مجله مطالعات علوم پزشکی
سال نوزدهم شماره 2 (تابستان 1387)

Succinylcholine 1 mg/kg usually produces excellent tracheal intubation in 60 s. Recovery of respiratory muscle function after this dose, however, is not fast enough to forestall oxyhemoglobin desaturation when ventilation can not be assisted. In this study, smaller doses of succinylcholine effects were investigated for producing satisfactory intubation conditions fast enough to allow rapid-sequence tracheal intubation with shorter recovery time of respiratory function. In this prospective randomized double-blind and case-controlled clinical trial, 120 patients class I or II of American Society of Anesthesiologists (ASA), were investigated. After induction of anesthesia with fentanyl/thiopental, all patients were randomly allocated to three groups according to the dose of succinylcholine 0.3 mg/kg (1ÍED95), 0.6 mg/kg (2ÍED95), and 1 mg/kg (3ÍED95). Evoked adductor pollicicis responses to Train-of-four (TOF) in ulnar nerve stimulation were rewarded using nerve stimulator. Onset time, maximal twitch depression, tracheal intubation conditions, respiration recovery time (apnea time), and time to 90% twitch height recovery were recorded. Onset times ranged between 81s and 49s, decreased with increasing doses of succinylcholine but not differing between 0.6 and 1 mg/kg. Maximum twitch depression was similar after 0.6 and 1 mg/kg (98.2%-100%). Intubation conditions were often unacceptable after 0.3 mg/kg doses, but acceptable intubations were achieved in all patients receiving a 0.6 and 1 mg/kg dose of succinylcholine. Time to respiration function recovery was significantly shorter in 0.3 and 0.6 mg/kg doses (1.8±0.6 min and 2.4±0.6 min, respectively) versus patients receiving 1 mg/kg (6.3±0.8 min p< 0.0001 v.s 0.3 mg/kg, p< 0.001 v.s 0.6 mg/kg doses respectively). Twitch recovery time to T1=90% (regular spontaneous respiration) were significantly lower in 0.6 mg/kg dose (5.2 ±1.0 min) than 1.0 mg/kg group (8.8±1.3 min p<0.001). The use of 0.6 mg/kg of succinylcholine can produce acceptable intubation conditions after 60 seconds of administration. The conditions achieving after 0.6 mg/kg are similar to those after 1mg/kg. These smaller doses are associated with shorter apnea time and faster twitch recovery.

Folate is important for the functioning of the nervous system. The results of studies are controversy and there has been no study on assessment of folate and vitamin B12 status in depressed patients in Iran. So the aim of the present study was the assessment of folate and vitamin B12 status in patients with major depressive disorder (MDD), and determination of relation between dietary folate and vitamin B12 with plasma levels of folate and vitamin B12. In 70 depressed patients with major depressive disorder plasma folate and vitamin B12 were measured with radio assay method and dietary intake was assessed using 24-hour-recall method. Definition of MDD was according to DSM-IV-R criteria for depression. The mean plasma folate and vitamin B12 was 5.18±0.73ng/ml and 389.05±41.46pg/ml, and prevalence of low plasma folate and vitamin B12 was %51.4 and %5.7, respectively. According to dietary assessment 97.1% and 95.7% had folate and vitamin B12 intake less than RDA. Plasma folate levels were significantly associated with dietary folate intake (r = 0.283 p< 0.05). There was no significant association between plasma vitamin daily intake of B12 or other vitamin B group. Findings of this study indicate that folate and vitamin B12 levels should be taken into account in depressed patients. Low plasma levels of these micronutrients reveal the necessity of the appropriate intervention for adequate intake in these patients.

