مجله دانشگاه علوم پزشکی شهرکرد
سال هشتم شماره 4 (پیاپی 32، زمستان 1385)

Hemorrhoidectomy is usually associated with severe pain in the immediate postoperative period. Today, a number of local blockages and sedatives are used to reduce this pain. However, so far, no specific method is recommended for this purpose. Therefore, the aim of this study was to investigate the efficacy of the ischioanal fossa block, in reduction of postoperative pain and analgesic requirements. This clinical-trial study was performed on eighty candidates of elective hemorrhoidectomy. Patients were randomly assigned to either case (receiving ischioananl fossa block) or control (no ischioananl fossa block). All aspects of surgery and anesthesia were standardized. In the postoperative period, analgesia was maintained with pethedine. Pain was assessed using VAS (Visual analogue scale) at 0 (arousal), 4, 12 and, 24 hours after operations. The time interval for the first request of analgesia and the total amount of analgesic consumption were recorded. There was no statistical difference between the two groups with respect to age, sex, weight, and duration of operation. The pain score of the case and the control group was 2.65±0.92 and 4.93±1.09, respectively (p<0.05). Also, the pain score at 0, 4, 12, and 24 hrs post operation was significantly lower in the case than that in the control group (p<0.05). The time interval for request of the first analgesic was significantly longer in the case group (8 hr versus 1.5 hrs) (p<0.05). Total dose of pethedine consumption was statistically different between the two groups (p<0.05). Based on the results, the administration of ischiorectal fossa block and bupivacain before the operation resulted in a significant decrease in postoperative pain and analgesia requirements. Therefore, this method is recommended.

Despite using different preventive drugs, postoperative nausea and vomiting (PONV) are common after strabismus surgery. According to some published results an alpha-2 agonist, clonidine has had variables effects on PONV after some surgeries. Therefore, the aim of this study was to investigate the effect of oral clonidine on PONV after strabismus surgery. In this randomized double-blinded clinical trial study, 135 patients, younger than 18 years, were randomly divided into three groups. 1cc/10kg clonidine syrup or 0.25 mg/kg metochlopramide or placebo was used in each group, 90 minutes before surgery. The methods of induction and maintenance of anesthesia were similar for the 3 groups. The frequency of PONV in the recovery room or ward was recorded during 24 hours. Data was analyzed using Chi-squire with Fischer exact and ANOVA with Dennett T3 correction tests. In the group receiving clonidine, postoperative frequency of vomiting was less than that in the group-receiving placebo (p<0.05). Also the number of vomiting in the clonidine group was less than that in the placebo and metochlopramide groups (p<0.05) Clonidine decreased the frequency of postoperative vomiting and nausea. Thus, its usage is recommended for prevention of the postoperative complications

Gastric cancer is the second cause of cancer death throughout the world. Identification of precancerous lesions is important for designing preventive measures. Therefore, the aim of this study was to evaluate the correlation between lesions and the cancer. Histological findings of 55 patients with gastric cancer including atrophy, intestinal metaplasia, dysplasia, gastric grade, lymphoid follicles, infiltration of eosinophil and presence of H. pylori were compared with those of the patients with chronic gastritis without any tumor or ulcer. The data was analyzed using Chi-square, Mann-Whitney and Odds ratio tests. There was no statistically significant difference between the two groups with respect to atrophy, infiltration of eosinophil and lymphoid follicle. The frequency of intestinal metaplasia (OR: 19/89), dysplasia (OR: 76/22) and lymphoid follicule (OR: 22/46) in the case and control groups was 47.3% and 10.9% (p<0.001), 14.5% and 1.8% (p<0.01), 81.8% and 32.7% (p<0.001), respectively. The frequency of severe and moderate chronic gastritis in control group was more than that in the case group (p<0.05, OR: 0.93). There was strong correlation between gastric cancer and dysplasia, intestinal metaplasia and lymphoid follicles. Therefore, the presence of such lesions in the gastric biopsy is alerting and these patients should be checked up regularly.

Exercise is one of the important methods recommended for treatment of patients with chronic low back pain (CLBP). Exercise is effective in improvement of function in these patients. Therefore, the aim of this study was to evaluate the effect of stabilization method and Williams exercise on functional improvement of patients with mechanical chronic low back pain. In this clinical trail, 34 patients with CLBP were randomly divided into two equal groups of stabilization exercise and Williams exercise group. Each group performed 14 days of exercise. Using McGill questionnaire, inability of doing daily functions was measured before and after the intervention. The data was analyzed using independent and paired t-tests. The pain score in stabilization exercise group before and after the exercise was 33.5 and 14.4, respectively (p<0.05). In Williams exercise group, this score was 31.8 and 11.5 before and after the exercise respectively (p<0.05). The mean score of inability of doing daily functions changed significantly (p<0.05) in both groups. There were no significant differences between the two groups in the cases of self-reported pain and disability. Based on our results both stabilization exercise and Williams exercise are effective in decreasing short-term disability and pain in patients with CLBP.

