مجله علوم پزشکی رازی
سال نهم شماره 1 (پیاپی 28، بهار 1381)

Exercise is one of the most prevalent predisposing factors of asthma and in mild asthma, clinical symptoms may appear only because of physical activity-clear under standing of exersise-induced asthma in order to reduce it’s complication and finding more effective treatments should cause to sight especially with respect to asthma because one sporter might be accused of doping. In a clinical Trial study the general population is all soccer-players of city of Tehran. Selected in study. Four soccer-clubs were selected randomly as a cluster random sampling and causes was carried out of the players. Data collection was after history-taking physical examination and spirometry at rest and 5 and 12 minutes after exercise. The mean age of 100 players in the investigation was 20 ± 4.26 years old, The mean FEV1 5 minutes befored, 5 and 12 minutes after exercise were 4.15 ± 0.44, 4.13 ± 0.54 and 4.12 ± 0.49. FEV1 change seemed to reduce with the elevation of age. As the whole %6 people had FEV1 reduction 15 to 17% and mean of FEV1 change before exercise of 4.28 ± 0.52 and in the twelvth minute after exercise it was 3.57 ± 0.33. Asthma prevalence was 6% in this sample in comparison with 3 to 11% reportes in similar studies. Low prevalence observed in this study may due to high age mean. And lacking a history of allergy and pulmonary disease. Key Words: 1) Asthma 2) Exercise induced asthma 3) Foot bal player.

Neuroblastoma is a tumor with neural cells origin. It usually originated from adrenal gland and sympathetic ganglions. This tumor is the most common tumor in infants and is in forth grade amonge tumors in childhood. In this reaserch we determine to study the prognostic factors in survival of children with neuroblastoma.This is an analytic cross- sectional reaserch on 119 children with neuroblastoma admitted in oncology service of Ali Asghar hospital from 1986 to 2001. In each case Demographic indicators, signs, symptoms, initial paraclinics, examination, stage of tumors, Kind of chemotherapy and whether the patient is alive or dead was observed. In statistic study Acturial, Kaplan meir survival Analysis and cox regression was used. Median of survival time in this study was 33.33 month. Mean of survival time in female was significantly longer than male [Exp(B) = 0.59, P= 0.04]. Mean of survival time in patients younger than 1 years old, were significantly better than others [Exp(B)= 0.31, P= 0.008]. We understood that having no metastasis engagement increased the survival time of the patients. [Exp(B)= 0.44, P= 0.03]. If the patient is female, younger than 1 year old, dosen’t have any metastasis, and if there is no engagement of bone marrows, there are better prognosis. Of course as you know Ali Asghar oncology center is one of the refferal center in pediatrics oncology, then almost all patients who are reffered to this center are in a high stage of tumor So the survival time which is determined in this study is probably lower than the real survival time of patients with neuroblastoma in all over Iran.

Premature labor is one of the great difficulties endangering the health of the society and undoubtedly one of the tragedies of the world since many people suffer from the consequences of prematurity. An analytic research was performed from the records of all premature infants (gestational age less than 37 weeks) who were admitted to hospital of Shiraz Medical University (Zeinabieh and Hafez)in 1999. 160 neonates were chosen randomly as a control group. The clinical characteristics recorded included: Mother’s age, route of delivery, parity, mother’s difficulties and diseases, prenatal care,sex, apgar, birth weight, gestational age, neonatal diseases and outcome. Among 9743 neonantes who were born at the above mentioned hospitals in one year, 522 newborns were premature infants an incidence of 53.5 per 1000 deliveries. There was a reverse relation between weight and gestational age with neonatal death (P<0.000001). The number of alive infants in normal vaginal delivery (87%) was more than infants born by cesarian sections (71.6%) (P<0.0005). There was no significant relationship between gender and outcome, or the route of delivery and gestational age. In comparison to neonates in the case group, the control group had the highest apgar scores in the first and fifth minute, 22.5% versus 72.5% and %0.6 versus 10.9% respectively (P<0.0002). Regarding prenatal care, the control group enjoyed more care (78.1%) as compared to the case group (50.3%) The most prevalent diseases of premature infants were: respiratory distress syndrome, jaundice, and sepsis. In 78.7% of these neonates, their mothers had problems at delivery time such as: premature rupture of membrane, premature labor pain, and preecclampcia. It is certain that, increasing the mother’s knowledge and information, especially in young mothers, about the dangers of prematurity, the importance of prenatal care and avoidance of premature labor is very imporant factors in decreasing the incidence of prematurity.

