[Measurement of cervical length changes during normal pregnancy by endovaginal ultrasound device]

Cervical inability to preserve pregnancy is called cervical insufficiency. On-time diagnosis of cervical insufficiency is important for taking appropriate preventive actions. Endovaginal sonography is a powerful predictor for spontaneous preterm pregnancy loss. Importance of cervical length measurement is to diagnose cervical insufficiency and to decide on cerclage. In this study, we evaluated endovaginal sonography assessment of cervical length changes during a normal pregnancy. In a prospective cross-sectional study endovaginal sonography on 150 pregnant women [50 in every trimester] was performed to measure cervical length and mean of the cervical lengths in the three trimesters was compared together by one way ANOVA test. The patients were followed until labor. Twin pregnancies and cases with history of uterus curettage, cervical anomalies, preterm labor and cerclage were excluded from the study. Mean of the cervical length in the first, second and third trimesters of pregnancy respectively were 39, 40.7 and 39.3 mm respectively. In addition, the minimum and maximum length of cervix in the same trimesters were 28 and 56 mm, 26 and 52 mm, 27 and 52 mm respectively. Minimum cervical length was seen in the first pregnancy and maximum cervical length was seen in past NVD. No significant statistical differences were seen between the means of cervical length in the three trimesters of pregnancy or maternal age. However, there was a significant statistical difference between mean cervical length and maternal parity [p=0.05]. The mean cervical length in three trimesters was 39 mm and considered as an accepted value for mean cervical length in different trimesters. According to presence significant correlation between cervical mean lengths and multiparity with no preterm labor history, it may be safer if there is no preterm labor history in a multiparity pregnant woman

Effects of dexamethasone in primary intracerebral hemorrhage in the south west of Iran

Previous study revealed the value of dexamethasone in the treatment of vasogenic edema associated with brain tumor and abscess. However there are poor documented studies about its usefulness in primary intracerebral hemorrhage. In this study we evaluated dexamethasone effects in primary intracerebral hemorrhage. In a double blind randomized placebo-controlled clinical trial we evaluated 200 intracerebral hemorrhage cases between 40 to 80 years old whom were admitted at Golestan Hospital [Ahwaz, IR] between March 2002 And March 2003. They were divided in two groups; dexamethasone [N=100] and placebo [N=100]. Then mortality, GI bleeding, fever, electrolytes disturbances, hypertension and hyperglycemic status were analyzed in two groups. Ethical considerations were employed and subjects were followed by appropriate statistical methods for 21 days to assess the major outcomes. Mortality was much higher in the dexamethasone group; Dexamethasone group [49.3%] and placebo [23.4%] and also fever was higher seen in the dexamethasone group; dexamethasone group [40.2%] and placebo group [24.7%] but there was not any significant statistical difference between two groups as regards other complications. Dexamethasone is widely used for cerebral edema associated conditions but in this study we saw that it's complications in intracerebral hemorrhage such as increasing fever and mortality are significantly higher. Hence it use for treatment of primary intracerebral hemorrhage should be reconsidered

[Comparison of preanesthetic sedation after intranasal administration of fentanyle, ketamin and midazolam]

Induction of anesthesia in children can be a challenge for anesthetist. A stormy induction may increase the personality and behavioral changes. Therefore, it is desirable that they enter the operating room sedated. Many drugs are used for preanesthetic medication and there are many routes for administration. One route of administration is nasal mucous. In this study we compared the effect and side effect of three drugs [midazolam, ketamin and fentanyle] after intra nasal administration. This is a double blind clinical trial. In this study we selected 60 patients [20 patients for every group A, B or C.] We used 3 mg/kg ketamin or 3 microg/kg fentanyle or 0.3 mg/kg midazolam by intranasal spray. After administration and in 5, 10 and 15 minutes, we observed the SPO2, PR and RA. After 15 min's we separated children from parents and brought them to the operating room and controlled the acceptance of separation, depth of sedation with Ramsay score, acceptance of mask and tolerance of IV canulation. The data were then analyzed using K2 and kruskal-wallis test. In our study we found that in SPO2 fentanyle had the highest rate of reduction even though none of the children had SPO2 lower than 90%.There were no differences between drugs in RA. In fentanyle group, we had the lowest rate and in ketamin group the highest rate. Midazolamhad the medium rate. The rate of sedation for acceptance of separation from parents had no difference between the groups and all drugs with this dosage were effective for this aim. However, in Ramsay score, acceptance of mask and tolerance of IV canulation, the midazolam was more effective than the others. Intranasal administration of midazolam is a safe route for sedation in children in the pre-anesthetic time