Medical Journal Of the Islamic Republic of Iran
Volume:18 Issue: 3, Autumn 2004

Auditory Electrical Stimulation for Tinnitus Suppression Tinnitus is the conscious experience of sound which arises in the head of its owner, but without a voluntary origin obvious to that person. About 10-15% of all adults report prolonged spontaneous tinnitus (PST). There are a lot of methods for suppressing this complaint. One of these methods is electrical stimulation. Electrical stimulation for tinnitus suppression was investigated by many authors that reported its effectiveness from 22% by Grahams and Hazell (1989) to 87% by Portman (1979). The purpose of the present project was to design and structure a new Auditory Electrical Stimulation device for tinnitus relief in patients who suffer from tinnitus. Our other goal was to execute a pilot project by modelling of our new device on animals. In this project an instrument for applying Auditory Electrical Stimulation (AES) is designed. This device consists of two generators: one is a carrier square wave generator (30 KHz to 100 KHz), the second is another low frequency square signal (1 Hz through 20 KHz) that has an adjustable duty cycle. The entire user interface is on PC, and there are a lot of options that the user can adjust. The PC is connected to a circuit by a serial port and the serial port is isolated from the other pat1s of the circuit. Modulation can optionally be enabled or disabled. The amplitude of current flow can vary from 1 microamp to 1000 microamp (lmilli- Amp) with 1 microamp resolution. The impulse duration can be adjusted (this is a third pulse generator) by the user from 500 microsec delivered at 1/sec to 2000/sec. The combined electrical signal has the maximum peak to peak amplitude of 10 V, which varies to make a constant current through electrodes. A warning device indicates insufficient skin electrode contact. In addition the impedance between electrodes can be monitored on PC. There are several parts that increase the safety of this system. The dimension of the PC board is 11 cm x 14cm. By now the first version which could be used in hospital and/or clinics is made and could be used by patients who suffer from tinnitus. We believe that tinnitus reduction occurred or even disappeared during and after the treatment period by AES. Our results applying Auditory Electrical Stimulation (AES) were effective in our many patients who had clinically been identified as having peripheral or central lesion tinnitus sites. We made a new auditory electrical stimulation device for tinnitus relief in patients suffering from tinnitus that can do electrical stimulations. Also, in an experimental study design on rabbits, we had tested this new device, and evaluated the efficiency to deliver electrical currents and other capabilities in tinnitus suppression. Although study comparisons are confounded by differences in success criteria, subject sampling, methodology and acute tinnitus suppression have been reported in up to 62.5% of subjects (Mahmoud ian et aI., 2001), AES reduces the effects of tinnitus; several factors could be involved in this reduction, i.e. synchronizing discharge of auditory nerve fibers, inhibition of the abnormal activity of the cochlear nerve, the revival neural coding and positive neural plasticity.

Embolectomy has long been the gold standard for treating limbs acutely threatened by arterial occlusion. Delayed embolectomy has not been investigated adequately due to the belief that accompanying mortality and morbidity render the case futile. Following our previous experience with late arterial repair for leg or knee salvage I we applied the same principle to limbs threatened with prolonged ischemia as a result of missed emboli. In this study the response of patients with delayed embolectomy in a 2-year interval is evaluated. All of the patients who presented to Shohada Tajrish Medical Center, Tehran, Iran between 2001 to 2003 with prolonged ischemia of the lower limb (more than 12 hours) were selected for this study. All underwent embolectomy and prior to reinstitution of blood to the ischemic leg, all those with calf rigor underwent simultaneous venotomy and irrigation of the arterial tree with heparinized solution and were studied accordingly. Of the total 76 patients 20% had muscle rigor on admission who underwent simultaneous venotomy and irrigation. The limb was salvaged in 45% of patients with above knee sensory deficit and 40% of those with above knee motor deficit. The salvage rates of the limb for below knee sensory and motor deficits were 79% and 85% respectively. We were able to save the knee in 20% of our patients. The short term m011ality rate in the whole was 9.2%. We had only one operative mortality in this high risk group of patients & our figures are lower than those reported in the literature, while at the same time we were able to salvage their limbs or knees.

