Iranian Red Crescent Medical Journal Iranian Red Crescent Medical Journal http://www.irmj.ir 48 journal48 en jalali 1386 4 1 gregorian 2007 7 1 9 3 online 1 fulltext

en General Medicine General Medicine Original Article Original Article      Background: The assessment of family coping patterns and resources will provide a further basis<br />for helping family's adaptation. This study was undertaken to assess the coping strategies used by<br />parents of children with cancer in Aliasghar Cancer Hospital affiliated to Shiraz University of Medical<br />Sciences.<br />Methods: Data collection was conducted based upon Family Crisis Oriented Personal Evaluation<br />Scale (F-COPES) including social and spiritual support, reframing, seeking help and passive appraisal.<br />A total of 72 parents including 28 couples, 8 single mothers and 8 single fathers participated<br />in this study.<br />Results: The spiritual support ranked the highest and the social help, the lowest strategies used<br />by the parents. Seeking help, reframing and passive appraisal were the remaining strategies.<br />Statistically significant differences were found between the age of participants and reframing and<br />seeking help strategies. A significant difference was also observed between the level of parent’s<br />education and reframing strategy but not between gender and coping strategies.<br />Conclusion: Familiarity with coping strategies and the method to use them could balance the<br />emotional, psychological and social consequences of parents who have a child with cancer. Coping strategies; Parents; Children; Cancer; Iran 124 128 http://www.irmj.ir/browse.php?a_code=A-10-1-14&amp;slc_lang=en&amp;sid=en F. Hashemi hashemifa@hotmail.com 4800319475328460061 Yes

en General Medicine General Medicine Original Article Original Article Background: Metronidazole has been reported to reduce postoperative anaerobic infections<br />following surgical procedures. Because of high cost and poor availability of intravenous metronidazole<br />compared with that of oral preparation, we decided to measure the serum level of metronidazole<br />after oral administration in patients during postoperative ileus, and to evaluate the<br />substitution of intravenous metronidazole for the oral product.<br />Methods: The present study comprised 45 adult patients undergoing major abdominal surgery<br />via long laparatomy incision from Aug to Nov 2003.<br />(500 mg of Metronidazole was administered as a single dose orally to each patient twice, one in<br />ileus condition and the other in nonileus condition. Blood sampling was done 1 hour after each<br />episode of the drug administration).<br />Results: A significant reduction (P&lt;0.001) was found between the mean serum metronidazole<br />concentration (2.90 ± 2.29 SD g/ml) during postoperative ileus, and that of controls<br />(11.07±6.72 SD g/ml). In majority of patients (62.5%), the serum level of metronidazole in ileus<br />did not reach its minimum inhibitory concentration (3 µg/ml) for the most clinically important<br />anaerobic bacteria.<br />Conclusions: Postoperative ileus significantly affected the oral absorption of metronidazole. As a<br />result, if we want to control an active anaerobic infection with a prompt antibiotic therapy, it seems<br />that initiating of the therapeutic regimen with oral Metronidazole postoperatively is not justified Metronidazole; Ileus; Oral 129 132 http://www.irmj.ir/browse.php?a_code=A-10-1-15&amp;slc_lang=en&amp;sid=en A. Manafi dramanafi@yahoo.com 4800319475328460062 Yes

