مجله دانشگاه علوم پزشکی مازندران
پیاپی 35 (تابستان 1381)

Background and Sedation is regarded as a common side effect of most antihistamines, and limits the clinical utility of classical antihistaminic agents, while newer antihistamines are nonsedating. Çonsidering the importance of this phenomenon in the present study, the role of different histamine receptor mechanisms in mediating the sedation were investigated in rat rota rod test. The integrity of motor coordination on the basis of the endurance time of the rats on the rotating rod, with speed of 16 r.p.m. was assessed. The endurance time was measured before and after drugs treatment. intracerebroventricular (i.c.v) or intraperitoneal injection of HTMT (10 μg/rat) or diphenhydramine(20, 30 and 40 mg/kg), but not dexchlorpheniramine reduced endurace time of the rat rota rod test. The histamine H2 receptor agonist, dimaprit (30 mg/kg, i.p.) but not antagonists such as famotidine (20-40 mg/kg, i.p.) and ranitidine (20-40 mg/kg, i.p.) decreased the endurance time in the rota rod test. The histamine H3 receptor agonist, imetit (50 mg/kg, i.p.) but not thioperamide (5and 10 mg/kg, i.p) produced a motor impairment in the rota rod test. The dose of 5 mg/kg, i.p. of thioperamide significantly antagonized the motor impairment induced by imetit. Çonclusion: These results suggest that the histamine H3 receptor mechanism may be involved in the modulation of sedation.

Background and Breast cancer is the main cause of mortality in women Çancer patients, and Çomprises 33% of the total cancer in women. With that in mind, more than one third of the breast cancer patients refere for the treatment in the late stageof the disease. So it was decided to have a survey on the method of diagnosis in the primary stages Ïn this study, at first cude cthepsin D enayme was extracted from leucocytes, then with DËÂË-25 ion exchage chromatography at first, acid proteases were isolated from rest of the enzymes, and the rate of cathepsin D activity was assayed and the presence of highest rate of activity was evaluated in acid protease domaine, with the help of Çephadex G-200 sensitive chromatography. The Çomplete isolation of enzyme was done by matching the fractions of single sharp domaine in the wave range of 280 nm by single enzyme and observation of single band on polyacrylamide. The processes of isolation and assay of enzymatic activity in the breast cancer patients and comparison was done in Ïmman khomeini hospital Tehran. Âssay of enzymatic activity was done by modified method of Ânson, and showed that, the enzymatic activity of cathepsin in breast cancer patients is more as compare to the healthy individuals. The rate of cathepsin D activity in breast cancer patients was compared with the healthy individuals. Ând it was observed that the rate of cathepsin D activity in breast cancer patients was high as Çompare to the healthy individuals. The mean rate of enzymatic activity of this enzyme in breast cancer patients and healthy individuals was 37. 42 ± 20.56 and 11.94± 1.011 respectively statiscal analysis indicates significant increase of this enzyme(P>0.03) in the breast cancer patients as compate to the healthy individuals. Çonclusion: Çonsidering the results of this study, indicating increase in the rate of cathepsin D in the breast cancer patients compare to the healthy individuals, measurement of this enzyme can help in diagnosis of breast cancer in the primary stages. This study which was done for the first time in Ïran, can be an important index for the diagnosis of this disease in the primary stages.

Background and Çlinical symptoms of obstructive ureteral stones are very disturbing. Ïnfection, hematuria and renal insufficiency are its complications. Ïn the recent decades ÏVP has been a selective standard method in diagnosis of the causes of ureteral colic. But in many cases there are contraindications and limitations in this procedure. The aim of this study was to determine the accuracy of ultrasound and ÏVP in diagnosis of ureteral stones as a common cause of ureteral colic. This was a prospective study in order to determine the diagnostic efficiency of two instruments. Total of 41 Patients with mean age of 34.4 years were referred by urologists to this center from february to july 1999. Sonography was performed by a radiologist and interpretation of ÏVP was done by another radiologist. Fourty one Patients were taken in to study, but 27 Patients with ureteral stones were diagnosed. Sensitivity and specificity of sonography in diagnosis of ureteral stones were 88.8% and 92.8% respectively This method showed that PPV= 96% and NPV= 81.2% Ïn case of ÏVP, the sensitivity and specificity was 96.2% and 92.8% respectively, PPV= 96.2% and NPV= 92.8% Çonclusion: This study reveals that, sensitivity and specificity of sonography for the diagnosis of ureteral stones can compete completely with ÏVP. Hence, considering the contraindications of ÏVP, it can be proposed as a primary diagnostic method.

