Tehran University Medical Journal

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Background: Hyperglycemia is a metabolic response to surgical stress. In this study, patients’ blood glucose changes were measured before, during and after elective eye surgeries under general anesthesia, with two methods: glucometer and glucose oxidase enzyme lab assay. Probable influencing factors and the correlation rate of these two methods were evaluated.

Methods: This analytic cross – sectional original study was performed on 230 American Society of Anesthesiologists (ASA) Class 1or 2 non–diabetic patients. All the patients underwent a similar general anesthesia and their blood glucose levels were measured simultaneously with two cited methods on three occasions.

Results: In all cases, post-surgery blood glucose in comparison to pre-surgery levels increased significantly in both methods irrespective of independent variables of the study. Considering these independent variables, increase in blood glucose levels was significant in most of the patients. The mean increase in blood glucose post-surgery in comparison to pre–surgery, measured with lab assay, had significant statistical correlation with the type of eye surgery but not with other variables like age, gender and duration of surgery. Correlation of the two methods were also partially significant statistically.

Conclusion: Considering the results of this study and the fact that blood glucose changes under general anesthesia is usually unrecognized clinically, we recommend blood glucose measurement in non–diabetic patients during long surgeries. It is advantageous to use Accu–chek (Sensor model) glucometer for this purpose.

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Background: The male antifertility activity of Gossypol, the active ingredient of cotton seed, inspired the idea for development of an agent with male contraceptive activity. The result of subsequent studies lead to the discovery of several class of compounds with antifertility activity. In this study the antifertility activity of iso-Propyl and iso-Butyl derivatives of dihydropridine were evaluated.
Methods: The two aforementioned compounds were administered subcutaneously in (10 mg/kg/day) dose to male rats. The animals were treated and kept according to the TUMS committee recommendations on ethical and animal maintenance considerations. Sixty days after the first injection the following fertility and histological indices were evaluated, animal’s body weight difference (B.W.D), sperms motility, sperm viability, ESR (epididymal sperm reserve), DSP (daily sperm production), serum testosterone concentration, fertility index, GSI (gonado somatic index). Histological indices are respectively the area and circumference of seminiferous tubules, each testis and their crosswise dissections, the diameter of seminiferous tubules and the number of seminiferous tubules per square millimeter, that were determined.
Results: The values of the two test groups were determined and compared with the results of normal group that were using normal saline only and the blank that were receiving propyllenglycol only.
Conclusion: The significant inhibitive activity of candidate compounds on animal's physiologic indices were in accordance of our pervious estimation of compounds activity as (lead compound) for synthesis and preparation of new compounds with male contraceptive activity

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Background: To identify the risk factors of fourth-degree laceration during vaginal delivery.
Methods: This is a retrospective, case control study. We reviewed 131802 records of vaginal deliveries within 14 years period from 1990 to 2004 in two obstetric center. Cases were 93 vaginal deliveries with fourth-degree laceration and 7 cases were delivered at home, control subjects were 200 vaginal deliveries without third- or fourth-degree lacerations and were identified with the use of random selection. We studied the effects of: maternal age, nationality, parity, gestational age, hour of delivery, birth attendants, episiotomy use and duration of second stage of labor, use of oxytocin, use of forceps or vaccum, Infant birth weight, presentation and postion of fetus, previous severe perineal injury, maternal medical illness and place of delivery.
Results: We found 93 cases (%0.07) of documented fourth-degree laceration in 131802 deliveries
Conclusion: This study identified several factors associated with fourth-degree laceration. Median episiotomy should be avoided. Nulliparity, fetal macrosomia and OP position are significant risk factors that require caution by birth attendants during delivery

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Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias.
Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist.
Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years) and 38 young (group II, age<65years) subjects. Delirium was seen more in elderly group (p=0.05). The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02). Smoking (29.1%), neurological disturbances (19%), congestive heart failure (15.2%), chronic obstructive pulmonary disease and diabetes mellitus (13.9%) were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients.
Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.