Liposarcoma is one of the malignant tumor of soft tissue. Liposarcoma of the digestive tract is very rare only a few cases of liposarcoma of the stomach has been reported so far. As far as we know this is the first reported case of liposarcoma of the larg bowel in the world. The patient is a – 29 – year old woman with history of long – standing mid abdominal pain and has been treated for anemia and peptic ulcer disease for sometimes, which did not affected her symptoms until a barium enema revealed a filling defect in the cecum. At laparatomy the tumor was a 3× 4cm lipoma like tumor – lobulated with yellowish colour. A right hemicolectomy was performed. The pathology reported a liposarcoma of the cecum with no mesenteric lymph node involvment. The patient is free of disease 1 years after surgery.

In this cross-sectional research, 600 women with unintended pregnancy (U.P) were studied.The incidence of U.P was higher in women with age> 30 years / Level of education lower than intermediate school, and parity of 3. In 35% of cases there was no contraception before current pregnancy and incorrect believes was the most common cause. Coitus interruptus was the most common method of contraception when contraception was used before pregnancy. In cases which oral contraceptive was used before pregnancy, the correct usage was lower when OCP was received from private centers. In 58.3% of cases there was no education about family planning before the current pregnancy. In 16% of cases the pregnancy was due to wish of husband.

Dandy-Walker syndrom was described by blackfan, dandy in 1914. Dandy-Walker syndrome is characterized by a triad of complete or partial agenesis of the cerebellar vermis, cystic dilatation of the forth ventricle and enlarged posterior fossa with upward displacement of the transvers sinus, tentorium and torcular. The most striking abnormality is the presence of a huge dilated forth ventricle which acts as a cyst and is roofed by a neuroglial-vascular membrane lined with epandyma. This cyst herniates caudally and separates the cerebellar anteriorly and choroid plexus are rudimentary the formation of the fourth ventricle are often occluded by membranes or are atretic. A varient form, in which is cystic dilatation of the fourth ventricle and hypoplasia of the cerebellar vermis without enlargement of the posterior fossa is more common than the classic Dandy-Walker malformation and account for one-third of posterior fossa malformations. Hydrocephalus is precent in 90% of patients. Some of the patients have other malformations associated with this syndrome include, Occipital Encephalocel, facial angioma, midline cleft palate, cardiovascular malformations and polycystic kidney. Hydrocephalus is not presen at birth. It often appears by 3 months of age. In some instance, hydrocephalus fails to develop and this condition remains Asymptomatic throughout life. Prenatal diagnosis with ultrasonography and Postnatal diagnosis with CT scan and MRI in progressive hydrocephalus Treatment is surgical. Befor birth in 10 embrio, dandy walker syndrome was diagnosed with ultrasound, that after delivery, diagnosed and confirmed in eight cases. Two siblings with Dandy-Walker syndrome presented in a family that their parents were turkish. The first case was male and 3th child of this family was died in 5 months. The second case, was female and 5th child was died in 1 years old. This study is a case report of Dandy-Walker syndrome in a newborn.