This study aimed to evaluate the effects of auditory-verbal rehabilitation on voice parameters after implantation with cochlear implants 2 and 5 months after rehabilitation and compare them with normal voice children (under 12 years of age). A perceptive and electroacoustic evaluation of voice was carried out through a digital analysis after implantation and rehabilitation. The study was performed at Khorasan Cochlear Implant Center in Ghaem Hospital, Mashad University of Medical Sciences in Mashhad. There were 5 prelingually deaf children and 5 children with normal voice and hearing. Voice parameters (average pitch and intensity, perturbation, jitter and shimmer), were obtained. All patients showed better control of voice pitch and intensity and a considerable reduction of voice perturbation, jitter and shimmer after auditory rehabilitation. This study showed no considerable difference on voice parameters between cochlear implanted children and normal children (voice and hearing). ft could be concluded that auditory-verbal rehabilitation as a necessary and important training program for cochlear implanted children provides a recognizable moment-to-moment auditory control on parameters of voice

Hepatitis C virus (HCV) infection is highly prevalent in thalassemic patients, and this may decrease the serum antibody response to hepatitis B virus (HBV) vaccine. There is also some alteration of the immune system in multi-transfused thalassemic patients, as a consequence of iron overload. We investigated whether HCY infection may reduce the effectiveness of HBY vaccine in multi - transfused thalassemic patients. Subjects were cited and studied prospectively in three groups: group I: 125 multi-transfused thalassemic patients with negative serum HCY antibody; group 2: 96 multi-transfused thalassemic patients with positive serum HCV antibody (ELISA II), in at least 2 different occasions; group 3: 100 healthy subjects. Matching was performed between three groups in sex, age and body mass index and subjects in all groups had negative serum HBsAg, anti-HBc and anti-HBs and received three 20 flgr/dose injections of recombinant HBV vaccine (Heberbiovac HB) in months 0, 1, 6. Anti-HBs titer was obtained one month after the last dose of vaccine and it was considered seroprotective if it was 2: 10 lUlL. Seroprotection rate was 83.2% in group 1 and 80.2% in group 2 (p=0.74) and was 86% in healthy subjects, which didn''t significantly differ with HCV positive and negative thalassemics (p>0.05). Moreover, the mean values of ALT among the responders and non-responder thalassemic patients were 55.5 ± 4 l. 9 and 57.4 ± 48.5 U/L respectively(p=0.802). During vaccination periods, patients in all 3 groups did not show any significant adverse reactions. Our study shows that three standard doses of HBV vaccine are immunogenic and safe in multi-transfused thalassemic patients with or without HCV infection.

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor size greater than 4 cm (bulky) in diameter have worse outcome.'' The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NArC) programs followed by radical hysterectomy in stage Ib - lIb bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage Ib - IIb bulky cervical cancer were treated with preoperative extemal beam radiotherapy to 45Gy plus weekly cisplatin 50 mg/m2 or preoperative neoadjuvant chemotherapy by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7-10 days, for three courses, Surgery was perfonned 4-6 weeks after completion of the preoperative treatment. There was no significant difference between age, stage, tumor size and histopathological type in the two groups (p>0.05).Toxicity associated with the two treatment methods was usually mild. In the chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long term hydronephrosis that needed ureteral stenting. Before surgery, complete and pmiial clinical response had no significant difference between the two groups (p>0,05). After surgery, lymph node and parametrial involvement had no significant difference between the two groups (p>0.05). In the NAIC group more patients had significant residual tumor (p=0,0 12) but residual tumor size had no significant difference between the two groups (p>0. 05). Pathological complete response was significantly higher in the chemoradiation group (p= 0. 004), According to the results of this study it seems that NArC and chemoradiation have similar effects on survival prognostic factors