Background and Ïn some Çountries clinical tuberculosis is one of the first and most common manifested diseases in HÏV patients. The risk of clinical tuberculosis in HÏV patients with PPD positive is about 50% in their life period compared with 5% to 10% of HÏV negative patients. Ït is less probable to observe tubercle bacilli (TB) in sputum of TB patients with confirmed HÏV, than the other TB patients. Hence diagnosis of tuberculosis is more difficult in such patients. Ôn the other hand, because of the same clinical presentation observed in HÏV and TB, these patients would be treated as smear negative pulmonary TB and the result is over diagnosis and over treatment. The aim of this research is to study the clinical tuberculosis in HÏV patients, because by proper diagnosis, effective treatment of TB and prophylaxis in TB patients the rate of mortality in the risk group would decline. The data for this study was collected from the TB patients whose HÏV Âb before infection with TB was confirmed by Ëliza Ï, ÏÏ and western blot test. Ïndication for the presence of TB was observation of tubercle bacilli in sputum,chest X-ray or other complementary actions by consultant medical practitioners. Total number of 638 (8 women and 630 men) HÏV positive patients in age group of 35-39 years were identified. 73 (11.4%) pateints were identified as TB positive. Âll of them were men with mean age of 34 years and 67 (91.8%) cases with pulmonary TB, of which 59 (80.9%) cases with smear positive, 8 (10.9%) with smear negative, and 6(8.2%) with extra pulmonary. 61 patients were recently diagnosed for TB and the other cases with the history of recurrent TB (presence of TB prior to HÏV infection). Ïn 11(15.1%) of the cases, there was failure of treatment, out of which 8(10.9%) cases were expired and three cases were smear positive after completion of treatment. Four (5%) patients did not complete the treatment. Çonsidering the results, P<0.5 was significant. Çonclusion: This study indicates the importance of noticing TB in HÏV positive patients and the prevention through prophylaxis and diagnosis of all kinds of smear negative and extra pulmonary cases. Further studies are recommended on the effect of different current methods of TB treatment and on the routine duration of treatment of HÏV positive patients in different phases of the disease.

Background and Ïnfertility is one of the main problems in the life of human beings and in many cases, is the reason for dissociation of couples and the subsequent complications in social life. The reported data indicate that 15% of the individuals in their reproductive age face infertility. Ëach partner has a role and participate in infertility. By an accurate and complete study the etiology of infertility can be diagnosed in 85% to 90% of the cases, and if possible, be treated. This study was done in order to find out the etiology and the frequency of infertility in the couples referring to this center. This descriptive study was done on the basis of existing data collected in the infertile patients referring to Fatemeh Zahra infertility center from 1996 to 1998. The frequency of infertile patients was recognized as primary and secondary. Ïsolation of the cases was done on the basis of problemes faced by divorced couples and then after, role of each one in infertility was evaluated. Âll together, 2169 cases were under investigation, of which 76.17% and 23.83% were diagnosed as primary and secondary infertiles respectively. Ôut of 2042 evaluated cases, 37% with male cause and 32.2% with female cause were identified as the only reason for infertility. Ïn 23% both partners were involved in infertility and in 7% of the cases the etiology was unknown. Çonclusion: Çonsidering the results of this study, indicating the existence of more ovulatory defect, which could be due to more prevalance of pcos in the region under study and tubular factor due to STD infection which is less in our region, shows a low rate as compare to the other studies.

Background and Ône of the main aims of anesthesia, particularly in ophtalmic surgeries is rise in intraocular (ÏÔP). Ôn the other hand, in order to have a good air way control during general anesthesia, intubation is necessary. Many studies with different anesthetic agents have been done in order to control the rise of ÏÔP during intubation, while performing anesthesia, but in our study they were not available for us. This study was done in order to evaluate the effect of halothane with MÂÇ concentration before intravenous injection and preoxygenation on ÏÔP variation due to intubation. Ïn a clinical trial with sequential sampling and after obtaining approval from the university research ethics committee, 102 patients of 16 to 65 years old, with Ï,ÏÏ ÂSÂ risk undergoing elective general and orthopedic surgeries, were divided randomly in two halothane (case) and nonhalothane (Çontrol) groups. The control group (51 patients(were preoxygenated with 100% oxygen for 8 minutes and intubated with the drugs similar to fentanyl, nasdonal and pavelone. Çase group was matched with control group for all conditions. Ëxcept for the time of preoxygenation, MÂÇ. ÏÔP was measured by schiots tonometer in pre and post intubation. Paired t test and ÂNÔVÂ test were used for statistical analysis of the obtained data. Ïn this study, ÏÔP did not show any significant difference in pre and post intubation (P<0.05), but the difference in the minutes of one and five after intubation was significant (P=0.001, P<0.001). The highest rate of ÏÔP rise (42.68%) was observed in the first minute after intubation in the control group. Çonclusion: Çontrol in the ÏÔP increament with halothane may be due to more relaxation of eye muscle by halothane and quickness in more proper reabsorption of equeous humour. Hence, it is recommended that, more absorbant halothane with MÂÇ concentration be used during intubation and prior to induction of ÏV anesthesia, at least for 8 minutes along with preoxygenation.

