Iranian Red Crescent Medical Journal
Year:2002 | Volume:4 | Issue:2|Papers Count:17

Background: Delayed graft function (DGF) remains as an important complication in renal transplantation with obvious short-term and possible long-term disadvantages.Objective: To determine the influence of recipient and donor factors on the development of delayed graft factors and their impact on the long-term graft survival.Methods: A total of 237 living kidney recipients were reviewed with regards to recipients and donors’ factors. Delayed graft function was defined as a need for dialysis during the first week after transplantation or failure of serum creatinine to decrease below pretransplant levels within one week regardless of urine out put. Effect of patients’ factors on the development of delayed graft function and its effect on I and 5 years graft survival were studied.Results: Thirty-six out of 237 patient's experienced delayed graft function (15.2%). Incidence of delayed graft function was 10.6% in recipients of living related donors compared to 24.4% in living unrelated donors (p=0.002). One and 5 years graft survival were 85.5% and 69.5% in patients with immediate graft function and 81.0% and 57.9% in patients with delayed graft function respectively.Conclusion: The only risk factor for delayed graft function in recipients of living kidney transplant as shown by this study was living unrelated kidney donation. Delayed graft function seems to have no deleterious effect on 1 and 5 years graft survival.

With the objective of defining the cause and the course of illness in babies who present with respiratory distress, a study was done one 82 full-term neonates admitted in the hospital.Birth weight o fat least 2.5 kg, gestational age between 38-42 weeks and a respiratory rate of >60/minute with or without other signs of respiratory distress were regarded as sufficient criteria of inclusion.The study revealed a wide spectrum of pulmonary and extra-pulmonary conditions, all resulting in an increased respiratory rate. Some of these diseases were significantly different from those usually seen in the premature infants.Hyaline membrane disease was not seen. The diagnoses included pneumonia, (26 cases), meconium aspiration syndrome (15 babies), congenital heart disease, (6 patients) and anomalies of the upper respiratory tract were seen in 2 children.Twenty-one neonates without obvious cardiopulmonary pathology presented with rapid breathing, these included sepsis with accompanying dehydration, acidosis, hypoglycemia or anemia without pulmonary involvement. Five infants with hypoxic ischemic encephalopathy and two with acute renal failure also presented with tachypnea.The present study outlines the highly varied range of diseases that can present with respiratory distress in the full term newborn. It lays stress on the necessity for a high index of suspicion in cases of non-pulmonary conditions presenting with pulmonary symptomatology and briefly discusses some of the measures that may help in reducing adverse sequelae in the full-term baby.

Difficult intubation has been a problem for anesthesiologist especially during maxillofacial surgeries with limited mouth opening.A technique of nasopharyngeal airway has been applied in 45 cases. This method has been completely successful in relieving upper airway obstruction and allowing normal ventilation. This technique is simple, quick and absolutely free from untoward reaction.

Objective: This clinical trial was performed to comate the effectiveness of oxytocin with misoprostol for induction of labor in Bahonar Hospital, Kerman-Iran.Methods: Sixty pregnant women with indication for labor induction were randomly assigned to receive either misoprostol or oxytocin. Misoprostol tabet, 25μg was inserted in the posterior fornix and was repeated every four hours in the first group (to a maximum dose of 100mg). The second group received intravenous oxytocin (2mu/min).Results: The results showed that 83.3% of women in the misoprostol group were delivered vaginally within 3.5 to 21 hours of the initiation of induction it was 76.7% within 4.5-17.5 hours in oxytocin group and there was no significant difference between them. The total cesarean section rate was approximately similar in both groups. Women receiving oxytocin had higher rate of cesarean section for dystocia (5 versus I). The mean and median interval from induction to delivery was not significantly different between the two group, (685±223 and 710 minutes in the first group compared with 685±198 and 690 minutes in the second group). There was no significant difference in Apgar score and meconium staining between two groups. Hyperstimulation was seen in one patient in the first group with neither low Apgar score nor adverse neonatal outcome.Conclusion: This study showed that the outcome of induction was not significantly different in the two groups. Therefore considering the advantages of misoprostol, it is recommended as an alternative to oxytocin.

The red blood cell indices of 63 patients (35 boys and 28 girls) with cyanotic congenital heart disease were reviewed to determine the incidence of hypochromic microcytic anemic and its correlation to neurologic complication in these cases. Mean age was 3.6±4.4 years with a range from 1 month to 15 years. Fifty-two percent of patients were less than 1 year of age. Eleven patients (17.5%) presented with MCV<3rd percentile for age and sex. MCH and MCGC<3rd percentile for age and sex were noted in 44.4% and 62% of our cases respectively. Hypochromia was more prevalent than microcytosis in the patients.There were eight cases with neurologic complications. We didn’t find significant difference between red blood cell indices of this group and that of the remaining children. Patients with neuroligic complications were significantly older (P<0.006).We conclude that the incidence of hypochromic anemia is high in cyanotic young patients in developing countries and prolonged period of chronic hypoxemia predisposes these children to neurologic sequelae.

