فهرست مطالب

Medical Journal Of the Islamic Republic of Iran
Volume:23 Issue: 4, Winter 2010

  • تاریخ انتشار: 1388/12/11
  • تعداد عناوین: 10
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  • Mahmoud Jabalameli, Mohammad Rahbar, Mehdi Ramezan Shirazi Page 177
    Background

    Different methods of surgical treatment for acromioclavicular joint injury were considered in the literature. The purpose of the study was to compare intra-articular AC repair technique with the extra-articular coracoclavicular repair technique for the patients with Rockwood type III and VAC joint injury when indicated.

    Methods

    Nineteen consecutive patients with Rockwood type III and VAC joint injury were treated with intra-articular (Group I - 12 cases) and extra-articular (Group II - 7 cases) repair technique between 1380 - 1386, and the results reviewed. When the diagnosis was established, the mean age of the patients was 32.5 years (Range, 18 - 60); group I and II 31.8 years (Range, 18 - 60) and 34 years (Range, 22 - 58) respectively. The mean duration of postoperative follow - up was 24 months. The Constant shoulder scoring system was applied to obtain clinical results.

    Results

    Only in group I, the post-surgical complication was associated with fiber allergy, wound infection and pin site infection in two patients respectively. No pain was detected in fourteen cases. Four patients in group I had occasional mild pain during sport activity, while one case in this group reported severe pain during resting which prevented the patient from activity. Also, there was an ossification in thirteen patients particularly in group I. Clinical results showed the mean constant shoulder score was 93.4 in group I and 97.1 in group II.

    Conclusion

    At the time of the follow - up, there was a clear difference between both groups regarding to postoperative pain and discomfort. Therefore, it seemed that potential cause of pain was due to postoperative complications. An interesting postoperative complication without interfere in the functional outcome was coracoclavicular space ossification in most cases. This was probably because of soft tissue injury during the operation. It seemed that surgical treatment of Rockwood type III and VAC joint injuries when indicated had acceptable clinical results particularly if the extra-articular AC repair technique (screw fixation) was chosen. The new arthroscopic surgical technique with endobutton may decrease the rate of complications such as fracture site ossification and morbidity although more study in this field is required.

  • Azizeh Afkham, Ebrahimi, Maryam Rasoulian, Zahra Taherifar, Maryam Zare Page 184
    Background

    A significant relationship between psychiatric disorders principally depression and anxiety and insomnia is well-known in general population. Ahigh percent of insomnia sufferers report anxiety symptoms. Anxiety is also frequently seen in medical patients whom complaints of sleep problems are often prominent.

    Method

    250 outpatients with various medical complaints participated in the study and completed Pittsburgh Sleep Quality Index(PSQI) and Beck Anxiety inventory (BAI).

    Results

    The patients reported moderate anxiety on BAI. Significant correlations were found between anxiety and four components of sleep; sleep quality, sleep latency, sleep duration and habitual sleep efficiency.

    Conclusion

    The correlation of sleep complaints with anxiety symptoms indicated a high interrelatedness between anxiety and sleep complaints. Insomnia is a disorder of hyperarousal. Nonetheless inqury into mechanisms of arousal regulation could further explain the anxiety and sleep disorders as well.

  • Abbas Madani, Alireza Parsaii Sadr, Ali Yeganeh, Gholamreza Shahoseini Page 189
    Background

    The purpose of this study was to evaluate the significance of the Q angle with respect to the patella position. We assess the correlation between the Q angles (calculated by clinical exam) in different positions and CT indices (with more impression on TTTG).

    Method

    Atotal number of 68 knee joints of 50 cases entered the study. Clinical examination was used to measure Q angle (in 3 positions of sitting, standing and supine). CT scan performed in 2 axial view of proximal tibia, and distal femor for measurement of Tibial tuberosity-trochlear groove distance (TTTG) and other CT indices. Correlation between main variables calculated.and analysed with spss.

    Results

    Supine Q angle were strongly correlated with standing Q angles and moderately with sitting Q angle. Sitting Q angle was moderately correlated with supine and standing Q angle and weakly with PTA. we found no other significant correlation between Q angle and CT indexes.

    Discussion

    Our findings suggest that Q angle is not a valuable index for predicting the presence of patelofemoral malalignment.

  • Mohammadreza Ehsaei, Fariborz Samini, Gholamreza Bahadorkhan Page 201
    Backgrounds

    Pott''s disease is a rare form of extrapulmonary tuberculosis, and presents with several clinical patterns. Delay in diagnosis and management may cause serious complications. We conducted a retrospective study between 1991- 2006 to evaluate clinical presentation, radiologic and laboratory findings, and therapeutic approaches to spinal tuberculosis.

    Methods

    We reviewed clinical presentation, radiological and laboratory findings of 58 patients with spinal tuberculosis retrospectively. The diagnosis of tuberculous spondylitis was based on characteristic histology or microbiologic evidence of the disease. The results of study were recorded, and statistically analyzed by SPSS 11.5.

