CASE_STUDY Arthroscopic treatment of synovial chondromatosis of the shoulder joint: case report and review  Abstract Two cases (20 and 15 years old) of shoulder joint synovial chondromatosis were initially treated with arthroscopic debridement. One was further treated with a second arthroscopy and partial synovectomy (case 1) the second was fully treated by arthroscopic surgery (case 2). The postoperative control X- ray revealed no loose body and the joint was normal. One of the cases (case 1) was affected by Degenerative Joint Disorders (DJD) according to X-ray and arthroscopic findings after treatment physiotherapy was started as soon as possible. The use of arthroscopic surgery allowed the patients to return to normal activity much sooner than a formal open synovectomy. Additionally, the morbidity associated with arthroscopic techniques is much lower than that of an open procedure. Synovial chondromatosis is a condition resulting from intrasynovial formation of multiple metaplastic cartilaginous foci. When these foci are enlarged, they become pedunculated and are extruded into the joint as loose bodies. Subsequently, these loose bodies calcify and ossify and continue to grow because they are nourished by the synovial fluid that surrounds them. Although synovial chondromatosis can affect most joints, it very rarely affects the shoulder joint.  http://mjiri.iums.ac.ir/article-1-300-en.pdf 2007-08-15 118 122 synovial chondromatosis synovial osteochondromatosis synovectomy debridement arthroscopic surgery of the shoulder joint Ali Khorsandi alikhorsandi@yahoo.com 1 Iran University of Medical Sciences, Iran Mehr HospitaGholhak, Tehran, Iranl AUTHOR
CASE_STUDY Thymoma with pancytopenia: a case report and review of the literature   Although the most common hematological disturbance in thymoma is pure red cell aplasia, pancytopenia is a very rare paraneoplastic syndrome in this disorder. We only found one case in literature reviews. We report a 36 year old female with an anterior mediastinal mass and severe pancytopenia. With a mediastinotomy incision, biopsy of the tumor was obtained. The report of the pathologist was thymoma of predominant epithelial type. After a median sternotomy, there was complete resection of the tumor with removal of two segments of the right upper lobe and the involved pericardium (stage 3 of Thymoma). Unfortunately, after complete resection of the tumor there was no improvement in the pancytopenia. The patient died because of sepsis about 33 days after operation. Abstract http://mjiri.iums.ac.ir/article-1-299-en.pdf 2007-08-15 115 118 Thymoma pancytopenia red-cell aplasia Thymectomy M. Aghajanzadeh maghajanzadeh 2003@yahoo.com 1 Yazda Building, Sadra St. Golsar, Rasht, Iran AUTHOR F. Moghadam Manesh 2 Department of Thoracic Surgery, Razi Hospital, Gilan University of Medical Sciences, Rasht, Iran AUTHOR T. Fakheri 3 Department of Hematology, Razi Hospital, Gilan University of Medical Sciences, Rasht, Iran AUTHOR S. Hoda 4 Department of Pathology, Razi Hospital, Gilan University of Medical Sciences, Rasht, Iran AUTHOR H. Amani 5 Department of Pulmonology, Razi Hospital, Gilan University of Medical Sciences, Rasht, Iran AUTHOR A. Alavi 6 Department of Pulmonology, Razi Hospital, Gilan University of Medical Sciences, Rasht, Iran AUTHOR
ORIGINAL_ARTICLE The effect of oral clonidine pretreatment on intraocular pressure and hemodynamic stability after succinylcholine injection and intubation in cataract surgery  Abstract Background: Providing better surgical conditions with meticulous control of Intraocular Pressure (IOP) is one of the most important factors that affect the success rate in ophthalmic surgery. Clonidine is a selective central α2 agonist with analgesic, antianxiety and sedative effects which makes it a good choice in premedication recently. In this study, we compared the effects of oral clonidine with oral diazepam as premedicants on IOP and hemodynamic stability after injection of succinylcholine and intubation in cataract surgery. Methods: 109 patients with physical status 1-2 were randomly assigned in 2 groups. The C Group (54 cases) was treated with oral clonidine (3 mic/kg) and the D group (55 cases) was treated with oral diazepam (0.15 mg/kg), 2 hours before induction of anesthesia. Induction of general anesthesia in all patients