Intranodal palisaded myofibroblastoma (IPM) is a rare primary nonlymphoid Tumor of the lymph node, which can easily be mistaken for other spindle cell tumors. Intranodal palisaded myofibroblastoma is thought to arise from intranodal myofibroblasts. We describe a 13 year Iranian boy with IPM arose in the right arm. The tumor was well-demarcated and composed of a fascicular proliferation of spindle cells with focal nuclear palisading and acellular stellate shaped collagen-rich areas. Histologically and immunohistochemically myofibroblastic differentiation was confirmed. To our knowledge this case represents only the first case of IPMin the lymph node of arm.

The effect of position on the spread and the onset time of epidural anesthesia has not been well documented. This study is undertaken to assess the effect of modified trendelenburg position on the spread of epidural anesthesia for cesarean section. 739 parturients were undergone epidural anesthesia for elective or emergent sesarean section. They were divided into 2 groups in a randomized controlled study. All patients received a standard epidural anesthesia. The first group was placed in 15-degree trendelenburg with 10-degree head-up position and the second in horizontal position. The onset time and the level of anesthesia, patients hemodynamics, and neonate’s apgar score were recorded in both groups. Hemodynamics, arterial oxygen saturation, and apgar scores had not significant differences in positioned and non-positioned groups. The results show significant differences in the time of onset (in average 4 minutes faster in modified-Trendelenburg-positioned group)(P<0.001), and in achieving T5 level sensory blockade (97.5% versus 42.8%) between positioned and non-positioned pregnant women. This study demonstrates that modified trendelenburg position has a significant effect on the spread and the onset time of epidural anesthesia, and can be used safely in term parturients who are candidate for emergency or elective cesarean section.

In medicine many cases which seem to be difficult and are rarely diagnosed can be discovered easily if precise attention be paied towards them so that they can be treated properly. This can be proved by discussing the following case. The case to be presented is an 11 month years old female baby with chief complaint as respiratory symptoms since 8 months ago. During the work up secretions and inflammations in both bronchuses, hyperinflation in both lungs - especially in right - and right posterior mediastinal mass were observed. The patient underwent surgery under the probable diagnosis of having a bronchogenic cyst (BC) which later on was documented by the pathologist. BCs are rare benign congenital developmental lesions of ventral foregut. They account for approximately %10 of mediastinal masses among children. These occur most frequently in the posterior part of mediastinum, usually more common on the right and middle. They are always symptomatic in children but rarely diagnosed at the time of the birth. Because of dangerous complications, early diagnosis is imperative. A chest radiograph raises any suspicion about having a BC, that can be documented by a chest CT-scan with contrast. All identified BCs should be surgically removed. BCs should be placed in the differential diagnosis of mediastinal masses, chronic productive cough, recurrnt pulmonary infection, unilateral lung hyperinflation in radiograhy, and FTT in children.

To determine the usefulness of a method of percutaneous needle muscle biopsy in patients with suspected idiopathic inflammatory Myopathy. The yield of percutaneous needle muscle biopsy was studied in 15 patients during 1997-2000 who were hospitalized in Hazrat Rasool Akram hospital. A diagnosis of idiopathic inflammatory myopathy was confirmed histopathologically in 8 patients from 10 patients with clinical diagnosis of idiopathic inflammatory myopathy. One patient didn’t have enough sample and one of them had normal biopsy. In 4 patients with clinical diagnosis of overlap syndrome, one pathological sample was inflammatory and three others were myopathic. In one patient with clinical diagnosis of vasculitis biopsy was diagnostic. None of the patients developed hematoma, infection or prolonged pain after biopsy. Percutaneous needle muscle biopsy is a safe and convenient method with a high diagnostic yield for the pathologic confirmation of idiopathic inflammatory myopathy spescially idiopathic form. It should be considered as a primary method of acquring muscle for histopathologic examination in the evaluation of suspected idiopathic inflammatory myopathy.

The 2 part greater tuberosity fracture dislocation of shoulder can usually be reduced by close methods. We report a case of failed close reduction due to interposition of long head of biceps tendon and greater tuberosity and botton hole deformity of subscapularis musclue.

