Showing 732 results for GhA
Jamshidi A.r , Gharib Doost F, Larijani B, Forouzesh Nia S M,
Volume 64, Issue 7 (9 2006)
Abstract
Background: Scleroderma is an important chronic disease with unknown ethiology and two subtypes: limited type: Skin involvement limited to distal of extremity and face. Diffuse type: Skin involvement is both distal and proximal of extremity, face and thrunk. Thyroid dysfunction is a main problem in these patients but there is no published data of Iranian scleroderma patients
Methods: This is a cross-sectional study to determine the prevalence of hypothyroidism (clinical, subclinical and autoimmune) in patients with scleroderma 125 patients with scleroderma selected and T3, T4, TSH Anti Tpo Ab and Anti TG Ab measured in them.
Results: 33 patients with scleroderma had hypothyroidism. (%26/4). Two patients with scleroderma had hyperthyroidism. (%1/6). %12/8 had clinical hypothyroidism. And %13/6 had subclinical hypothyroidism, %33/3 of patients with subclinical hypothyroidism and positive autoantibody had limited type. Where as %66/6 of patients with subclinical hypothyroidism and autoantibody had diffuse type, %28/5 of patients with clinical hypothyroidism and positive auto anti body had limited type. Where as %71/4 of patients with clinical hypothyroidism and auto anti body had diffuse type. All of patients with hyper thyroidism had diffuse type and autoantibody positive.
Conclusion: It seems hypothyroidism has an increased prevalence in patients with scleroderma and we suggest that thyroid function test must be done in primary evaluation of these patients
Forouzan-Nia S.k, Abdollahi M.h , Motafakker M , Dehghan Hr , Rajabiun H ,
Volume 64, Issue 7 (9 2006)
Abstract
Background: Atrial fibrillation is the most common arrhythmia following CABG. This complication can cause palpitation, significant hemodynamic instability and thromboembolic events. This prospective randomized study evaluate prophylactic effects of propranolol low dose amiodarone and high dose amiodarone in patients candidate for CABG.
Methods: Three hundred consecutive patients undergoing elective CABG were randomly categorized into three groups (each group contains 100 patients). Patients in group1 (control group) received 10mg/TDS propranolol per oral (P.o), preoperatively. Patients in group 2 received 10mg propranolol TDS, P.o plus 350mg/24h amiodarone. Patients in group 3 received 10mg propranolol TDS P.o plus 1000mg/24h amiodarone 24 hours before operation.
Results: Atrial fibrillation occurred in 12 patients (12%) in group 1, four patients (4%) in group 2 and 10 patients (10%) (P=0.035) in group 3. AF occurred in 10.36% of men and 3.84% of women. There was no AF in off- pump groups and 9.73% in on-pump groups
Conclusion: This study suggested the combination of propranolol plus low dose amiodarone for post CABG atrial fibrillation prophylaxy.
Nabavi Sm, Poorfarzam Sh, Ghassemi H,
Volume 64, Issue 7 (9 2006)
Abstract
Background: Multiples sclerosis is a common demyelinating disease of CNS and the main cause of disability in young adults all over the world so any research in different aspects of the disease has great value. researches in Iran are few in quantity and low in sample size. To determine clinical course and prognosis of the disease in Iranian MS patients we have studied these items in a considerable sample size.
Methods: Two hundred and three definite MS patients (according to MC’donalds 2001 criteria) included in this study and a planned questionnaire completed by visiting the patients or by degree of disability estimated according to EDSS (Expanded Disability Status Scale) score system. The results analyzed with SPSS software.
Results: Mean age of the patients was 35. All required examinations have been done by a neurologist and 60.6 percent were female. Mean duration of disease was 8.3 years. the main form of onset of symptoms was sensorimotor (mixed). Mean Attack rate was 5.5 times during the disease duration. Clinical course in 72.4 percent was relapsing-remitting type. Mean disability scale number according to EDSS was 5.2. Death rate was two percent. 69.3 percent of patients were able to work in the society. The degree of disability increased with increasing age, in lower educational state, in longer duration of the disease and in male gender.
