Journal of Research in Medical Sciences
Volume:15 Issue: 1, Jan & Feb 2010

Drooling is a common problem in children and adults with neuromuscular disorders. This problem is best dealt with using a multidisciplinary team approach. The objective of this paper is to assess the results following surgery at the Drooling Clinic of Amiralmomenin Hospital. The results of the surgical protocol used between 1994 and 2007 at the Drooling Clinic of Amiralmomenin Hospital in Rasht, Iran, reported thirty-two patients underwent submandibular duct relocation and sublingual resection. The preoperative and postoperative levels of drooling were measured. The parents of the patients were contacted by telephone at least one year after operation. Of all the patients, eighteen were male and fourteen were female and were aged 6 years to 26 years. Of 30 patients with complete patients'' chart, the mean drooling score fell from 7.59 to 2.71 after surgery (p < 0.0001). In 30 patients, results of operation were ascertained by telephone at average of 5.6 years after operation. In 78.1% of patients, long-term result was successful and none were considered worse after the procedure. There were few complications, none of which had any long-term adverse effects. Swelling of submandibular glands was frequently observed in the immediate post-operative period. Only one ranula was seen as delayed complication. Submandibular duct relocation with simultaneous sublingual gland excision is a safe and consistently efficient procedure for the treatment of chronic sialorrhea. It is believed that this operation is more physiological procedure than others.

The effect of ilioinguinal and iliohypogastric (II-IH) nerve block on postoperative pain is well documented when performed before Caesarean section (CS) but the efficacy remains unclear when performed after the surgical procedure. The aim of this study is to investigate the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when performed after CS. Sixty ASA I-II patients, scheduled for elective CS were included in the study. After general anaesthesia, patients were allocated into 2 groups randomly. In group I bilateral II-IH block has been performed after the skin closure, with 10 ml of 0.5% ropivacaine on each side. In group II sham block had been performed. For postoperative analgesia all patients received tramadol via i.v patient controlled analgesia. Visual analogue scale (VAS) scored tramadol consumption and side effects. The mean VAS scores in II-IH block group were significantly lower than in sham block group at 6th, 8th, 12th, 24th hours at rest (p < 0.05) and at 6th, 8th hours with movement (p < 0.05). Tramadol usage in II-IH block group was significantly less than in sham block group at all estimated time intervals (p < 0.05). Total tramadol consumption was 331 ± 82 mg in II-IH block group and 622 ± 107 mg in sham block group (p < 0.05). It was observed that II-IH nerve block when performed after the surgery may reduce analgesic consumption after CS.

Primary focal segmental glomerulosclerosis (FSGS) is defined by the presence of proteinuria, often in nephrotic range and pathologically by segmental scars (SS). The aim of this study is to identify the possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis. In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patients'' identities or outcomes. Patients were divided based on their histopathological findings and outcomes were compared among these groups. There were significant differences in the complete remission rate in subjects with and without mesangial hypercellularity (p < 0.05), and in patients with and without hyalinosis (p < 0.05). According to the cut off points based on ROC curve analysis for the quantitative data, there was significant difference in renal insufficiency between the patients with and without global scars more than 12% (p < 0.05). Also multiple logistic regression analysis strongly suggests the association of mesangial hypercellularity and global scar with no complete remission and progression to renal insufficiency, respectively. In the studied patients, presence of mesangial hypercellularity and hyalinosis has been suggested as prognostic factors for lower remission rate. According to multivariate analysis, only mesangial hypercellularity and global scar were found to act as independent prognostic predictors of lower complete remission rate and progression to renal insufficiency in patients with FSGS, respectively.

The existing evidence about the clinical situations of the bipolar patients with opioid dependence is scarce. The present study was carried out to compare the clinical features and course of the bipolar disorder type I regarding the two subgroups of opioid dependent and non-dependent. There were 178 adult patients with bipolar disorder type I consecutively referred to the Iran Hospital of Psychiatry, Tehran, Iran, from January 2008 to January 2009 who enrolled in the study. The Persian Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), HDRS-17, and Y-MRS were administered for all patients. Other clinical information was gathered through the face-to-face interviews with the probands and the hospital records. The T test, Chi square test and logistic regression were used to analyze the data. The mean age of probands were 33.6 ± 11.1 years old and they were mostly male. Among the evaluated indices, the factors gender, anxiety disorders comorbidity, non-adherence, and positive family history were different significantly and independently from the other studied factors between opioid dependent and non-dependent bipolar patients. Despite some differences, the opioid dependent and non-dependent bipolar patients did not have any significant difference regarding most of the examined clinical and course indices