was performed with sodium thiopental (5mg/kg), fontanel (2mic/kg) & succinylcholine (1.5mg/kg). Heart rate and mean arterial blood pressure were measured before and immediately after induction and 5 & 10 minutes after intravenous injection of succinylcholine. Measurements of IOP were performed before and 5 and10 minutes after injection of succinylcholine. Results: IOPs’ were always lower in C group as compared with D group but the IOP difference between groups was only significant at 5 minutes after succinylcholine injection. Mean arterial blood pressure and pulse rate were lower in C group compared with D group and the most significant difference observed was at the time 5 minutes after succinylcholine injection. Conclusion: Small doses of oral clonidine as premedicant can effectively reduce the IOP and provide better hemodynamic stability after intravenous injection of succinylcholine and intubation in cataract surgery. http://mjiri.iums.ac.ir/article-1-298-en.pdf 2007-08-15 111 114 clonidine diazepam succinylcholine IOP cataract Hamid Zahedi hamid_zahedi@yahoo.com 1 Farabi Eye Hospital, Tehran University of Medical Sciences AUTHOR M. Nikooseresht nikoo_mahshid@yahoo.com 2 Hamadan University of Medical Sciences. Hamadan, Iran AUTHOR M. Rahro-Taban 3 AUTHOR
ORIGINAL_ARTICLE Assessment of the relationship between serum fibrinogen level and chronic Helicobacter pylori infection in patients with or without  Abstract Background: Infectious agents such as Chlamydia pneumonia or Helicobacter pylori (H. pylori) have been linked to ischemic heart disease (IHD) as the epidemiologic studies have shown. Other studies believed that raised plasma fibrinogen level has been claimed as a possible link between H. pylori infection and IHD. Methods: An analytic cross-sectional study was undertaken on 261 patients. 131 hospitalized patients were selected from CCU ward, as cases and 130 hospitalized patients from surgery and orthopedic wards of Iran University of Medical Sciences hospitals, as controls. HP infection, serum fibrinogen level and cardiovascular risk factors were determined in all cases and controls. T-test, chi-square test, general linear model and logistic regression model were used in analysis. Results: H. pylori infection was not in association with IHD. High fibrinogen level was also not associated with IHD in cases with H. pylori infection. Conclusion: Although there was no link between H. pylori infection, fibrinogen level and IHD in this study, some authors believe that the probable mechanism of this association is that under stimulation by the bacterium, mononuclear cells produce a tissue factor- like procoagulant activity that, through the extrinsic pathway of blood coagulation, converts fibrinogen to fibrin. http://mjiri.iums.ac.ir/article-1-297-en.pdf 2007-08-15 105 110 Helicobacter pylori ischemic heart diseases fibrinogen Amir Hossein Faghihi 1 Gastrointestinal & Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran AUTHOR Shahram Agah shahramagah@yahoo.com 2 Gastrointestinal & Liver Disease Research Center (GILDRC), Iran Universityof Medical Sciences, Crossroads of Hemmat and Chamran Expressways, Tehran, Iran AUTHOR Seyed Mohammad Fereshtehnejad 3 Medical Student Research Committee, Iran University of Medical Sciences AUTHOR Mohammad Ali Bahar 4 Iran University of Medical Sciences. AUTHOR
ORIGINAL_ARTICLE Evaluation indices of hepatitis-related hepatic cirrhosis and their relations to postoperative awakening time  Abstract Objective: To investigate the anesthesia-postoperative awakening time (AT) of hepatitis- related cirrhosis patients and their relations to grading scores, portal venous pressure (PVP), prealbumin (PA), and age, to predict postoperative AT and provide a basis for adjustment of anesthetic doses during operation. Methods: Atotal of 71 patients with hepatic cirrhosis and hypersplenism at ASAgrade I to II were subject to splenectomy and gastric cardia devascularization under total intravenous anesthesia. The depth control of anesthesia (MAP±20% base value BIS40-60) and the monitoring of muscular relaxation were taken by HXD-I multifunctional quantitative electroencephalogram monitor. Child-Turcotte-Pugh (CPT) and Model for endstage liver disease (MELD) scoring were carried out prior to operation so that intraoperative PAand PVP as well as