مجله علوم پزشکی رازی
سال هشتم شماره 2 (پیاپی 24، تابستان 1380)

In hydrops fetalis, the affected fetus may show considerable subcutaneous edema, usually associated with ascites and pleural effusion. Severe hemolysis, marked erythroid hyperplasia of the bone marrow and large area of extramedullary hematopoesis, particularly in the spleen and liver which may cause hepatic dysfunction, are the symptoms of hydrops fetalis.Hydrops fetalis is divided to Immune and Non-immune. Immune hydrops fetalis is caused by Rh-system incompatibility and Non-immune is caused by chromosomal abnormality, cardiovascular malformation, skeletal malformation and etc. Ultrasonic evaluation may provide a diagnosis and mother’s evaluation is controlled by indirect coomb’s and if indirect coombs titer is positive and goes up the fetus must be evaluated by amniocentesis or cordocentesis. If the situation of fetus is hazardous, intrauterine transfusion and termination of pregnancy must be considered. In this report we have two living neonates which had been non-Immune hydrops fetalis and treated by some medical treatment and are now living a normal life.

Superficial mycoses is an endemic diease in Iran specially rural area and area of poor hygiene, where the children are dealing with domestic animals. Scalp mycoses is almost always seen in school age children and younger.So study of fungal investigation in Iran is important from point of view of public health and preventive medicine. Varamin, an agricultural city near Tehran was selected for study. Five boy and five girl primary schools have been chosen randomly in that area. The office of education and statistics authorities of the area have cooperated in this study. 1099 boys (53.51%) and 956 girls (46.5%), a total of 2050 students aging 7-14 year were investigated. Sampling was taken from suspicious as well as normal appearing children for mycological study. Special questioner was made for all children containing required informations in relation to special items except the skin diseases. Two cases of periungal candidiasis, 2 cases of tinea versicolor (2 girls, 0.1%) and 1 case of tinea capitis (a seven year old girl, 0.05%) affected by trichophyton violaceum were found. No significant difference was noted with similar studies in other areas of the country.

The number of women who need medical attention for perimenopausal bleeding has been increased because of the factors such as hormonal therapy after menopause. Determining the cause is essential in planning appropriate therapy. Although endometrial biopsy is still the preferred method as the first diagnostic test, hysterosonogeraphy (HSG) is a sensetive diagnostic method.37 perimenopausal women were enrolled in a prospective study. Patients were at the range of 36-65 years old and were asked about the use of oral contraceptive, tamoxifen and the history of hyperlipidemia, hypertension and hyperglycemia. All the patients with endometrial atrophy were excluded from the study. In HSG evaluation endometrial thickness in separate walls, echogenicity smoothness and irregularity were assessed and diagnosis were made based on sonographic data. Results of HSG were compared to data issued from pathologic results obtained from surgery. HSG was achieved in 37 patients. In all patients the procedures were well tolerated by patients with no complication during or after the examination. HSG had a high sensetivity and specificity in the discrimination of normal cavity from the ones with intrauterine lesion (sensitivity=95%, specificity=94%, positive predictive value=95%, negative predictive value=94%, accuracy=95%) HSG appears as a reliable method for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who just need a medical therapy from the ones who require a surigical exploration.

Wresting is one of the most involve sports in sport injuries. Because of Increasing number of wrestlers in Iran as the native sports, and lack of a precise study about the cervical root lesion and associated peripheral nerve lesion, we decided to study prevalence, type, involved root of probable cervical radiculopathy and also associated predisposing factor in 40 wrestlers, age range of 36-63 year and minimum 10 years of wrestling in Tehran.These groups were examined clinically, then by electrodiagnostic study and finally were referred for MRI study of cervical spins. Following results were obtained by electrodiagnostic studies in 40 persons and MRI in 21 persons. About 45% of patients studied by electrodiagnosis had cervical Radiculopathy. All of patients studied by MRI were reported by radiologist to have one type of cervical spine involvement as follows: degenerative changes: 61%, disc protrusion: 28%, cervical canal stenosis: 19%, and disc extrusion: 9%. The most common involved root in electrodiagnostic study was bilatrally C6 root lesion. The most common involved level in MRI was C5-C6 disc disease. There was no statistically significant correlation between root lesion and previous nerve Injury, age and years of wrestling. Based on this concept that electrodiagnostic is the most specefic test, MRI was calcuated to have 41.6% specifity and 100% sensitivity in evaluation of cervical root lesion. Twenty seven percent of cases had associated peripheral nerve lesion of upper limb, among these bilatrally capral tunnel “15%”, tardy ulnar palsy “12.5%” were most prominent. There was high statistical correlation between ulnar nerve lesion and previous elbow injury. Fifty four percent of patients had concomittant peripheral nerve injury and cervical root lesion “Double crush syndrome”.