Conclusion: The results of clinical course and type of MS, mean of disease duration from the onset and mean EDSS are compatible and comparable with similar studies in other countries though some results are different. For future large sample, multicenter studies recommended
Gharegozl Ki, Abbasi Siar F, Kolahi A.a, Bolhari J, Zaman Gh, Keyhanidoost Zt, Poortaherian P,
Volume 64, Issue 8 (13 2006)
Abstract
Background: Despite advances in medical science and modern technology, epilepsy remains as a stigmatized condition and negative public attitude toward epilepsy is a common phenomenon especially in developing countries such as Iran. It is the major factor causing serious social discrimination against people with epilepsy which in turn may be more devastating than the disorder itself. Thorough understanding of the knowledge and attitudes toward epilepsy is essential to modify these negative attitudes.
Methods: We conducted a face-to-face questionnaire interview survey in crowd locations of Tehran in August, 2004-April 2005. A total of 1079 persons all more than 15 years old were asked to fill the questionnaire.
Results: Eighty eight percent of respondents had heard about epilepsy before, 42.2% of them knew one person with epilepsy. However, out of responses about the causes of epilepsy, 52/4% said it was caused by brain damage, 26.4% said it was an inherited disease,, 14.3% said it was due to fever, 34.8% believed stress as the cause of it and1.1% said evil spirits was the cause. 56.9% considered pregnancy to be appropriate for epileptics. 94% believed children with epilepsy could go to school and have normal education.
Conclusion: According to this survey, public knowledge and attitudes about epilepsy in study population is not satisfactory. It is suggested that additional efforts must be made to increase the knowledge of the general population through education programs especially among school children.
Mahmoudi-Gharaei J, Mohammadi Mr, Bina M, Yasami Mt, Fakour Y,
Volume 64, Issue 8 (13 2006)
Abstract
Background: Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder. We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.
Methods: In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy group CBT plus art and sport interventions art and sport interventions without group CBT and control group.
Results: Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.
Conclusion: Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we couldn't find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.
Salimi J, Taghavi M, Shojaeefar A, Shadman F,
Volume 64, Issue 8 (13 2006)
Abstract
Background: A plan for management of infected arterial pseudoaneurysm has evolved from our experience with forty two cases of such aneurysms treated between 1378 and 1382.
Methods: Clinical data of 42 patients with femoral pseudoaneurysm resulting from addictive drug injection who presented in emergency department of Sina Hospital between 1378 and 1383 were retrospectively reviewed.
Results: All patients were men with the mean age of 36.9 years. Twenty eight patients were referred from other medical centers. The mean time of delay in presentation was 17.3 days. The mean duration of drug injection was 14 months. Primary repair and emergent vascular bypass were performed in 3(7.1%) and 2(4.8%) patients, respectively. 5(11.9%) patients undergone delayed revascularization. Thirty two (76.2%) patients returned to their normal lifestyle without any vascular bypass. One patient required amputation and one patient died due to sepsis and acute renal insufficiency.
Conclusion: Management of infected femoral pseudoaneurysms is simple ligation of the external iliac or femoral artery. When Doppler is not available “Operation Room and postoperative Direct Observation” is recommended in such patients to avoid unnecessary revascularization surgery.
Modarres M, Mir Mohammad Ali M, Haghani H, Arami R, Rahnama P,
Volume 64, Issue 9 (1 2006)
Abstract
Background: The most frequently used test for evaluation of fetal health is the Non Stress Test (NST). Unfortunately it has a high incidence of false positive results. The combination of vibroacoustic stimulation with the NTS has been shown to reduce non reactive results.