In this study, a colorimetric method for the determination of serum lecithin is examined using LPL, phospholipase C and glycerol dehydrogenase. The results showed that serum lecithin concentration in the obstructive jaundice patients was increased compared to that in the control group [185.47±16.12 (mean ±SD, no=57) vs. 112.38±9.27 (mean ±SD). No.=39, P<0.05] mg/100 ml. The increase of serum lecithin in the patients with obstructive jaundice is a good indicator of liver disease, especially obstructive jaundice. Our results showed that measurement of lecithin is considered to be one of the most specific and sensitive methods for the detection of obstructive jaundice.

Schizophrenia is an important disorder in psychiatry with an unknown etiology. Many factors (e.g. birth order) have been mentioned as its risk factor. Since few studies with scientific designs on birth order and schizophrenia have been performed in Iran, this study was conducted.Every consecutive patient in psychiatric ward for 3 months was assessed and categorized according to the DSM-IV into four groups (i.e. schizophrenia, schizoaffective and bipolar, major depressive disorder and others) and demographic characteristics (age, sex, birth order and family size) were evaluated.In comparison with the non-schizophrenic group, this study indicated that schizophrenia is more prevalent among the first-born children (P<0.01), even in schizophrenic group itself, the-born child was more commonly affected (P<0.001). This result was independent from age, sex and family size.

Growth velocity standard is an efficient tool for monitoring child growth. The purpose of this paper is to present longitudinal growth velocity reference standards of a cohort of 317 infants (164 girls and 153 boys) born in Shiraz (Southern Iran) in 1996 and followed for two years from birth. The results showed that the velocity charts for the five anthropometric measurements (height, weight, arm, head and chest circumferences) fell down rapidly from 2 weeks to 7 months of age and decreased mildly later on for both sexes. Boy's growth velocity was higher than girls in the first months of ages but no significant difference was seen later on. However, girl's growth velocity centiles lie below boys. Variations in growth velocity of height and weight of Iranian infants were more than their counterparts in England. Also, the 3rd centile of British infants was consistently above our standard. But, this finding was not consistent for the rest centiles the paper concludes that local velocity reference standards should be used in Iran. Also, growth velocity charts were found to be sensitive and fast in diagnosing infant's failure to thrive. While growth charts display attained growth of a subject from birth to a certain age, they cannot predict growth trend and status in time intervals in longitudinal studies due to high serial correlations of the measurement at different occasions. The latter was achieved by using growth velocity charts in which velocity measurement are substantially less affected by serial correlations. Therefore, the two kinds of charts are found to be complementary in monitoring child growth.

In this study, we investigated the value of cytologic evaluation of ovarian cysts. In a prospective cross-sectional study, we compared cytologic results with pathologic findings in 55 patients with apparently benign ovarian cysts. For functional ovarian cysts, cytology had a sensitivity of 100% and specificity of 90.4%. In endometriosis, sensitivity and specificity of cytology were 66.3% and 100% respectively. In dermoid cyst, sensitivity and specificity of cytology were 100%. In mucinous cysts, we found sensitivity of 90.4% and specificity of 100%. Therefore, in patients with apparently benign ovarian cysts, especially in the centers without adequate equipment or trained personnel for laparoscopic ovarian cystectomy, we can evaluate the ovarian cysts by cytologic aspiration and avoid unnecessary laparatomy especially in infertile women.

Background: Kawasaki disease is a systemic vacuities of unknown etiology and a major cause of acquired heart disease in developed countries.Aim: The aim was to describe the epidemiology, management and the rate of cardiac complications of Kawasaki disease.Methods: According to a cross-sectional study, between 1995-2000, we recorded 45 children with Kawasaki disease who were admitted to pediatric ward of Al-Zahra medical center in Isfahan, Iran.Results: Out of 45 patients, there was 29 (64.4%) boys and 16 (35.6%) girls giving a ratio of 1.8:1 (p<0.05). The age range was between 0.5 to 11 years with a mean (SD) of 4.14 (2.46). The peak incidence occurred in second year of life. A total of 21 cases of cardiac involvement were detected, including pericardial effusion (5 cases), mitral regurgitation (6 cases) and coronary artery ancurysms (CAA) (10 cases). CAA in patients who received intravenous immunoglobulin in the first 10 days was less than untreated groups or patients treated later on (P<0.05). Laboratory investigations showed leucocytosis, thrombocytosis and a raised erythrocyte sedimentation rate in the most patients.Conclusion: CAA in this study was higher than in other reports. Risk of CAA will increase, if the diagnosis and treatment are delayed more than 10 days.

