Journal of Research in Medical Sciences
Volume:13 Issue: 3, May & Jun 2008

Central serous retinopathy (CSR) is a frequent disease often involves healthy men and causes visual disturbances. This study was undertaken to investigate the effects of propranolol tablet on improvement of CSR in referral cases to Farabi and Feiz hospitals in Isfahan in 2003-2004. This was a double-blind randomized controlled clinical trial. Patients with CSR referred to Farabi and Feiz hospitals were randomly divided into 2 groups: treatment group and control group, each one included 30 patients. Treatment group took propranolol tablets 20 mg twice a day, and control group took placebo tablets. Patients were examined weekly until complete improvement. Means of duration of disease and final visual acuity on the basis of lag mar were compared by t-test. Relative frequency of final visual acuity of 10/10 in the two groups was compared using chisquare tests. Two groups were comparable with respect to age, sex, involved eye, psychological tensions and clinical findings. The course of improvement in treatment group was 62 ± 29 days and in control group was 89 ± 44 days (P < 0.05). Means of final visual acuities were not significantly different between the two groups (0.98 ± 0.13 log mar in treatment group compared to 0.97 ± 0.18 log mar in control group). Relative frequency of vision < 10/10 was 30% in control group and 3.3% in treatment group (P < 0.01). Duration of disease and need to laser therapy in patients with CSR were decreased by the use of propranolol but it had no effect on the amount of final vision. Because the patients are mostly in the years of active life, propranolol use is recommended for these patients.

Magnesium (Mg) has been used as an adjuvant medication in postoperative analgesia. We planed this study to assess the effects of Mg, when added to lidocaine in intravenous regional anesthesia (IVRA) on the tourniquet pain. Forty patients undertaking hand surgery were randomly allocated into 2 groups to be given IVRA. They received 20 ml lidocaine 1% diluted with 20 ml saline to a total of 40 ml in the group L (n = 20) or 7.5 ml magnesium sulfate 20% plus 20 ml lidocaine 1% diluted with 12.5 ml saline to a total of 40 ml in the group M (n = 20). Sensory and motor block onset and recovery times, anesthesia and operation qualities were recorded. Before and after the tourniquet use at 5, 10, 15, 20, 30, 40, and 50 minutes, hemodynamic variables, tourniquet pain, and analgesic use were noted. Subsequent to the tourniquet deflation, at 6, 12, and 24 hours, hemodynamic variables, pain, time to first analgesic requirement, analgesic use and side effects were recorded. Shortened sensory and motor block onset times were established in group M (P < 0.05). Visual analog scale (VAS) scores were less in group M at 20, 30, 40, and 50 minutes after tourniquet inflation (P < 0.05). Intraoperative, analgesic requirement was less in group M (P < 0.05). Anesthesia excellence, as determined by the anesthesiologist and surgeon, was significantly better in group M (P < 0.05). Time to the first analgesic requirement in group M was 53.75 ± 6.94 minutes and in group L was 40.76 ± 14.55 minutes (P < 0.05). Postoperative VAS scores were higher at 6, 12, and 24 hours in group L (P < 0.05). Adding Mg to lidocaine for IVRA enhanced the quality of anesthesia and analgesia without causing side effects.

The Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH) secretion is the most common etiology of normovolemic hyponatremia, which occurs following non-physiologic release of antidiuretic hormone (ADH) from the posterior pituitary, or an ectopic source. SIADH has been reported as a complication of cardiothoracic, brain, and spinal surgeries. This study was conducted to assess the prevalence of SIADH following spinal surgeries and to identify the underlying risk factors. Samples were patients undergoing any spinal surgery at the Hospitals of Shafa Yahyaian and Rasoul Akram, Tehran, Iran in a 2-year period. Blood and urine sodium concentrations and osmolarity were measured before and after surgery. The amount of hemorrhage, as well as the patients'' fluid input and output during surgery were recorded. Fluid input and output was also recorded on the first postoperative day. The prevalence of SIADH following spinal surgeries was 60.3%. Mean duration of surgery in SIADH patients was longer than in others. Mean amount of hemorrhage and total fluid loss during surgery were significantly higher in SIADH patients than in healthy individuals. SIADH is the principal cause of hyponatremia following spinal surgeries; the reported prevalence rates vary widely from 5 to 100%. SIADH following surgery has been attributed to stress, and in spinal or neurological surgeries to dural damage or traction of neuronal pathways. Time is of the essence in the treatment of hyponatremia and prevention of complications that may increase the mortality and morbidity of spinal surgeries.