Methods: A tests assessment method was chosen with a simple randomized sampling. 40 pregnant women with non reactive NST in the first 20 minutes who received VAS in one of Tehran University's Hospitals were compared with BPP scores. A vibroacoustic stimulation was applied for a 3 seconds on the maternal abdomen and fallowed within 10 minutes.Data collection tools were NST, sonography instruments ,NST result paper, tooth brusher, watch, demographic questioner and check list. Data analysis was made by descriptive static and by using the Fisher's Exact Test (with level of significant at p<0/05). All statistical analysis were performed using an spss/win.
Results: After VAS, 70% of non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). False positivity of VAS was lower than NST.
Conclusion: VAS offers benefits, by decreasing the incidence of non reactive test and reducing test time. VAS lowers the rate of false positive NST. VAS is safe and allows more efficient of prenatal services. This test could be used as a rapid antepartum test to predict fetal well-being.
Fakour Y, Mahmoudi-Gharaei J, Mohammadi Mr, Karimi M, Azar M, Momtaz-Bakhsh M,
Volume 64, Issue 9 (1 2006)
Abstract
Background: Many studies have shown the efficacy of cognitive – behavioral
therapy and psychological debriefing in treatment of post traumatic stress
disorder (PTSD) and a few evidences are available for using these techniques
in large scale disasters. This study aimed to asses the effect of some
psychological interventions in reducing PTSD symptoms after Bam earthquake
in different age groups.
Methods: In a before-after quasi experimental clinical trial, we compared the
efficacy of one session of psychological debriefing and three sessions of group
cognitive-behavioral therapy in bam earthquake PTSD symptoms in different
age groups. We evaluated PTSD symptoms before and immediately and three
months after interventions by CASP scaling system and analyzed data.
Results: one hundred and thirty persons entered in the study and 51 persons
excluded during interventions because of migration. Interventions were
showed to be effective only in short term period. The means of PTSD
symptoms frequency and severity of avoidance symptoms were reduced during
three months period of study which were statistically significant P<0.05.
Interventions showed no efficacy for recall symptoms in long term and hyper
arousal symptoms in short term and long term periods. There was no
statistically significant difference among age groups.
Conclusion: Psychosocial supportive interventions may be effective on some
of the PTSD symptoms but there is no difference in different age groups.
Salman Roghani H, Pahlavanzadah M.r, Salman Roghani R,
Volume 64, Issue 10 (2 2006)
Abstract
Background: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. The clarithromycin–based regimen is not cost – effective for developing countries and also there is a lot of evidence about increase of clarithromycin resistance H-pylori. Furazolidone is a good substitute, but several side effects, limit its widespread use our previous revealed that most of side effects occurred in the beginning of second week of treatment, so decrease the period of furazolidone therapy to one week may be considered. The aim of the present study was to assess the efficacy and side effect of one week furazolidone in combination with bismuth subcitrate ,amoxycillin and omprazole
Methods: In this study, a total of 177 patients were enrolled and randomized to two groups and received the following medications: Group I: omprazole 220mg + amoxycillin 21gr + bismuth subcitrate 4120 mg for two weeks and furazolidone 2200mg for 1 week Group II: the same regimen as in group I except that one week furazolidone in group II patients followed by one week metronidazole 2500 mg/day (one week furazolidone and one week metronidazole).patients were followed after 2 weeks for side effect of drugs and compliance and control endoscopy was performed after 6 weeks and three biopsies spicimens from the antrum and three from the corpus were taken for a urease test and histology. Eradication was concluded if all the tests were negative for H-pylori
Results: One hundred fifty seven patients completed the study. Mean age was 38.84+10.42 and 55.4% were male and 44.6% were female. Two patients from group I and three patients from group II did not tolerate the regimen and were excluded from the study. No serious complication was detected in two groups. The eradication rate per protocol analysis and intention to treat analysis were 89% and 79.3% in group 1 and 86.6% and 74.4% in group 2.No significant statistical differents between two groups (P=0.32 , P=0.33).