Interlocking nailing and plating are two conventional methods of treatment of tibial-shaft fracture. Both methods have advantages and disadvantages. Therefore, the aim of this study was to compare the advantages and disadvantages of the two methods. This clinical-trial study was done on 90 patients with fracture of tibia and fibula. Patients were randomly divided into two groups. The individuals in groups one and two treated with plating and interlocking nailing methods, respectively. The mean time of union, hospitalization and returning to work as well as thickness of callus, range of motion of knee and ankle joints were compared between the two groups. The data was analyzed using t-test. The average time of bone union, hospitalization, callus thickness, time to return to work, range of motion of knee up to 130 degree, and ankle up to 50 degree in group one (plating) and two (interlocking nailing) were 4.8±0.2.5 months vs. 3.4±0.24 months (p<0.05), 5 vs. 3 days (p<0.05), 2.5±0.05 mm vs. 4±0.06 mm (p<0.05), 3±0.05 months vs. 1.5±0.06 months (p<0.05), 0.3.5±0.04 months vs. 2±0.03 months (p<0.05), 5.2±0.07 months vs. 3±0.04 months (p<0.05), respectively. Based on the results, interlocking nailing method is better than the other one and is preferred for fixation and treatment of tibial-shaft fractures.

In addition to control of the disease, improvement of quality of life is important for treatment of the patients suffering from bleeding disorders such as thalassemia. The impact of thalassemia and its complications on the quality of life of these patients and parents perspective has been little studied. Therefore, the aim of this study was to compare the perspective of children with thalassemia and their parents about the quality of life of these children. In this descriptive–analytical study, the quality of life of 39 children with thalassemia referred to Hajar hospital of Shahrekord was studied using a quality of life questionnaire (pedSQL). Opinions of the children and their parents about physical, social, emotional and school functions of the children were collected. The data was analyzed using t-test, Manvitni and Hebsti Spirman tests. Perspective of the children and their parents about the mean of quality and quantity of life in the children was 1.06 and 1.43, respectively (p<0.001). With respect to school and social life, there was no significant difference between the quality of life of the parents and the children. However, in physical (p<0.05) and emotional (p<0.001) aspects, there were significant differences between the two points of view. With respect to physical situation, quality of life of the girls was worse than that of the boys (p<0.05). Overall, quality of life of rural children was lower than that of the urban ones (p<0.001). Perspective of children with major thalassemia and parents abort quality of life especial abort emotional and physical is different. With respect to the role of parents in education of children, administration of programs to improve psychological health in children along with their the patients is recommended.

Transcranial Doppler sonography (TCD) is a noninvasive, inexpensive, timesaving and portable imaging modality for localizing cerebral arterial pathology in patients with acute stroke especially in middle cerebral artery (MCA). The present study was aimed to evaluate the predictive value of MCA hemodynamics status for recovery outcomes one and six months after the first appearance of the disease. This a prospective study was performed on 102 patients with cerebral ischemia who referred to Sina hospital of Hamadan in 1384. TCD was done during 24 hours after the admission along with routine medical management. Patients with previous stroke, head trauma, death and unknown diagnosis were excluded. The patients were divided into three groups based on their TCD. The first group, those with normal symmetric blood flow, the second one, those with decreased non-symmetric blood flow and the third, those with decreased symmetric blood flow of MCA. The physical examinations were repeated one and six months later and the outcomes were recorded. Using Cruscal-Vali statistical test, the data were analyzed. The mean of age in the patients was 65.39±12.67 and 48% of them were male. The motor function was improved significantly in the three groups (p<0.05). After six months, the patient of group two had a better clinical improvement compared with groups one and three (p<0.01). However, the speech and sphincteric disorders improved similarly in the three groups (p>0.05). Evaluation of MCA hemodynamics status by TCD predicts the motor function improvement six months later in the patients with acute brain stroke.