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Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation.
Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area.
Results: One hundred twenty one of 1311 patients (9%) had perforated appendicitis and 1190 patients (91%) had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year). When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital.
Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

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Background: Surgical wound infection surveillance is an important facet of hospital infection control processes. There are several surveillance methods for surgical site infections. The objective of this study is to evaluate the accuracy of two different surgical site infection surveillance methods.
Methods: In this prospective cross sectional study 3020 undergoing surgey in general surgical wards of Imam Khomeini hospital were included. Surveillance methods consisted of review of medical records for postoperative fever and review of nursing daily note for prescription of antibiotics postoperatively and during patient’s discharge. Review of patient’s history and daily records and interview with patient’s surgeon and the head-nurse of the ward considered as a gold standard for surveillance.
Results: The postoperative antibiotic consumption especially when considering its duration is a proper method for surgical wound infection surveillance. Accomplishments of a prospective study with postdischarge follow up until 30 days after surgery is recommended.
Conclusion: The result of this study showed that postoperative antibiotic surveillance method specially with consideration of the antibiotic usage duration is a proper method for surgical site infection surveillance in general surgery wards. Accomplishments of a prospective study with post discharge follow up until 30 days after surgery is recommended.

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Background: Germ cell tumor (GCT) account for approximately 2-3% of all malignancies in childhood. About 20% of patients with GCT are still resistant to therapy.
Methods: This study was undertaken on 57 patients with Germ cell tumor who were admitted to Ali Asghar Children’s Hospital during 1990-2004. Through this study, information about sex, age type of pathology, clinical sign, treatment and survival (5-year period) was gathered in order to have better treatment and follow up. This study was carried out as across-sectional survey and the obtained data was analyzed via Spss 10 soft ware.
Results: The findings showed that the mean age of patients was 4/9 ± 0/1 (1mo -14y), male 54%, female 46%, male/female, ratio=1/1. Site of tumor: saccrococcygeal 57/8 %( 33), gonadal 42% (24). Pathological type is yolk sac 61/4% (35), dysgerminoma 12/2% (7), malignant teratoma 14% (8), embryonal carcinoma 10/5% (6). The most common clinical sign were buttock mass 31/5% (18), abdominal pain 10/5% (6), abdominal mass 17/5%(10), testicular mass 28% (16). All of the patients were treated with chemotherapy (bleomycine, vinblastin, cisplatinum) mean of duration follow up were 48/4 months. In all of patients 31/5% (18) of the cases were alive and 70% (40) of patients were relapse and 15/7% (9) no information, 52/6% (30) of cases were expired. Five years survival of patients was 62%.
Conclusion: The analysis of the patients treated shows that extragonadal location of primary tumor (specially sacrococcygeal), level of AFP above 10 ng/ml in patients ,6 or more months of age and metastatic disease were the most unfavorable factors for overall survival.

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Background: Although there have been many studies on the role of mosquitoes in malarial transmission, the biology and interaction of plasmodium with its host is still not completely known. The aim of this study was primarily to follow the sporogony cycle of Plasmodium vivax in Anopheles stephensi mysorensis and then to explore the inhibitory effects of certain carbohydrates on parasitic development.
Methods: In a restricted insectary, An. stephensi were fed blood containing gametocytes from donor malaria patients. The development of plasmodium was followed by dissecting the infected mosquitoes and taking a smear at different time intervals. Other groups of Anopheles were fed infected blood plus one of the following carbohydrates: N-acetyl-glucosamine, N-acetyl-galactosamine, arabinose, fucose, manose, lactose or galactose.
Results: Exflagellation occurred at 5 minutes after the blood meal and then ookinet was observed at 20 hours, while oocysts and sporozoites appeared in days 8 to 12. The results indicate that An. stephensi strain mysorensis has can transfer P. vivax extremely well. Furthermore, the development of P. vivax was completed in the mosquitoes that had been fed with N-acetyl-glucosamine, arabinose, fucose and galactose. In contrast, lactose, mannose and N-acetyl-galactosamine interrupted the life cycle of the parasite.
Conclusion: The sugars lactose, mannose and N-acetyl-galactosamine have an inhibitory role in of oocyst and sporozoite development. Therefore, the results of this study can be used as basic information for inhibiting malarial transmission.