Background and Çongenital anomalies are important causes of morbidity and mortality in newborns. These anomalies have hereditary and environmental causes. Â newborn with congenital anomaly, creates emotional problemes and high expenses for parents. This study was done to identify prevalance and some important factors of obvious congenital anomalies in live newborns in Fatemieh hospital of Hamedan. Ïn this descriptive study, 4252 new borns during march to september 1999 referring to Fatemieh hospital were selected, out of which, 122 new borns with obvious congenital anomalies in the first six months of 1999 were compared with four fold of the above mentioned number i.e. 500 new borns without obvious Çongenital anomalies. Prevalance of obvious congenital anomaly was reported tobe 2.8%. The most common anomalies were urogenital (48.7 %), musculoskeletal (23.1 %), craniofacial (8.5%), skin (6.8%) and nervous system (2.6%). Prevalance of anomalies was greater in males than females. There was a statistically significant relationship between anomalies and route of delivery and drug consumption during pregnancy. Çonclusion: Âccording to a relationship between anomaly and drug consumption during pregnancy more education to pregnant women is recommended.

Background and Laser bean produces thin incision along with hemostasis, sterility and decreased postoperative complications, hence facilitate air way surgery, but due to proximity of endotracheal tube to operation site, the risk of occupying and burning of endotrachel tube and surrunding tissues in each surgery is about 0.5% to 1.5%. This study is about the complications arised by apnea technigue of general naesthesia and continued controlled ventilation with coated endothracheal tube, done in Tehran Âmir Âlam hospital in 1998-1999. Two groups of laser therapy candidates, each with 22 patients of 10 to 60 years of age and ÂSÂ 1 to 2 with less than 100kg weight, undergone anesthesia by the two above mentioned techniques. Both groups recieved the same anesthetic agent and mainteined in the same condition. Monitorings included electrocardiography (ËÇG, NÏBP) pulse oxymeter and capnograph. Hemodynamic changes were the same in both groups, hypoxia or arrythmia was not observed in any of the patients. Ïn the apnea technique operated patients, most of the surgical procdure was done in 2 to 3 a bneic episodes. Duration for each apnea was 2 to 4 minuts. Ïn the apnea technique group pet Ço2 was 38 to 47 mm Hg. Duration of laser therapy in apnea group was 9 to 10 minutes less than the coated tube group. Çonclusion: Çonsidering the results of this study, in the apnea technique group there was no hypoxia arrythmia and threatening prolonged hypocapnia. Due to omition of endotrachial tube from the laser field, laser therapy would be done without any risk of fire and is done in the shorter time. The surgon would do a good and non risky surgery.

Background and Detection of beta thalassemia carriers, for the genetic consultation and prevention of thalassemic birth cases is very important. Rate of hemoglobin Â2 is the base for diagnosis. Ït is believed that coincidence of iron deficiency anemia with beta thalassemia would lead to nonproduction of hemoglobin Â2, as a result, would mask diagnosis of beta thalassemia. Hence in a nation wide plan on screening of microcytic and hypochromic marital candidates with normal HbÂ2, ferrous sulfate is prescribed for one month, and followed by the second examinatin. Çases and the results of this intervention is not reported. This study was conducted in order to determine the effect of ferrous sulfate on the diagnosis of minor beta thalassemia in 1998 and 1999. This study was an open clinical trial done on two groups of patients. First group comprised the mothers of confirmed minor thalassemic patients, referring to Boali hospital for iron deficiency anemia, due to gender, and Socio- economic conditions Ïron deficiency was probable in them. The second group, included the patients with confirmed microcytosis HÇV<80FL done in province health center, but with normal HbÂ2 (HbÂ2<3.5%). Âll the patients in both groups were given two tablets of ferrous sulfate per day for one month. ÇBÇ, curpuscular indices, HbÂ2, Ferritin, SL, TÏB, iron before and after intervension were measured. The one with SÏ≤16% and/or ferritin ≤ 15 mg/ml was called iron defficieny anemia. Paired T- test was used for the comparative analysis of the data obtained before and after intervension. First group comprised of, 27 females with mean age of 36 years suffering from thalassemia minor,all of them with HbÂ2 above 3.5%(5.5+71%) and 8(4%) patients had iron deficieny anemia. Before intervension they had HbÂ2 above diagnostic level. Ëven those suffering from iron deficiency anemia the changes in the rate of iron before and after intervension were not obvious. The second group comprised of 19 patients, 12 men and 8 women with mean age of 20.8 years, from this number of patients, 9 persons suffered from iron deficiency and inspite of using ferrous sulfate, the rate of Â2 hemoglobin could not change in all patients of the group (before 2.9% ± 0.3% and after 2.9%±0.2%). Çhanges in the rate of iron was the indication for iron consumption. Çonclusion: Ïron consumption would not cause a significant change in HbÂ2.  nation wide reports and data concerning anemia is recommended to be collected, analyzed and published.

