مجله علوم پزشکی رازی
سال هفدهم شماره 4 (پیاپی 73، تیر 1389)

Different additives have been used to prolong sensory and motor blockade of the regional anesthetics. The aim of this study was the evaluation of sensory and motor blockade as well as the side effects of adding clonidine 75 mcg to a loading dose of bupivacaine %0.5 in supraclavicular brachial plexus blockade with catheter insertion for upper extremity procedures. In this prospective, randomized, double-blind, controlled study sixty patients aged 20 – 60 years (ASA physical status I or II), candidated for upper extremity orthopedic surgry under supraclavicular brachial plexus blockade, were allocated in two groups (30 in each group). The supraclavicular blockade was performed by peripheral nerve stimulator, and after desirable muscular responses, anesthetic solutions were injected. Control group (B) received 25 ml of 0.5% bupivacaine, and the study group (BC) received 25 ml of 0.5% bupivacaine containing 75 mcg clonidine. After that,supraclavicular catheter for additional injections was indwelt. For additional intraoperative analgesia, 0.5% bupivacaine (5 ml) through catheter and sufentanil and midazolam (Intavenously-IV) was administered. Onset of complete sensory and motor blockade, intraoperative drug administered (bupivacaine, sufentanil and midazolam), complications, duration of postoperative analgesia and motor blockade, time for first postoperative analgesic request, and demographic data were recorded. For normal distribution of the quantitative data t-test and otherwise Mann-Whitney's U test was used. For qualitativevariables, Chi2 test was performed. Statistical analysis was carried out by SPSS V.12. There were no significant differences in the demographic and clinical data between groups (in regard to age, gender, weight, anesthesia and surgical durations). Onset of complete sensory and motor blocks were more rapid in BC than B group (p<0.01). Also there were no siginificant differences in the number of bupivacaine administrations through supraclavicular catheter, and IV sufentanil and midazolam between the two groups. Duration of postoperative analgesia and motor blockade in BC group was more prolonged than B group (p<0.0001). Complications did not show significant difference between the two groups. Time for first postoperative analgesic request was significantly greater in the BC group than B group (p<0.0001). Addition of 75 mcg clonidine to 0.5% bupivacaine for supraclavicular blockade potentiates sensory and motor blockade, and prolongs the time for first postoperative analgesic request without having more side effects, and may be an appropriate alternative adjuvants for adding to bupivacaine.

Chondromatous hamartoma of the chest wall is an extremely rare, benign lesion that usually occurs in early infancy. It usually manifests as a palpable chest wall mass. In the present case report, the clinical, radiologic and histopathologic features of a rare neonatal case of chondromatous hamartoma are reported.Case report: A baby boy of 16 days old was admitted to Hazrat-e-Ali Asghar Childrens Hospital for a palpable right-side anterior chest wall mass with the dimensions of 3×5×4 cm. Ultrasonographic (US) and CT scanning evaluations showed a 16×28 mm mass without mediastinal invasions, necrosis or calcifications. The mass was surgically excised and benign chondroma without significant nuclear atypia, without any mitosis or necrosis, was histopathologically reported. Although rare, this condition ought to be kept in mind while dealing with infantile chest wall masses in order to avoid its complications such as respiratory problems. Surgical excision is usually curative in combination with conservative therapy if possible.

Not all patients benefit from ICSI. To establish the factors that affect the success rate of ICSI is probably useful in determining the prognosis of ICSI. The aim of this study was the evaluation of the relationship between semen parameters and the outcome of the Intra Cytoplasmic Sperm Injection(ICSI). A retrospective case control study was performed on 523 infertile couple who were the candidates for ICSI. After performing ICSI, two positive increasing titers of β hCG test was considered as pregnancy. The results of semen analysis were compared in the two groups with or without pregnancy. SPSS V.16 was used for statistical analysis, and student t and Chi2 tests were used for comparison of parameters. Out of total 523 cases studied there were 106(20.2%) positive pregnancy tests (pregnant group), and 417 cases without pregnancy(non pregnant group). Sperm count(49.10±2.78 million in pregnant group vs. 42.51±1.47 million in non pregnant group, p= 0.043), abnormal head (65.08±1.67 percent in pregnant group vs. 69.48±0.83 percent in non pregnant group, p=0.019), sperm agglutination (high agglutination in 20.8% cases in pregnant group vs. 10.3% high agglutination in non pregnant group, p= 0.006), and leucocytospermia(1.04±0.09 in pregnant group vs.1.41±0.14 in non pregnant group, p= 0.026) showed statistically significant difference between the two groups. The other parameters including abnormality in tail and neck, semen volume and motility did not have significant difference. More sperm count, less abnormal head and low leucocytospermia increase the success rate of ICSI. High agglutination does not reduce the success rate of ICSI.