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Background: Postoperative shivering is a common postoperative complication. The aim of this study was to compare the effects of morphine, pethidine and fentanyl in postoperative shivering control.
Methods: In this prospective, randomized, placebo-controlled, double-blinded, clinical trial, we enrolled 72 adults scheduled for elective surgery under general anesthesia at Imam Khomeini Hospital in 2003. All the patients were anesthetized in the same manner. After transferring the patients to the post-anesthesia care unit, shivering was noted and, in patients with a shivering score of one or more, morphine (2.5 mg), pethidine (25 mg), fentanyl (25 µg) or normal saline (all with a volume of 10 ml) was randomly administered intravenously by a two-minute injection. A second shivering score was recorded 10 minutes later.
Results: Pethidine and fentanyl were significantly more effective than normal saline, but there was no significant difference between normal saline and morphine groups. Pethidine was more effective than two other drugs in shivering control.
Conclusions: Pethidine was significantly more effective than two other drugs. Fentanyl decreases postoperative shivering less effectively than pethidine, but morphine had no effect on postoperative shivering with an effect comparable to normal saline.

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Background: Despite recent improvement in coronary intervention, there are many controversies about it’s results in diabetic patients. The goal of this study is comparison of in hospital outcome of diabetics after coronary intervention with nondiabetics.
Methods: In this study 115 diabetic and 115non diabetic patients who admitted for coronary intervention in our center during 1383&84 were entered in an analytic study of Cohort type. Datas about clinical, aniographic, procedural and post procedural (24hours) characteristics were entered in each patient’s form. Independent T test,chi-square and Fisher’s exact test were used for analyzing datas.
Results: The Diabetic Patients were most often older men, and they had higher angina class, more co-risk factors and lower ejection fractions. Diabetic’s lesions were longer and more located in proximal portion of vessels. But success rate, major complication (death, revascularization, Q Wave MI and CVA), and minor complications (coronary/peripheral arteries complication, pulmonary edema, ischemic ECG) had no significant differences between two groups.
Conclusion: Diabetes mellitus does not affect short outcomes of coronary intervention as an independent factor. So intervention could be done in these patients with considering favorable outcomes.

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Background: Respiratory failure and crisis is one of major complications of thymectomy in myasthenia gravis patients. There are different medication regimes for preparing these patients for surgery and reducing post-operative side effects. The goal of this study is to compare respiratory complications of oral vs. Parenteral preoperative administration of anticholinesterase agents for thymectomy in myasthenia gravis patients.
Methods: This randomized controlled trial included 101 patients in class IIA or IIB of myasthenia gravis according to the Osserman classification system. The control group fasted for eight hours before surgery and oral anticholines-terase agents were replaced with parenteral ones. The case group also fasted for 8 hours before surgery, but pyridostigmine was continued at its usual dose until the time of operation and the last dose was given to patients with a small amount of water in the operating room on the operating bed.
Results: There was no statistically meaningful difference between the two groups in terms of age, sex and pathologic findings. In comparison, the mean hospital stay for the case group was 3.98 days and 6.34 for the control group (p value = 0.003). There were eight cases of respiratory crisis or failure (16%) in the control group but only 1 case (2%) was observed in case group (p value = 0.014). Only one patient in the case group required re-intubation after the surgery however, six patients in control group were re-intubated (p value = 0.053). Plasmapheresis was required for five patients in the control group and one patient in the case group (p value = 0.098). Tracheostomy was performed on two patients in the control group to accommodate prolonged intubation, but none of the case group required this procedure.
Conclusion: This study shows that continuing oral anticholinesterase agents up to the time of operation, with the last dose at the operative theater, lowers the incidence of postoperative myasthenia crisis and respiratory failure, need for plasmapheresis and shortens the hospital stay. This method may also decrease the need for re-intubation, mechanical ventilation and tracheostomy, thus decreasing the chance of death resulting from complications of the thymectomy.