Pseudotumor cerebri (PTC) is a clinical syndrome charecterized by increased ICP without any evidence of mass lesion or obstructive process.The incidence is 0.9-2 Per 100.000 population. It is more frequent in adults of 20-30 years age group especially obese women, and less common in pediatric age group. However children ranged 11- 16 years of age may suffer from PTC, with equale occurrence in both sexes. In this study we reviewed the files of 27 children with diagnosis of PTC who were admitted during past ten years in the neurology department of Mofid children Hospital (22n) and Hazrat Ali Asghar children hospital during 1369-1379. The results of this study revealed that children of 5-10 years age group, specially girls are more vulnerable. The most frequent complaints that brought these patients to physician consisted of headache, vomit and strabismus. Common findings at neurologic examination were papilledema, abducent nerve palsy and ataxic gait. All cases recovered with medical treatment but only one of them need to surgical Procedure treatment.

We tried to decrease the dose of the consumed thiopental during induction of anaesthesia with intramuscular injection of the lidocaine as a premedication by using the lidocaine characteristics in decreasing anaesthesia MAC(minimum alveolar concentration).The manner of research performance is as follows: we injected lidocaine 5% (3 mg/kg) or Normal salin (0.06ml/kg) into Gluteus muscle of two hundred adult patients (anaesthesia risk ASA-I, ASA-II) who were Candidate for elective surgical operation (one hundred persons for each group). About 15 minutes after injection, induction of anaesthesia began based on constant protocol. After intravenous injection of the Midazolam, the Fenantyl and the Galamin, the Thiopental was injected in boluses at the dose of 0.5 mg/kg in interval of 30 seconds. When the patient can not perform the orders and the eyelash reflex become disordered, the patient intubated with the Succinylcholin. The hemodynamic parameters of the patients (blood pressure and heart rate) are measured before the premedication administration and during intubation. Analysing of the obtained results show that the average rate of the consumed Thiopental in the group who received Lidocaine 5% (3mg/kg) as a premedication decrease about 42.5% in compared with the control group during induction of anaesthesia. The stability of the hemodynamic parameters during intubation in the group who received intramuscular Lidocaine is very significant.

Therapeutic and educational protocols are widely used in biomedical aspects. These protocols are locally used in hospitals and universities or may have global acceptance. Orthopedic and traumatologic protocols are available in WWW pages, and not only made by academic sources, But also delivers by personal pages. Nowadays, need for evaluation of these sites is obvious and many works are presented in biomedical literature. In this article 100 sites reviewed and evaluated by Branfoot & Oliver criteria and 35 of them selected and ranked.

This research was conducted to examin the effects of adding forward running and backward running training in a wobble board training program on some of functional static balance tests. In this research sixty-five young healthy males (13-17years) were selected by nonprobability sampling and assigned randomly into three groups. Group I included 25 subjects that performed 10 minutes forward running training first and then 15 minutes wobble board training. Group II included 25 subject that performed 10 minutes backward running training first and then 15 minutes wobble board training. Group III included 15 subjects that performed just 15 minutes wobble board training. Each group, was trained for six weeks and three times weekly. The functional static balance tests included the most possible time of standing on domminant leg in the straight posture on the firm support surface (A), standing on dominant leg in the straight posture on the foam support surface (B), standing on dominant leg in the semisquat posture on the firm support surface (C), standing on dominant leg in the semisquat posture on the foam support surface (D). All tests were performed with closed eyes. These teste were performed and 4 times in the training period. Results did not show any significant difference of the means among three groups after 6 weeks of training, but significant difference of the means of A, B, D tests was observed among three groups in the end of the second week. We have concluded that backward running for two weeks has a facility effect on the static balance by wobble training.