postoperative extubation time (ET) and AT were determined. Results: Both ET and postoperative recovery time of the cirrhosis group were significantly longer than those of the non-cirrhosis group (P<0.05). There was a linear relationship between each two variables ET and AT (r=0.962, P<0.001). After the stepwise regression, variables of CTP, PAand PVPwere assigned into the regression equation as AT= -39.7+ 8.3×CTP+0.79×PVP-78.57×PA(the multiple correlation coefficient r=0.942, the coefficient of determination r2=0.887, and the corrected coefficient of determination r2=0.882 F=176.007), (P<0.001). The standard partial regression coefficients of CTP, PA and PVP were 0.460, 0.303 and -0.217, respectively. Conclusion: The anesthesia-postoperative AT of hepatitis-related cirrhosis patients is most closely related to CTP, PVP and PA(CTP>PVP> PA). The anesthesia-postoperative AT can be calculated with the following formula: AT= -39.7+8.3×CTP+0.79×PVP- 78.57×PA. http://mjiri.iums.ac.ir/article-1-296-en.pdf 2007-08-15 97 104 hepatic cirrhosis awakening time CTP scoring MELD scoring Prealbumin portal venous pressure; total intravenous anesthesia C. Xuexin chenxuexin@sohu.com 1 Associate Chief Physician in the Department of Anesthesiology of Ningxia Medical College,Xi’an, 710032, China AUTHOR M. Hanxiang 2 Department of Anesthesiology of Ningxia Medical College,Yinchuan,750004,China AUTHOR X. Lize 3 Department of Anesthesiology, Xi Jin Hospital, Fourth Military Medical University, Xi’an, 710032, China AUTHOR M. Jinhai 4 Department of Anesthesiology of Ningxia Medical College,Yinchuan,750004,China AUTHOR L. Hong 5 Department of Anesthesiology of Ningxia Medical College,Yinchuan,750004,China AUTHOR
ORIGINAL_ARTICLE Effects of rigid and soft foot orthoses on dynamic balance in females with flatfoot  Abstract Background: Various types of foot orthoses are prescribed for people with flatfoot. It has been reported that orthoses not only improve the biomechanics of the lower limb, but also have good effects on some balance parameters in these subjects. It is hypothesized that the latter effect is dependent on the rigidity of the orthoses. The aim of this study was to evaluate and compare the effects of rigid and soft foot orthoses on dynamic balance in females with flatfoot. The Biodex Balance System was used in a clinical trial study. Methods: 20 healthy students with bilateral flatfoot were randomly assigned to two equal groups. Each participant was tested on two days with 2-week interval. On each day, dynamic stability test was performed while standing in single-leg stance on an unstable platform of the balance system in 3 conditions (barefoot, with shoe, shoe with orthosis). SPSS11.5 was used for statistical analysis. Results: A significant group-by-day-by-condition interaction was found. Both groups on day 2 testing had a decreased overall stability index while wearing orthoses. Overall stability index was significantly lower on day 2 testing. Conclusion: Foot orthoses, depending on the amount of rigidity, were associated with some improvements in dynamic balance in subjects with flatfoot. http://mjiri.iums.ac.ir/article-1-295-en.pdf 2007-08-15 91 97 dynamic balance female flatfoot orthoses Mohammad Akbari akbarimo43@yahoo.com 1 Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran AUTHOR M. Mohammadi 2 Department of Technical Orthopedics, Iran University of Medical Sciences, Tehran, Iran AUTHOR Hassan Saeedi 3 Department of Technical Orthopedics, Iran University of Medical Sciences, Tehran, Iran AUTHOR
ORIGINAL_ARTICLE Evaluation of the analgesic effect of 2 doses of verapamil with bupivacaine compared with bupivacaine alone in supraclavicular brachial plexus block  Abstract Background: Different adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and elongate the duration and quality of regional blocks. This study was performed to study the effects of one of the adjuvants, verapamil, in supraclavicular block. Methods: In this double blinded clinical trial, we divided 60 ASA class I and II patients who were to undergo upper extremity surgery (aged between 18-40 yrs) into 3 different groups randomly. In group I the patients received 30ml Bupivacaine 0.5% plus 2ml normal saline for injection. Group II included patients who received 30ml bupivacaine 0.5% plus 2.5mg verapamil