Conclusion: One week furazolidone in combination with two weeks amoxicillin, omprazole and bismuth subcitrate is a good, safe and cost effective regimen for eradication of H-pylori. Addition of metronidazole in the second week of treatment period did not increase eradication rate.
Noyan Ashraf M.a, Mirghasemi A.a, Peiravy Sereshke H,
Volume 64, Issue 10 (2 2006)
Abstract
Background: We report a case with apparent resistance to local anesthetics. While regional anesthetics failure are often attributed to technical failure, the clinical presentation and medical history of this patient suggests a true resistance to local anesthetics.
Case report: A 28 years old man was scheduled for elective orthopedic surgery for right sided tibial bone fracture, and decision of spinal anesthesia was made. There was a questionable history of multiple prior episodes of local anesthetic unresponsiveness (Interscalan block, local infiltration for lipoma resection and dental surgery). Spinal anesthesia was performed and sensory or motor blockade was not obtained despite any evidence of technical problems. The surgical procedure performed under general anesthesia and skin analgesia (local infiltration of lidocaine 2% and bupivacaine 0.5% to forearm), did not achieve, the day after surgery.
Conclusion: While the failure rate of spinal anesthesia has been shown range from 4 to 13% and is often attributed to technical failure, this particular case showed a true resistance to local anesthetics.
Salehi Nodeh A.r, Ghaffori Sh, Alimohamadian M.h, Sarraf Nejad A, Mirshafiei A,
Volume 64, Issue 11 (7 2006)
Abstract
Background: TPS is one of the tumor markers which has specially been considered due to its exclusive physiological characteristics like its easy measurement in serum of cancer patients. This study has been due to evaluate the efficiency of this tumor marker in the prognosis, treatment control and follow up of patients with gastrointestinal cancers including esophagus, stomach and colorectal.
Methods: TPS has been measured in 109 persons including 28 healthy people and 81 patients with different gastrointestinal malignancies which were composed of 38 patients with esophageal cancer, 20 ones with stomach cancer and 23 ones with colorectal cancer. Sampling has been done in three times depending on treatment methods. TPS has been measured with ELISA in samples which contend of 2 to 3 ml of serum from patients and the health.
Results: The obtained results, demonstrate the obvious changes in TPS serum level in patients underwent various treatment procedures.
Conclusion: The results have revealed that the serum TPS is not only as a measure of prognosis but also would be helpful in follow up and treatment control of the disease. Moreover the results has shown that serological analysis can be settled in the diagnosis and follow up with production of polyclonal antibody against TPS gene family and planning appropriate pattern.
Goodarzi A H, Nikufar A R, Boluri B, Mahdavi S R, Ghazikhanloo Sani K,
Volume 64, Issue 11 (7 2006)
Abstract
Background: During breast three fields radiotherapy, the problem is that the divergency of the field interferes with matching the edges. So the matching point of these supraclav and tangential field will suffer from over-dose and under-dose. To prevent these these divergency, a half- block is often applied at supracluv field. Also in some techniques like collimator and couch rotation, corner blocks and custom blocks are applied at tangential field which it renders its own problem. Hence, this research employ half-block in all three different radiotherapy scheme to some how radiate the cancerous tissue more appropriately to lessen the over exposure and yet deliver the needed dose to the tissue.
Methods: Ten breast cancer patients of Sohadaye Haftome-Tir hospital were considered for this study. The divegency of the fields at the matching point was blocked by using a half-block application and a slope, under patients. Dosimetery was measured by TLD at desired location on the skin before and after the half-block application. The measurement was carried out at 2 groups under 2 different irradiation methods (SSD, SAD).
Results: Dosimetery showed that the mean over-dose values at SSD method before applying half–block was 151% which reduced to 97% after half–block application, and in the SAD method the under-dose was improved from 41% to 80%.
