Medical Journal Of the Islamic Republic of Iran
Volume:19 Issue: 4, Winter 2006

Hysteroscopy is considered as very important in the investigation of abnormal uterine bleeding. It is usually performed as an outpatient procedure under either local or no anesthesia. This study was designed to compare the combination of paracervical block (PCB) and conscious sedation with paracervical block or conscious sedation alone for outpatient hysteroscopy in terms of pain control and patient satisfaction. A total of 60 women with abnormal uterine bleeding were considered eligible for the study. Patients were randomized into three groups. Group A (20 patients) underwent diagnostic hysteroscopy with conscious sedation, in group B (20 patients) paracervical block was performed, and group C (20 patients) received both conscious sedation and paracervical block. Main outcome measures were pain control during the procedure, the postoperative pain score at 15 min, 60 min, and 24 h after the procedure, and patient''s satisfaction rate. There were significant differences between combination therapy with other groups in terms of pain control during the procedure (paracervical block plus sedation versus the other two groups: p

With respect to physical relations in force and pressure, we hypothesized that the prevalence of traumatic tympanic membrane perforation in patients with a patulous Eustachian tube is greater than normal, because in Eustachian tube patency, the internal air pressure of the middle ear will not increase after compression, subsequent to trauma. Therefore the force upon the tympanic membrane may cause it to perforate easier. In this study we evaluated 45 patients with traumatic tympanic membrane perforation. After otoscopy, modified inflation-deflation test was performed to determine the opening, closing, and residual pressure of the Eustachian tube. Approximately 60 percent had a patulous Eustachian tube, 27% had poor Eustachian tube function and 13% had normal Eustachian tube function. It appears that patients with a patulous Eustachian tube are probably at high risk for traumatic tympanic membrane perforation.

The aim of this study is to assess the therapeutic efficacy and safety of a particular brand of IFN alpha (PDferon B®) in combination with ribavirin (RlBA) on Iranian patients with chronic hepatitis C (CHC). The addition of RIBA to the standard treatment with interferon (IFN) alpha led to an improvement in sustained virologic response (SVR) from less than 20% with IFN monotherapy to 40-45% in combination therapy. 69 naive patients aged 18 years or older with CHC were enrolled and treated with 3 mega units (MU) IFN alpha-2b three times a week plus 800-1200 mg RIBA per day for 48 weeks and the patients were followed for 6 months. The efficacy was evident at the end of treatment and at the end of follow-up in terms of sustained normalization of alanine aminotransferase and sustained serum H CV-RNA loss. The rates of sustained biochemical and virologic response were 63% and 61%, respectively. Virologic response was 83.1% and 86.4% at weeks 12 and 48 as well. No patients had serious complications. Although we had no control group using standard IFN alone, our preliminary findings showed an acceptable and promising response rate to PDferon. On the other hand, it seems that adverse events with PDferon are as other standard IFNs.

Lip carcinoma is a common cancer with a good prognosis and when patients refer early in the course of disease the results of treatment are acceptable. Surgical procedures for reconstruction of lip defects are the use of remaining lip tissue, tissue from the opposite lip, adjacent cheek tissue, distant flaps and microvascular free flaps. The bitemporal (visor) flap is a regional flap that is used in large advanced upper lip lesions. This study shows that it can be used in the reconstruction of total lower lip lesions. It is in the same operative field, the defect can be covered in the same operation, spread of disease is detected more easily, and it can camouflage the scar. In male patients it is very acceptable aesthetically and multiple surgical teams are not required. Two patients with advanced lower lip squamous cell carcinoma were operated and the defect reconstructed with a bitemporal (visor) flap. After the hair is shaved, a bipedicle temporal flap including the major branch of the superficial temporal artery was swung in two portions over the defect, and a split-thickness skin graft used to cover the donor site. Both patients had no major problem with deglutition or speech after sectioning the pedicles. The bipedicle temporal flap can be used for reconstruction of midface defects. There is no report of! ower lip reconstruction with the bitemporal flap. This study shows that the bitemporal flap can be used in reconstruction of total lower lip lesions, especially in male patients. It is in the same field, the defect can be covered in the same operation, spread of disease is detected more easily, it can camouflage the scar and does not require two team management.