Parasitic infection of the liver and lungs derived from hydatid cyst is global and it can affect many organs of the body, it encompasses lots of significance. This disease can abide many phenomena its treatment is very expensive and has its own troubles. Recognition of diagnostic methods and mostly, treatment of hydatid cyst according to almost high prevalence of the disease does play an important role on controlling the disease. The definite treatment is surgery. But as a complimentary cure, at present albendazole is the most effective drug for hydatid cyst. After utilization, albendazole fastly absorbs and catalyses to sulfoxide which is the major metabolite of the drug. The goal of this study is to analyze the efficiency of albendazole sulfoxide on different densities and time intervals, in vitro on protoscolexes. This study was conducted interventionally and tentatively. After detachment of hundreds of hydatid cyst infected animals from abattoirs and after enough investigation on productivity of cysts, their protoscolexes were evacuated and were washed with serum physiology and their viability rate was examined under the microscope. On the other side albendazole sulfoxide solution on 25µg/L, 50µg/lit, 100µg/lit densities was prepared. Then precise amount of protosclolexes was added to tubes containing sulfoxide and examinations were done in different time intervals. On the next stage their percentage of survival using microscope according to movements of flame like cells were determined and recorded. Results revealed that time and the amount of drug has straight effects on protoscolexes survival time. In the group that 100µg/L albendazole was used, the drug had no effect up to first 20 minutes but increasing the gain age time to 1hour 60% of protoscolexes were dead. While in the density of 50µg/lit up to 35minutes, the drug did have no effect, but in an hour 40% of protoscolexes were dead.Conclision: According to the results this study and time limitations that surgeons have in operation room, albendazole sulfoxide can not be utilized to eliminate protoscolexes from patients infected organs in the op. process and to avoid recurrence of the illness.

S Shiva, MD R Sarisorkhabi, MD Received: 24 Oct, 2007 Accepted: 12 March, 2008 Abstract Combination of chelating therapy regimens with regular blood transfusion has significantly improved the life expectancy of thalassemic patients. Despite progresses in treatment of these patients, growth failure, and short stature are found in significant number of them. Factors such as iron overload, desferal toxicity, and endocrine disorders play roles in growth failure, but other unknown factors may contribute too. We aimed to study short stature and its contributing factors in our thalassemic patients. This descriptive-analytic study was conducted in 2006, on 71 patients with ß-thalassemia major who had regular visits and complete medical recordings. The patients were evaluated for stature, endocrine disorders, serum ferritin, pretransfusion hemoglobin, and liver enzymes. They were compared in two (short stature and non short stature) groups. 45 boys and 26 girls with mean age of 12.9±5.2 years were studied. 45.1% of patients were short stature and negative linear correlation between advancing of age and height SDS observed. Patients with endocrine anomaly were shorter and those with multiple endocrine anomalies had very severe growth retardation. Cases of hypersplenism were significant in short stature group, but there were no significant differences in pretransfusion hemoglobin and serum ferritin levels between the groups. Although liver enzymes increased in significant number of patients, we didnt find any meaningful differences between two groups. Coclusion: Growth failure of patients with ß-thalassemia major begins from first decades of life and aggravated with age advancement. For prevention of becoming short stature, they need to be evaluated regularly for height velocity, and contributing factors in growth failure should be recognized earlier and treated appropriately.

Metalloproteinase matrix (MMPs), a family of zinc and calcium dependent enzymes, is produced by a wide range of stromal and inflammatory cells. MMPs are capable of degrading all of the compounds of extra cellular matrix. The role of metalloproteinase matrix in pathophysiology of various inflammatory diseases, such as arthritis, cardiovascular disease, and cancer is well known. The previous studies have shown that dexamethasone and non steroidal anti inflammatory drugs (NSAIDs) have inhibitory effect on metalloproteinase matrix activity. The aim of the present study was to investigate the inhibitory and cytotoxic effects of glycyrrhiza glabra and matricaria aurea hydroalcoholic extracts on metalloproteinase matrix activity in comparison with diclofenac, piroxicam, and dexamethasone.

Herbal extracts were prepared by percolation method, then gelatin zymography and cellular cytotoxicity methods were employed using fibrosarcoma cell line culture (Wehi 164).