Conclusion: Half–block can solve adjacent filelds problem efficiently, and since making the half-block at low cost is easily possible at any radiotherapy center, it is suggested to use block more often.
Modarres M, Mosavi A, Mohammadifar M, Behtash N, Ghaemmaghami F, Soltanpour F,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Access to a safe and efficient chemotherapy regimen for improving the survival and live quality is a goal in ovarian carcinoma. Despite surgery is the base treatment of ovarian cancer, but in most patients chemotherapy is used due to progression of their disease. This study designed to compare two important chemotherapy regimens.
Methods: This historical cohort study compared two chemotherapy regimen cisplatin (75mg/m2)+ cyclophosphamide (750mg/m2), versus taxol (175mg/m2)+ carboplatinium (GFR+25)AUC between 1998-2005 in valiasr hospital. In this study toxicities of two regimes were compared. The survival function in these two groups were analysed with Kaplan-Meire curve.
Results: Gastrointestinal and mucosal toxicity were significantly higher in CP group compared TC group (p=0.02). Also there were no significant relation between decrease of serum CA125 and patient remission length in CP group but in other group with decrease of CA125 in lower than three cycle we had an increase in patient remission period. (P=0.02). Disease free interval in cisplatin group was longer versus taxol group (p<0.05), there was no significant difference in overall survival in two group.
Conclusion: This study revealed that cisplatin plus cyclophosphamide regimen can yet be used as a chemotherapy treatment in ovarian cancer. In this study there was no significant benefit in taxol regimen compared CP. In the adjuvant therapy of epithelial ovarian carcinoma.
Gharagozlou M, Montazeran M, Foroozanfar M, Khalili S,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Influenza epidemies which occur mosthly in cold seasons could be a risk factor for developing exacerbations and acute attacks of asthma. Although influenza vaccination is recommended for the asthmatic patients, there is a lack of sufficient clinical evidence that this annual vaccination prevents asthma exacerbation in children.
Methods: Prospective clinical trial study of 201 children with asthma, where 79 did, and 122 did not receive the influenza vaccine, was done. The two groups were compared with respect to use of bronchodilators, systemic corticosteroids, emergency department (ED) visits and hospitalizations for asthma. In multi variable analysis, adjustment was made for baseline asthma severity and demographic variables.
Results: After adjusting for other variables, the vaccinated group had a significant decreased in exacerbations frequency and duration. Also the frequency of used bronchodilators and the absence days of daycare center or school were lower in the vaccinated group (P<0.05). There was no significant difference between the two groups in relation to used systemic corticosteroids and ED or hospital admissions (P>005).
Conclusion: This study showed that influenza vaccination may be effective in prevention of some asthma exacerbation aspects.
Eftekhar Z, Mohagheghi S, Yarandi F, Izadi Mood N, Moghaddami Tabrizi N, Rezaee Z,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Endometrial cancer is the most common malignancy of genital system which is commonly seen after menopause. Rises in the age of marriage non-surgical methods, using systemic progestins, have been evaluated to treat the young patients with well-differentiated endometrial cancer who wish to preserve their fertility.
Methods: Twenty one infertile patients with stage Ia well-differentiated endometrial adenocarcinoma were enrolled in a quasi-experimental study. The treatment initiated with 160mg/d of megestrol acetate then continued with 320mg/d for non-responsive cases. Patients follow up with FD&C and hysteroscopy. Patients divided in two groups on the basis of response to therapy and persistent. The responsive patients were introduced to IVF group and evaluated for later fertility and birth of alive newborns for three years.
Results: This study showed a response rate of 85.71% and 14.29% undergoing TAH. The mean duration of treatment was 5.85±2.00 month. The response to therapy was observed in 27.78% with dose of 160mg/d and the remaining patients with 320mg/d. Pregnancy occurred in 27.78%, 2 of which ended up in a term delivery and the others ended before term. Recurrence happened in 16.67% that 66.67% of them experienced remission again.
