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P Pas Bakhsh , M Mehdi Zadeh , Zh Behzadi ,
Volume 58, Issue 1 (6 2000)
Abstract

In order to understand the function of mammalians serotonin system, we have to know the anatomical structure, because physiological changes are influenced through the anatomical changes. A number of thalamic nuclei are associated with functions known to be influenced by serotonergic input in brainstem, among them mediodorsal thalamic nucleus has relationship with limbic system and prefrontal cortex. The precise topographical projections of mesencephalic raphe nuclei to the MD nucleus of thalamus were identified in the rat using horseradish peroxidase (HRP) retrograde tracing substance. Injection of HRP in MD labeled a large number of neurons in rostral to caudal part of dorsal raphe nucleus. It exhibited a strong number of neurons in ipsilateral part of DR and a few cells in its contralateral part. Numerously labeled cells were also observed ipsilateral in rostral and medial part of MnR (86%) and a few cells in it's contralateral part. The present study has provided that the MD innervation by DR is more greater in density than that observed at the MnR. Upon these results and previous study, mesencephalic raphe nuclei are involved in several specific functions of thalamus as limbic system behavioral mechanism. A much more detailed knowledge is needed to show topographic relationships between mesencephalic raphe nuclei and forebrain.
Derakhshan Deilami Gh, Mehrabi S,
Volume 58, Issue 2 (7 2000)
Abstract

Despite the role of oral corticosteroids in management of sever asthma, use of these drugs needs careful awareness of its many side effects. There are controversies about the role of methotrexate in lowering the need for corticosteroides in these patients. In this study an attempt has been made to determine methotrexate effects in corticosteroid dependent asthma. Six patients were entered in a double-blind placebo controlled crossover trial and randomly allocated to two groups. Each group got a 12 weeks course of treatment with 15 milligrams of methotrexate or placebo which thereafter was changed to the other regimen. In comparison with placebo, methotrexate caused a 62.5% less need for oral corticosteroid (P<0.01) and a 20% increase in FEV1 (P<0.05). We concluded that the use of low doses of oral methotrexate results in less need for oral corticosteroid in treatment of corticosteroid dependent asthma.
Sobhani A, Radmehr B, Raji Ar,
Volume 58, Issue 2 (7 2000)
Abstract

Different ossificant materials have been used for induction of bone repair in many studies, and bone matrix gelatin which contains bone morphogenic proteins is one of the best ones. In present study we evaluated the role of this material in acceleration of bone repair in rabbit tibia. A hole of 3.5 mm diameter was made on right tibia of 10 and 12 rabbits as study and control group respectively. In the experiment group, in addition to Bone Wax, we applied bone matrix gelatin in the hole. Radiographic images were taken in days 0, 20, 40 and 53 after operation. In 6 rabbits of each group, photographic pictures were also taken after exposure of entire bone. In 6 controls less degree of restoration were seen on day 53. In 4 experimental animals restoration were completed by this time and in 2 speciments repair processing were better than controls. This results shows that bone matrix gelatin can be used as a accelerator of bone repair.
Ramezan Zadeh F, Khalaj Abadi Farahani F, Sadat Hashemi Sm,
Volume 58, Issue 3 (7 2000)
Abstract

Tubal ligation is one of the most effective and reliable methods of contraception and of successful program of birth control in Iran. Present study was done to evaluate factors affecting risk of complications during tubal ligation surgery. We studied 1780 women that had tubal ligation in 13 hospitals in Tehran during the years 1993-95. Data on operation were collected by questionnaire and analyzed using logistic regression method. Risk of complications was increased in women had had operation after vaginal therapy, in luteal phase, after cesarean section and in follicular phase, respectively. Modified pomery, pomery and parkland methods of operation were ascendingly related to increased risk of complications. Age, history of pelvic pain, method of anesthesia, incision size and time of operation were not significantly correlated with complications. Frequency of complications was higher in women that had other procedures during surgery. We suggest that tubal ligation be done after vaginal delivery and by modified pomery method.
Moetamedi M, Sigarroudi H, Vosooghi R, Hosseini Sj, Sahraeian Ma,
Volume 58, Issue 4 (8 2000)
Abstract

Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.
Jamal A, Mesdaghi Nia S,
Volume 58, Issue 4 (8 2000)
Abstract

In this paper we report a case of jejunal atresia that was detected pre-nataly. Polyhydramnios and multiple dilated bowel loops in the lower part of fetal abdomen in ulterasonography helped us to diagnose this abnormality. Post-natal barium enema showed it and also it was confirmed by laparotomy confirmed it. Pre-natal diagnosis is important in these cases to facilitate delivery in centers where expert team of specialists are available to allow optimal neonatal care.
Radmehr H, , ,
Volume 59, Issue 2 (5-2001)
Abstract

Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.


Radmehr H,
Volume 59, Issue 3 (8 2001)
Abstract

Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.


Fallahi G, Mehdizadeh M, Zandieh F,
Volume 59, Issue 5 (9 2001)
Abstract

One of the common problems in children and specially in infants is gasteroesophageal reflux (G.E.R). Present study was performed to compare diagnostic value of lower esophageal sonography with barium swallow. This study was conducted on 50 patients 1 month to 15 years age in center of pediatric clinic of Tehran, during the years 1999-2000. Patients suspected to have G.E.R studied with lower esophageal sonography and barium swallow and at the end, their results were compared with esophageal PH monitoring as a standard test. In this study sensevity of sonography was 90 percent against 50 percent for barium swallow but specifity of two test was the same 35 percent. We can concluded that sonography is a non invasive, low cost, with less side effects than barium swallow. We recommend sonography in place of barium swallow in diagnosis of G.E.R.
Mirkhani S. H, Delavarkhan S. M, Radmehr H,
Volume 60, Issue 1 (13 2002)
Abstract

In recent years off-pump coronary artery bypass surgery (OPCAB) has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG), we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery.
Materials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB.
Results: Of 150 OPCAB cases, 146 (97.3 percent) were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6). Total 595 distal grafts anastomosed to LAD (140) diagonals (140), right coronary artery (145), left circumflex (164). Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein.
Conclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.
Radmehr H, Hatmi Z , Jazayeri Tehrani Sa, Bayatian A,
Volume 60, Issue 3 (14 2002)
Abstract

Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (Coronary Artery Bypass Graft) is one of the therapeutic methods in ischemic heart disease.

Methods and Materials: Considering the increased incidence of coronary artery disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999). In 635 patients 467 male (73.5 percent), 168 female (26.5 percent) about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease), history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and coronary endarterectomy.

Results: Cigarette smoking (P=0.40), CHF in female (P=0.003). Endarterectomy in both gender (P=0.0001). Pace maker in both gender (P=0.00006), palpitation in both gender (P=0.0001). CPR in both gender (P=0.0000001), were associated with increased risk of mortality after CABG.

Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.


Gity M, Motamedy M, , ,
Volume 60, Issue 4 (15 2002)
Abstract

Background: Sport medicine is a relatively new scientific branch in Iran. In order to evaluate sport injuries in Iranian skiers we examined and followed all ski players who was injured while skiing in Shemshak slope during a skiing season (January to April 2000).

Materials and Methods: During a period of 3 months, a total of 32050 persons skied in Shemshak slope and 76 case of injuries were identified the injury rate was calculated as 2.3/1000 skiers. Among the injured organs knee (32%) and head and neck region (20%) were respectively the most common sites of injury. Sprain of the medial collateral ligament was the most frequent knee injury (28% of the cases). 26.7% of the injured cases were amateurs and 21% of them used hired ski instruments.

Results: In this study such factors as lack of exercise before skiing, fatigue and time of skiing (beginning or end of the season) were not found to be related to the injury rate. However, head and neck injuries in contrast to knee injuries were most frequent in the end of the season (P<0.01).

Conclusion: This study confirms the necessity of greater care of knee joints during skiing and probable need of wearing helmet for head protection in the end of skiing season. More studies are necessary to clarify other details regarding sport injuries in skiers.


