Showing 12 results for Treatment Outcome
Sh Najafi, M Mohammadzadeh, Hr Monsef Esfahani, Gh Meighani , N Rezaei,
Volume 71, Issue 2 (5-2013)
Abstract
Background: Recurrent aphthous stomatitis (RAS) is a common disease with unknown etiology. There is no curative treatment. Purslane is considered as a rich source of antioxidants with anti-inflammatory effects. The purpose of this study is to evaluate the effect of Purslane in the treatment of RAS.
Methods: A total of 50 patients were selected for this randomized triple-blind placebo-controlled clinical trial from School of Dentistry of Tehran University of Medical Sciences in 2011. All subjects were randomly divided into two groups. Groups A and B received placebo and Purslane, respectively, for three months. Pain intensity based on the visual analogue scale (VAS), the mean intervals of lesions occurrence, number of lesions and the mean duration of complete healing at baseline and at months 1, 2 and 3 were recorded.
Results: While no patient complained from increased severity of pain, decreased severity of pain for 4, 3, 2, and 1 grades were recorded in %16, %20, 20%, and 40%, respectively, which were much higher than 4%, 8%, 8%, and 28%, respectively, in the control group. A significant decrease in pain intensity in VAS scores were seen after treatment in group B (P<0.001). The mean duration of complete healing showed significant differences (P<0.001) between groups A (-1.52±4.07 days) and group B (-6.56±4.50 days). The mean intervals between lesions also showed significant differences (P<0.001) between group A (17.88 days) and group B (33.12 days). No significant differences were found between group A and group B regarding to number of lesions. No serious side-effects occurred in either group.
Conclusion: According to our study, Purslane is clinically effective in treatment of RAS and considering the lack of side-effects during the study period, this medicine may be a favorable alternative treatment for recurrent aphthous stomatitis.
Reza Karbasi-Afshar , Reza Noroozian , Ayat Shahmari , Amin Saburi ,
Volume 71, Issue 3 (6-2013)
Abstract
Background: Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension (HTN). We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension.
Methods: In this prospective cohort study, patients who received three or more anti-hypertensive medications with 160mmHg systolic blood pressure (BP) or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects.
Results: One hundred and seventeenth patients (54%) out of 212 screened patients were included in the first group (renal denervation) and 95 patients as the second group. The mean of BP changes in the first group was 35/15 mmHg with standard deviation of 22/11mmHg. (P<0.001) in the second group, the mean changes of BP was not statistically significant. (5/0mmHg± 22/11, P=0.79 for systolic BP and P=0.96 for diastolic BP). 92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls (P=0.001). There was no observed complication after denervation in the first group.
Conclusion: It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.
Reza Bagheri , Seyed Ziaollah Haghi , Mohammadtaghi Rajabi Mashhadi , Alireza Tavassoli , Davoud Attaran , Saeed Akhlaghi , Neusha Barekati , Maryam Esmaeeli ,
Volume 71, Issue 9 (12-2013)
Abstract
Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.
Seyed Masoud Majidi Tehrani, Hamid Ghaderi , Mahnoosh Foroughi , Manouchehr Hekmat, Mahmoud Beheshti Monfared, Hassan Tatari , Seyed Mohsen Mirhosseini , Zargham Hossein Ahmadi, Zahra Ansari Aval, Seyedeh Adeleh Mirjafari,
Volume 72, Issue 2 (5-2014)
Abstract
Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago.
Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study.
Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%).
Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.
Firooz Esmaeilzadeh, Nahid Hatam , Zhila Esmaeilzadeh , Abdolhalim Rajabi , Meysam Anami , Sajad Vahedi , Hossien Mirzaei,
Volume 72, Issue 9 (12-2014)
Abstract
Background: The rabies is a deadly disease and if its symptoms break out in a person, he will certainly die. However, the deaths caused rabies can be prevented by post-exposure prophylaxis (PEP).
Methods: In this study, subjects were recruited through census and with respect to in-formation which gathered from Fars Province health centers, Pasteur institution and previous studies In Iran. The mortalities for age groups and by sex type have been cal-culated. The decision tree model using probabilities, which the effectiveness of PEP treatment after getting bitten by an animal suspected, persons to receive specified. Dis-ability adjusted life year score (DALY) was applied to estimate the DALYs saved from PEP. In this study it was assumed that if a person suffering with rabies, a few days af-ter the onset of symptoms, death is compulsory. Therefore YLD rabies was considered zero. Finally, to increasing the accuracy and because inherent uncertainty of the data, and the increase the power of analysis, one-way sensitivity analysis was used.
Results: From March 2011 to March 2012, in Fars Province, total cases of animal bites were reported and received PEP treatment. The cases were 5394 (75.85%) male and 1717 (24.15%) female. PEP generally prevented from 177.076 deaths which 134.096 (75.72%) were men and 42.98 (24.27%) of them were women. The age distribution of suspected animal bites in youth more than adults, and in men higher than women. Also due to prevented mortality caused by PEP, it is prevented from 4455.71 DALYs. Based on the sensitivity analysis DALY prevented, except for dogs and cats, there was no change in the other animals.
