Prevalence of coronary artery diseases risk factors in Sari-Iran [2005-10]

Coronary artery diseases are one of the main causes of mortality and morbidity. This study was done to determine the prevalence of risk factors for coronary artery diseases in patients referred to angiography center in Sari, Northern Iran. This descriptive study was performed on 2540 patients referred to angiography center in Sari city, northern Iran, during 2005-10. Risk factors including diabetes, hypertension, hyperlipidemia, smoking, Family history, CRP and also ECG changes, type and number of involved artery and the severity of vascular involvement were recorded for each patient. Hypertension, hyperlipidemia, diabetes, smoking were seen in 40.8%, 40.5%, 29.1%, 12.5% of patients, respectively. Positive family history and CRP were found in 10% and 3.4% of the patients, respectively. 23.8% of patients had abnormal ECG. One, two and three vessel diseases were observed in 26.5%, 48.3%, 48.3% of cases, respectively. Left anterior descending artery constriction was seen in 75.8% and 80.4% of males and females, respectively. A significant relationship was found between diabetes and left coronary circumflex [P<0.04] and left anterior descending artery [P<0.03] constriction. Diabetes, hypertension, hyperlipidemia, smoking, family history, abnormal ECG are among the risk factors of coronary artery diseases in this area

[ effects of stabilization exercise on pain, functional disability and muscle endurance in patients supected to lumbar segmental instability]

Lumbar segmental instability is one of the subgroups of non specific chronic low back pain and it seems that 30-40% of patients with LBP suffer from lumbar segmental instability. Pain intensity, functional disability and reduced muscle endurance are common in such patients. The aim of this study was to evaluate the effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspected to lumbar segmental instability. Following ethical approval, a randomized clinical trial was carried out on 30 patients suspected to lumbar segmental instability ranging from 18-45 years old. They were randomly divided into two groups; the first group underwent routine exercise only while the second group performed routine exercise plus stabilization training for 8 weeks. Outcome measure included pain intensity, functional disability, and flexion and extension range of motion and flexor, extensor and side support muscle endurance which were evaluated before and after treatment. Data were analyzed using paired t test and independent t test. Muscle endurance and flexion range of motion increased in both groups although the increase was higher in stabilization training group [p=0.00]. Pain intensity and functional disability significantly decreased in both groups [p=0.00], but decreasing of pain intensity and functional disability were more in stabilization training group [p=0.00]. Stabilization training is more effective than routine exercise in improvement of pain intensity, functional disability, muscle endurance and range of motion in patients suspected to lumbar segmental instability

Spina bifida aperta in southern Iran, 15 years experience

Spina bifida aperta is a lesion that communicates with the external environment; and includes meningomyelocele and meningocele. We investigated all clinical presentations in meningomyelocele and meningocele patients in Shiraz, southern Iran. Patients' files of spina bifida aperta who were admitted from 1989 through 2005 to Nemazee Hospital were reviewed for meningomyelocele and meningocele in Shiraz, southern Iran. CSF shunting by ventriculoperitoneal [VP] shunt was also performed. Out of 580000 patients, 100 cases of spina bifida aperta were registered. In 67 patients with meningomyelocele and 33 with meningocele with male and lumbar and lumbosacral areas predominance, cystic mass was more common. 35% of patients showed congenital anomalies including talipes equinovarus and congenital hip dislocation that were more in meningomyelocele patients. 10% of the patients were operated in the first 72 hours and the others 1 month to 1 year after birth. CSF shunt insertion was more in meningomyelocele patients. Among meningomyelocele patients, mortality occurred in 3 patients [meningitis in 2 and post-operative pneumonia in one case]. It seems that water-thigh dural closure and use of dural patch could decrease the rate of postoperative CSF leakage. Our results resembled the pattern in other series, except the low prevalence of hydrocephalus and a male predominance. Earlier referral of spina bifida aperta patients should be encouraged, because it could lower the complications and lead to better outcomes

role of estrogen and progesterone receptors in grading of the malignancy of meningioma

