Tehran University Medical Journal

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Children undergoing general anesthesia for strabismus surgery have a higher incidence of postoperative vomiting than those receiving the same anaesthesia for other types of ambulatory surgical procedures. Droperidol (0/0 75 mg/kg IV) and promethazine (0.05-1.0 mg/kg) were used in 100 children between 2-15 years old. Promethazine which has sedative property, anticholinergic antihistaminic, antiemetic and anti-motion sickness effects is recommended for children 0.05 mg-1.0 mg/kg of body weight IV. After induction of anesthesia and before operation and manipulation of the eye and combined with 0.5 mg/kg IM promethazine after operation. The incidence of vomiting following strabismus surgery might be reduced more than with intravenous droperidol

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Since its introduction in 1988, laparoscopic cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1) Recurrent biliary colic (88.4%), 2) Non-specific manifestations of gallstone (5.8%) and 3) Asymptomatic gallstone (1.7%). Contraindications for LC are: 1) Acute cholecystitis 2) CBD stone and/or dilatation, 3) Gallbladder cancer, 4) Intra-abdominal malignancies, 5) The need for other elective abdominal operation, 6) History of upper abdominal, laparatomy, 7) Sepsis, 8) Ileus, 9) Peritonitis, 10) Pancreatitis and 11) Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision making is based on patient's general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: Severe adhesions, technical and enforced. There was no death after LC.

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One of the disturbing complications of propofol is pain on injection and the incidence ranges from 28% to 90%. Metoclopromide is commonly used as an anti emetic drug. Some investigators reported that this drug could reduce the pain on injection of propofol. The aim of this study was to assess and comparison of the efficacy of propofol pretreatment with metoclopromide in incidence and severity of its pain on injection.
Materials and Methods: In a randomized, prospective, double-blinded, placebo-controlled trail, 150 patients 18 to 40 yr old were randomly allocated in one three groups. C group (2ml of normal saline), L group (40mg lidocaine in 2ml), M group (l0mg metoclopromide in 2ml). Immediately after injection of study or placebo drugs, 10 mg of propofol with injection rate of 0.5 ml/s (In 4 Seconds) were injected in to the same vein that was inserted to the most prominent dorsal hand vein. Pain severity was measured using Visual Analogue Pain Scale that were educated to the patients before the trail (0 for no pain and 100 for the most aggressive pain in life) and values other than zero was encountered pain appearance. Patients with signs of sedation were excluded.
Results: There was no statistically significant difference between patients in three groups in number of men and women (P = 0.66), age (P = 0.29) and weight (P = 0.49). Furthermore severity (P = differences (C = 41.18, L - 25.4 and M = 13.1, P < 0.001) and patients in metoclopromide group experiences lower pain than other two groups (P < 0.001). Pain incidence in Control group was 77.1% and it was significantly reduced in lidocaine and metoclopromide group (P = 0.002), but there were no significant difference between them (P = 0.051). The 0.69) and incidence (P ~ 0.29) of pain has no significant difference between men and women. Pain severity between three groups has significant results showed that metoclopromide could significantly reduce the seventy of pain on injection of propofol more than lidocaine (opposite to diazepam), but they had no difference in pain incidence. It might lie on the different mechanisms that they produce pain. Pain on injection of diazepam is primarily attributed to propylene glycol, as a vehicle, but the pain mechanism in propofol is remaining unknown.
Conclusion: Finally as regards to other useful effects of metoclopromide including postoperative nausea and vomiting and propofol induction dose reduction, especially when there is a medical condition where lidocaine is contraindicated, it may be a reasonable alternative before injection of propofol.

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Kimura's disease (K.D) is an uncommon, benign, chronic inflammatory condition of unknown etiology and pathogenesis involving subcutaneous tissue presenting as a tumor like lesion with a predilection for the head and neck region. If parotid gland is affected clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnosis before tissue biopsy and fine middle aspiration (FNA) has only limited value. There is no evidence of malignant transformation and occasional spontaneous resolution occurs. Various treatment modalities have been suggested in the management of this condition but none is proved best and recurrence is common. we describe a 33 - year- old man with KD who presented with left parotid mass.