Intra-articular T- type or Y- type fractures of the distal end of the humerus are relatively rare, and consequently few surgeons will be able to attain extensive experience with the surgical treatment of these injuries. The current emphasis is on operative intervention with rigid internal fixation and early mobilization. In this prospective and retrospective study, we reviewed a series of 38 displaced-comminuted intra-articular T-type or Y-type fractures of the distal end of the humerus that were operated through the trans-olecranon approach by a single surgeon and fixed by multiple pins and/or screws over an 8 year period from June 1995-July 2003.The fracture patterns were classified according to RR (RisboroughRadin) and a strict rating scale (Jupiter et al.) incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow up of 18 months, 14 results were rated as excellent; 15 results as good; 6 results as fair; and 3 results as poor. Complications included postoperative ulnar nerve neuritis in one patient; non-union in one patient; elbow joint stiffness in two patients; superficial infection in three patients; and pin protrusion in three patients. Over-all, follow up examination showed 76% excellent and good results, 16% fair results and 8% poor results. We prefer anatomical reduction and stable fixation with pin and screw with limited soft tissue dissection in adults and in old patients with good bone quality.

The goal of this study is to evaluate the efficacy of intraperitoneal (JP) cisplatin as consolidation treatment, in epithelial ovarian cancer patients with pathologically negative surgical reassessment, following first-line platinum-based chemotherapy. This study included 22 patients with FIGO stage (IIc- IV) epithelial ovarian cancer (EOC) which had no evidence of disease and were assessed by second- look surgery. They were given 3 cycles of intra peritoneal (IP) cisplatin (100 mg/ m2) with 3 weekly intervals as consolidation therapy. Survival was compared to that of a group of contemporaneous patients undergoing observation only, after completion of standard therapy. Median age of these 22 patients was 56 years (30-70 years). Stage distribution was II (3), III (16), and IV (3). Histologic grade was I (1), II (11), III (9), and residual disease at completion of initial surgery was none/microscopic in 4/22 (17%) patients. Median age of 43 patients who did not receive consolidation therapy was 52 years (28-74years). Stage distribution was II (7), III (32), and IV (4). Histologic grade was I (8), II (17), III (15), and not recorded (3). Median follow-up for both groups has been 46 months. Median disease-free survival (DFS) for the observed patients is 28 months and 44 months in the consolidation group. DFS distribution between groups was compared using the log-rank test and found to be significant (p= 0.03) Multivariate analysis revealed that the only significant predictor of improved DFS was protocol treatment (p< 0.01). This study indicates that consolidation IP cisplatin following negative second-look surgery is feasible, severe toxicity was not frequent and may provide a favorable outcome in terms ofDFS compared to nonprotocol patients who underwent observation alone. Further trials will be required to evaluate the role of consolidation treatment and improve its options in ovarian cancer.

Because nerve stimulators are not always available for brachial plexus block, fmding the right injection spot for nerve blocks is important. In this study we used physical examination to determine the appropriate spot for injection. All patients who were candidates for upper extremity surgery and were either in class ASA I or ASA II, were selected. Paresthesia was elicited in the operation field and the three middle digits using the physical examination method. 50 cases were included totally. Paresthesia in the operation field or the three middle digits was elicited in 46 cases in which complete block was produced by local injection (success rate: 100%). Paresthesia was elicited in the shoulder region in 3 cases and in the upper arm in 1 case. In the latter case complete block was achieved by blind local injection. In the former three cases general anesthesia was necessary. No adverse effects were seen. Apparently, eliciting paresthesia in the operation field and the three middle digits before injecting the anesthetic solution will increase the success rate and reduce adverse effects.

