---

---

  Background & Objective : Even though the medical sciences have developed increasingly, ectopic pregnancy is still an important cause of maternal mortality. Despite many researches on medical therapy of ectopic pregnancy (EP), surgery is still the first management of patients with EP. Most of these patients have become pregnant for the first time and keeping their fertility in the future is very important. Surgery especially salpangectomy can do nothing to keep this fertility. It seems that efficacy of medical therapy of EP, especially in Iran is unknown. This research was conducted to determine the efficacy of medical therapy of EP with Methotrexate in some patients.

 Methods: In a prospective uncontrolled clinical trial study 26 patients with EP were hospitalized in Yazd Madar hospital. Six of them did not have any indications of medical therapy and were treated surgically.20 patients were treated with Methotrexate considering all the requirements. These patients received Methotrexate 1mg/kg daily. For the prevention of side effects, folinic acid with a dose of 0.1 Methotrexate was given. The efficacy of treatment was determined afterwards with the serial measuring of serum level. The data were analyzed using Chi-Square test and SPSS software.

 Results: The average age of these patients was 27.19 years and most of them had spotting as a symptom. They had been married for 6.9 years on average and most of these patients (42.3%) were experiencing their first pregnancy. Fourteen patients (53.8%) had a history of infertility and 26.9% had a history of abortion. 50% had experienced a previous abdominal surgery. Four patients had recurrent EP and the average of gestational age at the time of diagnosis was 6.2 weeks. Finally fifteen patients (75%) were treated successfully. Four out of five patients, who had a failed medical treatment, had a serum level higher than 1000 IU/L. Five out of eight patients, (62.5%) who were followed, experienced normal intrauterine pregnancy after one year of treatment.

 Conclusions: Medical therapy of Ectopic pregnancy with Methotrexate seems to be safe and effective but when serum level exceeds 1000 IU/L it is less likely to succeed.

---

  Background & Objective : Regional anesthesia is a method of choice in cesarean section. But in emergency cesarean sections general anesthesia is usually preferred. On the other hand, intravenous sedative drugs used in general anesthesia induction rapidly crosses the placenta and result in fetal depression. Because of higher prevalence of general anesthesia in Iran it is reasonable to conduct more researches in this field. This study set out to compare the effects of Propofol and Thiopental-Na as induction agents on the neonatal Apgar score and maternal hemodynamic status.

  Methods: In this double blind clinical trial 60 pregnant women with ASA class I & II were studied. In a random way 30 patients received 2mg/kg Propofol and the rest of them were given 4mg/kg of Thiopental-Na. All these subjects had full term and normal fetus. Pre and post-induction status of the patients was monitored noninvasively after tracheal intubations and during 12 minutes after that. Also time intervals between induction and birth (cord clipping) and between uterus incision and birth were measured. Apgar score of neonates was evaluated through clinical examination in 1^st, 5^th, 10^th and 15^th minutes after birth. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test, chi-square and ANOVA.

 Results: Apgar score in different times (1.5,10&15 minute) had no significant difference between two groups. (In the 1^st minute Propofol was 7.1 ± 2.2 and Thiopental was 74 ± 1.8, in the 5^th minute Propofol was 9.2 ± 0.7 and Thiopental was 9.1 ± 0.9) Maximum variation of heart rate and blood pressure in two groups were not significantly different. The time intervals between induction and birth (less than 8 minutes) on the one hand and uterus incision and birth(less than 130 seconds) on the other were similar in two groups.

  Conclusions : Thiopental-Na and Propofol can be used with similar results for induction of general anesthesia in cesarean section.

---

  Serious vascular complications of IV drug abuse are being encountered with increasing frequency. These patients often present with cellulitis, abscess and endocarditic. Due to having viral infections these people can be a hazard to health care workers. Medical intervention is usually conducted after the emergence of one of the dreadful complications of IV drug abuse. The subject is a 40-year old male prisoner who referred to Emergency Department with 24 hours history of chill and fever, intermittent bleeding from a painful ulcerated lump in right groin along with hypotension and severe edema of right lower extremity necessitating packing and initial resuscitative measures. It was clinically diagnosed as ruptured infected pseudo aneurysm and urgent exploration was undertaken. Excision of common femoral artery was conducted by interpositioning of saphenous graft between external iliac and superficial femoral artery along with ligation of deep femoral artery drainage of abscess and debridment of necrotic tissue. The patient recovered with limb salvage except seroma on original site of vein graft.