en General Medicine General Medicine Original Article Original Article Background: Traditionally, pain has been thought to be an unfortunate but inevitable part of<br />disease and its treatment. Pain associated with medical procedures was ignored because it was<br />thought to be unavoidable. The question of why physicians should treat pain is as important as<br />the knowledge of preventing it, since it is a right measure to take.<br />Objective: This study was conducted to compare the effectiveness of lidocaine iontophoresis<br />with that of local infiltration of lidocaine for the prevention and reduction of pain during radial<br />artery cannulation, in patients undergoing open heart surgery.<br />Methods: The present study comprised 60 adult patients, 36 males and 24 females, aged from<br />29 to 84 years with a median age of 63.8 (±10.35 SD) and 65.4 (10.48±SD) for groups 1 and 2,<br />respectively. The patients underwent elective open-heart surgery in Nemazee Hospital affiliated<br />to Shiraz University of Medical Sciences. Prior to induction of general anesthesia, patients were<br />randomly allocated to one of two groups for analgesia prior to radial artery cannulation on an<br />alternate week basis. Group 1 (n=30) patients received one-week analgesia using lidocaine iontophoresis,<br />and analgesia in Group 2 (n=30) was performed using lidocaine infiltration the following<br />week. Both groups were similar in terms of gender distribution.<br />Results: The VAS scores in group 1 were significantly lower than group 2 with no significant<br />difference in the difficulty of cannulations between the two groups. There was no complaint of<br />pain from patients during iontophoresis, and no report of any significant side effects. Slight skin<br />erythma was noted after removal of the iontophoretic anode patch in 4 patients, which lasted for<br />about 0.5-4 hours.<br />Conclusion: This study has demonstrated that lidocaine iontophoresis is a useful, non-invasive,<br />rapid, painless alternative to lidocaine infiltration for dermal analgesia for radial ar Lidocaine; Lidocaine Iontophoresis; Pain relief; Radial artery cannulation; Open heart surgery 133 138 http://www.irmj.ir/browse.php?a_code=A-10-1-16&amp;slc_lang=en&amp;sid=en H. Kamalipour kamalih@sums.ac.ir 4800319475328460063 Yes

en General Medicine General Medicine Original Article Original Article Background: The thoracic sympathectomy is traditionally performed through open surgical thoracotomy.<br />It is an extensive procedure associated with an unacceptable inconvenience. The present<br />study describes a less morbid and minimally invasive thoracoscopy as the procedure of<br />choice for thoracic sympathectomy.<br />Methods: The present study, carried out during 2001 to 2005, was performed on 33 patients<br />aged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females. They<br />suffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitable<br />for revascularization. Of 33 patients, 15 had Buerger’s disease, 3 emboli, 5 essential hyperhidrosis,<br />3 Raynaud’s syndrome, 3 intra-arterial injections, 2 advanced arthrosclerosis, 1 acute<br />thrombosis, and 1 patient post-traumatic ischemia. The patients were indicated to undergo a<br />probable emergency thoracotomy. They were anaesthetized using one lung endobronchial intubations<br />and underwent a two-port videothoracoscopy. Sympathetic chain resection was limited to<br />T2–T3 and lower third of the stellate ganglion. The patients were kept under careful observation<br />and comparisons were made between their preoperative and postoperative symptoms. Moreover,<br />the early and late complications were carefully documented and analyzed.<br />Results: The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, rest<br />pain, cyanosis and cold extremities, as well as excessive hand sweat respectively. The foregoing<br />thoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients.<br />Conclusion: Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapy<br />with surprisingly good results and low complications in patients with primary hyperhidrosis as<br />well as limb threatening upper extremity ischemia, an entity unsuitable for revascularization.<br />Additionally, the results of sympathectomy Sympathectomy; Thoracoscopy; Ischemia; Hyperhidrosis 139 142 http://www.irmj.ir/browse.php?a_code=A-10-1-17&amp;slc_lang=en&amp;sid=en H. Modaghegh modaghegh@lycos.com 4800319475328460064 Yes

en General Medicine General Medicine Original Article Original Article Background: Controversy still exists about the best surgical method for the treatment of<br />pilonidal sinus. The aim of this study was to compare two methods of excision and primary<br />closure.<br />Methods: One hundred and seventy-three patients with pilonidal sinus, 119 (69%) men and 54<br />(31%) women, and a mean age of 23.3±7.5 yrs and divided into two Groups of A (electrocautery)<br />and B (excision) for the removal of pilonidal sinus. Wound complications, hospital stay,<br />times to heal, return to work, patient’s comfort and recurrence rate were recorded for the two<br />groups. The postoperative follow-up was 6 months.<br />Results: All patients were able to resume their normal lives and activities 7-9 days after the<br />operation. Wound infection and recurrence rate were significantly (P&lt;0.05) less prevalent in<br />Group A (5% and 3.8%) than in Group B (1% and 0%). There was no significant difference<br />between two groups in regard to hospital stay, time to heal, time to return to work and patients’<br />comfort after 6 months of follow-up.<br />Conclusions: The use of electrocautery at the base of the wound is not recommended because it<br />may obscure the exact extent of the pilonidal sinus and increase the rate of recurrences. Primary excision; Pilonidal sinus; Recurrence; Wound infection; Electrocautery 143 146 http://www.irmj.ir/browse.php?a_code=A-10-1-18&amp;slc_lang=en&amp;sid=en H. Abbasi abbasih@sums.ac.ir 4800319475328460065 Yes

