مجله پزشکی بالینی ابن سینا
سال شانزدهم شماره 1 (پیاپی 51، بهار 1388)

Introduction & The brain choroids plexus (BCP) plays an important role in the cerebrospinal fluid (CSF) production, but its characterization is still incomplete. Collagen type IV, is one of the most important proteins of basement membrane (BM) and extracellular matrix (ECM) of BCP. In the present study we investigated the differential period of type IV collagen in basement membrane of the BCP of mouse fetuses using immunohistochemical method. Intact female balb/c mice were kept under normal conditions. After mating, vaginal plug was assumed as day zero of pregnancy. From days 10 to the last day of pregnancy, the mice were sacrificed and their embryos were collected. For processing, the head of embryos were fixed, serially sectioned and immunohistochemistry study for tracing collagen type IV of BCP were carried out. This study indicated that collagen IV appeared by weak reaction on day 12 of gestation in BM of primary BCP and increased continuously until day 17th of gestation. After this period, collagen reaction did not show significant changes in the next embryonic days. Our previous study showed that renal glomeruli development is dependent on the collagen type IV appearance in BM and ECM. So, the present investigation confirmed that the BCP development is also dependent on type IV collagen synthesis in BM of brain ventricular choroids. These data indicated that the specific localization of this protein may be shared by renal glomeruli and the choroid plexus leads us to hypothesize that the type IV collagen protein may function as a selective permeability barrier.

Introduction & ECT is an inevitable therapy for many of psychiatric patients. During ECT severe hemodynamic changes occur which may cause dangerous cardiovascular complications especially in elderly patients with cardiac disease and may lead to arrhythmia,ischemia and myocardial infarction. The purpose of this study was to show the effect of clonidin and propranolol on the prevention of hemodynamic changes following the ECT. This study was a controlled double blind clinical trial which was carried out on 31 patients ASA I, II hospitalized in psychiatry ward of Hamadan Sina hospital who were in need of ECT. In order to increase the accuracy of the study the personal factors on the drug metabolism were omitted and the chosen patients were given ECT three times separately with the interval of 48 hours. Two hours before every ECT clonidin (0.2 mg), propranolol (40 mg) and placebo (vitamin c) were administered and after each ECT the hemodynamic parameters including systolic blood pressure, diastolic blood pressure, rate pressure product and ECG were measured at certain intervals and recorded on information forms and then analyzed by SPSS 9 soft ware. The result of this study showed that the average changes of hemodynamic parameters in different times occurred in all groups significantly(p<0.001). Following ECT, arrhythmia in control group has been plentiful in comparison with the other two groups, and the changes were statistically meaningful (p=0.001). We concluded that the modifying hemodynamic changes and decrease of arrhythmia taking the drugs in comparison with placebo have been more effective and of the two drugs, propranolol has been more effective on the prevention of hemodynamic changes after ECT.

Introduction & H. pylori is a human pathogen which infects the gastric mucosa and causes an inflammatory process leading to gastritis, ulceration and cancer. It is not clear what factors determine these divergent outcomes of infection. The aim of the present study was detecting the immunogenic proteins in H. pylori strains isolated from patients with different gastric diseases. Total proteins of 144 strains of H. pylori isolated from 3 groups of patients (gastric ulcer 37, gastritis 77 and gastric cancer 30) were separated by 1D-SDS-PAGE and then were blotted with the sera of their respective hosts. In SDS-PAGE the members of each group showed high correlation regarding to similarity in their patterns, resulting in considering them in the same cluster. The patterns of immunoblots differed from that of Commassie Brilliant Blue stained gels. Some of the protein bands in the SDS-PAGE were not recognized by blotting method. Only the bands of 106 and 45 kDa from H. pylori strains isolated from patients with GC were significantly recognized specifically with the sera of their respective patients and the band of 13 kDa was recognized specifically with the sera of nonulceric patients. With the exception of these bands, in the patterns of blotting of the sera from all patients no significant differences were observed. Using 1D blotting methods we could find 2 antigenic protein bands (106 and 45 kDa) for H. pylori strains isolated from cancerious patients and one (13 kDa) for the strains isolated from nonulceric patients which were specifically recognized with their respective host. Further studies have to be conducted to show if the antigens described here are of predictive value for certain clinical states.

Introduction & Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral). The patients induced general anesthesia with thiopental (5mg/kg), fentanyl 1.5 mg/kg and succinylcholin(1-1.5 mg/kg) and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. There was no significant difference in age, education,. .. Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine) in dextromethophan was less than placebo group Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time, 2 and 4 hours after the surgery.

Introduction & One of the important problems in dentistry is post endodontic pains. The purpose of this study was comparison of the effect of prophylactic oral ibuprofen 800mg and oral predenisolone 30mg on prevention of post endodontic pain. The present study is a double-blind, randomized and controlled trial. It was conducted on 60 patient (16men and 44 women between the ages of 18-63) who needed endodontic treatment. Inclusive criteria for selecting of patients were: need for root canal therapy in one of the posterior teeth, having no systemic problem, no evidence of abscess; not taking analgesic or similar drug for at least 6 hours before treatment. Patients were divided into three experimental groups randomly taking one of the drugs before the treatment {ibuprofen 800 mg, prednisolone30mg and placebo (oral dextrose)}. Patients completed VAS at 6,12 and 24 hours post root canal therapy and analyzed using the spss15 by chi-square, ANOVA test and Tukey test. During 24 hours after treatment post endodontic pain is 95%- 100% in the placebo group. The prevalence of no-pain was not significant 6, 12 and 24 hours after treatment between the ibuprofen and predenisolone groups. The mean scale of pain in ibuprofen and predenisolone groups was significantly lower than placebo group 6, 12 and 24 hours after treatment. Differences between the drug groups are significant only on 6 and 12 hours after treatment. Post endodontic pains are present 24 hours after treatment. 6 and 12 hours after treatment 30 mg predenisolone are significantly better for pain relief than 800 mg ibuprofen. But after 24 hours it is not significant.