---

Background & Objective: Ectopic pregnancy (EP) is the most common cause of maternal mortality in the first trimester. 10% of maternal death is due to EP and only one-third of women with previous ruptured ectopic pregnancy could have a normal delivery in future. Research about prevalence and risk factors of this kind of pregnancy, could help early diagnosis and treatment of EP and improve the prognosis of fertility rate in the future.

Methods: In this retrospective, descriptive and cross-sectional study, seventy-two patients with EP diagnosis admitted and treated in Yazd hospitals were studied. The data were collected using a questionnaire and hospital records. Sonography and laparoscopy confirmed the diagnosis. The data were analyzed by SPSS using Chi-Square test.

Results: 11176 pregnancies were recorded in Yazd between March 1999 and March 2000 and seventy-two of these pregnancies were ectopic. So prevalence of EC in yazd was found to be 0.5%. Most of the patients (58 cuses) were 20 to 39 years old. 52.8% of the patients had primipar. 25% had a history of one to three times abortion. From 43 patients who used contraceptive, 19 ones used OCP (oral contraceptive). 39 patients had a history of previous surgery, 7 patients had a history of EP and 25 patients had a history of treatment of infertility. The most common symptom of patients was abdominal pain. Only 4 out of 72 patients were treated with a medical method using methotraxe and the rest of them were operated. Three out of these four patients were finally obliged to undertake surgery.

Conclusion: The prevalence of EP was 0.5%, which is lower than the national scale. 

---

 

Background & Objectives:�Aortic coarctation occurs in 6 to 8% of patients with congenital heart disease. It is the fourth most prevalent heart disease which requires catheterization and surgical involvement in the early years of life. If surgical repair is not conducted on-time, it can lead to heart failure (HF) and death. That is why we decided to study this disease in shahid Madani hospital, Tabriz.

Methods:�53 patients with aortic coarctation who underwent surgery from early 1999 to late 2003 in Tabriz Shahid Madani Research and Health center were studied retrospectively. 

Results: 88% of the cases were diagnosed during routine examinations. The most frequent complaints of the patients were palpitation (45%) and exertional dyspnea (41%), and the most important signs were systolic ejection murmur in 96%, weakness of lower limbs pulses in 86% and hypertension in 45%. In ECG, 96% of the patients had LVH and in CXR, 45% had cardiomegaly. In angiography, 100% of the patients had apparent aortic coarctation, which in 14 this was associated with Patent Ductus Arteriosus (PDA) In other 15 cases, PDA was not reported in angiography but was discovered during operation. The most common surgeries were resection, end-to-end anastomosis (43%) and Dacron patch angioplasty (39%). In both methods the pressure graradient decreased to under 10 mmHg in the site of anastomosis and the late complications in the patch method was more than the other one.

Conclusion:�The diagnosis of this disease had been delayed in these patients because of imprecise examination of all four limbs' pulses at the first examination of the patients, the patients' own ignorance, misdiagnosis, mismanagement and symptomatic therapy. In spite of PDA and low blood pressure in coarc region, these patients did not have severe pulmonary hypertension. Resection and end-to-end anastomosis is associated with less common late complications and if conducted in early ages, it can lead to complete recovery.

---

  Background & Objective: Flatulence is one of the most common postoperative disorders, which leads to abdominal distension, respiratory disorders and the openning of sutures. Some of the drugs used to alleviate the abdominal flatulence are associated with complications and harmful effects, which gives us a hint to adopt herbal medicine. The present study investigates the effect of supermint on the flatulence intensity after cesarean section.