en General Medicine General Medicine Original Article Original Article Background: Open lung biopsy may be required in the patients with parenchymal lung disease<br />who do not have a clearly defined diagnosis. There is no doubt thoracotomy with general anesthesia<br />is preferable to local anesthesia; but it is associated with high risks in the severally ill patients.<br />The aim of this study is to review our experience and compare the efficacy and complications of<br />using local anesthesia versus general anesthesia for open lung biopsies in high risk patients.<br />Methods: From January 2002 to September 2004, Twenty five patients (18 males, 7 females)<br />underwent open lung biopsy using minithoracotomy in the Baqiyatallah hospital in Tehran. 14<br />(56%) of them had open lung biopsy using general anesthesia (GA) and 11 (44%) selected for<br />this procedure with local anesthesia (LA), all of LA group were excluded from GA because of their<br />poor condition. we reviewed effectiveness of LA for minithoracotomy and also compared the safety,<br />accuracy and various complications of this procedure between the two methods of anesthesia.<br />Results: The mean age in the first (GA) group was 42.5 (±14.7) years and in the second (LA)<br />group was 49.6 (±12.2) years (NS). The average length of hospital stay, postoperative air leak,<br />and the diagnostic accuracy was not significantly different between the two groups. There was<br />one operative-related mortality in the second group (NS).<br />Conclusion: In selected patients with diffuse lung disease or peripheral lesions Local anesthesia<br />is an acceptable substitute to general anesthesia for minithoracotomy to obtain adequate lung<br />tissue for accurate diagnosis. Lung disease; Open lung biopsy; Video-assisted thoracic surgery; Local anesthesia 147 149 http://www.irmj.ir/browse.php?a_code=A-10-1-19&amp;slc_lang=en&amp;sid=en S. Mehrvarz mehrvarz@bmsu.ac.ir 4800319475328460066 Yes

en General Medicine General Medicine Original Article Original Article Background: Asthma is a life threatening disease which may lead to the death of patient by<br />causing spasm and airway obstruction. Stress is reported to spark off the disease and anxiety is<br />an accelerating factor. This study was performed to evaluate two training methods in reduction of<br />anxiety and improving the quality of life in patients suffering from asthma.<br />Methods: The present study comprised 84 patients with asthma referred to Shiraz University of<br />Medical Sciences Clinic. They were divided into two groups of 29 subjects for face-to-face and 26<br />for pamphlete training methods, with 29 individuals considered as controls. In addition to two<br />questionnaires relating to demographic information and quality of life,the present study included<br />Krunbach Alpha, Hamilton anxiety tests and Lickhert classification. The total numbers varied from<br />zero to 56 and scores of more than 14 indicated anxiety.<br />Results: The mean age of cases and controls were 43 and 52 years respectively. Among the participants,<br />41.8% were males of which 61% held a high school degree or higher with a monthly<br />income of more than 110 $. Of these, 34.6% had a disease duration of more than 10 years.<br />Conclusion: Both training methods had significant impact on reducing patient’ anxiety and improving<br />their quality of life. However, no relationship was observed between gender, age, education<br />and income levels. Education; Anxiety; Quality of life; Asthma; southern Iran 150 153 http://www.irmj.ir/browse.php?a_code=A-10-1-20&amp;slc_lang=en&amp;sid=en F. Naeemi hosseini fakhrozaman_naeemi@yahoo.com 4800319475328460067 Yes

