[Repeatabilifi of ctinico-histopathologiculft.ndings and direct immanoflaotescence offtxed, paraffin embedded specimens fot diugnosis of lichen planas]

Background and. Aim: Lichen planus [LP] is a chronic mucocutaneous disorder mediated by the impaired immunity' in which the concomitance of clinical and histopathological findings are necessary for a definite diagnosis. In case of discrepancy between clinical and histopathological findings, use of adjunct diagnostic methods such as direct immunofluorescence [DIF] is recommended. This study sought to assess the repeatability of clinico histopathological findings and direct immunofluorescence of fixed, paraffin embedded specimens for diagnosis of LP.

Matertuh and Methods: In this retrospective descriptive study, 49 oral and cutaneous LP specimens were subjected to DIF assessment using fibrinogen, c3 and IgM. The intensity of fluorescence staining was graded as 0, I or 2' Findings were compared in each group and between oral and cutaneous LP groups using statistical tests.

Results: Statistical unulyr",, "rr"aled a correlation between C3 and IgM expression [Spearman's rho: 0'697, p=0'000]' which was more prominent in cutaneous specimens [p:0.000]. Additionally, a correlation was observed between fibrinogen and IgM expression in oral LP [Spearman's rho: 0.764, p:0.02].

Conclusion:It seems that DIF assessment of formalin-fixed, paraffrn embedded specimens using C3' fibrinogen and IgM does not have adequate repeatability for clinico-histopathological findings; although, combined application of C3 and IgM in cutaneous uoa IgVt and fibrinogen in oral LP specimens showed higher repeatability.

Evolution of gas exchange abnormalities in patients with liver cirrhosis candidate for liver transplantation

Hypoxemia is common in patients with cirrhosis but the natural history of this syndrome is unknown. This study was conducted to evaluate the natural history of arterial oxygenation in patient with end stage liver cirrhosis. Sixty eight patients with liver cirrhosis were followed up for 6-12 months. Arterial blood gas [ABG] and pulse oximetry were obtained on day of presentation and follow up. There were no significant changes in the oxygen saturation by pulse oximetry [SpO[2]], partial pressure of oxygen [PaO[2]] and alveolar arterial oxygen gradient [A-a O[2]] after 6-12 months. Mean arterial oxygen saturation [SaO[2]] in 46 patients was 95.42 +/- 1.92, and after follow up changed to 95.45 +/- 2.96. Thirty eight patients had SaO[2] > 94% [mean 96.12 +/- 1.08 after 6-12 months changed to 95.66 +/- 2.58]; 8 patients had SaO[2] ? 94 [mean 92.08 +/- 1.44 after 6-12 months changed to 94.46 +/- 4.47]. There were no significant changes in the SpO[2], PaO[2] and A-a O[2] after 6-12 months

[Comparison of fentanyl and combination of pethedine and midazolam for pain control during extracorporeal shock wave lithotripsy]

Background and aim: Shock wave during extracorporeal lithotripsy causes pain for which analgesic drugs are prescribed most often. The aim of this study was to compare the efficacy and adverse effects of fentanyl and combination of pethedine and midazolam for pain control during extracorporeal shockwave lithotripsy [ESWL]

Methods: In this single blind clinical trial study, 89 patients older than 18 years with renal or upper urethral stones who were candidates for ESWL were randomly allocated into Intervention [45 patients] and control groups [44 patients]. First group [Intervention] was given I.V. fentanyl [1 mg/kg] and control group was given I.V. pethedine [0.7 mg/kg] and [0.02 mg/kg] midazolam before starting ESWL. Then ESWL was performed in two groups with guidance of fluoroscopy by standard technique. During operation every 20 minutes and 2 hours after operation severity of pain was checked according to visual analogue scale. Efficacy of operation was evaluated in two groups according to follow up KUB and ultrasonography. Data were analyzed by SPSS software using Chi square test