Meningioma is the most common brain benign tumor with a higher prevalence in women. Regarding the conflicting reports on the probable effect of estrogen and progesterone in tumor growth and the putative role of growth during pregnancy, menstruation cycle, luteal phase and contraception, this study was undertaken to evaluate the role of estrogen receptor in relation to meningioma. Fifty patients with meningioma were divided into three groups of benign, atypical and anaplastic ones and the presence of estrogen and progesterone receptors for malignancy grading of the tumor was determined using avidine biotine immunohistochemistry method. Estrogen receptor was not seen in any of these patients. Progesterone receptors were present and significantly more in women and in benign tumor types. The receptor showed no correlation with age, but the malignant type was significantly more frequent in men. Women with this tumor are suggested to avoid pregnancy or to be treated before, and not to receive any contraceptive pills containing progesterone. Patients in whom progesterone receptors are present and the tumor removal is incomplete, are anticipated to have medical problems or recurrence, particularly in old age, if the tumor removal is not possible by surgery, anti-progesterone therapy would be beneficial

Papilledema as a presentation of spinal cord tumor: a case report

To report a case of spinal cord tumor with visual symptoms and papilledema due to increased intracranial pressure.A 24-year-old woman was referred because of recent blurred vision in both eyes. Visual acuity was 20/25 and 20/20 in the right and left eyes, respectively. Fundoscopy revealed bilateral papilledema. Other ophthalmic examinations were normal. Visual fields showed blind spot enlargement and brain ET scan revealed dilated ventricles. Ventriculoperitoneal shunt was inserted for the patient with a diagnosis of hydrocephalus. Ten weeks later, she returned with low back pain and lower extremity weakness. Lumbosacral MRI revealed a tumor in the region of LI-L4. The patient underwent surgical removal of the tumor and histopathologic study showed mixopapillary ependymoma.Increased intracranial pressure and papilledema without evidence of a space occupying intracranial lesion may be the presenting sign of spinal cord tumors

Cerebral hydatidosis: a reappraisal

The remarkable evolution of surgical management of cerebral hydatidosis towards an earlier diagnosis and proper treatment is evident from this 22-year retrospective study of our experience with 19 cases seen at Shiraz University Medical Institutions. Both cases of iatrogenically-induced infected cysts were seen during the pre-CT era. The optimistic view of being able to remove all the cysts intact seems to be elusive because six cysts ruptured during extraction even with application of the Dowling technique. These cases were followed for a mean of 44 months and in only one case was the patient referred again with subarachnoid cysts of the lumbosacral region after two years. In six cases we had involvement of other organs also. There were two cases of multiple cysts in the brain, a case with de novo infection of the cyst contents, and one in which the cyst was epidural in the parieto-occipital region. One patient died pre-operatively and three were lost to follow-up; however, fifteen patients were followed for a mean of 27 months with eleven being neurologically intact and four with focal neurological deficits. One patient with a tapped cyst before extraction was readmitted two years later with paraplegia due to drop parasitic infestation of the thoracolumbar region

Secondary hydatid cyst of the brain: a case report

A fifteen year old boy is reported with one month history of headache, dysphasia and right sided weakness which were due to progressive growth of more than fifteen hydatid cysts spread in both cerebral hemispheres. Echocardiography proved the origin of the cysts from the heart

Intradural extramedullary hydatid cyst: report of four cases

Progressive myelopathy was noted in three and an incomplete cauda equina syndrome in a fourth patient with intradural extramedullary hydatid cysts. In three patients the presence of medullary cysts were thought to be "de novo", but in one was a consequence of an intra-operatively ruptured cerebral cyst two years previously. Surgical exploration was modestly successful in relieving the symptoms. In at least three patients there was involvement of lung and liver with multiple cysts

Causes of infections in penetrating head wounds in the Iran-Iraq war

In a retrospective study, the incidence of central nervous system infectious complications of 913 patients were studied during the eight year Iran-Iraq war. The overall infection rate was 9.9% [91/913]. Infection rate was 4.4 percent in 412 patients who were primarily operated at Nemazee Hospital [Group A]. In 224 patients who were primarily operated in frontline hospitals, the infection rate was 15.6 percent [Group C]. Infection rate was 15.9% in a third group of patients [No. 277] who were secondarily explored in our center [Group B]. The increase in infection rate between Group A and B, and A and C is statistically significant [X[2]=22.6 and 21.3 respectively]. Up to seventy percent of the organisms cultured were gram negative which resulted in a mortality rate of 68%. Mortality was 15 percent in patients having gram positive central nervous system infections. Klebsiella, pneumonia and Staph aureus coag positive were among the most frequent organisms. One hundred twenty-six patients died during the study, of which 38 were due to infection [30%]. The overall mortality from infection was 4% [38/913]. In conclusion, patients may have a better prognosis, in terms of infection rate, if they are sent directly from the front line to a large medical center