Massive pulmonary embolism (MPE) is in most cases an unpredictable, life-threatening lung injury. In order to test this shock and its natural sequence, MPE animal model was established. Based on previous models, discussed within the article framework, this model was designed to closely narrate clinical pulmonary embolism. MPE was induced by a single injection of minced radioactive blood thrombi into an internal jugular vein. Thrombi were prepared from the autologous blood of each animal. Using rabbit model allowed sampling and recording additional data necessary for better analysis. Clotting additives were used for rapid clot stabilization. Clot was stabilized at room temperature for one hour and separated into micro-emboli of comparable size prior to the intravenous injection. A radioactive tracer, I-125 labeled rabbit fibrinogen, was added into thrombi to measure dynamic lung thrombiturnover. Thrombolysis dynamic efficacy was characterized by presence of high statistical significant difference (P < 0.001) found between released radioactive I-125 fibrin degradation products (FDPs) at 10 minutes and all others FDP time points until 60 minutes. Pulmonary thrombolysis was characterized by measuring residual radioactivity of the lungs at 10 and 60 minutes and was found statistically significant (P < 0.05) during the period of 50 minutes. For the purpose of model validation, systemic blood pressure, measured in carotid artery, significantly increased from the baseline point 47 mmHg to 80 mmHg at the first 10 minutes. Enormous mechanical thrombus injury of lung vasculature was depicted by MSB staining. This MPE model contains a set of important and original patho-physiological data mimicking the fundamental characteristics of this shock situation in humans, which enhances the understanding of MPE, and leads to better characterization of this critical clinical condition.

Adhesions are common consequences of abdominal operations and they can cause significant complications such as bowel obstruction, infertility and abdominal pain. A wide variety of adhesion-reducing substances have been evaluated but we are still far from the ideal adhesion preventing agent. In this study, we decided to evaluate the effects of peritoneal exposure to betadine and heparin in post-surgical adhesions in rats. A total of 39 male Wistar-Albino rats weighting 200-250 grams were randomly assigned to three groups. Anesthesia was performed using intramuscular ketamine and xylazine. After a midline laparotomy, enterotomy and repair, bowels were irrigated by saline 0.9%, heparinized saline and betadine solution. Finally, adhesions were evaluated and scored after 20 days. All groups were almost similar in mean adhesion score in the site of enterotomy but mean total abdominal adhesion score in betadine group was significantly higher than those of other groups. According to pathological studies, peritoneal inflammation was more severe in the betadine group but there wasn’t any statistically significant difference between frequency of foreign body reaction and wound healing stage among three groups. Surprisingly, anastomosis leakage was significantly more common in heparin group. To date, the most effective means of limiting adhesions is a meticulous surgical technique although intraperitoneal irrigation with heparin seems to reduce adhesions but further studies should be done to evaluate the effects of local administration of heparin on anastomosis leakage.

A case of five and half-year-old 46,XX phenotypic male with hyper pigmented empty scrotum, penile urethra, epididymis along with fallopian tubes, uterus and upper vagina as well as ovary is described. Hormonal studies were consistent with the diagnosis of congenital adrenal hyperplasia. The case represents the first documented case of 46,XX disorder of sex development due to virilizing CAH associated with differentiation of Wolffian ducts into epididymis.

The role of Nitric Oxide (NO) and its metabolites in stroke has been examined clinically and experimentally. The relationship between plasma NO level and Lesion Size (LS) or clinical severity of stroke is still under investigation. In this clinical study, the serum level of Nitrite (NI); the last metabolite of NO was measured in first and fifth days of onset of the stroke, and its correlation with LS was determined. 37 Cerebrovascular Attack (CVA) patients were considered. The National Institute Health Stroke Scale (NIHSS) was assessed to determined neurological impairment within 24 hours of onset. On the basis of NIHSS, the patients were divided into mild, moderate and severe groups. CT Scan for all patients were obtained in the first day, and based on CT Scan results, the patients were also divided into hemorrhagic, ischemic and normal groups. The serum level of NI and the LS were determined. The mean serum levels of NI in 37 patients in the first and fifth days of stroke were 8.43± 1.23 and 7.46±0.72 7mole/liter with no significance difference. The analyses of data indicated no significant correlation between NI concentration and NIHSS, but in patients with abnormal CT Scan, statistical correlation was existed between NI concentration and LS (r=0.521, p=0.022). The NI concentration is not correlated with NIHSS, but it is correlated with LS. The sources of NO metabolite sources are different; neuronal, endothelial or inducible. Therefore the concentration of NO or NI is not exactly the endothelial NO reprehensive which is beneficial in stroke, and it seems that the relationship between NO precursor subtypes and NIHSS or LS is needed to investigate.

An anal fissure is a split in the mucosa extending from the anal verge towards the dentate line. It currently affects 10% of patients attending proctology clinics. Recent studies have highlighted the role of increased internal anal sphincter pressure and decreased anodermal blood flow in the pathogenesis of chronic anal fissures. Acute fissures usually heal with conservative management. Fissures lasting greater than two months with features of chronicity, are unlikely to heal with conservative management. Lateral internal sphincterotomy has been the treatment of choice for chronic anal fissures. Because of the disability associated with surgery for healing anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Among different chemical agents, Glyceryl trinitrate (GTN) has been shown to be the first line treatment for chronic anal fissure but the transient sphincteric relaxation effect of pharmacologic agents such as GTN, makes them less effective than surgery. Although we have different forms of GTN products, they do not show a long acting effect on relaxing and enhancing the perfusion of anal sphincter, because they are soon metabolized. Most difficulties with current usage of drugs are due to poor compliance of patients. It can be taken into consideration that new formulation and novel combination of GTN with other treatments, in slow releasing forms may lead to acceptable strategies in the management of chronic anal fissure. As authors’ experience in this field, other clinical trials on the drug combination and slow releasing formulations are warranted to generate new data on the subject.