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Background: Quality assurance is a prevention-oriented system that can be used to improve the quality of care, increase productivity and monitor the performance management in clinical laboratories. ISO 9001: 2000 requirements are a collection of management and technical systems designed to implement quality assurance and monitor performance management in organizations.
Methods: A checklist was prepared to monitor the preanalytical, analytical and postanalytical stages of laboratory performance management in 16 areas and all laboratory activities in 14 of the clinical laboratories of the Tehran University of Medical Sciences (TUMS) hospitals. Collected data were stored and statistically analyzed using SPSS software.
Results: The best performance, in which 77.73% of quality assurance indicators were observed, was found in Sina Hospital. However, only 57.56% of these indicators were fulfilled at Farabi Hospital, with the lowest-level performance among the clinical laboratories of TUMS hospitals. The highest level of compliance with quality assurance indicators was in the hematology departments and for facility demands in management areas. Overall, quality assurance indicators were appropriately followed in only 7% of the clinical laboratories.
Conclusion: The average quality assurance observation rate in the clinical laboratories studied was 67.22%, which is insufficient and must be remedied with stricter enforcement of the ISO 9001: 2000 regulations.

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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.

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Background: Sudden sensorinueural hearing loss (SSNHL) is a baffling condition for patients, and its etiology, audiologic characteristics, prognostic factors, and treatment are still controversial.
Methods: In this prospective study, we performed pure tone audiometry (PTA), impedance acoustics (IA), auditory brainstem responses (ABR), otoacoustic emissions (OAE), and transiently evoked otoacoustic emissions (TEOAE) before beginning treatment for 53 patients with SSNHL. We then entered each patient, randomly and alternately, in one of two treatment groups: oral steroids + acyclovir vs. intravenous urographin.
Results: In 22 (41.5%) of the 53 patients (22 female, 31 male), we found negative or no signal to noise ratio and overall correlation in TEOAE. Furthermore, 26 cases (49%) had positive overall correlations less than 50%, and five cases (4.4%) had overall correlations >50%. Although 15 cases (28.3%) responded well, 20 cases (37.7%) showed only a partial response, and 18 cases (33.9%) had poor or no response to our treatment. The mean value for overall correlation in the three subgroups of patients (no response, partial response, and complete response) was -3.5% (±1/16%), + 11% (±1.99%), and +36.6% (±3.07%) respectively (P = 0.01). From 52 cases, 20 had no reproducible wave in ABR (38.5%), three cases had abnormal ABR with normal OAE, all of which responded completely to treatments. Thirteen cases had abnormal ABR and OAE, none of which responded to treatment, and six cases had normal ABR with abnormal OAE, which often responded to treatment.
Conclusions: ABR and OAE may be useful in the diagnosis of SSNHL and determining the site of such lesions as ischemia or neuropathy. The overall correlation (and S/N ratio) in TEOAE is a valuable prognostic factor in SSNHL.