  Methods: This double-blinded clinical trial study was conducted on 107 women (47 cases as placebo group and 60 cases as drug group) who had cesarean section in shahid Mobini hospital, Sabzevar. After stopping the administration of IV fluid, the subjects in both groups received 40 drops of drug and placebo every 20 minutes for 3 days.

  Results: The intensity of flatulence in the first 20 minutes (p=0.042), in second 20 minutes (p=0.001), in the third 20 minutes (p<0.001) and 120 minutes after intervention (p<0.001) was lower in drug group compared to before intervention.

  Conclusion: Supermint is effective in reducing the postoperative flatulence in cesarean section and is recommended to be used in these cases.

---

Background & Objectives: Congenital cataract surgery is one of the complicated and difficult surgeries in ophthalmology. Its prevalance is one per 2000 live birth but it is one the main causes of blindness in children. This prevalence is even higher in underdeveloped countries (30 in 100000 cases). Lensectomy & vitrectomy by vitrectome device are the latest methods in this regard. The objective of this study was to evaluate the post-operative results of this method of surgery in patients operated because of congenital cataract.

  Methods: After the diagnosis of the congenital cataract and primary examinations, the patients, in necessary cases, were examined under anesthesia and if possible, in all patients retinoscopy was conducted and intraocular presure was measured. If the examination of the retin was possible, the red reflex was determined. Then the patients were garded to D( absence of cloudy lens), 1( the presence of opacity up to 1 mm), 2A (the area of apaque part less than nonopaque area), 2B (the area of opaque part more than nonopaque area) and 3 ( complete opaqcity of lens). All of the patients were evaluated in two groups: first, only congenital cataract second cataract due to trauma.

  Results: In the first group (with 24 patients and 33 eyes). 26 eyes (79%) had very good postoperative condition, 4 eyes (12%) had good condition and 3 eyes (9%) were nearly good. In the second group including 17 patients, 9 eyes (56%) were very good and 4 eyes (26%) good and 4 eyes (26%) moderate in terms of postoperative results, and none of them had poor results.

  Conclusion: Because of the good surgical results of lensectomy and vitrectomy in congenital cataract and rapid visual acuity they are still methods of choice in congenital cataract surgery.

---

Ulnar nerve involvement is the second most common local mononeuropathy. The ulnar nerve consists of motor and sensory fibers that arise in C₈-T₁ roots and extends to the lower trunk and medial cord of brachial plexus. Manifestations of this nerve involvement range from elbow pain and intermittent hand paresthesia to marked sensory loss, wasting and weakness  of hand muscles and a claw hand. Ulnar nerve lesion in the elbow region commonly follows surgery in which general anesthesia is used (particularly in patients with coronary artery bypass graft surgery). The patient presented in this article was a 56-year-old male who was involved in left ulnar nerve lesion after undergoing coronary artery bypass graft. In electrodiagnostic study we noticed diffused demyelination lesion of the ulnar nerve with dominancy in elbow region along with secondary axonal degeneration. Therefore, suitable positioning of elbow is recommended to avoid the  nervous complications of these operations.

---

 Background & Objectives: Hysterectomy is the most common surgery among nonpregnant women. A review of indications of hysterectomy can provide the specialists with new insights about these patients’ treatments. The aim of this study is to investigate the indications and methods of hysterectomy in patients referring to Alavi hospital.

 Methods: This cross-sectional study was done in Alavi hospital for two years (2002-2003). The data from 257 hysterectomized patients collected through interview and studying their records were entered into previously-designed questionnaires. The collected data were then analyzed using SPSS software.

 Results: The number of hysterectomies decreased 38.4% in 2003 compared to 2002. The mean age of patients was 45.8±8.09. The most common indication of hysterectomy was lyomyoma in 42.2% of cases. Abdominal hysterectomy and vaginal method were done in 93% and 7% of the cases respectively. In patients who were operated for pregnancy and delivery complications, the most common indication for hysterectomy was placenta increta (50%). The most common complication was hyperpyrexia (25.7%). The prevalence of complications of abdominal hysterectomy and vaginal method was 26.3% and 16.6% respectively.