Febrile convulsion (FC) is one of the most common emergency diseases in childhood that has an incidence of3-4%. The most common causes ofFC are gastroenteritis and respiratory infections. We know that exclusive breast-feeding in the first 6 months oflife decreases this disorder. In this study we evaluated the frequency of exclusive breast-feeding on children who had FC and were admitted in the pediatric emergency department of Imam Reza hospital. Control group was 100 children, who were matched with the case group. 65.5% of the case group had exclusive breast-feeding in the first 6 months oflife, compared with 7 5% in the control group. It was not significantly different (p>0.05). However, 55% of children with complex FC had been exclusively breastfed compared to 75% in the control group (p<0.05). Exclusive breast-feeding in the first 6 months oflife does not have a significant effect on FC, but it may protect children from complex FC which is a predisposing factor for epilepsy.

The purpose of this study was to investigate the ratio of Electromyography (EM G) activities of the vastus medialis obliqus (VMO) and vastus lateralis (VL) within seven angles of knee joint range of motion using isometric contraction in open kinetic chain (OK C) and closed kinetic chain (CKC). The dominant knees of 44 healthy female subjects (mean age: 24.84 with range: 20-30 years old) were analyzed. Surface electrode pairs were attached over the VMO and VL by using Basmajian methods. The EMG biofeedback data was collected while the subject performed isometric contraction on isometric and squat exercise within 7 degrees (0° to 90°) with 15° intervals of knee flexion angle. Paired T-test andANOVA were performed between variables. Results demonstrated that in this study there are significant differences: I) between OKC and CKC exercise in 0°, 15°, and 30° ofknee flexion, II) between all angles in CKC except: 0-15°,0-30°, 0-45°, 15-30°, 60-75°, and 75-90°, and III) between 15-60°, 30-60°, 45-60°, and 60-90° in OKC (p)

Calcineurin inhibitors (CNI) have significantly reduced the incidence of acute rejection. Nephrotoxicity however may contribute to long-term allograft dysfunction. Mycophenolate mofetil (MMF) may allow cyclosporine (CsA) dose reduction without increasing the risk of rejection. In seventy-eight living unrelated kidney transplant patients with renal dysfunction, we studied the effect of CsA dose reduction in association with MMF on renal function and cardiovascular risk profile. We reduced the cyclosporine dose from mean 3.5±0.94 mg/kg/d to 2±0.51 mg/kg/d,p

There is a conserved portion in the 16S rRNA gene of bacteria which can be amplified by the universal PCR method. This fragment is 996 bp in length. In this method, only one set of universal primers is used for the amplification of the conserved region of the 16S rRNA gene, in common bacterial pathogens. Therefore, using the universal PCR method, these bacteria are detectable only by one set of primers; then for detection of the bacteria, the PCR products are digested by the restriction endonucleases. Since the restriction patterns of bacteria (RFLP) are expected to be different from each other, on that basis we can identify the bacteria. The conserved fragments of the 16S rRNA genes ofthe following bacteria were amplified by the universal PCR Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa and Neisseria gonorrhoeae. The PCR products were digested by BsuRI (Hae III) restriction endonucleases and were electrophoresed on agarose gel. The restriction patterns of these bacteria were different. Thirty isolated E. coli and 28 isolated S. pyogenes from clinical samples were studied by this method. The size of PCR products and RFLP patterns of every bacterium were the same as standard strains. In comparison with culture method, the sensitivity of the universal PCR is 92.3 %.The sensitivity of this method was determined up to about 11 and 190 bacteria for gram negatives and gram positives respectively. These studies suggest that the universal PCR method accompanied with RFLP is a very useful and rapid method, for detection and identification of bacteria in body fluids.