Our results indicated that all drugs and herbal extracts showed dose-dependent reduction in metalloproteinase matrix activity. Herbal extracts showed this effect in higher doses but they had lower cytotoxicity compared to other drugs.

Matricaria aurea extract, as compared to glycyrrhiza glabra, have low toxicity effect (IC50 = 3450 µg/ml) and better inhibitory activity (IC50 = 933.33 µg/ml) upon MMPs. Address: Immunilogy Department, Jondi Shapoor University, Ahvaz.

Cerebrovascular accident (CVA), atrial fibrillation, renal failure and gastrointestinal complications after cardiac surgery are devastating complications that lead to excess mortality, health resource utilization, and intensive care unit stay. The purpose of this study was to identify the incidence of major complications that influence intensive care unit stay in patients undergoing open heart surgery. In a retrospective observational study the charts of 475 patients undergoing open heart surgery and being operated on cardiopulmonary bypass CPB, (coronary artery bypass graft, valve replacement, repair of atrial septal defect and ventricular septal defect) were reviewed between March 2005-February 2007. Postoperative incidence of common complications such as: CVA,gastrointestinal problems, renal failure, and atrial fibrillation were calculated. Then descriptive tests were used for data analysis. The mean age for coronary artery bypass graft (CABG) was 58±9 years, and the average length of intensive care unit stay was 3.4±0.9 days. The incidence of major complications occurring in intensive care unit for CABG patients wasCVA (1.7%)gastrointestinal complication (0.25%) renal failure (1.7%) atrial fibrillation (20%) and for valve replacement were 4.1%, 0%, 2.2% and 21.1% respectively. Some complications such as stroke after open heart surgery are associated with high short-term morbidity and mortality. Increased complications risks can be predicted by preoperative and postoperative clinical factors. The incidence of major complications in patients after open heart surgery varies widely across studies and patient populations.

As acute appendicitis is the most common etiology of acute abdomen. This study was done in order to determine sensitivity, specificity, and accuracy of colour Doppler sonography in diagnosis of acute appendicitis. 164 patients clinically suspected to acute appendicitis underwent preoperative colour Doppler sonography and the presence of blood flow in the wall of appendix was indicative of positive result of the study. Sensitivity, specificity, and accuracy of the sonography were 100%, 94.4% and 98.8% respectively. PPV and NPV of the study were 98.4% and 100%. Colour Doppler sonography is a very accurate method for diagnosis of acute appendicitis but non visualization of blood flow in the wall of appendix or RLQ is against the diagnosis of acute appendicitis.

In this study, we aimed to compare helical CT scan with routine imaging modalities (IVP and/or retrograde pyelography) in patients with acute flank pain and non-diagnostic findings in KUB and ultrasonography. During a five month period, 32 patients referring to the emergency center with acute flank pain, and having nondiagnostic KUB and ultrasonography were selected for the study. All patients underwent regular diagnostic procedures. IVP and retrograde pyelography were done when necessary and Helical CT scan without oral or IV contrast media as well. The results were reported by a radiologist positive and an urologist as well. Results included observation of stone plus its secondary signs. Merely positive secondary signs without finding any stones were considered negative. Any other pathologies resulting in acute flank pain e.g. UPJO, tumor, and strictures presumed as a positive result as well. Among 32 patients, 25 entered the study, in 7 patients no pathologies were found - stone or other, and the resulting lack of gold-standard made us put them off. Of the remaining 25, five had pathology other than stone. One case was of ureteral stricture with polyp and 4 cases of UPJO. Helical CT scan was precise in accurate diagnosis of all 25 patients. In one occasion, the study continued with oral and IV contrast CT. Helical CT scan is more accurate than other imaging tools in diagnosing radiolucent stones and other causes of acute flank pain. Also CT scan can definitely rule out a urologic origin of acute flank pain. While suspicion remains about causes other than stone, oral, and IV contrast enhanced CT increases the accuracy. Finally, when there is a contraindication for using contrast media, non- contract helical CT poses as a double value. We propose using non-contrast helical CT as the next step for patient with non - diagnostic KUB and ultra sonograpic findings.