Conclusion: The implementation of PEP for animal bitten people remarkably reduced the burden of disease in community. Calculations with primitive cost estimations im-plicitly revealed that this intervention is a most cost-effectiveness program.
Amir Keshvari , Mohammad-Sadegh Fazeli , Alireza Kazemeni , Alipasha Meisami , Mohammad-Kazem Nouri-Taromloo,
Volume 72, Issue 12 (3-2015)
Abstract
Background: Sacrococcygel region is the most common site for pilonidal sinus and surgery is the most common treatment for it. Numerous operative techniques have been described for management of this disease but a technique with low recurrence and complication rates is the best treatment option. Karydakis has been introduced as a method with less recurrence rate, but it seems that surgeons debate on complications and it is not a common technique in our country. In this article, we will discuss Karydakis procedure and its results after a prospective follow-up in our patients.
Methods: This is a prospective single cohort study on the patients with sacrococcygeal pilonidal disease. Cases evaluated in this study included patients underwent Karydakis procedure for their pilonidal sinus from 23 September 2006 to 22 September 2013. Patients were followed-up prospectively after their discharge within the first week, first month and third month for early complications and then annually for recurrence. The length of follow-up ranged from 3 to 77 months (median 36 months).
Results: Of 141 patients, 119 (84.4%) were male and mean operating time was 55.52 (35-120) minutes. Mean time to healing wound with no need to dressing was 15.92 (range: 2-120) days and mean time to return to work was 14.44 (range, 1-35) days. Overall rate of early post-operative complications was 21.3% that most of them treated conservatively. Wound breakdown within the caudal part was the most common complication detected in 12.1% of patients and infection was detected in 5.8%. Hematoma, seroma and complete wound breakdown were seen in one patient each. The mean score of patient's satisfaction after one year was 4.91 out of 5. Recurrence was appeared in 1.42% of patients.
Conclusion: Karydakis procedure for sacrococcygeal pilonidal disease is associated with low complications, short healing time and return to work, and reasonable recurrence rate.
Hossein Mashhadinezhad , Babak Ganjeifar ,
Volume 73, Issue 3 (6-2015)
Abstract
Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature.
Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction.
Results: Mean age of our cases were 34±7.4 years. According to the duration of the sciatica, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to <12 months and >12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of sciatica for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P= 0.022). However, there could be found no such disparity in other clinical scores (P= 0.63 for MODI, P= 0.85 for Prolo scale and P= 0.73 for satisfaction).
Conclusion: Patients with less than three months of sciatica may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of sciatica and the satisfaction after two years.
Azadeh Meamarian , Shayesteh Ashrafi Esfahani , Shahrokh Mehrpisheh , Atoosa Mahdavi Saeedi , Kamran Aghakhani ,
Volume 73, Issue 3 (6-2015)
Abstract
Background: The relationship of the base of appendix to the cecum remains constant, whereas the tip can be found in a retrocecal, pelvic, subcecal, preileal, or right pericolic position. These anatomic considerations have significant clinical importance in the context of acute appendicitis. The knowledge about the correct anatomical position of appendix may facilitate in generating an accurate diagnosis of appendicitis as well as assist in achieving a better prognosis and early treatment. The present study aimed to determine the anatomical location of the appendix in Iranian cadavers.
Methods: This descriptive cross-sectional study was conducted on 200 cadavers who were referred to the Forensic Center of Tehran from March to September 2013. The data including age, sex, weight, and appendix length and position were collected and analyzed using SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA).
Results: In the present study, 200 cadavers were evaluated accidentally, of which 173 (86.5%) were males and 26 (13%) were females, and the mean age was 39.96 years±16.31 (SD). The mean wall thickness of the appendix was 9.78 cm±16.31 (SD). The mean appendix length was 9.86 cm±1.79 (SD) in men and 9.30 cm±1.56 (SD) in women. The appendix height was long in 20 cadavers (10%), short in 3 cadavers (1.5%), and moderate in 177 cadavers (88.55%) cadavers. The appendix position was posterior in 120 (60%), ectopic in 32 (16%), and pelvic in 48 (24%) cadavers.
Conclusion: Majority of appendices examined in the present study were positioned at the posterior (Retrocecal) of pelvis. According to different positions of appendices in different populations and different races, the knowledge of appendix position in various populations is necessary for early diagnosis and treatment and fewer complications for related disease.
Malihea Khaleghian , Issa Jahanzad , Abbas Shakoori , Neda Zargari, Maryam Mohamadi , Cyrus Azimi ,
Volume 73, Issue 4 (7-2015)
Abstract
Background: The incidence rate of gastric cancer in Western countries has shown a remarkable decline in recent years although it is still the almost common cancer between men in Iran. The proto-oncogene MYC, located at 8q24.1, regulates almost 15% of human genes and is activated in 20% of all tumors. MYC amplification and overexpression of its protein product are observed in 15-30% of gastric neoplasia. The objective of this study was to find the preference of CISH or IHC in the diagnosis and prognosis of gastric cancer.
