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Volume 59, Issue 1 (7 2001)
A 4.5 years old boy with left postero superior lateral neck mass admitted to Shahid Rahnemoon hospital in Yazd. The mass had been noticed 2 years ago and there was no improvement after three times antibiotic therapy. On physical examination there were two masses on the neck. One of them was approximately 3×4 cm and the other was 2×2 cm. On of the masses was located in the left posterior auricular area and the other one in anterosuperior border of SCM. Both masses were mobile, non adhesive, with slight tenderness and without inflammatory signs (ie, redness, warmness etc). In surgery, the parapharyngeal deep neck space was filled by the yellowish-white color tumor with it's «worm-like» projections, extended into the jugular foramen superiorly, lateral oropharyngeal wall medially and supra clavicular area inferiorly. Total resection of tumor was done. The patient was discharged after 5 days with good general conditions. Pathologic report was «Plexiform neurofibroma».
Volume 61, Issue 3 (14 2003)
Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach.
Materials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes.
Results: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen.
Conclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable.
Volume 64, Issue 1 (30 2006)
Background and Aim: Adenoids and tonsils are active lymphoid organs and playing an important role against invading antigens of upper aero digestive tract in children. The purpose of this study is observing the changes in cellular and humoral immunity of children six months after adenotonsillectomy.
Materials and Methods: The study population consisted of 30 children (aged 4-10 years) with chronic adenotonsillar hypertrophy and 30 age- matched healthy children. In all children serum level of IgM and IgG, percentage of T lymphocytes (CD3) , T helper (CD4) , T (CD8) and B lymphocytes (CD20) were measured. These parameters were re-measured in patients 6 months after adenotonsillectomy.
Results: Before the operation, a reduction in percentage of T lymphocytes (CD3) , TCD4, TCD8 and B CD20 was seen compared with control group. This reduction was only significant in T lymphocytes (CD3) (P.Value=0.03). The serum IgM level was not different in two groups and IgG level was elevated in two groups but not significantly different. Six months after operation the percentage of lymphocytes T CD3+, TCD8+, TCD4+ and BCD20+ was increased and reached the control group. The IgG level was also significently decreased in patients after operation (P.Value=0.00).
Conclusion: Our results indicate that cellular and humoral immunity decreases in children with chronic adenotonsillar hypertrophy preoperatively and increases to healthy children level, six months postoperatively. It means that chronic adenotosillar hypertrophy affects some parameters of cellular and humoral immunity and adenotonsillectomy by removing chronic stimulations reverses these changes without any negative effect on immune function of patients.
Volume 64, Issue 2 (30 2006)
Background and Aim: It seems that diabetes mellitus affects hearing system by several mechanisms including microangiopathy ,sorbitol deposition and glycosilation ,dealing to progressive bilateral sensorineural hearing loss which is related duration of diabetes.
Materials and Methods: This is a descriptive cross-sectional study performed on 300 patients with type 2 diabetes mellitus aged 30 to 50 years and a control group of 300 persons matched regarding age and gender .The cases were selected randomly and they were assessed by a quastionaire before performing audiogram. The exclusion criteria were conductive hearing loss sensorineural hearing loss with any other cause and other metabolic diseases .Audiometric test battery consisting of pure tone audiogram (PTA) and impedance were perfumed on both case and control groups.
Reasults: In this study the hearing threshold in low and high frequencies in case group was higher than control group. In different age groups, the mean high and low frequencies hearing threshold in case group was higher than control groups. Based on duration of diabetes , the mean hearing threshold in the group with 8 to 18 years duration of diabetes was higher than the other two groups with 1 to 3 years and 4 to 7 years diabetes duration. The hearing level of hypertensive and normotensive diabetic patients were not significantly different. The mean hearing threshold was not significantly different between male and female diabetic patients.
Conclusion: In general, diabetic patients have a poorer hearing compared with normal population and there is a significant relationship between duration of diabetes and incidence of sensorineural learning loss.
Volume 64, Issue 3 (1 2006)
Background: Intra-rater agreement in observing and decision making in diagnosis of any disease is of great importance.This investigation is to observe and read ultrasound pictures of ovarian cysts and distinguish its category for any radiologist. Distinguishability is one of the related entities in this matter and radiologists&apos ability in correct diagnosis is of great concern. In this study, we evaluated radiologist’s distinguishability of ordered categories of ovarian cyst diseases (benign, borderline and malignant) in ultrasonography. To do this, we measured intra-rater agreement of radiologists by Weighted Kappa coefficient, and then by the help of “square scores association model” and “agreement plus square scores association model” we evaluated their distinguishability in diagnosis of the severity of the ovarian cyst’s diseases.