locally and 1ml normal saline for injection. In group III the patients got 30ml bupivacaine 0.5% plus 5mg of local verapamil. All blocks were performed through a supraclavicular brachial plexus procedure, and time of initiating sensory and motor blocks and onset of complete anesthesia and also blood pressure alterations and heart rates were studied and taken into consideration. For data analysis we used SPSS 11.5 software. Results: Our results clarified that verapamil decreased the onset time of anesthesia, motor block and total anesthesia but there was no statistical difference between 2.5 and 5mg doses of verapamil (P>0.05). Among patients who received verapamil in the block, variation of more than 20% from baseline wasn’t detected in blood pressure and heart rate. Conclusion: According to our findings, verapamil causes a decrease in onset times of sensory and motor block and the initiation of complete anesthesia of bupivacaine in supraclavicular block, but there were no significant differences between groups II (verapamil 2.5mg) and III (verapamil 5mg). Blood pressure and heart rate fluctuations were not more than 20% in group II and III. http://mjiri.iums.ac.ir/article-1-293-en.pdf 2007-08-15 87 90 supraclavicular block verapamil onset time of sensory and motor blocks initiation time of complete analgesia Faramarz Mosaffa faramarzmosaffa@yahoo.com 1 Department of Anesthesia, Akhtar Hospital, Elahieh Street, Tehran, Iran AUTHOR A.R. Salimi 2 Akhtar Hospital,Shahid Beheshti Medical Univesity, Tehran, Iran AUTHOR F. Lahiji 3 Akhtar Hospital,Shahid Beheshti Medical Univesity, Tehran, Iran AUTHOR M. Kazemi 4 Toos Hospital,Tehran, Iran. AUTHOR A.R. Mirkheshti 5 Imam Hossein Hospital,Shahid Beheshti Medical University, Tehran, Iran AUTHOR
ORIGINAL_ARTICLE Risk factors of enacting spouse abuse in a sample of Iranian male adults  Abstract Background: The aim of this study was to investigate the modelling of different processes that could account for the link between psychopathology, cognitive social and demographic risk factors and enacting assault by husband. Method: This article reports a test using data on 230 males who participated in a family violence survey study. The sample was selected by a multiclustral sampling method from 4 different randomized regions of Tehran. All participants completed Conflict Tactic Scales, Personal and Relationship Profile, Marital Attitude Survey Questionnaire, Symptoms Checklist Inventory, Social and Demographic Measure. Logistics regression was used to estimate spouse abuse model for men. Results: The findings were consistent with the theoretical model. The path from social- demographic, cognitive and psychopathological risk factors to enacting spouse abuse was demonstrated. Conclusion: The implications of the findings for understanding spouse assaults, cognitive, psychopathological, social and demographic differences in male population are discussed. http://mjiri.iums.ac.ir/article-1-292-en.pdf 2007-08-15 79 86 risk factors enacting spouse abuse family domestic violence Parvaneh Mohammadkhani parmohamir@yahoo.com 1 Clinical Psychology Department, University of Social Welfare and Rehabilitation Sciences,Evin, Kodakyar Ave,Tehran, Iran AUTHOR E. Rezaei Dogaheh 2 Welfare Organization, Tehran, Iran AUTHOR S.A. Forouzan 3 University of Social Welfare and Rehabilitation Sciences AUTHOR H. Azadmehr 4 Welfare Organization, Tehran, Iran. AUTHOR H. Jafari 5 Alameh Tabatabaie University, Tehran, Iran AUTHOR
ORIGINAL_ARTICLE Medical students and mental health by SCL-90-R  Abstract Background: The process of medical education is stressful and medical students are at risk of psychological problems. In addition to the normal stressors of everyday life, medical students must deal with stresses specific to medical school. The aim of this study was to assess mental health in senior medical students and residents. Methods: This cross-sectional study included 100 senior medical students and 100 residents of Iran University of Medical Sciences, Tehran, between October and December of 2006. The measurement method was the SCL-90-R questionnaire. Respondents rate 90 items using a 5-point scale to measure the extent to which they have experienced the listed symptoms during the last 7 days. In this study we only reported GSI and raw scores of SCL-90-R subscales. We used the cut off point of 0.7 for GSI. All statistical analyses were carried out by using SPSS for Windows 14. Asignificant level was considered as 5%. Results: The mean and standard deviation of GSI was 0.55. Overall 19.4% of participants had GSI more than 0.7, as suspected mental illness. 