We evaluated the short-term results of 49 tibial plateau fractures in Shafa Hospital between march 1996 to march 1998.Thirty-one patients treated by surgery and 18 treated by conservative (non-surgical) methods. In both group the most common type of fracture was Schatzker type I and the least common were type VI and then type III. The average age was 36.9 years (18-65years) in surgical group and 46.5years (14-78years) in non-surgical group. Follow up was 15 months in average (6-24 months). The treatment in surgical group was fixation of fracture by surgery and using screws, Buttress plate and external fixator or all of them and in non-surgical group was 4 to 6 weeks long leg cast, then cast brace for knee motion. Partial weight bearing 6 weeks and full weight bearing 12 weeks post treatment commenced.A new scoring system was designed with regard to function, pain, X-rays of final results, and marked from 0 to 100. Overall achieved score in surgical group was 80.5% (excellent and good) and 55.5% in non-surgical group. Three patients had complications in surgical group, one had infected non-:::union::: of fracture site and the two others had severe limitation of knee motion: The latter may be due to severity of trauma ofcourse. Limitation of knee motion was the main complication in non-surgical group and we think that it would be due to unnecessary and longer immobilization. There is a meaningful differenc between the results of treatment of two groups surgical group had much better results. Our results show the same principles, as others do, that the main goals in Plateau Fracture treatment is achieving the well aligned limb, stable and congruent joint. Early and controlled knee motion is the second aim.

The causes of small bowel obstruction are very different and one of the intraluminal causes are enteroliths which are found in Patients who have chronic obstruction of the bowel, such as regional enteritis.The patient is a 41 year-old male with 12 year history of regional enteritis which presented with acute bowel obstruction in X-Ray studies. Eliptical calcifications with pointed ends and radiolucent center in RLQ has been observed and enteroliths due to prune pits ingestion has been diagnosed as a cause of obstruction.

In this survey upper end angles of femur (N/S & antiversion) on 1032 Normal and CDH cases, aged between Birth to 76 years old, were meagered. Simple A/P X-rays were used to sign on them by marking on axis of head and Neack also on body axis of femur.The angle between two axes were measured by roller and goniometer. The results of linear regression and multivariation are analysed by paired t-test and these results were obtained: 1- Mean of N/S angle regardless of sex for normal cases was 130.85 ˚ and for CDH cases was 130.87 ˚. 2- N/S angle regardless of sex, by increasing of age was significantly decreased. 3- Mean of N/S angle in Female cases was 129.4 3˚ and in male cases was 131.99˚. 4- Mean of antiversion angles in normal cases was 23.03˚ and in CDH cases was 36.11˚.

Nucleoalr organizer Region (NORs) are loops of DNA that transcribe to ribosomal RNA. A silver colloid staining techique to identify nucleolar organizer region associated protein (AgNOR’s) can visualize them by intranuclear black dots. The objective of the present research is to determine to what extent the staining method can be effective in screening and diagnosis of endometrial lesions. In this investigation, the technique is applied to 120 sections of endometrial tissue. The specimens were taken from patients admitted to Shahid Akbar-Abadi Hospital in Tehran between 1372 - 1376. These sections were obtained either after curettage or from hysterectomy specimens. The histological diagnosis are as follows: normal proliferative (n=30) or secretory (n=30) endometrium, simple cystic hyperplasia (n=29), complex hyperplasia (n=6) and adenocarcinoma (n=25). The average number of NOR(s) in normal proliferative, normal secretory, simple and complex hyperplasia and adenocarcinomatous tissues were 8.9, 5.7, 9.7, 10.3 and 14.6 respectively. There are clearly significant variations between these average counts, as quantified by an ANOVA (p<1.42E-43). Power analysis of the results shows that about 83% of variance of the dependent variable (NOR count) is due to the effects of independent variables, that is the aforementioned lesions. The sharp variation between NOR counts in different normal tissues with each other and with abnormal pre malignant and malignant lesions, and also between pre malignant and malignant lesions, strongly suggest using AgNOR in differential diagnosis of endometrial lesions.