Results: Frequency of painless operation and mild pain in fentanyl group were found 26.6 and 24.4 percents, respectively. Although severe pain was more observed in the control group [32.5%], but it was not significantly different [P>0.05]. Efficacy of operation didn't show significant difference between two groups of patients [P>0.05]

Conclusion: Similar pethedine and midazolam lower dose of intravenous fentanyl provides adequate analgesia with minimal side effects and suitable efficacy for pain control during ESWL, which can be used in outpatients, without need to monitoring in adult patients

[Systemic presentation of retained foreign body in the peritoneal cavity [gossypiboma]]

One of the infrequent complications of surgical operations is retained foreign body in body cavities which lead to morbidity and mortality for patients and also medico-legal problems for surgeons. Gossypiboma is an uncommon surgical complication, which is defined as a mass or cystic lesion due to retained surgical sponge in the abdominal cavity. Retained foreign body causes abscess, fistula, mass, obstruction after surgical operations and is diagnosed by x ray evaluation. In all patients, it is presented with pain, palpable mass. The infected post operation retained foreign bodies should be considered in differential diagnosis. In this study, we reported a patient with systemic presentation of retained two foreign bodies [surgical sponge] in abdominal cavity. The patient is a 32 years old female, which after cesarean section in 2008 developed abdominal pain, anorexia, and weight loss. The patient was referred to a specialist, and para-clinical checkup was done on her. In sonography and CT-scan, two cystic lesions with calcified wall were reported in the left and right sides of the abdomen. Then, the patient was referred to a surgeon with the diagnosis of hydatid cyst. During operation, cystic lesion with adhesion to viscera in the right side of the abdomen and a mass lesion in the descending colon in the left side were seen.The pathology report showed a surgical sponge in the right cystic lesion and surgical towel in the descending colon. Retained foreign bodies should be considered in differential diagnosis of any post operative patients who are presented with pain, infection, or palpable mass

[Determining the most suitable spirometric parameters to differentiate chronic obstructive pulmonary disease [COPD] from asthma]

Chronic Obstructive Pulmonary Disease [COPD] and asthma are common diseases with difference in prognosis and treatment. It is believed that spirometry is the best modality for differentiating the two conditions; however, the data is heterogeneous. This study aims at determining the most suitable spirometric parameters in this regard. In this case control study, fifty patients [25 patients with asthma and 25 patients with COPD] in pulmonology ward of Dr.Faqi'hi Hospital of Shiraz in 2008 under the base spirometry and post bronchodilator were recruited and comparison between these two groups was done. The collected data was analyzed by the SPSS software using independent t-test, Man-Whitney, Chi-square and Fisher test. Frequency of male patients and the mean age were significantly higher in the COPD group. Increase of forced expiratory volume in one second [FEV1] after administration of bronchodilator was significantly higher in asthmatic patients with an optimal cut-off point of >/= 0.165 L [15% increase] yielded a sensitivity and specificity of 64% and 60%, respectively. Change of other parameters was not significantly different between the two groups. The best differentiating spirometric parameter was post-inhalation FEV1/predicted value with an optimal cut-off point of >/= 64.2, with relating sensitivity and specificity of 88%. According to our results and in concordance to other reports, changing of spirometric parameters after inhalation of a short-acting bronchodilator is not a reliable indicator of asthma or COPD. Post-inhalation FEV1/predicted value is the best parameter in this regard; however, the clinical suspicion should not be replaced by it

[Determining the adequacy of hemodialysis in hemodialysis units of Kohgilouyeh and Boyerahmad hospitals in 2009]

