مجله علمی پزشکی جندی شاپور
پیاپی 43 (اسفند 1383)

The liver is one of the vital organs. It carries out various important functions needed for sustenance of life, namely synthesis of various compounds and coagulation factors. In addition, it has an important role in the breakdown of toxic substances. Pathological damage to the liver may occur following external or internal causes that result in changes in serum factors, or following an infectious agent. Patients suffering from chronic renal failure (CRF) and are on renal dialysis are at increased risk of contact with various infectious agents. On the other hand, since they can not remove the serum waste products properly, different organs such as the liver are subjected to development of various lesions. Hence it is considered necessary to study the histopathological changes in CRF patients. This study was carried out over a period of 5 years in Gholestan hospital, Ahwaz. The data were collected from patients files among those who were on dialysis or who had undergone kidney transplantation and had a biopsy examinatic of the liver. All the patients were also tested serologically for anti-HCV and liver enzyme tests.From 274 liver biopsies, 18.61% were patients with a history CRF and various inflammatory conditions of liver. Amongst this number 11.68% had chronic hepatitis. Liver enzymes showed higher than normal values. Histopathologic study, using light microscopy, of liver biopsy showed scattered leucocytes in the portal area, some showing ballooning type degenerative changes. Necrosis and fibrosis were not clearly seen but in a minor percentage of patients, piecmeal necrosis was seen in some hepatocytes in peripheral areas of the lobules. The results of this study showed that 1.96% of transplant patients and 7.84% of dialyzed patients had suffered from chronic hepatitis, which is approximately four times of transplant recepients. It is therefore recommended that petients suffering from CRF be transplauted as earlier as possible.

In Iran, sickle cell disease (SCD) is often mild with a high level of hemoglobin. Furthermore, there is lack of sufficient published research works on the nature, prevalence, clinical features and distinct mutations involved in SCD in Khozestan, a province in the southwest of Iran. Serial evaluation of patients and their family using hemoglobin electrophoresis, CBC, RBC indices and clinical feature conducted on 28 SCD and 139 other concurrent associated thalassemias or sickle trait over 8 years of follow-up, showed SCD to be the second most common congenital inherited hemoglobinopathy disorder second to -thalassemia syndrome among the referral cases to Ahwaz Thalassemia and Hemoglobinopathy Research Center. The pattern of geographical distribution showed that the number of patients was on an creasing trend from the south and southwest in toward central part of this province. This area is where the Arab population are mainly living. The family screening also showed that the 97% of carrier states are among the ethnic Arab tribes of Khvozestan, from which only 10% were Arab-Persian half breeds and only 3% were non-Bakhtiry Persians. No Bakhtiary origin was found among the SCD patients referred to our research center during the 8-year period of this study. These findings showed that the SCD in the Khozestan to be different from that of black Africans. Their general appearance is usually good-looking Caucasian boys and girls.

Insulin dependent diabetes mellitus is the most common endocrine disorder of childhood and adolescence. Diabetic ketoacidosis (DKA) is the most important and dangerous complication of IDDM. The major causes of mortality and morbidity in diabetic ketoacidosis are abnormalities in metabolic and electrolytes. Studies suggest that metabolic acidosis impairs the contractile function of the heart. The aim of this study was to evaluate of the effect of diabetic ketoacidosis on the myocardial function. This study was a cross sectional- analytical study. Twenty-six children with diabetic ketoacidosis who were admitted to the endocrine ward of Nemazee Hospital were studied. Clinical, laboratory and electrocardiogram findings of these patients were evaluated. To determine the side effect of diabetic ketoacidosis on myocardial function, echocardiography, ejection fraction and fractional shortening of the heart were assessed on admission and 48 hours after recovery. The results of this study showed that ketoacidosis was the initial presentation among 17 out of 26 patients with diabetic ketoacidosis, and most of these patients had severe acidosis. Suggesting that diagnosis and referral of diabetic children to the hospital is made with delay. The echocardiographic results showed that the initial ejection fraction and fractional shortening during ketoacidosis were significantly lower than the final post recovery state (P<0.05). This effect was directly related to severity of acidosis. Our findings support the idea that diabetic ketoacidosis has a detrimental effect on cardiac contractility, and it can be prevented with its severe complications with implementation of an educational program both for diabetic children and their parents, rapid diagnosis and proper management of diabetic ketoacidosis.

Quality assurance in radiologic and radiographic departments is necessary and the analysis of causes for reject of x-ray films has a central role in this respect. Analysis of reject rate of x-ray films is one of the useful indices for assessing the extent of avoidably repeated and unoptimized x-ray examinations. The film reject is rate analysis identifies the factors responsible for the deterioration of radiographic images from which correct solution may be realized. This paper presents the results of investigation on the causes of rejection of x-ray films made at two of the major hospitals affiliated to Ahwaz University of Medical Sciences in year 2000, namely Imam Khomeini and Golestan. A total of 2505 rejected films were analyzed. The overall reject rate was 14.7%, which in comparison with reported reject rates in other studies, was found to be high. While the investigation of 49 studies conducted in other countries indicated that the overall reject rates were between 3 and 15%. Moreover, according to other investigations the overall reject rate should not be more than 8%. The largest proportion of waste films in this project were due to inappropriate selection of exposure factors (42.8%), equipments deficiency (42.6%), faulty positioning (42.5%), artifact (26.15), uncontrolled patients motions (8.1%), and processing defects (3.3%). Statistical Chi-square test showed significant relationship between reject rate and radiographic projections (P<0.01), with the axial projection contributing to the highest percentage (40%). The relationship between reject rate and various positions was significant too (P<0.01), with highest percentage in decubitus position (42.9%). These relationships, for various qualifications, was also significant (P<0.01), with the highest percentage of rejecion pertained to new employed radiographers with associte degrees.