Methods: In this analytical cross-sectional study, two radiologists and three radiology residents assessed ultrasounds of 40 patients separately and independently in two periods (with the interval of one week). Patients selected from those who were referred to Mirza Koochak Khan Hospital in January 2005. Ultrasounds were performed by an expert radiologist and by a single apparatus.
Result: Data from radiologists was evaluated by “square scores association model” due to their superior results of distinguishability. Mean of Weighted Kappa coefficient was 0.81 and intra-rater agreement was 0.99 for our radiologists, but due to weaker results of our residents, we used “agreement plus square scores association model” for analyzing and mean of Weighted Kappa coefficient was 0.65 and intra-rater agreement was 0.97 for them.
Conclusion: Although radiologists had a better function than their residents, all of them showed appropriate distinguishability and intra-rater agreement in diagnosis and categorizing of the ovarian cyst’s disease. To distinguish benign category from borderline was more difficult than to distinguish malignant category from borderline and radiologists showed better results in this than their residents did.
Volume 65, Issue 2 (8 2008)
Background: Traumatic tympanic membrane (TM) perforation is a common injury of the ear with a high rate of spontaneous healing if the patients strictly adhere to water precautions. The purpose of this study was to determine the factors involved in the spontaneous healing of traumatic TM perforations in order to ascertain the best treatment plan including observation, paper patch and finally surgery.
Methods: In this correlative–descriptive study, we recorded the outcome of each patient with three-month follow up. Included in this study were a total of 202 forensic medicine patients from the Dept. of Otolaryngology Head & Neck Surgery at the Yazd University of Medical Sciences, Yazd, Iran. All patients included in this study had traumatic TM perforation. Based on otoscopic examination, the perforations were classified as pinpoint or large. All patients received an audiometry exam and were followed for three months. The data was collected using a special form and analyzed by chi-square test, Fisher exact test and ANOVA.
Results: This study consisted of 118 male and 84 female patients with a mean age of 23.6 years (6-48 years). The types of trauma included compression injury (104 patients), instrumental injury (59 patients), burn–slag injury (2 patients) and blast injury (1 patient). One hundred and eighty patients had pinpoint TM perforations, 99.4% of which healed spontaneously by the second month, and 32 patients had large TM perforations, 50% of which healed spontaneously by the second month. During the first month, 87.3% of the patients observing water precautions had healed, however the healing rate was only 5.6% in patients not adhering to water precautions, who suffered from otorrhea. Therefore, during this study, 185 (91.58%) patients had spontaneous healing by two months and only 6 patients of remaining 17 patients healed with paper patch. The mean hearing loss at 500, 1000 and 2000 Hz was 10.55 dB (5-30 dB).
Conclusion: In our experience, patients with traumatic TM perforations have higher spontaneous healing rate when observing water precautions. Furthermore, we recommend observation and paper patching for three months before attempting any surgical intervention in such patients.
Volume 65, Issue 8 (3 2007)
Background: In rhinoplasty, periorbital edema and ecchymosis is due to soft tissue trauma and small vessel injury with subsequent exudation and bleeding. The main purpose of this study is to determine the effect of dexamethasone in reducing periorbital edema and ecchymosis and intraoperative bleeding in rhinoplasty patients.
Methods: This double-blind study included 90 patients who underwent rhinoplasty from October 2004 to March 2005. In group A, 8 mg of intravenous dexamethasone was administered only preoperatively. In group B, 8 mg of dexamethasone was administered preoperatively and continued every 8 hours postoperatively. Group C, the control group, received no dexamethasone.
Results: The degree of upper lid edema in groups A and B was significantly less than that of group C. During the first and second day the severity of upper lid edema in group B was less than that of group A, but the difference was not significant. The degree of lower lid edema during the first and second days in groups A and B was significantly less than that of group C, although it was identical in all groups during the fifth and seventh days. The degree of upper lid ecchymosis during the first and fifth days in group C was significantly more than that of groups A and B, but it was similar on the seventh day in all groups. The degree of lower lid ecchymosis on the first day in groups A and B was significantly less than that of group C however, it was similar in all groups during the second, fifth and seventh days. The volume of intraoperative bleeding in the three groups was similar. The mean period of recovery (12 days) was comparable in all groups.
