Acta Medica Iranica
Volume:49 Issue: 9, Sep 2011

A complicated and controversial subject in obstetrics i.e., toxemia of pregnancy is looked upon, both from an anesthesiological and obstetrical point of view. As pre-eclampsia and eclampsia involve immediate treatment and obstetric considerations, the choice between epidural and general anesthesia becomes necessary when cesarean section is contemplated. Apart from the pathophysiology of the vessel spasm as it is induced by preeclampsia, the therapeutic managements of fluid administration, the drugs of choice to treat hypertension as well as the technical aspects of anesthesia are reviewed.

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10μg/kg/s.c. to neonates in group A and as 10μg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10μg/kg) was effective in treating neonatal septicemic neutropenia.

Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a frequent complication either for diagnosis or treatment of pancreatobiliary diseases. A number of pharmacological agents have been tried for prevention or alleviation of the complication. Allopurinol with free radical scavenger property has been considered as an effective prophylactic agent in some clinical trials. Administration of allopurinol in these trials was done in a long period before doing ERCP. Hence allopurinol converts to oxupurinol in the liver rapidly; it seems that clinical judgment about the net effect of allopurinol on prevention of post ERCP pancreatitis is doubtful. In this randomized double blind clinical trial, effect of allopurinol on prevention or alleviation of clinical and laboratory signs of pancreatitis has been evaluated in 74 patients undergoing ERCP. Results showed that there is not any difference between allopurinol and placebo in occurrence and severity of post ERCP pancreatitis (P=0.97). Also there is not any significant difference in amylase rises between 2 groups in 8 and 16 hours after ERCP (P=0.947, 0.287 respectively). Beneficial effects of allopurinol in some of the previous studies may be attributed to its active metabolite (oxypurinol). Further studies recommended about the net effect of allopurinol and oxypurinol in the complication.

Malignant pleural effusion is a common complication in certain malignancies. Pleurodesis is the best option most of the time. The purpose of this study was to compare the choice of belomycin with povidone-iodine, which is not only determined by the efficacy of the agent but also by its cost, accessibility, safety, ease of administration and the number of administrations to achieve a complete response. We performed a randomized clinical trial on 39 patients presenting with symptomatic malignant pleural effusion. Patients were selected and randomly assigned to undergo chemical pleurodesis with either bleomycin or povidone-iodine. Primary characteristics of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. A complete response was obtained in 79% of belomycin group and 75% of povidone-iodine group which was not statistically significant. Patients on belomycin treatment had a significantly lower score for dyspnea in one month follow up. This was significant after controlling for age, pain score and dyspnea score after drainage, using general linear model. Due to similar effect and significant cost advantage between bleomycin and povidone-iodine, we conclude that povidone- iodine is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

Urinary tract infection is a common pediatric problem and vesicoureteral reflux is its most common complication. Detection of this reflux has classically been achieved by voiding cystouretrography (VCUG). Ultrasonography for evaluation of vesicoureteral reflux is shown to be feasible but is not widely accepted. Our aim was to assess the value of routine sonography in detecting vesicoureteral reflux is young children with urinary tract infection. This study was carried out in 105 patients suffering from urinary tract infection admitted to Shahid Sadughi Hospital in Yazd, Iran. These patients were evaluated by two methods (sonography and VCUG). Overall sensitivity and specificity value of sonography in suggesting vesicoureteral reflux were 63% and 95% respectively. The most accurate results were obtained with high grades reflux (75% and 955). The results reconfirmed that sonography is reliable in the exclusion or verification of high grade reflux and it has a low sensitivity in low grade vesicoureteral reflux.

This study was conducted to determine the effect of Swedish massage on blood glucose level in children with diabetes mellitus (DM). It was prospective randomized controlled trial study that conducted on 36 children, 6-12 years old with DM, recruited from a hospital in Qom City, Iran. The children were randomly assigned to intervention and control groups. Swedish massage was performed 15 minutes, 3 times a week, for 3 months in intervention group. The blood glucose levels were evaluated immediately after every session of massage in two groups. The mean ages of children in the intervention (n=18) and control (n=18) groups were 9.05 ± 1.55 and 9.83 ±2.03 years respectively. There was statistically no significant difference in blood glucose levels before intervention between two groups (P=0.586), but the blood glucose levels were lower significantly in intervention group in comparison with control group after intervention (P<0.0001). Addition of Swedish massage to daily routines; exercise, diet and medication regimens, is an effective intervention to reduce blood glucose level in diabetic children.

Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis (AIS) and careful application of pads on apical segment of curve is very important for correction. Control of pads` appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases (182 female, 33 male) of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2±1.8 years (9-16) and mean duration of follow-up was, 16.1±16.4 months (0-114) that treated by 4 type of brace; 89 with type 1(Milwaukee with metal pads), 87 with type 2 (Milwaukee with simple pads), 17 with type 3 (Boston with metal pads) and 22 with type 4(Boston with simple pads). Cobb angle recorded at 5 stages (initial, best, wean, stop and final follow-up). Mean initial Cobb was 36.2˚, at stop stage, 35.2˚ and reached 38˚ at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients (27.4%) underwent spinal fusion that for brace type 1 to 4, was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50˚, at follow-up, 12 were ≥50˚ or had spinal fusion. Correction of lumbar (P=0.008) and main thoracic curves (P=0.002) was better by Boston than Milwaukee, however, In general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use.