en General Medicine General Medicine Letter to Editor Letter to Editor Background: Lifetime treatment of persons with hemophilia entails a heavy financial burden. The<br />main goal of this study was to determine the factors influencing care cost of hemophilia A in<br />southern Iran.<br />Methods: The present study comprised 88 of 170 hemophilia A patients who had been registered<br />and virtually treated in Fars Hemophilia Treatment Center in southern Iran. The data concerning<br />patients’ characteristics and medication schedules were collected from their past medical records<br />and staff interviews. The scale utilized by the Hemophilia Utilization Group Study (HUGS) was used<br />to assess the status of patients’ functional health.<br />Results: The severe, moderate and mild deficiencies of factor VIII were found in 43.2%, 21.6%<br />and 35.2% of 88 patients respectively. The mean age in the study group was 21.8 years (±12.2)<br />and 58 (65.9%) enjoyed high health status. In regard to laboratory records, 25 (28.4%) patients<br />were HCV-positive, 2 (2.3%) HBS-positive and all were HIV negative. The average cost of care for<br />a patient with Hemophilia A was $8,510 (±8,066) and the total annual costs were significantly (p<<br />0.05) associated with: severity of arthropathy, presence of factor VIII inhibitor and its titer, severity<br />of factor VIII deficiency, positive HCV infection and functional health status. Costs unrelated to<br />foregoing factors included only 1% of the total.<br />Conclusion: The total cost of patient care was correlated with severity of factor deficiency, arthropathy,<br />positive HCV infection and functional health status. Financial resources to meet factorunrelated<br />costs should increase, in order to provide patients with improved quality of medical care. Cost of care; Hemophilia A; Iran 154 157 http://www.irmj.ir/browse.php?a_code=A-10-1-21&amp;slc_lang=en&amp;sid=en M. Karimi karimim@sums.ac.ir 4800319475328460070 Yes

en General Medicine General Medicine Case Report Case Report Extraadrenal paraganglioma makes up a dispersed neuroendocrine system which extends from<br />the base of the skull down to the pelvic floor. Paraganglioma have been found in particularly<br />every site in which normal paraganglia are known to occur. Herein, we present a typical case<br />of carotid body paraganglioma according to both histological and immunohistochemical findings.<br />The presence of a large ribbon-like amphophilic to basophilic amorphous material which,<br />according to the history of angiography, must result from the precipitation of angiographic dye<br />makes this entity unique and the first to be reported. Paraganglioma; Radiographic dye 158 160 http://www.irmj.ir/browse.php?a_code=A-10-1-22&amp;slc_lang=en&amp;sid=en N. Azarpira negarazarpira@yahoo.com 4800319475328460069 Yes

en General Medicine General Medicine Letter to Editor Letter to Editor The incidence of tuberculosis is high and extrapulmonary tuberculosis is seen more frequently, the<br />thyroid tuberculosis is rare. Thyroid tuberculosis is presented as thyroid nodule, thyroiditis or abscess<br />formation. This condition should therefore be recognized whenever goiter is being treated,<br />because it has an entirely different treatment. The aim of this report is to present thyroid tuberculosis<br />in order to gain a better understanding of its clinical characteristic, diagnosis and treatment<br />we present 9 cases of thyroid tuberculosis since 1995-2006 from north of Iran. They comprised 5<br />patients with thyroiditis, 2 cases with abscess formation and 2 with thyroid nodules. All patients<br />were diagnosed using Fine Needle Aspiration (FNA) and treated by repeated surgery and antituberculosis<br />drugs. It is concluded that tuberculosis of thyroid should be kept in mind while treating<br />diseases of the thyroid such as thyroid nodule, thyroiditis, thyrotoxicosis especially in communities<br />with high prevalence of tuberculosis. The diagnosis of thyroid tuberculosis is facilitated by<br />FNA and its treatment is achieved by simple surgery as well as anti-tuberculosis therapy. Thyroid; Tuberculosis; Southern Iran 161 163 http://www.irmj.ir/browse.php?a_code=A-10-1-23&amp;slc_lang=en&amp;sid=en F. Safarpor safarpor@yahoo.com 4800319475328460071 Yes