This is a retrospective study of 83 patients with polioscoliosis, treated surgically in Shafa hospital (1970-1997), and the results are as Follow: implant failure: 15 cases (18%), pseudoar throsis: 12 cases (14.5%) deep infection: 4 cases (4.5%) superficial infection: 3 cases (3.6%) cast sore: 17 cases (20.5%) and loss of correction: 28 cases (33.7%). Implant failure was more common in Harrington distraction system (HD) and Harrington with Zeilke system, and was rare in Harrington with sublaminar wiring (HD+SLW). Pseudoarthrosis was common in the HD and was very rare in the HD+SLW. Also pseudoarthrosis was more common in the fusion with sacral involvement, posterior fusion alone, thoracolumbar and lumbar curves, than Fusion without sacral involvement, anterior with posterior fusion, and thoracic curve. So in polioscoliosis with thoracolumbar and lumbar curves that need fusion with sacral involvement, the most appropriate procedure is anterior and posterior fusion with HD+SLW instrumentation.

According to the type of procedures, excision of extensive and circumferential hemorroids can distored the anal canal and caused anal stricture and mucosal ectropion formation.The whitehead technique of hemorroidectomy has developed a requtation as undesirable procedure. The chief criticisms have been disturbance of continence, formation of an ectropion, poor healing, stricture formation and prolapse. However with the new modification suggested firstly by authors, these complications were rare or do not occur. In this study 95 patients underwent four flap anal reconstruction (FFAR), performed by authors between 1989 and 1996. All of patients had circumferential prolapsing and bleeding hemorroids and mucosa with or without thrombosis. Postoperative complications included abscess in one case(1%), flap detachment in 9.8%, flap loss in 3.1%, fissure in 10.6%, anal stricture in 3.1% and high stricture in one case(1%). There were no recurrences and there was no ectropion formation. Total morbidity without early and temporary complications was 4.1%. This study suggested that a new modified whitehead technique named FFAR has become the authors’ procedure of choice for circumferential prolapsing and bleeding hemorrhoids.

Fifty consecutive patients with ACL deficiency and inability to do sports and daily activities underwent endoscopic ACL reconstruction with a four strands of hamstring tendon. After completion of a brace free, intensive rehabilitaion in a prospective study we analysed the results.The graft was placed arthroscopically without impingement by the intercondylar roof and was fixed within the tibial tunnel to conserve the length of the graft for the Fixation by A.O screw and spiked washer to the supracondyle of femure. After 6 months the patients returned to unrestricted sports and daily activities. Clinical evaluation performed using the IKDC scoring system. Forty-six patients (92%) considered their knee function normal or near normal. Thirty-one patients (62%) return to their preinjury activity level. One leg hop were more than %90 of opposite side in 24 patients (%48) and more than %76 in 16 patients (%32). In ligament examination group of IKDC, 8 patients (%16) were graded A and 38 patients (%76) graded B. In overall IKDC assassment 45 (%90) were considered normal or nearly normal. Knee function, and return to preinjury activity level had no correlation with ligamnt examination tests (X2=3.19, P>0.05) (X2=1.64, P>0.05), but had a significant correlation with IKDC score (X2=21.42, P<0.001), (X2=19.8, P<0.001) Return to preinjury activity level had a significant correlation with one leg hop (X2=19.8, P<0.001). These results indicate that endoscopic ACL reconstruction using four strands of hamstrig tendon graft and AO screw and spiked washer fixation achieves acceptable knee stability and function, with a high rate of return to preinjury activity level. Knee function mostly correlated to one leg hope and IKDC score, and return to preinjury activites have significant relationship with IKDC score.