Angiotensin I-converting enzyme (ACE) converts the inactive angiotensin I molecule to the active angiotensin II. ACE is abundant in epithelium, endothelium and neuroepithelial cells so it found largely on the brush border of intestine and kidney proximal tubules. ACE also presents in the serum. Some pulmonary and renal toxic drugs change the serum and tissue ACE contents. In this study changesin ACE activity was studied in gentamicin induced renal failure of rats. Rats were sacrificed 1, 3, 5 and 7 days after intrapritoneal injection of 100 mg/kg of Gentamicin and ACE activity was measured in serum, kidney and lung. These data were compared with vehicle-treated rats. Rats with acute renal failure had proteinuria, polyuria, and decreased creatinin clearance. The damage to the proximal tubule of kindy was evident by (a) the histological analysis at light microscopy and (b) the augmentation in the urinary excretion of NAG. (N-acetyl β-D-glucosaminidase) Kidney ACE activity significantly decreased and lung and serum ACE activity didn’t change until 7 th day. Then lung ACE activity increased significantly at 7 th day as well as kidney and serum ACE activity. Blood pressure increased significantly on the 7 th day correspond with the increment in lung ACE activity. These data support the idea that kidney ACE activity decrease are due to local nitric oxide release in damaged kidney, and this effect reversed by an universal signal which increase ACE contents in the body probably to increase systemic blood pressure and subsequently increase glomerular filtration rate (GFR).

Cutis laxa is a congenital disorder transmitted as autosomal ressesive and dominate trait. This disorder has an acquired form that develops after febrile illness or skin inflammatory fisease. A 5 month old girl with generalized loose skin and these facial features including a hooked nose with everted nosetrils, long filtrom, high arch palate, wide fontanels, hypertelorism, epicantal folds and antimongloid slants in eyes and umbilical hernia was presented. CXR and echocardiography was normal X-Ray of the hips show bilateral dislocation. Lab study results including CBC. P, Ca, ALP, thyroid function test, U/A and U/C were normal. Pathology study of skin biopsy was compatible with cutis laxa.

Free radicals and lipid peroxidation have been proposed to play a role in the pathogenesis of atherosclerosis. Reactive Oxygen species can induce the oxidation of low-density lipoproteins and LDL oxidation has been shown to be responsible for plaque formation in the vessel wall. However living cells and organisms are very well equipped with defense systems against the damaging effects of radical oxygen species. Free radical scavenging enzymes are an important part of this system. The aims of this study were to evaluate the enzymatic activity of antioxidative enzymes of erythrocytes, catalase(CAT) and glutathione reductase(GR), that might be indicators of protective mechanisms involved in atherosclerosis, and also to evaluate the serum lipids and lipoproteins that thought to be correlated with these two antioxidative enzymes. The study comprised 90 patients with angiographically proved coronary stenosis in Tehran Rajai cardiovascular center and 30 subjects without and coronary heart disease used as controls. Glutathione reductase activity in erythrocytes was evaluated by a method of Goldberg & Spooner spectrophotometrically. Catalase activity in erythrocytes was assayed by the method described by Hugo Aebi with using a UV/visbile spectrophotometer. Serum lipids were measured by automated methods. Patients had similar glutathione reductase activities compared to the control subjects. However the catalase activity was decreased in erythrocytes of the atherosclerotic patients compared to the control subjects (P<0.05) and those with three vessels stenosis (P<0.008). In patients with atherosclerosis, the serum cholesterol, LDL-c and LDL-c/HDL-c (atherogenic index) were significantly increased compared to the control group (P<0.002). Atheroscleroticsmoker patients had similar catalase activity compared to the nonsmoker patients. However the glutathione reductase activity was decreased in erythrocytes of the atherosclertic smoker patients compared to the nonsmoker patients(P<0.003). No significant correlations were found between serum lipids and two antioxidative enzymes activity in patients and control subjects. However the activity of catalase was positively correlated to atherogenic index(r=o.49, P<0.005) within control group.