 

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Background: The damaging effect of exposure to loud noise on the structures of internal ear has been studied from many years ago. The effect of drill-generated noise on the non-operated ear is one of the problems that are less discussed. This study aims to evaluate the hearing loss that occurs in the non-operated ear in patients who undergo mastoidectomy by use of PTA (pure tone audiometery) and DPOAE (distortion product otoacoustic emission).

Materials and Methods: In this descriptive- analytic study, 49 patients who underwent mastoidectomy in Amir-Alam and Iman Khomeini hospitals, were evaluated for noise trauma generated by drilling on the non-operated ear. Patients were between 9-55 years old (mean age= 29) and they consisted of 25 males and 24 females. The patient's preoperative state were measured by PTA and DPOAE on the opposite ear also the postoperative state were re-evaluated by PTA and DPOAE.

Results: As a result, in 4 cases a significant change in PTA thresholds were observed, while two of them showed recovery after one month. Seven cases showed significant change in DPOAE amplitudes, of whom five cases recovered later.

Conclusion: In conclusion, the drill-induced hearing loss on the non-operated ear occurs in a few patients and it is often reversible.

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Background: The combined MMCOA deficiency and Hemocystinuria results from defect in cb1c & cb1d & cb1F genome. Until now only 100 cases of this disease has been reported. Most of them with cb1c deficiency. Due to this enzymatic defect, mild to moderate retention of Hemocystin (MMA) and their precursors in the body fluids (blood and urine) ensues. Although, acidemia, Hypoglycemia & megaloblastic anemia are common but hyperamonemia and hyperglycemia were not reported in these patients. Our case is a 3 years old girl with known MMCOA deficiency and Hemocystinuria who needed G.A for partial resection of the mandible because of osteomilitis.

Materials and Methods: In this report we explain the preoperative preparation of the patient, induction and maintenance of Anesthesia, and discuss the biochemical, lab results during & after surgery.

Results & Conclusion: Due to our result, the urine and blood hemocystin & MMCOA were not increased. This case is interesting because no theoretical or practical report on the G.A of these patients exists.

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Background: Both hypoxia and hypocapnia can cause broncho-constriction in humans, and this could have a bearing on performance at high altitude. The objective of this study was to examine how pulmonary ventilatory function during high-altitude trekking.
Methods: This study was a before and after study on spirometric parameters at Base line (1150 m above sea level), and after ascending at 4150 m above sea level. This study was performed in summer 2004 at Cialan Mountain in Iran. Fifty six healthy male University student volunteers were enrolled in the study. Respiratory function was assessed in participants before ascending at baseline (1150 meter) and after ascending at 4150 meter in Cialan Mount with a Spirolab II. Spirometric parameters changes were compared using paired t-test statistical analysis computations were performed by spss 11.5 and p≤0.05 was considered significant.
Results: The mean age and body mass lindex of our subjects were 22.9±5.3 years and 21.5±2.5, respectively. Forced vital capacity (FVC) was significantly decreased with increasing altitude from baseline level (P<0.01). Forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) and maximal midexpiratory flow rate (FEF 25-75%) were significantly increased with increasing altitude (P=0.001). There was no significant change in forced expiratory volume in 1 second and peak flow (P>0.05). FVC fell by the average of 7.1% at 4150m (2.4% per 1000m increased altitude) in comparison to 1150m.
Conclusion: The changes in some pulmonary ventilatory parameters were proportional to the magnitude of change in altitude during a high-altitude trek.

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Background: Food security is defined as access, for all people at all times, to enough food for an active and healthy life. Food security includes: 1) the ready availability of nutritionally-adequate and safe food, and 2) an assured ability to acquire acceptable foods in socially acceptable ways. The increase in childhood as well as adulthood obesity and food insecurity has caused many recent investigations on obesity, food insecurity and some associated factors. However, there appears to be a lack of published information regarding some factors affecting obesity and food insecurity. This study aimed to determine the prevalence obesity and food insecurity and some associated factors among Yazd province primary school students in Iran.