    Results

    The most frequent symptom was back pain (84%), with thoracic region being the most affected site (46%). Paravertebral abscess noted in 67% of cases and the average time for diagnosis was 16 months.

    Conclusions

    The 42 cases of this study underwent surgery and all were treated with drug therapy for 12 months. There was no worsening of the neurologic status in any patient. All patients with tuberculous spondylitis began to improve 3 months after chemotherapy and healed within 12 months in nonsurgical and surgical groups.

  • Zahra Eslami Nejad, Noureddi Nematollahi Mahani, Fereshteh Saffari, Hamid Mollaii, S. Ali Mohammad Arabzadeh Page 207
    Background

    The interest in using bacteria as anti- cancer therapeutic agents dates back to the end of the19th century. Some bacteria like Salmonella and Listeria replicate effectively inside malignant cell lines and suppress their growth. The bacterium Streptococcus pyogenes has become medically famous as a flesh-eating pathogen since mid-1980s. It is the causative agent of a life threatening clinical condition called necrotizing fasciitis. S. pyogenes usually produces a range of lytic enzymes that promote bacterial pathogenesis. With these characters, can S. be employed as a curing agent for certain cancers? The aim of this study was to determine the influence of S. pyogenes on malignant cellular death (apoptosis or necrosis)- in an ex-vivo "experimental- interventional" study.

    Methods

    The cytotoxicity of fifteen internalized streptococcal strains(including 12 clinical isolates, 2 known M types [M1, M3] and standard strain), on four types of malignant cell lines- A549, BT-20, PC-3, L-929- were tested by Trypan blue exclusion, DNAfragmentation and WST-1 methods. The streptococcal protease, lipase, DNase and serum opacity factor (SOF) were tested concurrently. The standard strain of Streptococcus (Enterococcus) faecalis was employed as negative control. The results were analyzed by statistical Minitab software.

    Results

    The overall cytotoxicity rate of -internalized- S. pyogenes was 57% by trypan blue method and 50 % by DNA electrophoresis. False positive results occurred for the negative control in WST-1; therefore this test did not present reasonable results. The correlation between production of SOF, lipase, DNase and cytotoxicity of S. pyogenes was not significant (p > 0.05). However, 67% of the protease positive strains induced cellular death in at least one type of - malignant cell line (p<0.05).

    Conclusion

    Our findings indicated that, some non-invasive S. pyogenes that cause benign infection like pharyngitis can induce cell death in various cancerous cell lines. It seems that among bacterial products, the proteolytic enzymes-which are linked to the streptococcal pyrogenic exotoxin B (spe-B)- are more related to bacterial invasion.

  • Masoumeh Ghiasvand , Ramin Heshmat Koroush Soleimani Page 218
    Background
    Irregular Working hours, including night work and shift work, have been found to be associated with alteration in various levels of biochemical factors. And some studies have showed association between shift work and blood biochemical disturbances in blood. In this epidemiological study we investigated, whether regular schedule of working hours can minimize the associated biochemical effects.
    Methods
    Atotal of 442 air traffic controllers between the ages of 21 and 59 years in this study filled out questionnaire, and triglyceride, total cholesterol, and HDL-C concentration and FBS were measured after 12- hours fasting. The correlation between shift work and the biochemical variables was measured. The SPSS software version 11.5 and STATAversion 8 were used for statistical analysis, the X2 and fisher''s exact test used for comparing the qualitative variables and the parametric tests for quantitative variables with normal distribution. Odd''s ratio (OR), and 95% confidence interval (95% CI) were used for estimating the effect of shift work on lipid profile and high blood glucose levels. Logistic regression modeling was used for multivariable analysis and adjusting the effect of different variables.
    Results
    sample size of this cross-sectional study was consisted of 305(69%) shift workers and 137(31%) day workers. The mean age of the shift workers was 40 ± 10 years old and the day workers 40 ± 9.The mean of variables in the present study for total cholesterol, LDL-C, HDL-C, triglyceride and fasting blood glucose in the shift workers were respectively: 195±37mg/dl, 116.8±34.8mg/dl, 48.2±15.1mg/dl, 154±80mg/dl, 92±20mg/dl and in the day workers were respectively: 200±40mg/dl, 125.3±38.6mg/dl, 48.8±23.3mg/dl,151± 77mg/dl, 90± 14mg/dl. Adjusted Odd''s ratio for the effect of shift working on the biochemical blood factors did not change the results..
    Conclusion
    This study showed that air traffic control workers with various shift did not have any disturbances in their biochemical blood factors, and this finding persisted after adjustment was made for age. These results could be due to regular shift schedule as well as periodic evaluation for biochemical blood factors in this group. But this study did not rule out physiological and behavioral effects of working shift on the shift workers. It was concluded that shift workers should be on regular working schedule and examined periodically for biochemical blood factors, physiological flunctuation (gastrointestinal, endocrinal, cardiovascular….) and behavioral effects induced by variation in shift working.
  • Reza Salehi, Ismaeil Ebrahimi, Takamjani, Ali Esteki, Nader Maroufi, Mohammad Parnianpour Page 224
    Background

    Postural instability has been identified as a potential precursor of falls in elderly subjects. Postural stability in quiet stance is commonly assessed with center of pressure (COP) measures. The purpose of this study was to determine testretest reliability and minimal detectable change (MDC) for the center of pressure (COP) measures in the elderly subjects.