Conclusions: Dexamethasone administration leads to the reduction of upper lid edema, ecchymosis and lower lid edema during the first and second postoperative days, and reduction of lower lid ecchymosis on the first postoperative day.
Volume 70, Issue 4 (5 2012)
Background: Inflammatory enzymes and free radicals are important factors affecting the immune system. However, there seems to be no detailed information about the extent to which these factors can affect superoxide dismutase 1 gene expression in female athletes, especially in incremental exercises. Therefore, the aim of the present study was to investigate the correlation between superoxide dismutase 1 gene expression with lactate dehydrogenase (LDH) and free radicals in female athletes after an incremental intensity exercise.
Methods: Fifteen 22-24 year old female athletes from Urmia, Iran voluntarily participated in the study after completing an informed consent form in 2010. Venous blood samples were collected in three stages: prior to, immediately and 3 h after an incremental exercise (12 km/h at a 5% gradient for 20 min). Real-time PCR was used to assess superoxide dismutase1 (SOD-1) gene expression as was an autoanalyzer for hydrogen peroxide (H2O2) and LDH concentrations.
Results: LDH concentration significantly increased in both stages of the exercise (immediately and 3 h after the exercise), (respectively, P=0.009 and P=0.026), but H2O2 concentration significantly increased only in the recovery phase (P=0.002). SOD-1 mRNA did not significantly increase in any stage of the exercise (P=0.05). Moreover, there was only a significant correlation between SOD-1 mRNA and H2O2 increase (P=0.014).
Conclusion: Incremental exercise increased H2O2 and LDH levels in female athletes but only free radicals had a significant effect on SOD-1 gene expression.
Volume 75, Issue 6 (September 2017)
Case presentation: A 37-years old woman was admitted in an University Hospital of Mashhad University of Medical Sciences, Iran, in 2016 two weeks after genital surgery. The chief complaints were fever, painful tenderness, ulcerative lesion and inflammatory papule on surgical site and thigh. She suffered of fever despite received oral and then wide spectrum intravenous antibiotic therapy. Blood cultures and wound culture were negative. In addition to two deferent intravenous antibiotics, topical wound debridement was performed. Despite this course of treatment which did not improve the lesion, biopsy was performed. Histopathology features of biopsy specimen indicated prominent neutrophils mixed inflammation and lymphocytic vasculitis indicated as pyoderma gangrenous. The patient's medical history included associated ulcerative colitis from 18 years ago and she was under irregular oral receiving of Asacol (mesalamine). Intravenous corticosteroid therapy was administered which led to response of skin of right thigh and surgical site inflammation. After 6-months follow-up, the patient is still in good condition.
| Conclusion: Based on major variable clinical manifestations and no diagnostic serologic test of pyoderma gangrenosum, diagnosis of this disease is difficult. Increased awareness about PG and exclusion of other etiologies such as inflammatory and immunologic disease will aid in prompting of pyoderma gangrenosum diagnosis and proper management of the disease. |
Volume 75, Issue 12 (March 2018)
Case presentation: In the first pregnancy of a 29-year-old woman with gestation age of 31 weeks was referred to obstetric emergency unit Ghaem Hospital, Mashhad, Iran in March 2015. She had Grave’s disease in her past medical history which was treated with methimazole before pregnancy and propylthiouracil (PTU) during pregnancy. In admission, she presented with tachycardia and tachypnea and hypertension and lower extremity edema. During pregnancy, she used propantheline instead of propylthiouracil due to pharmacy mistake. She admitted in Intensive care unit. After rule out of pulmonary embolism, ultrasonography showed a fetus with 30 weeks of gestational age with an approximate weight of 1680 grams. The amniotic fluid was reduced. She was treated with thyroid storm diagnosis due to a medication error. In serial obstetric visits fetal heart rate was not detected. Due to the fetal death, the pregnancy was terminated. Hyperthyroid therapy continued with PTU after delivery. She was discharged with a good general condition.
Conclusion: Despite the rarity of thyroid storm during pregnancy, in the event of unstable hemodynamic condition and cardiac dysfunction in pregnant women, rule out of thyroid disorders should be considered. Clinician should be paid attention to past drug history and underline disease of patient.