This study investigates patients with transient synovitis of Hip in Hospitals of Iran Medical center & Sciences (1991-1999). Prevalence age were children under 10 years (67%) and boys (67%). Clinical symptoms was pain, limping, limit range of motion in Hip joint. Most of patient (83%) had history of respiratory & disease and Trauma. Most of patient had systematic symptomlike fever, anorexia.100% of patients had mild degree of fever. Synovial fluid show clear fluid, raising in W.B.C count (200-2000) increased glucose (more than 60 mg/dl) increase synovial vicosity. All of these symptoms indicates no inflamatory condition. In most cases E.S.R & C.R.P were high. Synovial culture in all cases were negative. Treatment was done by antibiotics or analgesic & rest or combination of two methods. In fact it seems to be an self limited Disease and the treatment is to take rest.

Post anesthesia shivering induces a number of complications, which causes a variety of therapeutic approaches. Meperidine has been used as a drug of choice for the treatment of the complications in some patients while it is forbidden for some (e.g. those who use M.A.O inhibitors). In a randomized clinical trial 50 cases were selected and divided randomly in two groups, the first group received 25 mg meperidine (I.V) while the second group received methadone 2.5 mg/ 70kg (I.V) The anti- shivering effects were compared in the recovery room. The first group had a mean age of 33.76 years and second group 34.4 years. The mepridine group had a mean axillary temperature of 36.1 degrees ˚C while the second group had a mean of 36.08 degrees centigrade (P.value > 0.05) Also, the two group had shivering relief 84%, and respectively. The meperidine group had shivering relief after 30 seconds and the methadone group after 60 seconds, but these differences were not statistically significant (P.value > 0.05). The above results suggest similar anti- shivering effects for the two drugs and so, the two drugs could be used interchangeably.

Type III supracondylar fractures of humerus is a common fracture of children with high rate of complications. There is many contraversies about its treatment. Closed reduction and percutaneous pin fixation and also open reduction and internal fixation are two routine surgical methods for this fracture each with own risk and benefits. This is a retrospective study on 49 patients with type III supracondylar fractures. 28 patients treated with open reduction and internal fixation and 21 patients with closed reduction and percutaneous pin fixation. Informations obtained by visit of patients in out patient department and also attendence of examiner, at patients home. There was also 4 patients with type II gartland supracondylar fracture in closed reduction and percutaneous pin fixation group. All patients with ORIF group were type III Garteland. Results evaluated by Flynn criteria for range of motion and deformity. There was 76.2% Excellent and good results in closed reduction and percutaneous pin fixation group and 57.1% in ORIF group. Fair and poor results were 23.8% and 42.8% respectively. Surgeons were in limited safety zone for technical error in ORIF group. Main causes of poor results in closed reduction and percutaneous pin fixation group was deformity due to poor primary reduction and it was both deformity and stiffness in ORIF group. We recommend closed reduction and percutaeous fixation method for average surgeons with limited experience in ORIF techniques.

During the present decade, antifungal products usage without prescription has increased in women. Many women, use alternative medicines for relief of symptoms and health problems, but the extent of this usage and the costs are still unkown. This study was designed to investigate the use of antifungal and alternative medicines without prescription in women referred to the gynecologic clinic in Sari Emam hospital. It was a descriptive study done in 102 women referred to gynecologic clinics in Sari Emam Hospital and evaluated by recording data in questionair, clinical observations and laboratory investigations. The mean age of the patients was 28 years. Half of the patients has high school education and higher diploma. The mean term of symptoms in most of the patients was 18 months. Sixty (%58.82) patients had self-treated with Over The-Counter antifungal medicines such as clotrimazole (%85) miconazole (%5), povidone-iodine gell (%10). Twenty-two (%21.56), had used Alternative Medicines, most frequently vinegar sitz bath (%40.9), salt sitz bath or douches (%27.2), betadin sitz bath or douches (%3.2) and savlon (%8). In 20 (%19.6) of the patients did not use any method or drugs. In spite of most patients thought that vulvovaginal candidiasis was the cause of their symptoms (%72.5), only in 35 (%34.3) cases diagnosis at initial presentation were candidiasis. This study has show that self-treatment is common in our society that add health care costs and not beneficial. This way of treatment not only would delay the proper treatment but is a reason for peresistant and chronic candition of the patients.