Pilonidal sinus is a common disease with risk of infection in young adults, which occurs in the natal cleft and is common in hairy and fatty males. Treatment often requires surgical intervention. Current surgical method entails wide tissue excision that causes various morbidities such as long time rest. This study was conducted prospectively on 35 patients (test group) who were treated with the conservative surgical resection in Ahwaz Imam Khomeini Hospital in 1374-1375. The results were compared with 24 patients who were used as control group and treated with conventional wide resection method. Eighteen patients from the test group and fourteen patients from the control group were followed-up for 20 ± 4 months. Both groups were nearly similar for age, sex, occupation and body types (hairy, fatty). The results revealed that the mean hospitalization time for control group was 2 day, this was 1.27 days for the conservative group. Furthermore, need for resting and administration of analgesics were significantly different between the groups (P<0.0). Need for resting was 12.5 days in the control group which was significantly lower in the in the conservative group of 8.33 days. Analgesics were required for two days in the control group compared to one day in the conservative group. Wound infection was 11% in the conservative group compared to 14 % in the control group, and recurrence was 5% in test group and none in the in control group. Patient’s satisfaction in relation to scar formation was 88% and in the control group and 85% in test group. In conclusion, it seems that the conservative resection method for pilonidal sinus is a suitable method that results in less hospitalization time, decreased postoperative pain, and decreased resting time, but without any obvious difference in scar and cosmetic change at the site of operation.

Pregnant women are one of the main targets in health and prevention programs. Prenatal dental care is an essential process for promotion of the health status of the mother and her newborn and can be a preventive measure for delivey of low-birth weight new borns. In this cross-sectional survey, the dental health and oral hygiene status amongst 300 pregnant women were randomly selected among pregnant women attending the health centers in Ahwaz. For each person a WHO form was prepared and the teeth were examined. For data analysis tables of frequency distribution, t-test and ANOVA were used. The results showed that the mean DMFT was 6.23±3.01 in which the highest percentage belonged to the decayed teeth (3.52 ± 2.45). The attitude about oral hygiene was very low in all pregnant women (94.3%). The oral hygiene index (OHI-S) of most pregnant women (76.7%) was at moderate level. The highest mean of DMFT was in pregnant women who had the lowest level of education. In conclusion, the results of this study showed that most of the samples affected with DMFT were among pregnant women with low attitude towards oral health.

Posterior urethral valves (PUVs) are the commonest cause of severe obstructive uropathy in boys. The incidence of PUV ranges from 1: 8000 to 1: 25000 boys. Clinical complications result from obstruction, infection or both. Approximately 30% of patients experience end-stage renal failure or chronic renal insufficiency. Over the past decade, the diagnosis of PUVs has been radically changed with the development of ultrasound technique. The aim of this study was to determine the frequency of renal damages in children with PUVs. This study was conducted, over two years from March 2001 to February 2003, on twenty boys (median age 26 months, ranged from 1 day up to 10 years) with PUVs were assessed for deterioration of their renal function. The age at presentation in 8 cases was under 1 month, in 5 cases was between 1 to 12 months, 4 cases between 1 to 5 years and 3 more than 5 years. The most common clinical feature were fever in 13 cases (65%), dribbling in 9 (45%), dysuria in 7 (35%), abdominal mass in 5 (25%) and hypertension in 4 (20%). Azotemia was detected in 12 cases (60%), abnormal serum creatinine in 11 cases (55%), which in 6 patients was more than 3mg/dl. There were posterior urethral obstruction in all, vesicourethral reflux in 16 (80%) cases and small sized kidneys in 9 (45%) cases. Among these we found one with Bardet-Beidl syndrome and another with Down syndrome. After a supportive and medical treatment, we observed some improvement in serum creatinine levels in all the patients. In addition to the mentioned management 8 cases (including 5 neonates) underwent visicostomy. After initial stabilization, 5 (25%) patients developed chronic renal insufficiency and 4 (20%) progressed to chronic renal failure which is higher than similar cases in the developed countries. In 5 antenatally diagnosed neonates who underwent early vesicostomy, the kidney growth was favorable without subsequentl development of deterioration in their renal function. In conclusion, in order to prevent the serious complications of this obstructive uropathy in these children ultrasounographic screening should be performed prenatally and visicostomy be performed whenever needed.