 Conclusion: Lyomyoma is the most common indication of hysterectomy in patients referring to Alavi hospital. Besides, abdominal operation is the most prevalent method of hysterectomy in this hospital. Complications of vaginal method are less than those of abdominal method.

---

 Backgraund & Objectives: Asymptomatic urinary tract infection (AUTI) is common in childhood and will lead to renal scars. Since the prevalence of AUTI has not been studied in Ardabil, this study set out to determine the prevalence of AUTI among primary-school children of Ardabil.

 Methods: In this descriptive-analytical study, 470 cases were selected randomly from 40,000 primary school students. The data were collected with completing a questionnaire. The cases with symptomatic urinary infection and those with discontented parents were omitted. Midstream urine was collected and sent to laboratory for analysis and culture. Colony count ≥ 100,000 CFU / ml and higher was considered as UTI and the prevalence of this complication in the samples was studied.

 Results: Of 470 subjects, 16 ones were ruled out due to urinary symptoms or parents’ discontent, and the study continued with 454 students (238 girls and 216 boys). 19 students (4.2%) had positive culture (13 girls and 6 boys). Prevalence of AUTI was 5.5% in girls and 2.8% in boys. In this study only seven cases (36.8%) had pyuria ( WBC>5).

 Conclusion: The high prevalence of AUTI specially in girls is important. Regarding the known complications of AUTI, other researches seem to be necessary to determine the causes as well as ways to prevent and treat it.

---

  Background & Objectives: Respiatory Distress Synderome (RDS) is one of the major risks of elective cesarian section whose negative health and econemical outcomes are obvious. Maternal prophylactic injection of corticosteroid drugs can reduce RDS of neonate to some extent. On the other hand corticosteroid drugs have some side effects such as delay in the healing of the incision. This study considered the effect of betamethasone on surgical incision.

  Methods: This study was conducted on 60 primipara women divied into two equal groups that were candidate for elective cesarean. We injected betamethasone (IM) to trial group twice 48 hours poior to operation, (every 24 hours) and complication of surgical incision was clinically evaluated within 7 days after operation in both groups. The data were collected and analyzed by SPSS software chi-square and Fisher tests.

  Results: Most patients (60%) were 20-30 years old and the average age in both groups was 21. The relative frequency of patients with complication of surgical incision in trial group (betamethasone recipients) was 30% and in control group was 23.33% (the difference between them was not statistically significant). The most common complications were erythema and hyperemia. Other complications observed in 15% of the patients included serousal discharge, local warmness and enduration. Rgarding these complications also there wasn’t a statistically significant difference between two groups.

  Conclusion: Betamethasone does not increase early onest complications of surgical incision and we can safely use betamethasone prophylactically for fetal maturion in elective cesareans.

---

 Background & Objectives: Clinical findings show that stress can gradually affect the activity of various systems of the body such as immune system and impair them. Different variables potentiate and modify this effect. This research aimed at studying the relationship of personality traits (self-respect, tenacity, type A personality), stress, and stress coping skills with immune system status in nurses.

 Methods: In this descriptive-analytical study, 246 individuals were selected by simple random sampling method. At the first stage, the subjects on the job completed the questionnaires of self-respect, tenacity, type A personality, stress, and stress coping skills. At the second stage to determine the amount of antibodies, 2-cc blood of the subjects was assessed. The data were analyzed using correlational methods.

  Results: The findings indicated a significant, positive and meaningful relationship of immunoglobulin antibody with “self-respect”, and IgM antibody with “type A personality” in male nurses (p<0.05). But there was no significant relationship between the immune system variables and tenacity, stress, and stress coping skills. From among the predictive variables (self-respect, tenacity, type A personality, stress, and stress coping skills) only the stress variable had significant relationship with the criterion variable (IgA antibody)(p=0.05).

 Conclusion: Regarding the results it can be said that self-respect may adjust IgG variable in stress positions (especially in chronic stress). So in hard jobs such as nursing, psychological characteristics should be considered as an important job factor along with physical capabilities.