Spinal anesthesia due to its simplicity, rapid onset of its effect and low dose of drug administration, is a desirable procedure to anesthetics particularly for lower extremity and lower abdomen operations. Lidocaine is widely used in this method of anesthesia for prolongation of the sensory block. In the method, different drugs are used to prolong the duration of sensory block. Fentanyl and epinephrine are being used widely for this purpose and so far, the effects of these drugs were not compared. Therefore, in this study, the effect of the two drugs, alone or together, with and without lidocaine, on the duration and intensity of sensory and motor block has been investigated. In this double-blinded clinical trial, 60 candidates for elective surgery of lower abdomen were randomly divided into three equal groups. For spinal anesthesia, the first group was subjected to 50 mg lidocaine plus 0.2 mg epinephrine, the second one to 50 mg lidocaine plus 0.2 mg epinephrine and 20-µg fentanyl and the third group to 50 mg lidocaine plus 20-µg fentanyl. Subsequently, the patients in the 3 groups were evaluated and compared for the duration of sensory and motor block and their hemodynamic variations. The data was analyzed using ANOVA and Chi-square tests. Age and sex distribution among the three groups was not significantly different. The mean of sensory block duration in the first, second and third groups were 130.25±19.05, 133±32.7 and 116±14.58 min, respectively with no significant difference. The mean of motor block duration in the first, second and third groups were 120.95±14.63, 118.75±25.74 and 107±18.23 min, respectively. ANOVA test showed no significant difference among the three groups as well. Also, with respect to hemodynamic variation, there was no significant difference among the three groups. Our findings showed that addition of epinephrine and fentanyl and combination of them to the lidocaine had no effect on the duration of sensory and motor block and hemodynamic variations. Therefore, combined use of these drugs is not necessary

Starvation changes the pituitary hormones serum levels, especially gonadotropins and growth hormone (GH). There are controversies about the effects of starvation on the hormonal changes of the two axes. Therefore, this study was carried out to show the interaction of hypothalamus-pituitary-gonad (HPG) and GH axes during fasting. In this experimental study, thirty-two adult male rats were divided into four equal groups. The starvation group was deprived of food for 4 days with free access to water and received injection of the vehicle (corn oil, 1ml/day). The control group had free access to water and standard laboratory animal food and received injection of the vehicle (corn oil, 1ml/day). Starvation + testosterone (St+T) group were deprived of food for 4 days with free access to water and received injection of testosterone (1 mg/kg/day). Starvation + estradiol (St+E) group was deprived of food for 4 days with free access to water and received injection of estradiol (1 mg/kg /day). Then the levels of FSH, LH, GH, estradiol and testosterone were measured. Data were analyzed using ANOVA and Toki tests. During the fasting, the level of serum GH increased to 64% but the level of FSH, LH and testosterone decreased by 33%, 31% and 41%, respectively (p<0.001). No significant change was found in serum level of estradiol. The increase of serum GH levels in St+T and St+E groups were less than that of the starvation group (p<0.001). Also in St+T and St+E groups the decrease of FSH and LH were more than those in the starvation group (p<0.001). Based on the results of this study, the two axes showed the same mechanism in response to short-term starvation

Hydatid cyst is a zoonotic disease and is distributed worldwide. The disease is endemic in most parts of Iran and due to presence of husbandry jobs, Chaharmahal and Bakhtiari province of Iran is potentially one of the high risk areas for the disease. Seroepidemiological investigations in this province revealed that Lordegan area had a high prevalence of Hydatid cyst. This survey was performed to find the risk factors of the disease in Lordegan area. This descriptive and analytical study was performed on 500 cases selected randomly from all the people above 15 years old in Lordegan area. A questionnaire containing risk factors of the disease was filed in by each individual. Thirty butcher shops were also inspected and were asked about Hydatid cyst risk factors. Healthy drinking water was available for 88.2%. Effective washing of vegetables was practiced by 54.4% of the individuals. 7.2% were aware about transmission routes of the disease. In 8.4% of cases foods were exposed to dust. Dogs were kept at home of 22.4% of the cases and 42.6% of the individuals kept domestic animals in their houses. 75% of them expressed the presence of stray dogs in their living places. Questionnaire forms filled by butchers showed that in 30% of the cases, stray dogs were present in the butchery places and in 20%, the dogs were fed by infected meats. 40% of the butchers blow under the skin of slathered livestock to facilitate the process of skin off. Results of this survey indicated that all people especially butchers should be subjected to health education about risk factors of Hydatid cyst.

Diabetes mellitus is a metabolic disorder of carbohydrates, lipids and proteins caused by deficiency or lack of insulin. The side effects of chemical drugs have increased the requirement to use of medical plants with fewer complications than that of the chemical drugs. Securigera securidaca is one of the medical plants traditionally used. This medicine has antiepileptic, diuretic, hypotensive and hypoglycemic effects. This study was aimed to evaluate the hypoglycemic effect of hydro-alcoholic extract of S. securidaca seeds on streptozocine induced diabetic rats. In this experimental study, a total of seventy Wistar albino male rats were randomly divided into seven groups. Diabetes was induced via intravenous injection of streptozocine (45mg/kg). Then, the extract of Securigera securidaca seed was administrated orally in dosage of 500, 1000 and 2000 mg/kg in the mice. The blood glucose was measured before and one, two and three weeks after the administration of the extract. Using statistical methods, (Student t test, paired t test and ANOVA), the data were analyzed. Compared with the control group, Streptozocine significantly increased the blood glucose of the test group (p<0.001). Doses of 500 and 1000 mg/kg of S. securidaca extract had no significant effect on blood glucose after two weeks. However, dose of 2000 mg/kg significantly decreased the blood glucose (p<0.001). The extract had no significant effect on normal blood glucose in the rats. The findings showed that the extract of S. securidaca seed decreased the blood glucose in streptozocine induced diabetic rats dose-dependently. Therefore, it may be useful in diabetic patients.