    Methods

    Eighteen healthy elderly people over the age of 60 years participated in this study. For each subject the COP was recorded during quiet upright stance on different levels of postural difficulty (eyes open versus eyes closed, firm surface versus foam surface) and lean condition (forward and backward). All measurements were done on two sessions with 7 days interval. These indices: mean velocity, standard deviation of amplitude, standard deviation of velocity, phase plane parameter and area (95% confidence ellipse). Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and coefficient of variation (CV) were used to quantify testretest reliability. The MDC for each measure was calculated to quantify intervention effects.

    Results

    In general, test-retest reliability of COP measures in the elder subjects was increased whenever postural difficulty of task increased in quiet standing. In standing conditions, mean velocity and phase plane parameter were the most sensitive and the most reliable measures. The lean range was the most sensitive and the most reliable measure, in the lean conditions.

    Conclusion

    Center of pressure measures in the quiet standing especially in difficult postural conditions demonstrated high sensitivity in the older subjects. These results may be useful in quantification and assessment of balance performance and treatment efficacy.

  • Farzaneh Ebrahimi Fard, Arash Najaf Beygi, Ali Kavyani, Amirhosein Jalali Page 233

    Idiopathic granulomatous mastitis is a rare, inflammatory, and benign breast disease characterized by non-caseating granulomata and microabscesses limited to breast lobules. This condition presents as a firm breast mass that is clinically and radiologically indistinguishable from breast cancer, or as multiple or recurrent abscesses, or mastitis in a young non-lactating woman. Almost always, the diagnosis is made after surgical interventions to rule out other pathologies as differential diagnoses especially tuberculosis which is endemic in our country. We are going to report 3 cases of granulomatous mastitis besides a brief review of the literature. We emphatically recommend that although this entity should be kept in mind as a rare differential diagnosis, it shoud not be considered as the first one.

  • Bahram Haghi, Ashtiani, Farzad Sina, Fowzieh Ben Isa, Mohammad Rohani Page 238

    The usage of heroin is associated with a variety of neurologic disorders, including acute transverse myelitis. In this study we present a 19_year old man who was suffered from insufflated heroin after several months of abstinence, and admitted to hospital emergency department, unconscious. He responded to fluid therapy and Naloxone, but he could not move his legs on examination. He had flaccid paralysis of both legs, acute urinary retention and diminished rectal tone. Deep tendon reflexes were absent with downward plantar reflexes. Analysis of CSF was normal, and the MRI of the spine revealed confluent hyperintensity on T2-weighted images from the C5 to T2 vertebral levels involving the majority of the cord substance. The cord was mildly expanded without any enhancement after Gadolinium injection. Suggested mechanisms of heroin-associated myelopathy include hypotension, a direct toxic effect of heroin, vasculitis, and hypersensitivity reaction. Hypersensitivity has been the predominant theory since the initial reports, implied that most patients with developed myelopathy had relapsed into heroin use after a period of abstinence. Treatment with either IV corticosteroids or immunopheresis may blunt the immune response, preventing disability. Efficacy of these methods require more studies in future.

  • Seyed Hamid Moosavy, Hossein Froutan, Habibi Aghazadeh, Yasir Andrabi Page 241

    Gallstone ileus is a rare complication of cholelithiasis found in less than 0.5% of patients. It is an uncommon cause of small bowel obstruction, accounting for 1% to 3% of all mechanical bowel obstructions and over 25% of nonstrangulated bowel obstructions in patients older than 65 years with a female predominance. We report a 60-year-old woman who was referred to our hospital because of abdominal pain, nausea, vomiting and constipation forty days prior to admission. An upright abdominal X-ray showed air fluid levels and an oval calcified opacity in the region of right iliac fossa. The ultrasonographic examination revealed air in billiary tree and several small stones in the gallbladder. Afollowing abdominopelvic CT scan showed severe distention of small intestinal loops, pneumobilia and a 3cm-calcified intraluminal mass. The clinical diagnosis of gallstone illeus was made, but unfortunately her general condition worsened with the decline in Glasgow Coma Scale declined since she was suffered an extensive cerebrovascular accident and eventually she died of cardiac arrest. Inspired by the mentioned case we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.