مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال هفدهم شماره 5 (پیاپی 70، زمستان 1388)

Otoacoustic emissions are low density sounds produced from intact cochlea measureable in the presence of an intact conduction structure. The goal of this study was to assess the surgical success rate after tympanostomy tube insertion by Distortion Product Otoacoustic Emission (DPOAE) and Transient Evoked Otoacoustic Emission (TEOAE) as methods of evaluation of postoperative hearing.

A descriptive-analytic study was conducted on 130 patients with OME. Audiometrical tests included TEOAE, DPOAE that were performed before, one month and three months after surgery on patients and results were compared. Prior to surgery, TEOAE and DPOAE responses were not recordable in any of the patients, whereas after surgery, the responses were significant. OAE tests can be used as objective, simple tests in children, especially in toddlers who are not able to cooperate in performing PTA before surgery. These tests can be also be used for follow up of patients for hearing loss improvement and resolvement of middle ear effusion.

Increased numbers of nucleated red blood cells (NRBC) circulating in the blood of neonates can be associated with relative hypoxia and adverse outcomes. Thus, the aim of this study was to assess the NRBC count during the first week of life in neonates diagnosed with asphyxia as compared to healthy neonates and to determine the short-term morbidity and mortality for the affected babies. The cross-sectional study compared 15 healthy neonates with 15 neonates diagnosed with asphyxia confirmed by pH of cord blood or Apgar scores. The nucleated red blood cell (NRBC) counts were calculated right after birth, and on days 3 and 7, and the hematological parameters of umbilical cord blood were also evaluated. The infants were followed for mortality and associated morbidity. Statistical analysis was conducted using the Mann-Whitney U test, analysis of variance, chi-square tests, and Pearson’s correlation coefficient. A p-value < 0.05 was considered as statistically significant. The initial NRBC counts were significantly higher in the asphyxiated group than in the control group and the difference remained significant through the end of first week. All of the umbilical cord blood parameters were significantly lower in the study group and were negatively correlated with the NRBC count. At birth, higher NRBC count correlated with higher mortality. conclution: Results show that NRBC count is a useful predictive factor for neonatal asphyxia through the end of the first week of life, although a larger study population and a longer follow up period seems to be necessary.

Polycystic ovary syndrome(PCOS) is one of the most common cause of infertility in women. clomiphene is the first line of treatment. however 20% of patients are resistant to clomiphene. because of follicular hypersensitivity to gonadotropins in pcod, multiple follicular growth and development occurs which is cause of OHSS and multiple pregnancy. Our aim of this random and clinical study was comparation between step-down and low dose step-up methods for induction ovulation in clomiphene resistant. 60 cases were included 30 women in low-dose step-up group and 30 women in step-down group. In low-dose step-up HMG 75u/d and in step-down HMG 225u/d was started on 3th days of cycle, monitoring with vaginal sonography was done on 8th days of cycle. When follicle with>14 mm in diameter was seen HMG dose was continued in low-dose step-up and was decreased in step-down group. When follicle reached to 18mm in diameter, amp HCG 10000 unit was injected and IUI was performed 36 hours later. Number of HMG ampules, number of follicles> 14mm on the day of HCG injection and level of serum estradiol was greater in low dose step up protocol than step down protocol(p<0/0001). Ovulation rate and pregnancy rate was greater in lowdose step up group than step down group with significant difference (p<0/0001). Our study showed that low-dose step-up regimen with HMG is effective for stimulating ovulation and clinical pregnancy but in view of monofollicular growth, the step down method was more effective and safe. In our study multifolliular growth in step-up method was higher than step-down method. We can predict possibility of Ovarian Hyperstimulation Syndrome syndrome in highly sensitive PCOS patients.

