission. Ïn physical examination patient had severe hypotension, semishock and acute abdomen. Âfter stabilization, patient was transferred to operation room. Ïntraoperation finding showed ileoileal intussusception with a leading Meckel’s diverticulum. Following reduction, Meckel’s diverticulectomy was done and after convulsence the patient was discharged from hospital with good general condition.

There are frequent reports on the presence of foreign body in bladder. Âlmost any thing available in human environment, has been observed in bladder as a foreign body. The case is a 28 years old married man complaining of urinary irritation. History was taken from him and radiography was done, as a result, presence of foreign body in his bladder was confirmed. This is a first report on a rare case given by us.