Volume 81, Issue 2 (May 2023)
Case Presentation: In February 2022, a 36-year-old man who had undergone splenectomy due to trauma 16 years ago was referred to the emergency department at Imam Ali Hospital in Bojnord. He complained of sudden onset of severe abdominal pain, preferably in the upper region of the abdomen. The patient denied having any recent issues. Based on the patient's history and examination, at perforated stomach ulcer and pancreatitis were initially suspected. However, except for leukocytosis, no other abnormalities were observed in the laboratory tests. Ultrasound revealed a low-echo mass-like lesion in the anatomical location of the spleen. Another low-echo mass-like lesion, indicating a hematoma with abundant free fluid in the abdomen and pelvis, was also observed near the aforementioned mass. CT scan confirmed these findings. Open surgical and re splenectomy procedures were performed, and the diagnosis of spontaneous AS rupture was made based on clinical examination and imaging findings.
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Conclusion: In any patient with a history of previous splenectomy who presents to the emergency room with diffuse and acute abdominal pain, even without recent trauma, if a mass-like lesion is observed in the anatomically suspicious location of the spleen in the left subphrenic space, along with other evidence of rupture such as hematoma/laceration and free fluid in the abdominal cavity, accessory spleen rupture should be considered as the main differential diagnosis.
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Volume 81, Issue 4 (July 2023)
Methods: This study was conducted in Isfahan from April 2022 to February 2023. The participants consisted of 56 people with rotator cuff pathology. The process of adapting and translating the questionnaire was done with the methodology presented previously by Beaton et al. Content validity was first tested by a group of orthopedic and physical medicine and rehabilitation specialists and then through a pilot study consisting of 15 Persian-speaking patients with rotator cuff disease. Test-retest reliability was established with an intraclass correlation coefficient. Internal consistency was calculated using Cronbach's alpha. The measurement's error estimation was calculated with the standard error of the measurement. Reproducibility evaluation was measured with a 3-day interval between the completion of the test-retest questionnaire.
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Results: The age range of the participants was 34 to 68 years (55% men and 45% women). The mean (standard deviation) of the total score of the RC-QOL questionnaire was 44.33(10.81) and ranged from 17.35 to 70.88. Cronbach's alpha was 0.971, which showed high internal consistency. The intraclass correlation coefficient was 0.99, indicating high test-retest reliability. The mean values (standard deviations) of the DASH and SPADI questionnaires were equal to 77.66(13.69) and 66.66(18.25), respectively. The results of the study showed excellent and significant convergent validity of the RC-QOL questionnaire with both the DASH and SPADI questionnaires. The correlation value with the DASH and SPADI questionnaires was equal to 0.907 and 0.941, respectively.
Conclusion: The Persian version of the RC-QOL questionnaire is a valid and reliable tool to evaluate the quality of life in patients diagnosed with rotator cuff injuries. |
Volume 81, Issue 6 (September 2023)
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Case Presentation: The patient is an 18-year-old woman, 20 weeks pregnant, who came to the Emergency department of Bentolhoda Hospital in Bojnurd with diffuse sudden onset of abdominal pain in the September of 2023. On examination, the patient's vital signs were unstable, which was due to the presence of hemorrhagic shock. In the examination of the patient's abdomen, or generalized tenderness and rebound tenderness? was evident, suggesting peritonitis. According to the ultrasound report, abundant free fluid and fluid containing blood was drained from the abdomen under ultrasound guidance. The patient underwent surgery with the diagnosis of hemorrhagic shock with a midline incision of the abdomen above and below the umbilicus. In the performed surgery, evidence of splenic artery aneurysm rupture was evident. For the patient, ligature and resection of splenic vessels (artery and vein) and splenectomy were performed. After surgery and stabilization of the patient's condition, fetal health ultrasound was performed, and the fetus had no heartbeat. Therefore, medical induction of abortion was performed, and after 48 hours, the fetus was completely expelled, and then mother was transferred to the ward. And four days after the surgery, she was discharged with general improvement. No remarkable adverse effects were observed after surgery.
Conclusion: One of the rare diseases is splenic artery aneurysm, which is difficult to diagnose due to its asymptomatic rupture and high mortality rate. |
Volume 81, Issue 8 (November 2023)
Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly due to fibrosis and ectopic or excessive collagen fibers production in organs. Myocardial fibrosis is the main finding of cardiac involvement in patients with systemic sclerosis. In recent studies, the presence of Fragmented QRS complexes (FQRS) has been shown in the surface electrocardiogram in relation to fibrosis.
Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals.
| Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score. Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders. |
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