Pre-menstrual Syndrome (PMS), refers to a cyclic appearance of somatic and psychiatric symptoms in some women. Finding an effective and safe solution for the treatment of PMS had been always under consideration.The purpose of the present study is to evaluate of the effect of Omega-3 fatty acids on the treatment of PMS. A randomized double blind controlled trial was performed on 135 eligible women, and finally 120 women finished the study. The women were randomly assigned into two groups. In the case group (Omega-3 group= group A, n=68), Omega-3 in a dose of 2 gram (2 one gram pearls), and in the control group (Placebo group =group B, n=67), 2 placebo pearls which were completely similar to the Omega-3 pearls, were prescribed. Then, the severity and the duration of each of the symptoms werecompared in both groups, 1.5 and 3 months after beginning of the treatment. Then statistical analysis was performed using SPSS V. 11. Also, t and Chi2 tests were used for analysis. p value less than 0.05 was considered as significant. There were no significant differences between the two groups according to age, BMI, level of education, and the severity and duration of primary symptoms. Forty five days after the beginning of Omega-3, the mean severity of depression (1.85±0.73 vs. 3.72±0.65, p=0.03), anxiety (1.53± 1.04 vs. 4.07±0.91, p=0.02), lack of concentration (2. 49± 1.26 vs. 5.73±1.34, p= 0.03), and bloating (0.95±0.15 vs. 2.31± 0.19, p=0.02) in the case group were significantly lower than the control group. Also the duration of depression (4.25±1.02 vs. 7.21±1.32 days, p=0.04) and bloating (5.53±2.27 vs. 8.33±1.04 days, p=0.031) in the case group were less than the control group. Ninety days after the beginning of the treatment, the mean severity of depression (0.95±0.75 vs. 3.43±0.65, p=0.007), anxiety (0.79± 1.04 vs. 3.89±0.91, p=0.004), lack of concentration (1.48±1.26 vs. 5.63±1.34, p=0.009), bloating(0.74±0.15 vs. 2.14±0.19, p= 0.004), nervousness (2.15±0.93 vs. 6.09±0.86, p=0.01), and the duration of depression (2.12±0.25 vs. 7.46±0.02, p=0.01), nervousness (2.04±0.39 vs. 6.33± 1.45, p=0.02), anxiety (4.45±1.02 vs. 8.23±1.94, p=0.03), lack of concentration (2.16±0.26 vs. 5.55±1.02, p=0.02), bloating (3.32± 1.01 vs. 8.38± 2.32, p=0.004), headache (2.12±0.94 vs. 4.28±1.58, p=0.04), breast tenderness (4.35±1.31 vs. 7.85±2.08, p=0.02) were lower in the case group. It seems that Omega-3 fatty acids may reduce the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration and also may reduce the somatic symptoms of PMS including bloating, headache and breast tenderness, which these effects are increased by longer duration of treatment.