Prostate cancer is the most common male malignancy. Today, patients are screened with PSA and DRE, and in the presence of high PSA level (>4 ng/ml) or abnormal DRE finding, TRUS guided biopsy of prostate is performed for definitive diagnosis. Since multiple factors cause serum PSA to rise such as prostate massage, biopsy, inflammation we evaluated the effect of intravesical BCG therapy on serum PSA level. 66 patients with a history of superficial bladder tumor who had primary normal PSA level (<4 ng/ml) and normal DRE findings entered the study and underwent TURBT. Two weeks after the surgery intravesical BCG therapy was conducted weekly for 6 weeks, PSA level was checked before each session and after 3 months of the last one. Any rise in PSA level 2 folds of the baseline or PSA level more than 4 ng/ml was considered significant and the patients followed by TRUS guided biopsy of prostate 15 patients (22%) had significant rise in serum PSA level with mean of 2.3 ng/ml (range 0.1-10.3 ng/ml). In 10 patients (15.1%) PSA increased to more than 4 ng/ml but returned to basal level within 3 months. In the remaining 5 patients, doubled PSA level did not return to normal level after 3 months but finally decreased in 2 of them. Mean time of PSA level rise was 1.8 weeks (range 1-3 weeks). DRE findings were normal in 7 of 10 patients with PSA more than 4 ng/ml and all of 5 patients with doubled PSA. One patient had right lobe nodule and two had enlarged prostate gland. Six of the patients underwent TRUS guided biopsy, while the results were granulomatous prostatitis in 2 and normal prostatic tissue in the rest. Intravesical BCG therapy increases serum PSA level transiently which usually normalizes within 3 months. For PSA rising to last longer, TRUS guided biopsy looks wise.

Gestational diabetes Mellitus (GDM) is a carbohydrate intolerance disease with various grades that begins in pregnancy period and is defined with the first diagnosis of carbohydrate intolerance in this period. Most information about this disorder is gained in the United States. In the current study we tried to collect more information about this disorder and determine its incidence in Urmia. In this study we chose 84 pregnant women referring to Urmia medical centers that were in their 24th to 28th weeks of pregnancy and did not have any pre- pregnancy history of diabetes or any specific drug consumption. Pancreatic diseases, hormonal syndromes like cushing syndrome, acromegaly, pheochromocytoma, primary aldostronism glucogonoma, etc. and any kind of genetic disorders. We did fast blood sugar (FBS) test as well as screening test by 50 grams oral glucose at first and than glucose tolerance test by 100 grams glucose on the patients with screening test result of more than 130 mg/dl. We diagnosed gestation diabetes in those patients that had positive results of the glucose tolerance test by 100 grams glucose based on diagnostic criterions of Carpenter and Coustan. From all 84 women that were studied, 30 (35.7%) had glucose plasma equal or more than 130 mg/dL after consumption of 50 grams of oral glucose. We then did glucose tolerance test by 100 grams glucose on this group among whom 12 women (14.28% of all) didnt have glucose tolerance abnormalities or GDM, 8 women (9.5% of all) had only glucose tolerance deficiency, and 10 (11.9% of all) were diagnosed as GDM patients. Only two women (2.38% of all or 3.7% of under 25 years old patients) with the ages under 25 years old were diagnosed as GDM sufferers, and 8 (9.5% of all or 26.6% of above 25 years old patients) with the ages above 25 years old (mean 33.75  4.2) were diagnosed as GDM patients. GDM incidence was 11.9% among the women that were studied which is parallel to the results of other studies. It gained its incidence between 1 to 14 percent in various communities.