Methods: In this cross-sectional investigation, 102 paraffin blocks samples of Iranian patients with gastric cancers were studied. All the patients had undergone primary surgical resection at the Cancer Institute Hospital, Tehran University of Medical Sciences from 1987 to 1993. CISH and IHC techniques were applied to the samples. CISH was carried out on 3-µm-thick tissue sections and with a ZytoDot CISH Implementation Kit (ZytoVision GmbH, Germany). IHC was down using the HRP method with the monoclonal antibody. A universal peroxidase-conjugated secondary antibody kit was used for the detection system. All samples were gastric adenocarcinoma and were selected randomly.
Results: Our data revealed that both diffuse and intestinal types of gastric cancer occurred significantly in men more than women. Our results showed an indication of some correlation between grades and CISH results, although the difference was not significant. Our data also showed that CISH+ patients (43.1%) were more frequent in comparison with IHC+ patients (14.7%). There was a correlation between CISH and IHC. This result revealed that there was a significant difference between grades and IHC. There was also no statistically significant difference between CISH amplification in diffuse and intestinal types.
Conclusion: Our conclusion is that for the treatment, management of stomach cancer, and monitoring of progress and prognosis of the tumor that is almost important for patients and clinicians, CISH test is a better and feasible to IHC test, with regards to sensitivity and specificity.
Iraj Nazari, Seyed Massoud Mousavi, Hossein Minaei Turk , Davoud Fateminia,
Volume 80, Issue 2 (5-2022)
Abstract
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Background: The use of the traditional method for saphenous vein harvesting is associated with wound complications and not on-time patient mobilization. This has caused the improvement of minimally invasive vein harvesting techniques, together with general bridging. This study was designed to compare the therapeutic results of large saphenous vein harvesting with conventional and standard bridging techniques for lower extremity vascular reconstruction in patients with chronic lower extremity ischemia.
Methods: In this randomized clinical trial study, 66 patients with chronic lower extremity ischemia were randomly divided into two groups: large saphenous vein harvesting by conventional technique (continuous longitudinal incision) (n=30) and standard Bridging technique (small and multiple incisions) (n=36). Pain score (VAS), graft patency, wound complications, surgery results and patient satisfaction was recorded. The follow-up period was six months. (IRCT20190511043562N1).
Results: Graft patency (P=0.353), and Amputation-free Survival (P=0.397) did not show a significant difference between the two groups. Changes in pain score at rest (P=0.846) and movement (P=0.380) at different times did not show a significant difference between the two groups. One week after the operation, the incidence of infection in the bridging technique showed a significant decrease (P=0.045). During the six months of follow-up, the wound healing rate, ischemic pain relief, and claudication improvement were better in the bridging technique but did not show a significant difference with the conventional technique (P<0.05). Patient satisfaction was higher in the bridging technique but did not show a significant difference between the two groups (P<0.05).
Conclusion: It seems that the use of the bridging technique in venous resection large saphenous vein harvesting is associated with reducing wound complications and pain, reducing the length of hospital stay, increasing the speed of wound healing, and improving patient satisfaction. The duration of graft patency and Amputation-free Survival were similar in the two groups. We believe that each technique has advantages and disadvantages that should be considered by the patient and surgeon when choosing a surgical procedure.
Keywords: chronic limb-threatening ischemia, saphenous vein, treatment outcome.
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Mansooreh Jamshidian Tehrani , Haniyeh Zeidabadinejad, Fereshteh Tayebi, Mohammad Reza Khalili, Bita Momenaei ,
Volume 80, Issue 12 (3-2023)
Abstract
Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most prevalent orbital diseases in children and treatment of recalcitrant cases is always challenging. The purpose of this study is to identify the effectiveness of balloon dacryoplasty and stenting in persistent congenital nasolacrimal duct obstruction following previous intubation of nasolacrimal duct.
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Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.
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Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).
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Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.
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Alireza Dehghan, Mahbube Abshirini, Hamid Nemati, Mahdi Saeedi-Moghadam ,
Volume 81, Issue 11 (1-2024)
Abstract
Background: Developmental disorders in children include a group of problems and limitations in learning and acquiring specific skills of each age group. The term global developmental delay is used to describe developmental disability in children under five years of age, which is in at least two areas of major development. Neuroradiological imaging such as brain MRI provides important information for physicians. The purpose of this study is to determine the role of brain MRI in predicting the clinical outcome of global developmental delay in children.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.
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Results: Out of 37 patients studied, 23 were female and 14 were male with a dispersion of three 3 to 60 months of age. 31 of these children had at least one abnormal finding in brain MRI images and the other six were completely normal. In relation to the imaging findings, the highest frequency is related to abnormal head circumference with a prevalence of 54% and the lowest frequency is related to abnormal myelinization with a prevalence of 10.8%. Results of MRI findings correlation with developmental domains demonstrated that Children with white matter disorder on MRI show severe gross motor abnormality (P<0.049) and who had MRI finding of cortical problems suffer from developmental delay in fine motor area. (P<0.001).
Conclusion: Considering the mentioned findings; brain MRI can be a useful diagnostic tool in children with developmental delay and also focusing on the developmental area that is more likely to be affected, MRI can help with treatment and rehabilitation process of these children in the future.
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