Ghergherehchi M, Mehraein A, Sadeghi M,
Volume 60, Issue 6 (15 2002)
Abstract

Introduction: Succinylcholine is a depolarizing muscle relaxant, which has been used extensively in anesthesia to produce muscle relaxation. The present study was done with the aim of comparing Fasciculation and postoperative myalgia after injection of two different doses of Succinylcholine (1.5 mg/kg and 3 mg/kg).

Materials and Methods: In this study which has been conducted in the form of Randomized double blind study in Tehran Shariati Hospital in the year 2000, 50 male patients in two groups (25 in each) with ASA I&II, age between 18 to 65, were candidate for an elective surgical repair of inguinal hernia received a standard anesthetic technique, including one of the two doses of Succinylcholine.

Results: After collecting data it has been considered that the average difference of two respective groups is meaningful in terms of fasciculation (P<0.05), but not in terms of myalgia (P>0.05).

Conclusion: we came to the conclusion that, firstly, the percentage of myalgia after the injection of succinylcholine is totally low and with the increase of the dose of medication from 1.5 mg/kg to 3 mg/kg the very percentage does not change considerably. Secondly, regarding fasciculation the increase of the dose of medication from 1.5 mg/kg to 3 mg/kg causes the decrease of the average limit of fasciculation. This decrease is very obvious in server fasciculation. As a matter of fact no relationship was found between decrease in fasciculation and change in myalgia.


Jabal Amely F, Malek Zadeh F,
Volume 61, Issue 1 (13 2003)
Abstract

In Vivo, after administration of treatment, concentrations of anti‌microbial agents will reduce to sub-inhibitory levels (sub-MIC) and may therefore affect the properties of target bacteria. The purpose of the present study was to investigate the in vitro effect of sub-minimum inhibitory concentrations (sub-MIC) of ampicillin, gentamicin and nalidixin acid on morphology, growth, ammonium production and urease activity of proteus mirabilis. Proteus mirabilis is well recognized as an important urinary tract pathogen.
Materials and Methods: Several of its properties have been studied in relation to pathogenesis manifested in urinary tract such as urease activity.
Results: In the presence of ampicillin, long filamenteous cells was produced and the length of the cells was increased at the higher concentration of ampicillin. Sub-MIC of ampicillin and gentamicin affected the growth pattern and prolonged the lag-phase of growth. This affected was significant when gentamicin was used. Nalidixic
acid of 1/2 MIC greatly reduced the growth rate, while the lag phase was not
changed. In the presence of sub-MICs of ampicillin and gentamicin, the amount of
ammonium production increased. In medium with 1/2 MIC of ampicillin, the
ammonium production was 30 times of control, while the urease specific activity of sonicated cells did not show any significant changes.
Conclusion: It seemed that the antibiotics enhanced the cell membrane permeability for substrate and enzyme. Nalidixic acid didn't show any significant effect on ammonia production, and urease specific activity of proteus mirabilis. The results indicate that the sub-MIC of antibiotics can effect virulence factors of proteus mirabilis.
Radmehr H, Mirkhani S H, Sanatkar Far M, Soltatii Nia H, Emami S A, Ghorbandaei Pour I, Abolghasemi, Taghavi M, Moameni F,
Volume 61, Issue 6 (15 2003)
Abstract

Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The aim of this study was to evaluate the effect of autologous transfusion on patients' hematocryte value, intra and postoperative blood loss, hospitalization time, the development of infective complications and other factors.