Kawasaki disease (KD) is an inflammatory multiorgan disease of unknown etiology. The most dramatic organ involved is the heart. There were a few studies about cardiac involvement and sterile pyuria. This study guides to determine if sterile pyuria is associated with coronary artery aneurysm (CAA) in KD patients and to consider it as a predicting factor for coronary artery involvement. Forty seven patients with KD were studied by echocardiography in admission and one month later. Urine analysis, complete blood count, erythrocyte sedimentation rate and C-reactive protein were measured in admission. Data were analyzed using SPSS-14 software. Patient's age was ranged from 13 month to 7 years old (mean age of 3.43 ± 1.54 years). Thirty patients (63.8%) were male and 17 patients (36.1%) were female. Cardiac involvement was detected in 32 patients (68%) using echocardiography, of which CAA was reported in 8 cases (17%). Six of CAA (75%) were in association with sterile pyuria, although it was statistically insignificant (P>0.05). Although the majority of patients with CAA had sterile pyuria, this association is not statistically significant, thus it couldnt be considered as a predicting factor for CAA.

We determined the frequency of clinical thyroid ophthalmopathy in Iranian patients. This cross-sectional study was performed at the Endocrinology Institute of Tehran University of Medical Sciences. All patients with documented thyroid disorders from September 2003 to July 2005 were recruited. Eye examinations included evaluation of soft tissue changes, measurement of proptosis, lid width, lagophthalmos, evaluation of eye muscle function, and determination of visual acuity. The activity of ophthalmopathy was scored according to the NOSPECS scale. Among 851 visited patients, 303 cases had thyroid eye disease (TED). The nature of the ophthalmopathy breaks down as follows: 53.4% were hypothyroid (9.3% Hashimoto disease), 5.5% euthyroid and 41.1% had Grave's disease. The prevalence of TED in males was 60% which was nearly 2 times the prevalence of TED in females. There was a significant relationship between presentation of TED and active smoking of the patients (P<0.0001) while no significant relationship with passive smoking was obtained (P=0.181). The most common clinical sign of TED in descending order respectively were proptosis with 63.4%, soft tissue involvement (40.9%), extraocular muscle involvement (22.1%), corneal involvement (12.9%) and optic nerve dysfunction (6.3%). Myasthenia gravis occurred in only 2 patients. In the logistic regression, occurrence of TED was influenced by cardiovascular disease (OR=5.346), Grave's disease (OR=47.507), radioiodine therapy (OR=2.590), and anti-thyroid medications (OR=0.650). Thyroid ophtalmopathy (orbitopathy) is a matter of important health concern among patients with thyroid disorder. Since TED occurred with a high prevalence in all thyroid states, a close collaboration between endocrinologists and ophthalmologists along with timely referrals of patients with any eye complaint is deemed necessary. Also smoking was the most important risk factor for developing TED. Therefore, it is advisable to raise awareness and to strongly encourage smokers with thyroid disorders to quit smoking.

Endometrial stromal sarcomas (ESS) are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35±6.8 (range 36-61). The median parity of the patients was 5 (range 0-8). Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5±35.09 and 57.6±5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82±30 months. Of 17 patients, seven cases (35.29%) were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients (23.53%). Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function.

Communication skills play a paramount role in clinical practice. In every clinical setting, medical doctors need to interview their patients efficiently and be persuasive toward their health issues. This study aimed at assessing the attitudes of medical students toward learning communication skills at Hormozgan University of Medical Sciences in Iran. In this cross-sectional study, the questionnaires were distributed to 210 medical students. Twenty eight students were excluded since they either did not return the questionnaires or filled them out incompletely. So, totally 182 questionnaires were analyzed (response rate=%86.6). Data was collected using communication skills attitude scale (CSAS) which consists of 26 items, 13 indicative of positive attitude and 13 indicative of negative attitude toward learning communication skills. Data were analyzed using SPSS16 software. The mean age of the participants was 21.7 (SD=2.7). Male and female students accounted for 38.5% and 61.5% of the participants respectively. The mean scores for positive attitude was 54.8 (SD=7.3) out of 65, and the mean scores for negative attitude was 35.3 (SD=5.9) out of 65. There were statistically significant differences between male and female students and between basic sciences and pathophysiology students on the one hand and clinical course students on the other as regards their attitudes toward learning communication skills (P<0.05). Although students had strongly positive attitudes toward learning communication skills, curriculum planners should not lose sight of negative attitudes and measures need to be taken to minimize or if possible eliminate them.

Lipoma is the most common soft tissue tumor but the presence of osseous component within the tumor is quite rare. Some studies show that less than 1% of lipomas were ossified. We describe the histological, radiological and diagnostic features of an ossified intramuscular lipoma. To the best of the author's knowledge, a symptomatic ossified intramuscular lipoma without any cortical erosion and hyperostosis has not been previously reported in the literature.

Although gastrointestinal bleeding is common, hemobilia due to the rupture of hepatic artery pseudoaneurysm is uncommon. We report a case of hemobilia which was successfully treated via angiography.