Methods: Using two-stage cluster sampling, a total of 3245 students (1587 boys and 1658 girls), aged 9-11 years, were randomly selected from primary school pupils in Yazd, Iran. From these, 187 students having BMIs ≥95^th percentile, as defined by Hosseini et al. (1999), were identified as obese and 187 pupils of the same age and gender having BMIs between the 15^th and 85^th percentiles were selected as controls. Data were collected using 24-hour food-recall and USDA food insecurity questionnaires.

Results: We found that the prevalence of obesity among students aged 9-11 years was 13.3%, and the prevalence of food insecurity was 30.5%. Daily energy intakes, compared to those recommended by the RDA, carbohydrate intake and energy percentages from proteins and carbohydrates were higher in obese children, and all macronutrient intakes per kilogram of body weight were significantly higher. An association between obesity and food insecurity was observed with adjusted fat intake.

Conclusion: In conclusion, the prevalence of obesity and food insecurity is high among Yazd primary school students, and high-level intakes of energy, protein, carbohydrate are associated with obesity. Furthermore, variation in the rate of fat intake is a relative factor for food insecurity.

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Background: Hypertension is a very common and important disease. There are conflicting reports about mercury, a trace element, in the genesis of hypertension.

Methods: In this study we examined the relationship between blood mercury levels and hypertension prevalence in a population-based sample of hypertensive and normotensive patients at the Shariati Hospital and the Tehran Heart Center in Tehran, Iran. A cross sectional sampling of 224 patients, aged 40-80 years, who participated in physical examinations conducted in 2006 were included in this study. The population that participated in this study were sample of hypertensive (n=112) which had essential hypertension and normotensive (n=112) patients which had no history of essential hypertension at the Shariati Hospital and the Tehran Heart Center in Tehran. The consent of all the patients were taken in the written form before the experiments. After selecting the patients the range of blood mercury levels were measured with Flame atomic absorption.

Results: The range of blood mercury levels was 0 to 39.55 µg/dL. The mean blood mercury level of hypertensive patients (10.75 +1.23 µg/dL) was higher than that of normotensive patients (1.6 +1.02 µg/dL). There was a significant difference in the mean blood mercury level of normotensive men (1.74 +1.56 µg/dL) versus that of hypertensive men (11.9 +1.38 µg/dL). The mean blood mercury level of normotensive women (1.5 µg/dL) was also significantly different from that of hypertensive women (9.65 +0.53 µg/dL) (p<0.001).

Conclusions: In this population, there is a positive relationship between the concentration of blood mercury levels and the presence of hypertension.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Tuberculosis is an important cause of death in some countries. The world health organization estimates that if stronger measures are not taken up to control the prevalence of this disease, from 2000 to 2020 a billion people will be infected by the bacterium. According to time consuming of common detection methods of Mycobact-erium tuberculosis such as culture, it is necessary to evaluate a rapid detection tests such as PCR. Rapid diagnosis of tuberculosis may have profound effects in patients' care According to importance of rapid detection and treatment of tuberculosis and for determine of sensitivity, specificity, positive predictive value and negative predictive value of PCR by using IS6110 this study was done in Kashan university of medical science.
Methods: A total of 248 sputum samples from patients suspected of mycobacterial diseases were studied. DNA was extracted by boiling method. IS6110 PCR method by a specific pair of primers designed to amplify 123bp and 245bp sequences of the insertion sequence, 6110, in the M. tuberculosis genome was used to analyze sputum samples.
Results: 32 out of 248 (12.9%) of samples had positive culture. PCR yielded a sensitivity of 93.8% and specificity of 99.1% for the diagnosis of TB patients with TB confirmed by culture. There were two out of 32 (6.3%) PCR-positive cases among the patients with non-TB disease.
Conclusion: The findings of the present study indicate that Multiplex PCR may provide a faster method of detecting tuberculosis, thus enhancing diagnostic procedures and we conclude that the performance of an IS6110 PCR assay is valuable in the rapid diagnosis of tuberculosis.

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