The most serious form of Toxoplasma gondii infection, congenital toxoplasmosis occurs when a non-immune woman is affected during the pregnancy. Thus, having knowledge about Toxoplasma seroprevalence among women during childbearing ages and/or pregnancy is of public health importance. Therefore, this study was performed to determine the seroprevalence of Toxoplasma antibodies during the first trimester of pregnancy in women aged 15-45 years referred to the health centers of the province. In this descriptive-analytical study, 384 serum samples from pregnant women aged 15-45 years during the first trimester of their pregnancies were examined and tittered for anti-Toxoplasma antibody using Indirect Immunofluorescent Antibody (IFA) method. Using X2 test, the data were analyzed. Total anti-Toxoplasma antibodies were found in 106 women out of 384 (27.6%), with serum levels ranged between 1:20 and 1:2560. The highest rate of anti-Toxoplasma antibodies was found in pregnant women aged 40-45 years (50%) (p<0.05). There was a past history of spontaneous abortion in 29.3% of the sero-positive subjects. Also, 38.5% of the sero-positive women had a history of cat keeping in their house or had a close contact with the animal (p<0.05). There was also a history of lamb meat consumption in 82.2% of sero-positive subjects (p<0.05), while the rate of anti-Toxoplasma antibodies was 65% for raw vegetables consumers. The highest and the lowest rates of anti-Toxoplasma sero-prevalence occurred in Shahrekord (51.9%) and Farsan (6%) districts, respectively. This rate was also 25% and 29.5% for urban and rural areas, respectively. The findings showed that a large proportion of pregnant women from this area are at risk of infection with Toxoplasma and may be infected during next months of their pregnancies or in their further pregnancies

Noise is part of daily life in all human societies. It, like other pollutants, decreased the quality of life and is a hazard for public health. Therefore, the aim of this study was to find field data with respect to noise in the urban areas and to use data for applying measures to limit and control the exposure rate to environmental noise. In this study, sound level was measured across the city based on heavy, moderate, and light traffic jams; residential, educational, and remedial areas. Measurement was conducted in two times, 1992 using 8 stations and 2001 using 10 stations. To determine the noise level based on the public opinions, 20 persons were randomly selected in each overcrowding station and interviewed. The data was analyzed using Wilkoxon, chi-square and binomial analyses. The average of daily sound level in the first and the second period was 68.8±6.3 and 61.6±5.1 dB, respectively. The average of night sound level in the first and second period was 73.8±7.7 and 62.6±5.9 dB, respectively (p>0.05). The average of sound variations during day and at night was 24±5.2 and 24.5±5 dB in the first period and was 28.8±8.7 and 23.4±4.5 dB in the second period, respectively. Twelve percent of the citizens in the first and nineteen percent of them in the second period complained about noise pollution. As one of the most important environmental problems, noise was ranked fifth and third in 1992 and 2001, respectively. Our results showed that civilization patterns are improved slower than growth rate of noise-causing factors across the cities.

Amirkabiria odoratissima is widely used as an odorant in east south provinces. Many people believe that this plant is useful in treatment of some gastrointestinal disorders. Therefore, this study was conducted to investigate the effect of the plant extract on the secretion rate of acid and pepsin in the stomach of the rats studied. This is an experimental study involving 3 groups of rats, 8 in each group. The control group received placebo and case groups were received 100 mg/kg and 16.2 mg/kg of Amirkabiria odoratissima by gastrodeodenostomy canola. After anesthesia with nesdonal, 50 mg/kg IP, rats were gone under surgical process, tracheotomy. Subsequently, stomach secretion obtained using Wash Out method included in the first and the second base and measured acid by titrimetry method and pepsin by Anson method. Data were analyzed using t and ANOVA methods. The amount of acid significantly decreased in both Amirkabiria odoratissima groups compared to control group (p<0.001). However, there was no significant change in pepsin secretion (p>0.05). Using of Amirkabiria odoratissima decreases gastric acid secretion and may be useful in patients with gastro intestinal disorders