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Background: Magnesium Sulfate (MgSO4) has been used as a pharmacologic agent in different situations for many years in the treatment of tachyarrhythmias, myocardial ischemia, preeclampsia, and tocolysis among others. The analgesic effect of MgSO4 for postoperative pain has been used since the 1990s. Postoperative pain is one of the most common complications in the perioperative period and can result in serious consequences in different organs if left untreated. Inguinal herniorrhaphy is among the most common surgeries and is almost always accompanied by severe pain. The object of this study is to determine the effect of a pre-induction infusion of MgSO4 on the reduction of postsurgical pain after herniorrhaphy.
Methods: This double-blind, randomized clinical trial included 105 ASA class I and class II herniorrhaphy patients at Shariati Hospital in years 2004 and 2005. For statistical analysis, the 2 and T tests were used. The patients were divided into three groups based on block randomization. Patients in the following groups received: Group A, 200 ml of normal saline infusion (placebo) Group B, 25 mg/kg MgSO4 in 200 ml of normal saline Group C, 50 mg/kg MgSO4 in 200 ml of normal saline. All groups were infused twenty minutes before induction of anesthesia using identical methods and dosage in all three groups. Heart rate and mean arterial pressure (MAP) at pre- and postintubation and so at skin incision time were charted. Visual analog scale (VAS) pain score, nausea, vomiting and the amount of morphine used before recovery room discharge and in six, twelve and twenty-four hours after recovery discharge was recorded.
Results: The average age for the different groups was as follows: Group A: 33.6, Group B: 37.37, Group C: 32.74. Nausea and vomiting between the case and control groups were not statistically different (60% vs. 71.4%, p=0.0499), nor was the amount of Morphine used. On recovery room discharge, the VAS scores were 8.1, 7.2, and 5.5 for the first, second and third groups, respectively (P<0.001). However, no statistical significance was found for the VAS scores six hours after recovery room discharge.
Conclusion: The results in this study show that pre-induction with MgSO4 has no remarkable effect on decreasing postoperative pain or morphine use for inguinal herniorrhaphy.

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Background: The object of this study was to determine the epidemiological characteristics of deliberate self-poisoning in adolescents referred to the only poisoning center in Tehran.
Methods: In a cross-sectional study, all cases of acute poisoning at the Loghman Hakim Hospital from May to December 2003 were reviewed. Data for adolescents (13-19 years of age) were analyzed by SPSS for Windows, version 13 and STATA, version 8.
Results: From a total of 9203 cases of deliberate self-poisoning, 28.5% were adolescents (2626 cases). The male/female ratio was 1/2.2. Approximately 87% were unmarried and 56% were students, while a total of 4859 different drugs/agents were used for self-poisoning (an average of 1.85 for each case). The majority of patients was from urban areas and had no history of attempted suicide. There was no difference between males and females regarding history of psychiatric and somatic disorders, though there was a significant difference in the average of age between male and female adolescents.
Conclusions: Among adolescents, self-poisoning is more common in girls while the mean of age is younger in boys. Although the prevalence of psychiatric disorders in adolescents appears to be less than the general population, this may be related to differences in their situations or due to underestimation of their frequencies. Psychiatric care should be a necessary component of the care administered to adolescents who attempt suicide and must be based on the needs and basic assessment of the patient’s status. Research regarding the familial history of abuse, neglect, self-harm/ poi- soning should be undertaken so that such social issues can be prioritized and addressed.

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Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharmacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.
Methods: Fifty children with oncologic malignancies whose ages ranged between 2-12 years were enrolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.
Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001). After Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.
Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.

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Background: Nonlethal genetic damage is the basis for carcinogenesis. As various gene aberrations accumulate, malignant tumors are formed, regardless of whether the genetic damage is subtle or large enough to be distinguished in a karyotype. The study of chromosomal changes in tumor cells is important in the identification of oncogenes and tumor suppressor genes by molecular cloning of genes in the vicinity of chromosomal aberrations. Furthermore, some specific aberrations can be of great diagnostic and prognostic value. Comparative genomic hybridization (CGH) is used to screen the entire genome for the detection and/or location chromosomal copy number changes.

Methods: In this study, frozen sections of 20 primary breast tumors diagnosed as invasive ductal carcinoma from the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were studied by CGH to detect chromosomal aberrations. We compared histopathological and immunohistochemical findings.