Position changes are believed to increase the efficacy of phototherapy and this practice is routinely used in all neonatal departments in our country. The aim of this study was to determine the effect of routine turning on the total serum bilirubin (TSB) concentration versus only supine position. In a randomized clinical trial fifty healthy term jaundiced neonates who were admitted to the neonatal ward were selected. All babies were healthy tem1 jaundiced neonates more than 48 hours of age delivered after an uncomplicated pregnancy and had indirect hyperbilirubinemia with TSB 2: 15 mg/dL in 49- to 72-hour-oldjaundiced infants and equal or more than 17 mg/dL in 2:72-hours-old ones. Twenty five (turning group) babies were changed from supine to prone position every 150 minutes followed by a break of the 30 minutes for feeding and routine nursing care. The supine group (n=25) were kept in the supine position during the entire study period. TSB was obtained before phototherapy, 12, 24, and 48 hours after phototherapy. The analysis of data was done by SPSS and paired T and T independent student test. These two groups were similar in age, sex, weight at admission, duration of phototherapy, hematocrit and reticulocyte count. The average of bilirubin in these two groups, before phototherapy (p=0.93), 12 (p=0.58), 24 (p=0.74) and 48 hours (p=0.93) after phototherapy respectively were not significant. The results of this study demonstrated that TSB is not affected by the baby''s position during phototherapy.

The optimal fractionation schedule for radiotherapy of head and neck cancer has been controversial. The objective of this randomized trial was to test the efficacy of hyperfractionation vs. standard fractionation. Patients with squamous cell carcinoma of head and neck organs were randomly assigned to receive radiotherapy delivered with A) standard fractionation at 2 Gy/fraction/day, 5 days/week, to 65-70 Gy/7 weeks; B) hyperfractionation at 1.2 Gy/fraction, twice daily, 5 days/week to 75 - 80 Gy/7 weeks. All patients but one completed the treatment. The median follow-up was 24 months for all patients. Patients treated with hyperfractionation had significantly better local-regional control (p<0.005) than those treated with standard fractionation. Although acute morbidity was somewhat higher in the hyperfractionated radiotherapy group, late disturbing effect was much lower in this group. In conclusion, hyperfractionation is more efficacious than standard fractionation for locally advanced head and neck cancer. Acute but not late effects are also increased.

This study briefly reviews the heart abnormalities in diverse intracranial pathologies, including strokes, spontaneous and traumatic subarachnoid hemorrhage and intracranial hemorrhage, and presents the results of a one-year prospective study of heart abnormalities in patients with moderate to severe head injuries and subarachnoid hemorrhage. Different abnormalities such as: QT -interval, T -waves, U-waves, QRS complex, ST-Segment, arterial and ventricular flutter and PAC, heart arrhythmia, angina pectoris and blood pressure changes were recorded and analyzed. The most common electrocardiographic change was ST -segment depression (67%). This report tries to identify a rational relationship among the severity of head injury, site of lesion and level of consciousness at the time of admission, different surgical procedures, site of operation, prognosis and cardiac abnormalities. The presence of the complete pathway for sympathetic outflow from the orbital-frontal cortex to the limbic system via stellate ganglia to the heart is also discussed. In conclusion cardiac abnormalities can greatly increase the morbidity and mortality of patients with intracranial pathologies. Emphasis is made on timely prevention and treatment of cardiac abnormalities preferably by stabilization of homeostasis of the brain condition by medical and surgical techniques; anti-arrhythmic drugs should be avoided unless strongly indicated. Obviously ventricular flutter and fibrillation must be treated with countershock and anti-arrhythmic drugs.

Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. Nonnal term nulliparous women in spontaneous labor were divided into two groups in a quazi-experimental study, 100 in each group. The first group received epidural analgesia and the second had no analgesia at all. In the first group, an epidural catheter was placed in 3-4 cm cervical dilatation and the first dose of lidocaine 1 % was injected in 5-cm cervical dilatation. The next doses were injected according to certain criteria. Then data were collected and analyzed by EPI-6. There was no significant difference in cesarean rate in both groups (10% in the first group vs. 5% in the second one, p>O.l0) including cesarean for dystocia and fetal distress. Also, there was no significant difference in the variable of spontaneous vaginal delivery between both groups (89% in the first group vs. 94% in the second one, p>0.10). Occurrence of instrumental vaginal delivery was the same in both groups, no forceps, and one vacuum-assisted in each group. Also there was no significant difference in the second stage of labor between the groups (less than 1 hour: 79% in the first group vs. 81 % in the second group, p>O.1 0; more than 1 hour: 11 % in the first group vs. 14% in the second group, p>0.10). Epidural analgesia results in no significant difference in the course of labor and delivery in normal term nulliparous women and is a safe method of pain relief in these patients.

Abdominal tuberculosis is still a prevalent problem of underdeveloped countries. Although its incidence has been reduced in developed countries, it is still seen in immigrants and immunodeficient patients frequently. In Iran, even though it''s incidence has been reduced, we are still confronted with undesired mortality and morbidity. In this article we have evolved new management strategies for these patients and then we have performed a retrospective study of over 32 cases to evaluate the results on management of these patients during a 22 year period (1981 - 2003). Females had more involvement, and the mean age was 27.8 years. Fever, abdominal pain, and weight loss were common findings. There were three mortalities (9.3%) and three morbidities (9.3%) including two intestinal fistulae and one obstruction.

Ex vivo expansion of human umbilical cord blood cells (HUCBC) is explored by several investigators to enhance the repopulating potential of HUCBC. The proliferation and expansion of human hematopoietic stem cells (HSC) in ex vivo culture was examined with the goal of generating a suitable clinical protocol for expanding HSC for patient transplantation. Using primary human mesenchymal stem cells, we established a serum-free culture system to expand human primitive progenitors and transplantable stem cells. Non-enriched cord blood CD34+ cells were cultured on a monolayer of human mesenchymal stem cells in the presence of tlu-ombopoietin (TPO), flt31flk2 ligand (FL), and/or stem cell factor (SCF), interleukin 6 (IL-6), interleukin 3 (IL-3) under serum-free conditions. After I or 2 weeks of culture, cells were examined for clonogenic progenitors and percentage of CD34+ CD38- cells. In the presence of TPO, FL, and SCF, fetal MSC cells supported more than a 35- and 20-fold expansion of CD34+ cells and colonyforming units in culture after 1 and 2 weeks of incubation, respectively. In addition, LTC-IC assay were expanded more than 7- and 16-fold after 1 and 2 weeks of culture, respectively. UCB-HSC can be expanded in culture to numbers theoretically adequate for safe, rapid engraftment of adult patients. Additional studies are needed to establish the functional activity of expanded UCB-HSC. This ex vivo expansion system should prove valuable in clinical settings in which stromal cells are available from recipients or stem cell donors.