Materials and Methods: Between June 2001 to April 2002, 208 patients were underwent cardiac surgery in cardiac surgery ward in Imam Khomeini Medical Center. One or more blood units donate from 104 Patients before cardiopulmonary bypass and heparin injection, and transfused to them after CPB and Protamin injection (autologous Group, group 1). 104 patients underwent cardiac surgery routinely (control group, group 2).
Results: Mean of age was 55.9±8.6 in group 1 and 56.6±9.3 in group 2 (P=NS). 73 male and 31 females were in group 1 and 79 males and 25 females were in group 2 (P=NS). Smoking, familial history, hyperlipidemia, diabetes mellitus, renal failure, hypertension, stroke, and history of myocardial infarction was similar in two groups.
Severity of angina, urgency operation, number vessels disease, duration of cardiopulmonary bypass, duration of aortic cross clamp time, use of internal thoracic artery graft, and number of grafts was similar in both groups. Mean of bleeding post operation was 548 cc in group 1 and 803 cc in-group 2 (P=0.003). Bleeding that need to operation was 1.8% in group 1 and 8.6% in group 2 (P=0.002). Wound infection, mediastinitis, renal failure, ventilatory prolonged, stroke, need to Intra-aortic Balloon Pump (IABP), intraoperative bleeding, and hospital stay was similar in both groups. Mean of extubationt time was 10.2 hours in group 1 and 14.8 hours in group 2 (P=0.001).
Conclusion: Preoperative and intra-operative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.






 


Ramezanzadeh F, Tavafian S S,
Volume 61, Issue 6 (15 2003)
Abstract

Illicit drug abuse is a major area of interest for clinicians, as well as for public health and social authorities, but one of the major concerns is the illicit drug abuse during the periconceptional period and throughout pregnancy, because of its potential effects on the embryo and fetus. In this study we investigated the prevalence of illicit drug abuse in the first trimester of pregnancy in women who referred to Iran, Tehran and Shahid Beheshti universities of medical sciences, for prenatal care.
Materials and Methods: In this descriptive cross sectional study, a non-randomized sample of 2000 pregnant women that were in their second and third trimester of their pregnancy, were interviewed about drug abuse in their first trimester. Collected data were analyzed by SPSS software.
Results: The prevalence of illicit drug abuse in the first trimester was 2.5% which the majority of these drugs were in group B. The prevalence of drug abuse was 0.9% and alcohol usage and alcohol abuse was 0.2%, cigarette smoking was the most common drug abusing phenomena. Variables such as husband education, infertility and satisfaction with pregnancy have significant relation with drug abuse.
Conclusion: The results of this study support the need for continued education and this education must end in by itself to make dramatic changes in behavior. So results of this study showed that, improving education and knowledge of mothers and consultation with them in regard to risks and complications of drug abuse during pregnancy, would make dramatic changes in their behavior.







 


Miri S R, Kiani A, Mehrabi V,
Volume 61, Issue 6 (15 2003)
Abstract

Ectomesenchimal cells, placed near the embryonal tube, migrate to down and share in facial and cardiac structures. Migration or differentiation disorders of these cell causes cleft lip/ or palate and congenital heart disease (CHD). This item was performed to determine co-appearing of cleft and CHD and to know adjutant factors to that for better management of these patient.
Materials and Methods: Two hundered children with cleft lip and palate were registered. Finding was analyzed by fisher's exact text and chi-square tests.
Results: CHD is ten times of normal population in this research (p< 0.01 and odd ratio 10.39) and incidence of CHD in cleft is high in cleft patient if another congenital animalies were presented (p< 0.001, odd ratio 5.18).
Conclusion: By attention to higher incidence of CHD in cleft patients, it is advised to cardiologist consulting before cleft surgery for better managing.


 


Mehr Aein A, Davoodi S, Madani Givi M,
Volume 61, Issue 6 (15 2003)
Abstract

The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on post-operative bleeding and need for allogeneic transfusion.
Materials and Methods: In a prospective, randomized study, 200 patients undergoing CABG allocated into two groups:
□ AT group = 100 patients received 1-2 units (300-450cc) autologous blood after termination of CPB D TX group = 100 patients received tranexamic acid, 15mg/kg before the injection of heparin and 15mg/kg after protamin injection Postoperative bleeding, transfusions, complications, ICU stay and hospital stay were recorded.
Results: The postoperative bleeding was lower in TX group (600 ml) than in AT group (1100 ml) (P <0.001). The rates of transfused patients in AT and TX groups were 72% and 65%. Patients in the AT group received more whole blood (2.82 units per patient vs. 1.93 units in TX group) (P<0.01). The numbers of FFP units administered per patient in AT and TX groups were 3.08 and 2.38 (P <0.01). In TX group, ICU stays and hospital stays were 0.8, 5.4 days (vs. 1.2s, 6.7days in AT group). In AT group, there were 2 transient renal dysfunctions and two re-operations. There was no difference between all groups regarding to neurological dysfunction and coagulopathy. There is no hospital mortality in all groups.
Conclusion: Tranexamic acid in comparison with intra-operative autotransfusion effectively reduces postoperative complications and allogeneic transfusions in CABG. In addition this technique due to shorter ICU and hospital stay is cost- effective.