Results: Hybridization in four of the cases was not optimal for CGH analysis and they were excluded from the study. DNA copy number changes were detected in 12 (75%) of the remaining 16 cases. Twenty-one instances of chromosomal aberrations were detected in total, including: +1q, +17q, +8q, +20q, -13q, -11q, -22q, -1p, -16q, -8p. The most frequent were +1q, +17q, +8q, -13q, similar to other studies. In three cases, we detected -13q, which is associated with axillary lymph node metastasis and was reported in one previous study. The mean numbers of chromosomal aberrations per tumor in metastatic and nonmetastatic tumors was 1.5 and 1, respectively. No other association between detected chromosomal aberrations and histopathological and immunohistochemical findings were seen.

Conclusion: Since intermediately to widely invasive carcinomas are more likely to have chromosomal aberrations, CGH can be a valuable prognostic tool. Furthermore, CGH can be used to detect targeting molecules within novel amplifications which holds the potential for a new therapeutic approach for intractable cancer.

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Background: Despite major diagnostic and industrial progresses in the technology and use of Ionizing radiations, they have been found to be harmful to the health of the radiology and nuclear medicine staffs. Since Ionizing radiations have the potential to produce free radicals, therefore, it is likely that the total plasma level of anti-oxidant in medical and nuclear medicine staffs could be reduced.

Methods: In this case-control study the relationship of total anti oxidant level of plasma and the function of immune cells such as lymphocyte proliferating response using MTT method, Neutrophil chemotaxi, Intensity of respiratory burst (NBT) and evaluation of IL-2 and IL-4 (ELISA) were investigated. 101 samples were collected for this study and they were assigned as two groups: 61 samples cases from radiology and nuclear medicine staffs of Tehran University Of Medical Science hospitals (Shariaty, Imam Khomeyni, Ghalb-e-Tehran) were assigned as the exposed group, whereas, 40 samples from Pediatric, Orthopedic, Infirmary and Emergencies wards were assigned as control group. Using heparinized syringes, 8 to 10 ml of blood samples were collected from each person with age between 25 to 50, averaging 36.4±7.2, and several assays including Anii Oxidant Capacity of Total Plasma (FRAP Method), T cell proliferative response to PHA mitogen (MTT Method), Chemotaxi of neutrophils and Magnitude of respiratory burst were carried out on these samples. The results were analyzed using spirman correlation analysis.

Results: The results showed that exposure to ionizing radiation chronically with low dosed had no effect on chemotaxis of neutorophils and intensity of respiratory burst, but could have effect on lymphocyte function specially in cytokines secretion like IL-2 which are essential in the immune responses.

Conclusion: This study indicates that long term low dose ionizing radiation may have effect in some parts of the immune function.

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Background: Acupuncture is one of the most effective methods of alleviating pain in different situations including chronic and acute pain management. The aim of this study was to evaluate the effectiveness of acupuncture in the reduction of post-operative pain after hernia repair.

Methods: In this placebo-controlled, double-blinded clinical trial, we enrolled 60 male patients aged 30 to 60 years old with an ASA physical status of I or II undergoing elective inguinal hernia repair under general anesthesia in Imam Khomeini Hospital, Tehran, Iran. All patients experienced standard anesthetic and surgical procedures. After completion of the operation and while the patients were still under general anesthesia, they were randomly assigned to two groups: acupuncture (with stimulation of GV2, GV4 and SP6 points with sterile acupuncture needles), and control (with sham acupuncture stimulation). After termination of anesthesia, during the first six hours, the pain intensity was evaluated hourly. Pethidine (25 mg) was administered for the patients when necessary. Pain intensity and pethidine use were recorded and compared between the two groups.

Results: The mean age of two groups did not differ. Pain intensity was significantly lower in the acupuncture group between the second and fifth postoperative hours. Moreover, pethidine use was significantly lower in the acupuncture group versus the control group during the first six hours after surgery (12.07±7.5 mg vs. 12.91±6.5 mg, respectively p=0.0001).

Conclusion: The application of acupuncture in patients is associated with a marked decrease in pain after inguinal hernia repair and does not have any serious complications. Acupuncture is strongly recommended for all post-operative patients.