Conclusion: Use of 320mg/d seems to be associated with a better therapeutic response. Serious complications were not observed with this dose. Furthermore, continuance of the drug for three month following a normal pathology report was decreased the rate of recurrence.
Zafarghandi N, Torkestani F, Hadavand Sh, Zaeri F, Jalilnejad H,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Hysterectomy is a common surgery as treatment for chronic and benign gynecologic problems. Eeach year more than half million women in USA undergo hysterectomy.
Methods: This analytical cross-sectional study, was done on 100 women who had underwent hysterectomy at least two years before the study and met inclusion criteria of study. During interview, the questionnaire were completed, then examination was done by gynecologist. Most of the information were collected from the patient’s files.
Results: In this study the most indication of hysterectomy was fibroma and the most common type surgery was total abdominal hysterectomy, and mostly were done without oophorectomy. 20% of cases were without or weak prior to operation and 80% with medium (or high) libido, after hysterectomy the figures changed to 41% and 59% respectively. After hysterectomy libido with P=0.001, frequency of coitus with P=0.001, and sexual satisfaction with P=0.013, significantly declined. Libido after hysterectomy declined with aging (P=0.01). There was no significant correlation between oophorectomy and libido.
Conclusion: Sexual function declines significantly after hysterectomy, with no association with oophorectomy and type of surgery.
Fazeli Mr, Abbaspour M, Ghahremani Mh, Alimian M, Ilka H, Jamalifar H, Azadi S, Azizi E,
Volume 64, Issue 12 (6 2006)
Abstract
Background: Aluminum salts are common adjuvants in human and animal vaccine preparations. The two adjuvants aluminum phosphate and aluminum hydroxide show acceptable immunoadjuvant properties with many antigens. These two salts have different physicochemical characteristics that make each one suitable for certain antigens. The surface antigen of Hepatitis B (HBsAg) has several antigenic epitopes that bind to aluminum adjuvants by a ligand exchange mechanism. Although HBV vaccines using an aluminum hydroxide adjuvant are available, higher antigenicity is needed for the subgroup of people who do not respond sufficiently to the currently available vaccines.
Methods: A solution of recombinant HBsAg for making different formulations of vaccines with aluminum phosphate (Adju-Phos®) and aluminum hydroxide (Alhydrogel®) adjuvants was obtained from Darupakhsh Pharmaceutical Company. The total protein content, antigenicity, and purity of HBsAg solution were determined using BCA, ELISA, and SDS-PAGE methods, respectively. The different formulations were prepared in the lab and administered i.p. to two test groups of Balb/C mice and a third test group received the Engerix vaccine, which is currently available on the market and uses an aluminum hydroxide adjuvant. The control group of animals received the solution without antigen. After 28 days, heart blood samples were collected and serum was separated to determine the antibody titer against HBsAg using an ELISA kit.
Results: This study shows that the vaccine formulated with aluminum phosphate exerted more immunogenicity than both the aluminum hydroxide laboratory formulation and the Engerix vaccines.
Conclusion: Although the results of our study indicate higher immunogenic properties of the vaccine formulated with the aluminum phosphate adjuvant, complementary experiments are needed to further evaluate the biological properties with respect to effectiveness, adverse effects, product stability and finally possibility for manufacturing and distribution of this new formulation as a Hepatitis B vaccine.
Aghajanzadeh M, Safarpoor F, Khoshrang H, Mohammadzadeh A, Khatmi N,
Volume 64, Issue 12 (6 2006)
Abstract
Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S) in pain control after thoracotomy.
Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1) received a single dose (10 ml) of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h) four hours after surgery. Group 2 (G.2) received a single dose (10 ml) of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h) four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS). If VAS > 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS ≤ 3 was considered pain control.
Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P<0.001 and for other time points P=0.0001). During the 4-24 hour period after surgery, pain control in G.1 was 5% and in G.2 was 81%. The mean VAS at 28, 32, 36, 40, 44, and 48 hours after surgery in G.1 was 5.2, 5, 5.3, 4.4, 5.1, and 4.8, respectively, and in G.2 was 1.6, 1.8, 1.5, 1.6, 1.5 and 1.4, respectively, with a significant difference between the two groups (P<0.0001). In the first 24 hours, the mean of pethidine injection in G.1 was 3.7 and in G.2 was 0.6 (P<0.0001). In the second 24 hours, the mean pethidine injection in G.1 was 2.2 and in G.2 there was no need for pethidine (p<0.0001).
Conclusion: Continuous extrapleural infusion of bupivacaine is effective in pain control and decreasing demand for narcotics after thoracotomy.
Najafi M, Haghighat B, Ahmadi H,
Volume 65, Issue 1 (5 2008)
Abstract
Background: Atrial and ventricular arrhythmias are among the most common complications after coronary artery bypass graft (CABG) surgery. Previous studies demonstrated that cardiopulmonary bypass itself results in reduced serum magnesium levels. In this study, we evaluated the effect of total blood magnesium level (TMG) on the prevention of perioperative arrhythmias with routine regimens of 2-4 grams supplemental magnesium (SMG).
Methods: TMG was measured in patients who were scheduled for CABG on three occasions: just before anesthesia, just after entering the intensive care unit (ICU) after completion of the sugery, and on the first morning after the operation. Patients were evaluated for primary cardiac rhythm and other variables that could have an influence on the magnesium level, including serum creatinine, urine output in the operating room and diuretic therapy. The SMG dosage was also recorded in the operating room and ICU. Patients were then evaluated for the rate and type of arrhythmia for the next three days.
Results: The mean TMG levels in 174 cases were 2.2 (0.5), 2.6 (0.6) and 2.4 (0.6) mg/dl for the three occasions, respectively. The mean SMG was 2.5 (1.2) grams. Of 164 patients, 51 (31%) developed the following post-operative arrhythmias: AF (7.3%), non-AF SVA (15.2%) and ventricular (16.5%). The mean serum creatinine level and urine output were 1.2 mg/dl and 1800 ml, respectively. Although there was a significant difference between the TMG levels on the three different occasions (P<0.001), all values were within normal range. When we stratified the TMG levels of the patients based on administered SMG, the Mentel-Haenszel test revealed no significant difference between the first and third TMG (P=0.6). Although the TMG levels were higher in arrhythmic patients compared to those without arrhythmia (2.25 vs. 2.14 mg/dl), both values were within the normal range and there was no significant difference between the two groups. Serum creatinine levels and urine volume were not related to TMG levels.
Conclusion: This study indicates that routine magnesium administration has no significant effect on SMG levels. Also, serum creatinine and urine output are not determinant factors for SMG administration. There was no correlation between TMG levels and perioperative arrhythmia. We conclude that the routine regimen of magnesium administration has no effect on the incidence of perioperative arrhythmia, though it is necessary for maintaining normal magnesium levels.
Ghanaati H, Aghaee S, Salehianzandi N, Shakiba M, Jalali S.a.h,
Volume 65, Issue 2 (8 2008)
Abstract
Background: Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality.
Methods: In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity.
Results: Among our cases, 111 (43.5%) were male and 145 (56.5%) were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects (42.9%), 55.5% of which were male and 44.5% were female (P=0.001). Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis (29% versus 19.1% P<0.01).
Of those patients with sinus involvement, 16% were involved in the sphenoid sinus and 5% in the frontal sinus. The results obtained from the patients with sinus abnormality revealed that 85% suffered from cough, nasal obstruction, runny nose, facial pain and post nasal discharge and 24% had been diagnosed with chronic sinusitis by physician.
Conclusion: Our results showed that there was a high rate of incidental abnormalities in the paranasal sinuses that are unrelated to the patient's presenting problems.