The lipid peroxides and their degradation products are highly toxic to spermatozoa and may play a major role in sperm dysfunction. The purpose of this study was to determine the level of lipid peroxidation as indicated by malondialdehyde (MDA) in the spermatozoa and seminal plasma of asthenozoospermic and normozoospermic males. In addition, correlation of lipid peroxidation with motility grades: a (rapid progressive), b (slow progressive), c (nonprogressive), d (immotile), percent of normal morphology, acrosome and tail defect, and concentration of spermatozoa was determined. MDA of spermatozoa and seminal plasma was determined in 35 asthenozoospermic and 15 normozoospermic men by spectrofluorometry. Semen analysis was done according to the WHO standard. MDA in the spermatozoa of asthenozoospermic patients was significantly higher than normozoospermic males (0.14±0.0 1 and 0.09±0.0 1 nmol/1 0* 106 spermatozoa respectively, mean ±SE). A significant negative correlation was observed between MDA of spermatozoa with grade a motility and concentration of spermatozoa. In addition, a significant positive correlation was observed between MDA of spermatozoa with the acrosome and tail defect. The MDA value in the seminal plasma of asthenozoospermic and normozoospermic patients was 1.35±0.07 and 1.2±0.08 nmol/mL seminal plasma respectively (mean±SE). The MDA of seminal plasma exhibited a negative correlation with grade a+b motility and positive correlation with grade c+d motility and head defect. Lipid peroxidation has a deleterious effect on semen quality and MDA is an index of lipid peroxidation which may be a diagnostic tool for the analysis of infertility in asthenozoospermic patients.

This study investigated the applicability of the Post-traumatic Stress Disorder Symptom Scale (PSS) in a group of adolescents who had been directly involved in a disaster in Tehran. Participants were 20 adolescents who had survived a boat sinking in Tehran''s city park in 2002. The assessment measures used were the Post-traumatic Stress Disorder Symptom Scale (PSS) and clinical interview based on DSM-IV Seventeen participants (85%) were diagnosed with PTSD using PSS and seventeen (90%) were diagnosed with PTSD by psychiatric interview. The PSS appears to be an effective and efficient method of screening for PTSD.

The aim of this study was to review and characterize the pattern of CNS lesions in patients suffering from AIDS and to correlate these patterns with clinical disorders. The MR scan, medical records and laboratory findings of 58 AIDS patients were reviewed retrospectively during April 1994 to November 1997 at the Olive view/UCLA and Shiraz Medical Centers, and the patterns of CNS involvement by secondary pathologic processes were divided into three types: 1- Focal parenchymal lesions with enhancement and mass effect that could be solid or ring shaped. 2- Focal parenchymal lesions without mass effect and enhancement. 3- Leptomeningeal enhancement with or without adjacent cortical involvement. Focal parenchymal enhancing lesions appeared to be caused by toxoplasmosis and primary lymphoma. Multiple ring enhancing lesions were most common with toxoplasmosis. Focal parenchymal lesions without mass effect and enhancement were detected specifically in PML and all were deep within the white matter structure. Leptomeninges with or without adjacent cortical enhancement were seen in CNS infectious diseases such as TB, cryptococcosis/coccidioidomycosis and herpes zoster as well as in secondary CNS lymphoma. Granulomatous meningo-encephalitis mostly presented as basal leptomeningitis while herpes meningo-encephalitis was typically located in the temporal lobe. Secondary lymphoma showed high vertex leptomeningeal involvement. The medical history/clinical presentation/CSF findings/stereotaxic biopsy, therapeutic response and postmortem pathologic results were used to distinguish the different etiologic agents. Of a total of 58 HIV seropositive patients, 12 (20%) appeared to be infected by toxoplasmosis, 7 (12%) by TB, 8 (14%) cryptococcosis, 5 (9%) coccidioidomycosis, 2 (3%) herpes zoster and 3(5%) cases were diagnosed as PML (progressive multifocal leuko-encephalopathy) according to high serum titer for papova virus group B. Sixteen cases revealed evidence of CNS lymphoma of whom 9 were diagnosed as primary and 7 as secondary CNS lymphoma. In 5 cases HIV infection itself was suspected to be the etiology of the abnormal MRI finding. In spite of newly developing MR spectroscopy techniques for differentiation of CNS lesions in AIDS, categorization of different MRl patterns of CNS diseases in HIV seropositive patients is still helpful in differentiating various types of common CNS lesions in AIDS.