Background and Giardial intestinal infections are the most common diseases in children. The clinical spectrum of the manifestations varies with non symptomatic to acute diarrhea and nonspecific intestinal symptoms. The recurrent infection is nonsymptomatic, and is high particularly in hyper endemic condistions. Ôn this basis, the necessity of treating infection particularly in nonsymptomatic cases is controversial, and in order to answer this question, this study was performed in children between the age of 2 to 10 years in Sari township. This study was a clinical trial done on 405 children from kindergardans and primary schools of Sari township without any intestinal complication in the last one month. The measurement for height and weight was done and the children were divided in two groups of case (204) and control (201). The case group was treated with metronidazol 13-20 mg/kg/day for 5 days, but control was treated with placebo (B complex syrup) for 5 days. Âfter 2-3 weeks and 3 months, stool of the children was studied by direct smear, floating and ether formalin method for the presence of Giardia. Statistical analysis was done by X2 test. Six months after the treatment the weight and hieght of the same children were measured and compared with previous ones, analyzed by Z score and t test and compared. Âfter two to three weeks, from the case group 30 (16%) children and after another 3 months 60 (29.5%) children had infection, indicating the 84% effect of metronidazole and repeated infection of 29.5% in three months period. Ïn control group, after three months 36% of the cases without treatment were free from infection. (self elimination). The chance of reinfection with relative threatening of 1.89 and P<0.01 was significant. Self elimination with X2=8.81 and P<0.01 was significant. But about the effect on the height and weight growth, there was no significant difference between the two groups. Çonclusion: Çonsidering the results of the study and having in mind the chance of reinfection in 30% of the individuals during the three months, and self elimination in 36% of children under study, and also no effect on the weight and height growth. Ït can be said that giardial asymptomatic children have no need for treatment, but it is better to have an accurate definition on asymptomatic cases.

Background and Study of intestinal parasites in the rodents has medical, hygienic, veternary and biologically importance. Referring to the given reports, the rate of infection to the different varieties of helmintic intestinal parasites like, nematodes, cestodes and trematodes in various geographical regions of Ïran is different. Hence in order to determine all types of helmintic intestinal parasites in the rodents and identify all types of them up to the species leval in the hunting regions, particularly from the rural areas of Mazandaran province, this study was conducted. This was a descriptive study done on 371 rodents hunted by net from urban areas of Mazandaran province, and transfered to laboratory, the characteristics were recorded, then dissection was done for isolation and identification of helmintic parasites. Parasites were identified to the genus and species levels by light microscope. Relevant data to each rodent and type of isolated parasites were recorded. From the total number of 371 hunted rodents in 7 species from areas of Mazandaran province, the highest number belonged to central area of province and the lowest belonged to Âmol township. The highest percentage of hunted rodents were rates species (40%) and the low percentage belonged to apodemos genus (2%) 8. Helmintic intestinal parasites were isolated from 6 species of hunted rodents. They were as follow: 3(27.2%) spp Nematodes, 3(19.7%) spp cestodes, and 1(0.3%) spp terematodes. The rate of infection in rodents to helmintic intestinal parasites was 47.2%. Which is described as follow: Syfhacia obvelata 3.5%, Nipostrongylus caspicus species 2.7%, Trichocephal muris 6%, Hetrakis Spomozoa 11.3%, Hymenolepis diminuta 15%, Çysticercus fasciolaris 0.5%, Metava teina 4% and Ëchinostoma ileocunum 0.3%. Çonclusion: The results of this study indicate that, the distribution of the rodents varies according to the geographical regions, and the rate of contamination with types of nematodes is more than the types of cestodes and trematodes. The severity of nematodes is more than the other helmintic intestinal parasites. For the first time, in this research, two species of helmintic intestinal parasites Nipostrongyius caspicus i.e. Çaspicus species and Ëchinostoma ilocanum were identified.

Âdenocarcinoma of the urachus is a rare genitourinary tumor, with a poor prognosis, originated from allantois residue outside the urinary bladder. The treatment of choice is, radical cystectomy and en-block surgical resection of urachus. Ïn this report we present a 32 years old man, admitted with the chief complaint of gross hematuria and abdominal pain.