Introduction & The most common complications of cesarean section are post operative fever and endometritis. This study was undertaken to assess the effect of preoperative vaginal preparation with povidone iodine on these complications. A double blind clinical trial study was conducted on 430 term singleton pregnant women who referred to obstetric department of Ali Ebne Abitaleb Hospital in Zahedan city in 2006-2007 for elective cesarean. All patients received prophylactic antibiotic after umbilical cord clamping. In the control group (215 cases) we did only abdominal scrub, but in the case group (215 cases) we did additional vaginal preparation with povidone iodine solution before the beginning of cesarean. The exclusion criteria were: placenta previa, gestational or overt diabetes mellitus, corticosteroids usage, morbid obesity and fever before and at cesarean, presence of bloody or meconium-stained amniotic fluid or prolonged surgery. We investigated the patients after first post operative day until removing surgical sutures for development of febrile morbidity (temperature>38°C), clinical symptoms and signs of endometritis (fever persisting in association with uterine tenderness and foul lochia, in the absence of physical or laboratory evidence of other infections), wound inflammation (erythematic or tenderness of wound edges), wound infection (signs of inflammation in association with purulent drainage). The statistical data were analyzed by the SPSS software and P.value <0.05 considered significant. There was no significant differentiation between the two groups regarding socioeconomic situation, weight, age, length, parity and time of operation. The results of our study showed that preparation with povidone iodine in elective cesarean before the beginning of surgery, significantly reduces the post operative fever (13.9% in the control group and 2.3% in the case group, P=0.0001) and post operative endometritis rate (10.2% in the control group and 1.9% in the case group, P=0.0001),wound inflammation(4% in the control group and 0.9% in the case group P=0.0009) and wound infection (2.3% in the control group and 0.9% in the case group, P=0.2). According to our findings, vaginal preparation with povidone-iodine before elective cesarean section effectively reduces post operation fever and endometritis.

Introduction & The most frequent site of injury in football is the knee. In this study the value of prophylactic knee braces in reduction of MCL injuries was evaluated. In this prospective cohort study we evaluated 11480 athlete-exposure that lasted 30 minutes. After the explanation of study method to coaches and athlete we gave them two kind of study questionnaires. After data collection we analyzed data with SPSS 10. In this study 149 injuries happened out of which. 28 were knee injuries (21 in unbraced athletes and 7 in braced athletes (P=0.21) and 23 were knee ligamentous injuries (16 in unbraced athletes and 7 in braced athletes (P=0.662). There were 16 MCL injuries (11 in unbraced athletes and 5 in braced athletes). The relative risk in this study was 0.454. We evaluated the severity of ligamnetous injury and there was no significant difference between the two groups (P=0.5). In conclusion in this study we found that the prophylactic knee braces had no positive effect in prevention of knee injuries. Some epidemiological studies with large samples and longer period should be designed to discover the real effect of these braces in knee injuries prevention.

Introduction & Cutaneous leishmaniasis as one of the most important tropical diseases, is endemic in different parts of Iran. World Health Organization (WHO) has recommended and supported the investigation on this zoonotic disease. The purpose of this descriptive study was to determination some epidemiological aspects of cutaneous leishmaniasis in Hamadan Province. All confirmed and recorded cutaneous leishmaniasis cases who were diagnosed during 2002-2007 in Hamadan province entered in our study and their demographic and epidemiological information was analyzed by SPSS software. According to the results of this study, from a total of 210 cases of cutaneous leishmaniasis, 197 (93.8%) were male and 13 (6.2%) were female. The mean incidence of cutaneous leishmaniasis was 2.05/100000. The most common age group was 15-24 and 85.7% of the patients were between 15 to 44 years old. 99% of the patients had a history of stay in or trip to an endemic area. Migration of susceptible populations especially men in labor ages (>15 years old) to endemic areas, whose exposure to infection is highly probable, is the main cause of cutaneous leishmaiasis disease in Hamadan province. This situation indicates that cutaneous leishmaniasis is not endemic in Hamadan province.

The pancreatic endocrine tumors are rare. Insulinoma is the most common pancreatic endocrine neoplasm.30% of pancreatic tumors in MEN type I are beta cell tumors.Case Report: The presented case is a 23 year old male with a family history of MEN I syndrome. The patient presented with whipple triad. Radiologic studies revealed two small and round masses in body and tail of pancreas. With clinical diagnosis of pancreatic tumor the patient underwent laparatomy, distal pancreatectomy and splenectomy. According to macroscopic, microscopic, immunostaining findings, clinical and laboratory data the final diagnosis was insulinoma.

The writer's cramp syndrome is a kind of local dystonia which appears in the hands due to uncontrollable muscular spasms, making a hard and tiring job of writing for patients.Case Report: The present study investigates a 55 year old married male, a bank officer, who has been suffering from myoclonic epilepsy and compulsion since the age of 17, and a few years later developed the writer's cramp syndrome following a sudden stress. There is no report on the simultaneity of the writer's cramp, myoclonic epilepsy and compulsion. The patient's myoclonic epilepsy condition has been under control by a daily dosage of 5 mg of diazepam. However, the writer's cramp syndrome and the compulsion have not been under appropriate therapeutic control.