---

  Background & Objectives : Piracetam is a nootropic compound, which acts as a nervous system enhancer. Different processes are involved in memory formation and various parameters are able to disturb it. Due to increase of exposure possibility to electromagnetic fields in recent years and the effects of theses fields on memory consolidation, this investigation designed to clear the relation between these parameters and memory consolidation.

  Methods: In this research eleven groups of male wistar rats (ten rats in each group) with a mean weight of 275±25 gr aging 3-4 months were studied. To evaluate the effects of electromagnetic field, four groups of rats were exposed to 5mT/50HZ electromagnetic field for 1,4,6 and 8 hours respectively immediately after training. In other six groups 250mg/kg or 500 mg/kg piracetam were administered orally one hour before training. They were also exposed to electromagnetic field for 4,6,8 hours respectively immediately after training,. Retrieval test was performed 24 hours later in all groups.

  Results: 1 hour exposure on EMF had no meaningful effect on memory consolidation, however, in other three groups the electromagnetic fields impaired memory consolidation significantly compared to the control group (p<0.05). Piracetam administration with two mentioned doses significantly improved memory consolidation (p<0.05).

  Conclusions: Acute exposure to low intensity magnetic field can disturb memory consolidation and piracetam administration can prevent it.

---

 Background & Objectives: Otosclerosis is one of the causes of conductive hearing loss in different ages, the diagnosis of which sometimes becomes difficult using clinical and audiological symptoms. The early diagnosis and surgical treatment of this disorder will give a normal hearing to the patient. The goal of this study was to determine the role of exploratory tympanotomy in revealing the patients with hearing loss as a result of otosclerosis which is impossible to be diagnosed based on clinical and audiological, symptoms.

 Methods: This prospective study was conducted on 33 patients (18 females and 15 males) with conductive hearing loss suspected to otosclerosis, who were admitted to oto-rhino-laryngology department of Imam Khomeini hospital from 1999 to 2003 and underwent exploratory tympanomy. In 30 patients (16 females) otosclerosis was revealed during operation all of these patients underwent stapedectomy. During three weeks after surgery, the patients were examined in terms of facial paralysis, non-response to treatment, deterioration of hearing ability, dizziness, the probability of tympanic perforation and other complications. Audiological tests were also studied. The obtained data were recorded and compared with findings of other researches.

 Results:�The prevalence of the disease in women was more than men, and the majority of the patients had referred to be treated in the third and fourth decade of their life, while they had a history of hearing loss from the second or third decade of their life. The positive family history was below compared to other studies, but conductive hearing loss was more prevalent. This treatment led to hearing improvement in majority of the patients.

 Conclusions: Considering the proper time for stapedectomy is very important since better results can be abtained if the patients are operated with lower degrees of hearing loss. Thus, exploratory tympanotomy leads to early diagnosis and treatment in patients with conductive hearing loss suspected to otosclerosis.

---

 Background & Objectives: Ceasarean section (CS) has increased in rate during the past years. Due to postoperative complications, long recovery time and high costs of surgery, normal delivery is recommended as a routine method. Regarding the increase in the number of CS and its acceptability on the part of the public, it seems that women’s as well as health personnels' attitudes play an effective role in selecting the termination method. The aim of this study was to evaluate and compare pregnant women’s and health personnels' attitude toward termination procedures.

 Methods: This was a descriptive and comparative study. 84 health personnels and 300 pregnant women who referred to Ardabil health centers in 2002 were selected. These subjects' attitudes were collected through Likert questionnaire and the collected data were analyzed by SPSS, using t-test.

 Results: The findings showed that 30.1% of women and 50% of health personnels had positive attitudes towards normal delivery. The findings also indicated that there was a significant difference between pregnant women and health personnels in their attitudes toward normal delivery and cesarean (p=0.001).

 Conclusions: Since health personnels had a more positive attitude towards normal delivery than pregnant women did, it seems that the young as well as the pregnant individuals in society need more education and awareness to be able to change their attitudes towards delivery methods. Health personnel, due to their high positive attitude towards normal delivery, can play a more beneficial role in this regard.