Malignant peripheral nerve sheath tumor (MPNST) is a rare and fatal tumor. MPNST is very aggressive and likes to have distant metastasis. Skeletal involvement is usually secondary to soft tissue origin. Tumors of the scapula are unusual clinical challenges. Partial or complete resection of the scapula, with its attached musculo-aponeurotic tissue, is a seldom used technique for the treatment of primary bone and soft tissue tumors, as well as selected metastatic involvement of the scapula. Scapulectomy may allow wide margins of resection without amputation. The purpose of this study is to review our recent experience with scapulectomy. Our patient had local recurrence of tumor two years after subtotal scapulectomy.

The cases of cutaneous Leishmaniasis is increasing all over the world including Iran it increased from 1989 and reached its highest level in 1992. In Iran cutaneous Leishmaniasis is seen endemically in different parts of Isfahan, Khozesten and Kerman. Khozestan province was one of the important regions in Iran - Iraq war. On the other hand, this region is one the focus areas of rural cutaneous leishmaniasis in Iran. Climatic conditions for the vectors, war condition and lack of hygienic facilities predisposed such diseases among militants. Based on the mentioned problems, the best way of controlling the disease is immunization. For this reason, to immunize the people attending war, immunization against cutaneous Leishmaniasis was planned.The case of this study is a man from Miyandoab who received immunization against cutaneous Leishmaniasis 16 years ago, before attending the war. Three months after immunization, some lesions were seen around the injection point. The lesions were treated locally by Glucantime, the lesions relapsed and treated so many times. The patient was referred to parasitology department be a dermatologist, referring to history of the patient, sampling was done around the lesion and some smears were prepared. After Giemsa staining, N.N.N. culture was done. By using stained glasses and by applying a microscope with × 100 magnifying power only a few leishman bodies were seen. On the other hand, after 4 days, wet mount was prepared and they were examined to see promastigote. After 15 days, the same process was repeated and the promastigote was increased. For several times the patient was treated by Glucantime locally by a dermatologist the lesions were healed.Considering several problems that aroused in patients with cutaneous leishmaniasis and referring to reports by other parasitologists in different congresses, it can be suggested that it is better to check the patient considering his /her immunological status before vaccination. It is hoped to prepare a vaccine against leishmaniasis by the attempts of other colleagues in other immunology and parasitology departments.

Penile necrosis is a rare condition with different etiologies such as warfarin use, cholesterol emboli, cocaine consumption, post-TURP complication, and even circumcision. Calciphylaxis is a rare cause of penile necrosis and affects primarily patients with end-stage renal disease. Calciphylaxis is a serious condition characterized by ischemic ulceration of the skin and necrosis secondary to dystrophic calcification of the subcutaneous tissues and small arteries. A 56 year old man with two year history of ESRD due to HTN and diabetes mellitus admitted with glans necrosis initiated 40 days before admission. The necrosis was painful and refractory to medical therapy.He underwent partial penectomy and the pathologic examination showed necrosis of glans tissue and extensive fibrosis of glans with extensive calcification of arteriole walls. Post-operative course was uneventful and the patient voided well without any necrotic lesion after 3 months.Calciphylactic penile necrosis is a rare condition, and to the best of our knowledge, only 37 cases have been reported worldwide. Our case was a diabetic patient with ESRD who underwent partial penectomy with satisfactory wound healing in spite of compromised distal blood flow.

Juvenile dermatomyositis (JDM) is a rare autoimmune disease characterized by inflammation of the muscle, connective tissue and skin. Although localized edema is seen in juvenile dermatomyositis, generalized edema has been reported rarely. In this article, we report an 11-year-old girl with juvenile dermatomyositis presenting with generalized edema and classic sign and symptoms of juvenile dermatomyositis. In differential diagnosis of generalized edema, JDM should always be kept in mind. Early diagnosis and treatment of those cases by corticosteroids are important to decrease morbidity.