Preterm premature rupture of the membranes (PPROM) is one of the most important causes of perinatal morbidity and mortality. The aim of this study was to evaluate pregnancy outcome in preterm premature rupture of the membranes with amniotic fluid index less than 5 and more than 5. This prospective study was performed on 137 pregnant women with gestational age of 28-34 weeks with PPROM from Oct 2006 to Oct 2008. The patients were divided in two groups according to amniotic fluid index: AFI<5 (77 cases), AFI≥5 (60 cases). Chi-square test was used for qualitative variables, while T-student test was used for quantitative test. Both groups were similar with respect to number of pregnancies, gestational age at rupture of the membranes and birth weight. In the group with AFI<5, applied latency was significantly shorter (PV=0.049), rate of cesarean section was higher due to fetal distress (PV=0.008), neonatal Apgar score in first minute was lower during the first week (PV=0.0127) and the rate of neonatal death was higher (PV=0.045) during the first week. An AFI<5 cm after PPROM is associated with earlier delivery, higher rate of cesarean due to fetal distress, higher rate of neonatal death, and lower neonatal Apgar score in first minute during the first week

There are high concentrations of LH in Polycystic Ovary syndrome (PCOS) patients. These patients are usually obese and have increased leptin levels in their blood. It is not clear whether obesity or increased leptin levels cause changes in the hypothalamus- pituitary axis. This study evaluated the blood leptin, LH and FSH levels in PCOS group and compared them with a control group. The study included 27 PCOS patients and 27 normal individuals as control. They were matched for age (18-40 year). A fasting blood sample was taken and then freezed at -80 degrees Celsius. This sample was used for measurement of leptin, FSH, LH and insulin levels. There was a significant difference between leptin, insulin and glucose levels in the two groups (P<0.05) Leptin levels were higher in group with BMI>25 as compared to group with BMI<25 (P<0.05). The mean LH level in PCOS group was significantly higher than the control group. It is possible that in PCOS patients, high levels of LH could be related to an increase in leptin levels along with insulin resistance.

In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus), consciousness level, and intensive care unit (ICU) admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS). The population under study consisted of 202 men (80.5%) and 49 women (19.5%) with an average age of 34.1 years (range: 1-89 years). Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%). Head (220, 87.6%) and face (169, 67.3%) were the two most common sites of injuries. Mean (±SD) of ISS was 23.2 (±10.4). According to autopsy records, the main cause of death was head trauma (146, 58.1%). Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents.

Cyclophosphamide is used as an anti cancer medicine in chemotherapy. This is an alkalizing medicine and causes the binding of DNA strands, breaking of DNA and control of protein synthesis and RNA. The side effects of this medicine include lack of appetite, nausea, reduction in activity of sexual lymph nodes, causing amenorrhea, azoospermia and oligospermia. Ginger includes many compounds, some of which are shogaols, gingerols, pyrogallols and sesquiterpenes. Ginger has anti nauseating, anti cancer, anti oxidant effects and eliminates free radicals. This medicine is used along with cyclophosphamide to reduce its destructive side effects in the body.

For 21 days, the rats were fed with ginger and cyclophosphamide. After 21 days, the animals were weighed and rendered unconscious. Their testes were removed and tissue samples were provided from their testes.

The results showed that cyclophosphamide alone reduces body weight, testes weight and spermatogenesis as compared to the control group. In other experimental groups that were fed with ginger and cyclophosphamide, increased dosage of ginger increased the body weight, the testes weight and spermatogenesis in comparison to the other experimental groups.

It seems that compounds present in ginger are anti tumoral and control the production of active metabolites. Therefore, if administered together with Cyclophosphamide, it can be useful and effective in patients undergoing chemotherapy.

Solid- papillary tumor of the pancreas is an extremely rare, low malignant potential neoplasm affecting predominantly adolescent girls and young women. The presented case is an 18-year old girl with complaints of epigastric pain, fever, nausea, vomiting, early satiety and abdominal mass. Sonography and CT-Scan showed a large hypo dense mass in the retro gastric area, probably of pancreatic origin. She underwent abdominal laparatomy and distal pancreatectomy. According to microscopic and immunohistochemistry findings, the final diagnosis was a solid, papillary tumor of the pancreas.