 


Mirsalehian A, Jabalameli F, Kazemi B, Alizadeh S A,
Volume 61, Issue 6 (15 2003)
Abstract

Background: Staphylococci as a micro-organism, has the most importance to cause nosocomial infections, particularly in patients with indwelling catheters or other medical devices. Unfortunately 90% of Staphylococci isolated from the nosocomial infections are resistant to methicillin, and methicillin resistance strains are also resistant to a wide range of antimicrobial drugs, therefore detecting of these strains are valuable to eradicate the infection elements. Despite guidelines published by the national committee for clinical laboratory standards (NCCLS) for testing of susceptibility to methicillin for Staphylococci, the phenotypic method for detecting methicillin resistance remains controversial. Therefore, the genetic assays have been used to detect antimicrobial susceptibility of Staphylococci to methicillin.
Materials and Methods: Resistance to methicillin is coded by mec A gene in staphylococcus, and this gen must be detected in genetic assays. In this study 155 clinical staphylococcal isolates (70 coagulase- negative staphylococcus and 85 coagulase- Positive staphylococci) were evaluated for susceptibility to methicillin by using disk diffusion method.
ResuIts&Conclusion: Methicillin resistance was shown in 62 coagulase- negative staphylococcus (72.9%) and 27 coagulas positive staphylococcus (38.6%) but 63 coagulase negative Staphylococci (74%) and 28 coagulase positive isolates with mec a gene associated resistance were detected by PCR method. The results of this test were compared to the results for mec A gene detection by PCR test as a gold standard. The sensitivity, specifity and accuracy of the disk diffusion test for coagulase-negative staphylococcus were 96.8%, 95.45% and 96.47% and for coagulase positive staphylococci were 98.43%, 95.45% and 98.32% respectively.

 


Esmaeil Zadeh A, Mirmiran P, Mehrabi Y, Azizi F,
Volume 62, Issue 1 (12 2004)
Abstract

Background: Stenotic coronary arteryIt is essential to identify the best simple anthropometric index in any population to predict chronic disease risk. This study was designed to compare the ability of waist circumference (WC), body mass index (BMI) and waist-to-hip ratio (WHR) to predict cardiovascular risk factors in an urban adult population of Tehranian men.

Materials and Methods: This population-based cross-sectional study was conducted on 4449 men aged 18-74 years, participants of Tehran Lipid and Glucose Study (TLGS). Demographic data was collected. Anthropometric indices were measured according to standard protocol. Blood pressure was measured and hypertension was defined based on JNC VI. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as FBS≥126 mg/dl and dyslipidemia based on ATP II. The presence of “at least one” and “at least two” risk factors from the four major cardiovascular risk factors (hypertension, dyslipidemia, diabetes and smoking) was also evaluated.

Results: Mean age of men was 41.8±15.4. Mean BMI, WHR and waist circumference was 25.6±4.2 kg/m2, 0.91±0.07 and 87.7±11.7 cm, respectively. Of the three individual indicators, WHR had the highest sensitivity for all risk factors. No combination of indicators had higher average sensitivity + specificity than WHR alone. WHR had a higher percentage of correct prediction than BMI and waist circumference for all risk factors. No combination of measures was significantly more accurate than WHR alone, except for combinations where another indicator has been combined with WHR by “or”.

Conclusion: It is concluded that WHR is the best predictor of cardiovascular risk factors compared to BMI and WC in Tehranian adult men residing in district-13.



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