26% of residents compared to 12% of senior medical students scored higher than 0.7 on GSI with significant difference. 13% (11 subjects) of males compared to 24% (27 subjects) of female had GSI more than 0.7. This difference was significant (P= 0.05). 11.3% of participants with a good economic status versus 56% of those with weak status in economy scored GSI of more than 0.7 with significant difference (P = 0.006). The majority of participants (91%) with a good overall satisfaction scored less than 0.7 on GSI. This proportion between weak categories of overall satisfaction was 66%. There were significant differences between the two groups in the SOM, OBS, INT, DEP, ANX, PHO, and psychoticism subscales. Conclusion: About one-fifth of participants are suspected cases of mental disorder. Residents scored significantly higher than senior medical students on all subscales (except HOS and PAR) of SCL-90-R and GSI score. The GSI score was associated with overall satisfaction, gender, satisfaction of the studying major and economic status of participants. http://mjiri.iums.ac.ir/article-1-291-en.pdf 2007-08-15 71 78 mental health medical students residents SCL-90-R Marzieh Nojomi mnojomi@yahoo.com 1 Community Medicine Specialist and Sub-specialist in Clinical Epidemiology. Department ofCommunity Medicine, School of Medicine, Iran University of Medical Sciences. Crossroads of Hemmat and Chamran Expressways AUTHOR Banafsheh Gharayee 2 Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran AUTHOR
ORIGINAL_ARTICLE Comparison of one-stage free gracilis muscle flap with two-stage method in chronic facial palsy  Abstract Background: Rehabilitation of facial paralysis is one of the greatest challenges faced by reconstructive surgeons today. The traditional method for treatment of patients with facial palsy is the two-stage free gracilis flap which has a long latency period of between the two stages of surgery. Methods: In this paper, we prospectively compared the results of the one-stage gracilis flap method with the two - stage technique. Results: Out of 41 patients with facial palsy refered to Hazrat-e-Fatemeh Hospital 31 were selected from whom 22 underwent two- stage and 9 one-stage method treatment. The two groups were identical according to age, sex, intensity of illness, duration, and chronicity of illness. Mean duration of follow up was 37 months. There was no significant relation between the two groups regarding the symmetry of face in repose, smiling, whistling and nasolabial folds. Frequency of complications was equal in both groups. The postoperative surgeons and patients' satisfaction were equal in both groups. There was no significant difference between the mean excursion of muscle flap in one-stage (9.8 mm) and two-stage groups (8.9 mm). The ratio of contraction of the affected side compared to the normal side was similar in both groups. The mean time of the initial contraction of the muscle flap in the one-stage group (5.5 months) had a significant difference (P=0.001) with the two-stage one (6.5 months). The study revealed a highly significant difference (P=0.0001) between the mean waiting period from the first operation to the beginning of muscle contraction in one-stage (5.5 months) and two-stage groups (17.1 months). Conclusion: It seems that the results and complication of the two methods are the same, but the one-stage method requires less time for facial reanimation, and is costeffective because it saves time and decreases hospitalization costs. http://mjiri.iums.ac.ir/article-1-290-en.pdf 2007-08-15 63 70 One-stage method facial palsy free flap gracilis Hamid Karimi h.karimi@iums.ac.ir 1 Faculty of Medicine, Iran University of Medical Sciences. Hazrat-e-Fatemeh,Hospital, 21st Alley, Asad Abadi Ave. Tehran, Iran AUTHOR Mohammad Ashayeri 2 Faculty of Medicine, Iran University of Medical Sciences AUTHOR N Boddouhi 3 Iran University of Medical Sciences AUTHOR J Ghaffari 4 Iran University of Medical Sciences AUTHOR F Hoseini 5 Iran University of Medical Sciences AUTHOR