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the world. Determination of the risk factors and high risk groups plays an important role in the prevention and controlling programs. The present study aims to determine the relationship between opium consumption and severity of CAD. In this hospital based case-control study, 299 patients who were candidates for coronary angiography from 2006 to 2007 were recruited. The patients'' history of opium addiction was taken. Based on their history, they were categorized into three groups: non users, occasional users and current users. The relationship between opium addiction and severity of CAD was analyzed by a multiple logistic regression model, STATA v.10. According to angiographic data, patients were divided into 3 groups: 84 patients (28.09%) as non coronary artery disease, 81 patients (27.09%) as mild CAD and the remaining 134 patients (44.82%) as severe CAD. Univariate analysis showed that current opium users had higher odds of severe CAD compared with non users. Multivariate analysis showed a significant relationship between age, diabetes, hyperlipidemia, gender and severity of coronary artery stenosis. The findings indicated that current opium users - in comparison with non users - have a higher risk for severe CAD. But it is roughly confounded by other co-factors such as cigarette smoking, age and sex. A dose-response was noticed between the type of opium consumption and the severity of CAD.

This pilot study aimed to assess the differences in center of pressure trajectory in neuropathic patients with steppage gait. Steppage gait has previously been evaluated by several biomechanical methods، but plantar pressure distribution has been much less studied. The purpose of this study was to analyze the changes in center of pressure trajectory using a force plate. The steppage gait group was selected from the patients using drop foot brace (25 male) and the control group was selected from Isfahan university students (20 male). They walked at self-selected speed at a mean of ten trials (+2) to collect the center of pressure using a force plate. Center of pressure patterns were categorized into four patterns based on the center of pressure displacement magnitude (spatial features) through time (temporal features) when the longitudinal axis of the insole was plotted as the Y-axis and the transverse axis of the insole as X-axis during stance phase. The horizontal angle measured from center of pressure linear regression was positive in the control group (4. 6 ± 2. 4) (p < 0. 005)، but negative in the patient group (-2. 3 ± 1. 6) (p < 0. 005). The finding of this research measured center of pressure trajectory in steppage gait over time، which is useful for designing better shoe sole and also orthopaedic device and better understanding of stability in patients with drop foot

Childbearing years in the women''s life are associated with the highest risk of depression. In this study depression in third trimester of pregnancy and after delivery was studied. Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage. This prospective cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008. Subjects were all in their third trimester and followed up from the beginning of the study to 6-8 weeks postpartum. At all, 2156 pregnant women completed the self report questionnaires but 258 were excluded because they were incomplete and final analysis was done with 1898 samples. At the final stage the sample size was decreased to 1291. The prevalence of depression based on BDI score greater than 20 in last trimester of pregnancy, was 22.8% and rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery, was 26.3%. Incidence of Post Partum Depression (PPD) in 6 to 8 weeks after delivery in those who were not clinically depressed during pregnancy was 20.1%. Results showed that history of depression, unplanned pregnancy, being housewife and having 3 or more children had significant relation with ante partum depression. Two main risk factors for post partum depression are previous history of depression and depression during current pregnancy. It is important to assess these variables during pregnancy in order to facilitate timely identification of women at risk.

Cerebral microangiopathy is one of the most important complications in diabetes. It may interfere with cerebral vasomotor reactivity (VMR) which may lead to disability, stroke or even death. The aim of the present study was to determine and compare VMR changes in diabetic and non-diabetic patients. Fifty three diabetic and 51 non-diabetic patients (with no other vascular abnormality) were recruited. Vasomotor reactivity was evaluated with Trans-Cranial Doppler (TCD) before and after CO2 inhalation. There were 69 (66.30%) males. The mean age was 41.53 ± 17.80 years. The general average of VMR was 5.79 ± 3.00%, the figures in diabetic and nondiabetic patients were 5.31 ± 2.60% and 6.62 ± 2.00%, respectively (p = 0.02). The average of flow velocity (FV) change was 42.47± 29.00 in diabetics and 53.34 ±16.70 in non-diabetic patients (p = 0.04). It is recommended that such non-invasive method is necessary for evaluation of cerebral vasculature in diabetic patients for better prevention

Retaining of gauzes and surgical sponges in the abdomen is one of the most frequent medical errors usually manifesting as abscess or abdomino-cutaneus fistulas with no definite symptoms during lifetime. Here، we introduce a 35 year old woman with symptoms and signs of partial bowel obstruction and enterocutaneous fistulas caused by migration of retained gauze from abdominal cavity to terminal ileum، 9 months after cesarean section. This is called “Textiloma”. There are several reports of gossypiboma worldwide but migration of retained gauze into intestine causing an enterocutaneous fistula is rare.

The occurrence of Langerhans Cell Histiocytosis (LCH) in a patient with lymphoma is an indication of a probable relationship between them. The two conditions have similarities both clinically and histopathologically. Occurrence of these two conditions in the same patient, particularly not simultaneously, is rare. According to different management and treatment of these conditions, exact histopathologic evaluation and even using immunohistochemistery (IHC) can prevent misdiagnosis. In this report, a 10 year old boy presented who afflicted with LCH 3 years after diagnosis and treatment of mixed cellularity Hodgkin lymphoma.