We investigated neuronal uptake of noradrenaline (NA) at the level of larger vessels (thoracic aorta and vena cava; left renal artery and left renal vein; lateral saphenous artery and lateral saphenous vein and finally central ear artery and marginal ear vein) in a model devised to mimic heart failure. The model presented here is the rabbit coronary ligation model in which myocardial infarction was produced in male New Zealand white rabbits (2.6kg-3.0kg) by ligation of the marginal branch of the left descending coronary artery. The development of chronic heart failure was allowed to proceed over eight weeks. Animals were killed by overdose with pentobarbitone sodium (IV injection). Arteries and veins were carefully removed with as little connective tissue as possible and placed in cold physiological salt solution (PSS). The arterial and venous lings were mounted in 10mL isolated organ baths, bathed in Krebs maintained at 37°C and gassed with 95% O2 plus 5% CO2. The rings were then placed under different resting tensions. They were allowed to equilibrate for 1 hour before the experiments. Initially all tissues were exposed to cumulative concentrations of NA (lnM-300µM). Following complete washout, the preparations were left for 45 minutes to re-equilibrate. After preincubation with cocaine (10µM) for 10-15 minutes to inhibit neuronal uptake of NA, final NA cumulative concentration-response curves (CCRC) were conducted. Alierial plasma noradrenaline is 163% higher in patients with heart failure than in control patients. High plasma noradrenaline correlates directly with the hemodynamic severity of the disease and inversely with survival. Activation of the sympathetic nervous and renin-angiotensin systems may be important in the pathophysiology of heart failure associated with severity of the disease. Elevated levels of circulating noradrenaline in heart failure may result from impaired peripheral reuptake of this catecholamine. Cocaine has generally been used as the prototype drug for inhibition of neuronal uptake of catecholamines. The aim of our study was to investigate the possibility of changing reuptake of noradrenaline by using cocaine in this model of heart failure. In conclusion, effects of cocaine on noradrenaline responses were identical in sham operated compared with coronary ligated rabbits. These results suggest normal neuronal uptake of noradrenaline in this model of heart failure.

The treatment of thyroid cancer using an unsealed source of radioactive materials is usually associated with a large amount of 131I. A major problem for hospital admission of these patients is the waste disposal which requires protection of the public. 152 patients with thyroid cancer admitted to the nuclear medicine department of Said AI- Shohada Hospital for UI I treatment were studied. 1311 excreted from these patients during isolation was calculated. Exposure from patients were measured using a Victorian 190F survey dosimeter. More than 70 percent of the administered 131I was excreted after 24 hours, 90 percent after 48 hours and 96 percent after 72 hours of isolation. The mean biological half life of 1311 in patients with thyroid cancer was found to be 13.9±1.9 hours. There was no significant difference between the mean effective half life in the patients related for the first time and second time at 95 percent significance level. The results of this study showed that the difference in the discharge rate of 1311 from patients with thyroid cancer receiving first and second treatment was not significant. The mean discharge rate after the first 24 hours was more than 70%, and it was more than 96% after the third 24 hours of drug administration. The results can be used to design safe collecting and discharge methods of the wastes.

The effects of ethanolic and aqueous extracts of Rheum ribs L. (RR) of the family polygonaceae was studied on serum cholesterol concentration in rabbits. To induce hypercholesterolemia, 0.5 g/kg/day of pure cholesterol powder was given orally to each rabbit for two weeks; then cholesterol was halved and each group of animals was treated with a different regimen for another two weeks. Both the ethanolic and the aqueous extracts significantly decreased serum cholesterol conc-entration. The ethanolic extract decreased serum cholesterol by the end of the first and the second week by 43.9% and 59.1% (both p<0.001) respectively; while the cholesterol reduction with aqueous extract was 25.01% (p<0.05) and 43.82% (p<0.0 1) at the end of the first and the second week of treatment respectively. The ethanolic extract was found to be more potent than the aqueous one. When comp- ared with nicotinic acid as a positive control, the hypocholesterolemic effect of ethanolic extract was significantly higher than that of nicotinic acid. Therefore, we may conclude that RR extracts have hypocholesterolemic effect and thus can be used in the treatment of hypercholesterolemia which is the major risk factor of cor-onary heart disease (CHD).

Mucormycosis is a fatal and life threatening infection particularly in immunocompromised patients, so early diagnosis and rapid treatment is life saving. A 52-year-old female, known case of diabetes mellitus, presented with chills, fever, fatigue and anorexia. A subcutaneous mass was detected around the umbilicus (4x4). Fine needle aspiration of the mass showed mucor hyphea with little inflammation. The patient was treated with amphotericin B and her fever subsided. The patient was discharged in good health and general condition. Fine needle aspiration can therefore be a rapid and accurate method for the diagnosis of subcutaneous mucormycosis.