This study was done to compare the trauma scoring systems (ISS, RTS, TRISS and ASCOT) in prediction of patients’ outcome (including survival, hospital length of stay and hospital costs). A randomely selected sample of 525 cases were selected from patients who admitted to hospital for atleast 1 day and all in-hospital deceased patients. Totally, 6.5 percent of patients had died. Trauma severity of patients set was 8.57 (± 0.62) according to ISS, 7.59 (± 0.08) according to RTS, 1.8 (+ 0.12) according to TRISS and 4.03 (+ 2.5) according to ASCOT. Trauma severity of survivors and non-survivors were significantly different using each of the above systems. The largest area under ROC curve was belonged to ASCOT following with TRISS, ISS and RTS. ISS had the greatest correlation with hospital length of stay (r = 0.76, P< 0.01) and costs (r = 0.77, P< 0.01). There were significant regressions between each system point and hospital staying or charges, but even the greatest determination coefficient were not beyond the 0.37 (for hospital staying) and 0.36 (for hospital charges). ASCOT and TRISS had greater Precision to predict mortality and ISS was the best predictor of hospital length of stay and charges. Using these Scoring methods in a National Surveillance System for Trauma is Recommended.

Low back pain is the most common musculoskeletal disease and has a high prevalence rate in community that causes a significant morbidity, mostly due to degenerative discovertebral disease. MRI is the best and noninvasive method for assessing degenerative discovertebral disease. This study was conducted to determine MRI findings in degenerative discovertebral disease. This descriptive study is done cross sectionally on 110 patients (60 men & 50 women) with the average age of 45 years that have degenerative low back pain without a history of trauma, neoplastic, inflammatory or spinal surgery. Degenerative findings including changes in signal of nuclear disk complex, size and shape of nuclear complex, intranuclear cleft, disk height, disk bulging, disk herniation, dural sac compression and osteophyte formation are analyzed and graded form zero to three based on their severity. The result shows %92.7 of patients have degenerative discovertebral findings. The most common age is 4-6 decades. Degenerative findings occur in men one decade earlier. The most common time for patients’ reference was 1-6 months after the disease commences. The most common disk level involvement is L4-L5 that affected men %82 and women %75. After that the fifth, the third the second and the first disks respectively. The most common degenerative findings are change in intranuclear cleft %58.2, change in signal of disk complex %41.6, disk height narrowing %25.9, change in shape and size of disk complex %23.2. Prevalence of degenerative discovertebral finding, except for disk herniation, increase from the first to the forth disk and then decrease partially. Dural sac compression in upper disk is mostly due to disk and then decrease partially. Dural sac compression in upper disk is mostly due to disk bulging and in lower disk because of disk herniation. Mild grading of degenerative discovertebral findings is more common than moderate or severe geading, except for changes of signal intensity of disk, intranuclear cleft and disk height narrowing whose moderate findings have greater prevalence. Thereis no sex difference in degenerative discovertebral finding. Signal intensity changes increases with age (P<0.05). Also there are increases in changes of size and shape of nuclear complex, intranuclear cleft, disk height narrowing in the first to the third disks (P<0.05). But there is no significant rise in disk herniation, disk bulging or dural sac compression with age. Increase in ostheophyet formation in the first and the second disk is seen (P<0.05). Degenerative discovertebral findings show that according to degenerative proces the first, the second, and the third disks might be categorized in one group and the forth and the fifth disks in another group.