Panceas cacer is the fifth leading cause of death resulting from cancer and consists 10% of gastrointestinal (G1) tumors. There are several risk factors for it and smoking is the most important one. Prevalence of pancreas cancer is three time higher in smokers. The present study is performed in three teaching hospitals and two private clinics in order to find the exact relationship between pancreatic cancer and smoking.Patients and methods: This retrospective study based on existing data in patients’ files. Totally, 860 files were studied and the results were compared with results of other centers. 170 patients were smokers (65.21%) while 80 patients were not. There were 93 males (62%) and 57 females (38%) in the first group and most of them used to smoke 10 to 20 cigarettes daily (63.33%). Most of patients in the first group were over 60 years old (79.21%) and their body weight was more than 60kg (66%). There were 51 males (63.75%) and 29 females (36.25%) in the second group. Most of them were over 60 years old (76%) and their weights were over 60kg (61).Discussion: The study showed that cigarette smoking, obesity and old age are important risk factors for pancreas. The findings are close to other centers’ results. Other risk factory such as pancreatitis, constipation, alcohol drinking and genetic factors have been studied by other researcher but most of them believe that smoking is the most important one, so it is needed to increase people knowledge in this field.

Twenty five non-unions of the tibia (in twenty four patients) were initially treated by external fixation or pin & plaster and immobilization in a cast & bone grafting then they were treated by graft and plating. There were 23 open fractures and 2 closed fractures with compartment syndrome. Eleven non-unions (44%) had early soft-tissue reconstruction. The duration of external fixation was average ten weeks and the mean time from injury to plating ten weeks and the mean time from injury to plating was eight months. None of the non-unions were infected at the time of plating. The average preoperative deformity in the sagittal (anterior-posterior) plane was 8 degrees and in the frontal (medical-lateral) plane 9 degrees. After fixation, the residual angulations averaged 3 and 2 degrees respectively. Autogenous bone grafting was used in all cases.The patients were followed for an average of twenty-four months. 23 (92%) of the non-unions united in an average of seven months without further intervention. In 2 patients (8%), the plate broke, necessitating re-plating. A deep infection developed in 2 patients (8%). Ultimately, 24 non-unions (96%) healed without evidence of infection.Plate osteosynthesis is an effective method of treatment for patients who have had an open fracture of the tibia and has failed to unite after external fixation, pin and plaster or immobilization in a cast.

Bad breath is a common complaint and it is an important reason for patients medical consultation. A large number of patients complaining of bad breath are treated ineffectively leading to their withdrawal from social actively. Metronidazole was used as gel to treat malodor of breast cancer and bed sores. This trial is done to find the effect of metronidazole mouth wash on bad breath of 162 patients referring to GI clinic between 1990 to 1997. metronidazole mouthwash for 2 minutes used for 7 to 14 night before going to bed. The effect was evaluated by clinical examination and judged by McNemar test. 89 patients returned for follow-up. 80 patients (89.9%) had no more complaint (p<0.0001). So, it was concluded that metronidazote mouth wash is effective for bad breath. More clinical trials are recommended.

Congenital esophageal stenosis (CES) is a rare anomaly. It is an intrinsic stenosis present at birth with congenital malformation of esophageal wall architecture. Three forms of this anomaly are membranous web, libromuseualr and secondary to tracheobronchial remnant.

A 52-year-old man referred with fever for 40 days. On examination, he had no abnormal finding except for a slightly enlarged thyroid gland. Thyroid function tests demonstrated a thyrotoxic state with reduced uptake of radioiodine (RAI-U) compatible with subacute thyroiditis (SAT). He had leukocytosis, raised ESR and a painless nontender thyroid gland.

The diabetic foot is frequently susceptible to extensive infections and for its management a lot of tissue should be sacrificed. Vessel obliteration of the main arterial trunks associated with diabetic microangiopathy in most cases lead to major segmental amputations.Classics techniques of tissue revascularization using by-pass techniques are usually not effective in these pathologic conditions. Therefore, for well-selected cases (based on clinical examination, Doppler, angiography), the free tissue transfer may represent an alternative to amputation.The authors report the case of a diabetic patient who sustained a free transfer for plantar coverage, including the long-term postoperative improvement during 44 months. The final result stimulates us to consider the free tissue transfer as a viable solution for defect coverage in the diabetic foot.

By increasing the number of traumatic cases, burn victims and detection of rare congenital defects, plastic surgeons should improve their surgical techniques to manage these patients with better quality. Correction of these deformities is important cosmetically, increases the self-confidence of the patients and enhances their mental health.Tissue expanders have been used for several decades to eliminate different body scars, but healthy skin around the lesion would also be damaged. To prevent this complication, the author has used trans-scar incision technique and inserted the tissue expander under normal and abnormal skin (scarred area) to expand the healthy tissue and then after removing tissue expander, scarred area is covered b multiple flaps. This method has been used in 5 patients with scars of scalp (in two cases 2 tissue expanders were used and in 3 patients only one tissue expander was inserted). The results were satisfactory. By this method which is suggested by the author as periscar tissue expansion technique, it has two advantages:1. No new scar would be created.2. By expansion of healthy skin adjacent to the scar, the maximum expansion of normal skin will be achieved.In the present article, the periscar tissue expansion technique and its results in 5 patients is discussed.