The sino-atrial (SA) node is not a homogeneous tissue in terms of its structure and electrophysiological function. The regional differences in action potential configuration is well known. One reason for those differences is the differences on ionic currents underlying the regional differences in electrical activity. One of the currents thought to play an important role in SA node for pacemaker slope of action potential should be hyperpolarization–activated current if. In the present study the conventional glass microelectrode was used for intracellular recording. The if current was separately blocked by 1µM UL-FS49 for 90 min and 3µM ZD7288 for 40 min. The action potentials from different regions of intact SA node were recorded before and during using blockers. UL-FS49 significantly (P<0.05) decreased the pacemaker slope (PS) to 66 ± 5% in peripheral (n=5) and to 23 ± 6% in central (n=5) zones. UL-FS49 also significantly (P<0.05) decreased the rate of spontaneous activity to 16 ± 3% (n=10). ZD7288 completely abolished the pacemaker slope (PS) in peripheral (n=5) and to 22 ± 5 % in central (n=5) zones. ZD7288 also significantly (P<0.05) decreased the rate of spontaneous activity to 13 ± 3% (n=10). Base on the our results, it is possible to conclude that if current plays a major role in pacemaker activity in the periphery and a minor role in pacemaker activity in the center of intact SA node of rabbit heart.

The aim of this prospective clinical study was to determine the effect of different methods of ovulation induction on the pattern and thickness of the endometrium. For this purpose, 150 patients were recruited and divided randomly into in three groups: Group I: (Clomiphen-only group), which consisted of 60 patients, who received oral clomiphen daily for five days starting on day 3 of menstruation. Group II: (clomiphen + premarin group), which consisted of 30 patients who received oral clomiphen as above in addition to 1.25 g premarin for 10 days. Group III: (clomiphen + HMG), which consisted of 60 patient who received clomiphen as above in addition to HMG (2 to 4 injections). Measurement of follicular growth and endometrial thickness and pattern was determined by vaginal sonography. The results showed that the average number of follicles was 1-3 and follicular size was 19-23 mm. The average thickness of the endometrium was 7.99 mm in group I, 8.27 mm in group II and 7.94 mm in group III. The triple line pattern was 63.3% in group I, 72.4% in group II and 66.7% in group III. Endometrial thickness of  6mm was 35% in group I, 24.1% in group II and 28.3% in group III. These results suggest that the best endometrial pattern was observed in clomiphen-premarin group, and the worst pattern with least endometrial thickness was observed in clomiphen-only treated group. Endometrial thickness of equal to or less than 6mm, bad prognostic group for pregnancy, were more frequent in group I.. More than 60% of all patients had endematrial thickness of >6 mm and triple line pattern and statistical analysis did not show any significant differences between these groups. The overall conclusion suggests that clomiphen plus premarin to be more effective for promotion of induction of ovulation

The inner cell mass of blastocyst is able to proliferate unlimitedly in vitro and remain as undifferentiated cell population. If these cells occulated in vivo to mouse tissue or transferred to blastocyst, they can be induced to differentiate to derivatives of three germ layers and subsequently to teratoma or chimeric animals respectively. The modification of procedures of colony harvesting from inner cell mass was the aim of this study. In this study 118 embryos transferred to inactivated rat embryonic fibroblastic feeder layer (REF) and DMEM media containing Leukemia Inhibitory Factor (LIF). Two days later the embryos underwent outgrowth stage, and inner cell mass was removed from the dishes by trypsinization or mechanical methods (disaggregated stage) and then were transferred to dishes contained inactivated REF layer or dishes coated with collagen. The cell were cultured were checked for the formation of cell colonies every day for four days. The dishes with the positive colony were passaged in every 2 to 3 day and subcultured up to the sixth passages. The cell colonies were evaluated for morphological and speed of cell doubling criteria. Only 3 colonies were obtained from 30 disaggregated cell mass by mechanical method REF feeder layer. It seems that the mechanical method of disaggregation may damage the cells less than the trypsinization method and will increase the chance of cell colony formation.

Laparascopy is a new technique with a minimal invasive surgery that enables us to directly observe the pelvic and the abdominal cavity. After prep and drep, the technique entails a 1 cm incision which is made under the umbilical, opening the skin and underlying subcutaneous tissues and insertion of a10-mm trocar and lenzoscopy under general anesthesia. Using this method, the surgeons are able to see the pathological causes of acute vague abdominal pain and plan treatment accordingly. This type of operation facilitates painless and short hospitalization, very low rate of infection and complications, and early return to work. Furthermore, this technique can be a useful substitute choice for open invasive abdominal operations in acute vague abdominal pain. The outcome of this type of operation, which was carried out on 25 patients among 572, who were admitted to Golestan hospital, Ahwaz, for acute vague abdominal pain, is reported. Among these, 380 patients were operated on by conventional methods, 163 patients were treated with conservative treatment without resorting to operation and their pain was resolved and weres discharged. Four patients refused operation. Twenty-five of the patients were checked by various para-clinical tests, X-ray, sonography and repeated physical examinations and their pain persisted for more than 18 hours were candidates for this study. Pathological abnormalities were diagnosed in twenty patients (an accuracy of 80%) and five patients showed normal abdomen.