There is still controversy as to whether or not high tibial osteotomy can have any deleterious effects on the outcome of total knee replacement after high tibial osteotomy. The goal of this study was to compare the outcome of this group of patients (study group) to a group of patients with primary total knee replacement. This study was a clinical trial and 38 patients with 41 knee arthroplasties after high tibial osteotomy were compared with a matched group (in regard to duration of follow-up, age, sex, etiology) of patients with primary knee arthroplasty. The follow-up period averaged 4 years. Outcome was assessed using Hospital for Special Surgery (HSS) knee score. Radiologic assessment was also performed. In this study, Chi2, Mann-Whitney U-test, and Independent samples t-test were used to carry out the statistical analyses. SPSS V.16 was also used for data analysis. Surgery in the study group took on average 10 minutes longer (p=0.01), and operative problems were more frequently encountered in the study group. Although the overall Hospital for Special Surgery scores (HSS) showed no significant difference between the two groups, there were more patients in the study group with a poor result (without significant difference). Insall-Salvati ratio in study group was less than control group significantly both before and after surgery (p=0.03, p=0.01). Although there are significant technical difficulties, the overall clinical outcome remains good to excellent in both groups without significant difference.

Use of medicinal plants for attenuation of hyperglycemia and restoration of lipids to normal level is very important in diabetic patients. In this study, the effect of oral administration of Nasturtium officinale on serum levels of glucose and lipids, as well as morphology of Langerhans islets in diabetic rats was investigated. In this experimental study, male Wistar rats (n = 36) were divided randomly into 4 groups i.e. control, treated control, diabetic, and treated diabetic groups. The treatment groups received oral administration of plant-mixed pelleted food (6.25%) for 6 weeks. Diabetes was induced in the rats by administrating a single dose of Streptozotocine (60 mg/kg, IP) Serum glucose, triglyceride, total cholesterol, LDL- and HDL- cholesterol levels were determined before the study, and at 3rd and 6th weeksafter the study. Morphology of Langerhans islets in the 4 groups was evaluated using Gomori monochrome staining method. For statistical analysis of data, Repeated measurement and One-way ANOVA tests were applied using Sigma Stat. Treatment of diabetic rats did have a significant hypoglycemic effect (p<0.01). In addition, there were no significant changes regarding serum total cholesterol, HDL- and LDL-cholesterol levels in treated diabetic group as compared to untreated diabetic group. On the other hand, treated diabetic group showed a significant lower level of serum triglyceride as compared to untreated diabetic group(p<0.05). Regarding histology of Langerhans islets, diabetic group showed a lower number of beta cells, and treatment did not produce any beneficial effect in this respect. Oral administration of Nasturtium officinale has a significant hypoglycemic effect and leads only to appropriate changes in serum triglyceride.

Acute Renal Failure (ARF) is a common complication in Pediatric Intensive Care Units (PICUs) and its quick diagnosis at the bedside is of utmost importance. Various systems have been introduced for the rapid diagnosis of the condition. One of these systems is RIFLE, which based on Glomerular filteration rate (GFR) and urinary output, ARF patients are divided into 5 categories namelyRisk group, Injury group, Failure group, Loss of function, and End stage renal disease. At present we donot have enough data from our centers. The aim of this study was to evaluate the prevalence and risk factors of acute renal failure in PICU. This is a cross sectional study conducted between 2006-2007 on 121 patients admitted to PICU of Mofid Childrens Hospital. We evaluated our patients with demographic data, biochemistry and glomerular filtration rate. Based on patients renal function test and 24 hr urinary output, patient's were placed in one of the 5 groups of the RIFLE system. Prevalence of renal failure and the associated risk factors were evaluated. We also used Regression analysis test, t test, Chi², ANOVA and post hoc test for statistic analysis. We evaluated 121 pediatric patients; 65 cases were males (53.72%) and the rest were females. The prevalence of acute renal failure in our patients was 36.4%. Based upon the RIFLE scoring system 19.8% of our patients were in Risk group, 8.3% were in Injury group and 8.3% were in the other three groups. We found out a significant correlation between patient's Glomerular Filtration Rate(GFR) and diastolic blood pressure, platelet level, pH, PaCo2 and PaO2 and serum bicarbonate (p value 0.038,0.037, 0.044, 0.008, 0.004, and 0.004, respectively). There wasn’t any correlation between GFR and age, sex and urine output at the time of admission. Therefore there could be a relation between these factors and ARF in Intensive care units. We conclude that the incidence of Acute renal failure in ICU centers has significantly increased and hypotension, hypoxemia, acidosis and thrombocytopenia are the major risk factors for this disorder.