Cardiovascular disease and hemodialysis incompetence are the main factors determining the disability and mortality in dialysis patients. Increasing in adequacy of hemodialysis is quite effective in patients' prognosis. There are several methods for evaluating the adequacy and need of hemodialysis. One of these methods is the assessment of KT/V in patients. This study aimed to determine the adequacy of hemodialysis patients in hemodialysis units in Kohgilouyeh and Boyerahmad hospitals. This was a cross-sectional descriptive study which was conducted at Yasuj University of Medical Sciences in 2009. The study population included all patients under hemodialysis. In this study, 41 patients were eligible for study in hemodialysis units. From all patients, before and after hemodialysis, blood samples were taken and blood urea nitrogen and creatinine were measured. KT/V and URR were used for the evaluation of dialysis adequacy. Collected data were analyzed by descriptive statistics [mean, standard deviation] and inferential [one way ANOVA test and t-test] using the SPSS software. Results of this study showed that the mean BUN of patients before dialysis was 69.9 +/- 23/6 and after that was 32/63 +/- 11/96. Minimum KT/V, 0.45 and a maximum of 1.77 with average was 0.94 +/- 0.4. Considering the standard KT/V, 17 patients [41.5 percent] with optimal dialysis adequacy, 3 patients [7.3 percent] near-optimal rate and 21 people [51.2 percent] were less than optimal. The minimum URR was 28% and the maximum was 75% with an average of 50% +/- 0.69 respectively. Considering the URR criteria, 11 patients [26.8 percent] with optimal dialysis adequacy, 10 patients [24.4 percent] near to the optimum level and 20 patients [48.8 percent] were less than optimal. In view of the standard KT/V and URR, much of the patients had inadequate hemodialysis at these hemodialysis centers. Because of the direct connection between the clinical status and adequacy of hemodialysis and mortality, evaluation of the related causes is necessary

[Comparison of efficacy and complications general versus spinal anesthesia in PCNL]

Complication of general anesthesia, especially during change of position, is more than spinal anesthesia. We evaluated our experience regarding spinal anesthesia in comparison to general anesthesia in patients older than 18 years old that were candidate for PCNL. In this randomized clinical trial study, from March 2008 to February 2010, 110 patients older than 18 years who were candidate for PCNL, after informing them and getting their approval, they were randomly assigned into two groups by Zelen randomization method. Then, in group 1, general anesthesia was induced by parental and inhalational drugs as standard methods and PCNI was performed in prone position under fluoroscopy guidance by standard technique. In group 2, spinal anesthesia was done by spinal needle NO 23-25 gauge and injecting 2-3 ml of Bupivacaine and 0.5 ml Fentanyl in spinal space L4 in sitting position. Then urethral catheter was inserted in lithotomic position and head of bed tilted down for 5-10 minutes with checking level of anesthesia. Then, the patients were rotated easily by the help of in prone position and PCNL were done under guide of fluoroscopy by standard technique and results with complications were recorded and analyzed by SPSS software and chi-square and T student test. Mean stone size in group one and two were 34.2 +/- 9.8 and 31.3 +/- 7.9 millimeters respectively. Considering efficacy and successfulness of operation, clearance of system from stones or residual stones<5 millimeter was respectively 80 and 72.73 percent in groups 1 and 2 [p=.37. There were no major Intra-operative or postoperative complications such as visceral or vascular injury and unusual bleeding in our patients. Need to narcotic drugs in operative day [D0] in groups 1 and 2 were 12.4 +/- 3.1 and 7.8 +/- 2.3 milligram equivalent to morphine sulphate [p=0.3]. The coast of anesthetic drugs in groups 1 and 2 were 23 +/- 3.7 and 4.5 +/- 1.3$ respectively [p=.001]. Spinal anesthesia with combined Bupivacaine and Fentanyl is safe, effective, and also a comfortable method for performing PCNL and is a good alternative for general anesthesia in adult patients with low coast

[Developing appropriate criteria for benign prostatic hyperplasia surgery using RAND Appropriateness Method [RAM]]

Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient's condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal [AGREE] were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases [25.9%] were considered as appropriate, 14 cases [5%] as equivocal and 7 cases [2.5%] were considered as inappropriate. Also 22 cases [7.8%] were considered as appropriate indications for drug therapy and none were found to be suitable for waiting and watching. There were 94 scenarios related to surgery that 75 scenarios [80%] were grouped in appropriate and 8 scenarios [8.5%] identified inappropriate. At the present time, due to the lack of scientific evidence for suitable decision-making in providing health services, methods based upon agreement, including the one used in the present study, and the use of treatment standards derived from similar studies, are amongst the most important measures taken to improve the standard of hearth, provide suitable health services, and to reduce unnecessary costs. In addition, RAM appropriateness method could be an ideal method in determining the appropriateness of health care and in reducing the rate of inappropriate services provided. The similarity of results derived from other studies performed by the RAND method in determining the appropriateness of benign prostatic hyperplasia treatment with the current study shows the validity and reliability of this method

[Comparison of pathology and prevalence of Prostate Cancer in patients with PSA between 4-10ng/ml]

Prostate cancer is the forth common cancer in the world with different prevalence rate based on age, race and geographic area. Prevalence of prostate cancer in patients with PSA between 4-10ng/ml is reported to be about 20% in some studies. The aim of this study was to define the prevalence of prostate cancer in patients with 4-10 ng/ml PSA, in different age groups, based on Gleason grade. In this cross sectional descriptive-analytic study, after taking informed consent, TRUS [Tran rectal ultrasound biopsy] was done in all patients with PSA of 4-10 ng/ml who referred to Labafinejad hospital from 2005 to 2006. Their pathology was classified into 3 groups, from 1-10, according to Gleason grade. Patients with cancers were divided into three groups; 50-60, 60-70 and 70-80 years old, according to their age. Collected data were analyzed with SPSS software and descriptive tests. Prevalence of prostate cancer in 155 studied patients that underwent TRUS biopsy was 17.4%. Considering the age of patients, the rate of prostate cancer was 29%, 48.1% and 22.2% in 50-60, 60-70, and 70-80 years old patients. According to Gleason grade, the rate of prostate cancer was 3.7%, 74% and 22.2% in grades 1-4, 5-7 and 8-10, respectively. Prevalence of prostate cancer in patients with PSA between 4-10 ng/ml in this study was 17.4 percent and most of these patients were in 50-60 year-old age groups and have Gleason grade less than 7. The majority of these patients are curable by radical prostatectomy

[Prevalence of asthma among 1 5 to 64 years old in Kurdistan, Iran 2006]

There is geographic variability in the prevalence of asthma. Since there is inadequate of study on asthma in Iran, this study was performed in order to determine the prevalence of asthma in Kurdistan province. This cross-sectional study was performed as part of Iranian national survey to determine the risk factors of non communicable disease. This study includes 500 men and 500 women. Prevalence of history of asthma was 2.3%. There was no statistically significant association between asthma and place of residence, smoking and body mass index. Asthma were found in 6 [1.8%] of men and 17 [5%] of women [p=0.02]. Prevalence of asthma increased with increasing age [p<0.001]. The prevalence of asthma in this study was similar with other studies in Iran and seems lower than similar countries

Normal serum prostate specific antigen levels in men in Yasuj province, Islamic Republic of Iran

We assessed serum prostate specific antigen [PSA] levels in 650 men over 40 years referred to 3 Yasuj hospitals for blood cell count in 2003/2004. Men affected by prostate cancer, prostatitis or transurethral instrumentation were excluded. PSA was determined by an immunoassay technique. PSA levels in different age groups were: 40-49-year-olds-mean = 0.7 ng/dL, normal = 0-1.35 ng/dL; 50-59-year-olds-mean = 0.9 ng/dL, normal = 0-1.85 ng/dL; 60-69-year-olds-mean = 1.6 ng/dL, normal = 0-3.2 ng/dL; >/= 70-years-olds-mean = 2.3 ng/dL, normal = 0-4.4 ng/dL. Normal PSA levels in our society were lower than those in the United States, Europe and Japan