Tehran University Medical Journal

---

Background: The purpose of our study was to assess the potential of color Doppler (CD) and Power Doppler Imaging (PDI) to differentiate benign from malignant solid breast masses.

Materials and Methods: Seventy-one biopsy proven solid breast masses were evaluated with CD and PDI using 7.5 MHZ Transducer. Vascularity, Resistive Index (RI) and patterns of vascular distribution of masses were assigned before biopsy.

Results: There were 22 cancers and 49 benign lesions. All malignant masses had vascularity in some degrees, except 3 cancers which were less than 10 mm in diameter. Most of cancers were hypervascular (15 cancers) and had penetrating or diffuse vessels (14 cancers). Most of benign lesions and fibro adenomas were avascular (35 masses). 12 cancers, 2 fibro adenomas and all vascular benign lesions had RI>0.6. 7 cancers and 6 fibro adenomas had RI<0.6. By using hypervascularity to indicate malignancy sensitivity for CD and PDI was 68 percent and specificity was 90 percent and by using penetrating and diffuse vessels sensitivity was 64 percent and specificity was 82 percent. By using RI<0.6 sensitivity was 32 percent and specificity was 88 percent and by using these three criteria together sensitivity was 73 percent and specificity was 82 percent (P<0.00001).

Conclusion: The vascularity and pattern of distribution and morphology of blood vessels in solid breast masses seen at PDI and CD is a potentially important feature to predict the likelihood of malignancy. But RI appears to be of limited value.

---

Ilio-sacral screw is a technique for posterior pelvic fixation. In spite of its benefits, it had not performed commonly in Iran because of its difficulties. We changed this technique to insert the screw under CT-Scan guide with lical anesthesia to increase image quality and decrease neurological complications and performed it in two patients. In both cases the screws were inserted in correct position without any complication.

 

---

Background: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO) synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO) can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need.

Methods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated.

Results: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need.

Conclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Kienbock disease is characterized by avascular necrosis of the lunate bone. Without treatment, it is usually progressive. While many factors may predispose to Kienbock's disease, it is likely caused by a combination of repetitive loading, vascular risk and mechanical predisposition. Treatments therefore have been designed to decrease compressive loading of the lunate, to prevent lunate collapse, and to allow lunate revascularization. There has been suggested different treatments, no treatment has ever been proved successful and the rate of surgical complication is relatively high. In this study we performed a new surgical method in the treatment of Kienbock disease. In this method we performed lunate decompression which is a very simple procedure and has no potential complication.
Methods: in this study, 11 patients with Kienbock disease in the stage of I to IIIb were surgically treated by a new method of lunate core decompression. The pain, range of motion, functional disability and radiographic indices of the patients were evaluated after two years.
Results: the average age of patients were 29 years, 8(72%) were men. The mean pre-operative pain score (VAS) diminished from 87.5 to 13.5 postoperatively (p<0.001) and DASH score from 84 to 14 (p<0.001) and range of motion was also significantly improved. 7(63%) persons were very satisfied, 2(18%) were satisfied and 2(18%) were not much changed.
Conclusions: Our findings suggest that the new surgical treatment of lunate core decompression could probably be a simple and effective treatment of Kienbock disease without any potential complication.

---

Background: Cough is one of the most common symptoms for which outpatient care is sought. Since, a few research evaluated efficacy and therapeutic effect of baclofen in remedy of cough (especially chronic cough), In this study we compared the efficacy of oral Baclofen 20 mg with Dextromethorphan to improvement of cough in two groups.
Methods: In this double blind randomized clinical trial, 120 patients with chronic cough (up to three weeks) that were referred to respiratory diseases clinic of Ali Ebn-e Abitaleb (AS) hospital in Zahedan, Iran at 2007 were randomly devided to two groups. 60 peoples in each, (baclofen recipient group with mean age 32.32±6.51 and dextromethorphan recipient group with mean age 31.54±5.06 year) were evaluated for qualitative decline of severity, period and duration of cough for 14 days.
Results: In baclofen recipient group 73.3% and in dextromethorphan recipient group 65% all patients had decline of severity, period and duration of the cough. Statistically, there were no significant differences between two groups in regard to qualitative decline of severity, period and duration of cough (p>0.05). Also, there were no drug related side effects in the patients.
Conclusions: Baclofen decreased severity, period and duration of cough more than dextromethorphan. Because there were no significant differences between two groups, we needed to do more quantitative researches to compare them.

---

Background: Scaphoid non::::union:::: remains a challenging problem for hand surgeons. In this study, we assessed the functional outcome of scaphoid non::::union:::: treatment and the influence of a number of variables on it.
Methods: In this study we recruited 24 patients with scaphiod non::::union:::: by consecutive sampling at Dr. Ali Shariati Teaching Hospital, in Tehran, Iran in 2008-2011. We examined the patients by antero-posterior (AP) and lateral view radiographies and wrist MRIs. Functional outcome of surgery was scaled according to Mayo wrist and Quick DASH scoring systems.
Results: Among 10 cases with osteonecrosis, there were 7 (70%) cases of radiological ::::union::::. In 13 (92%) out of 14 cases who had no signs of osteonecrosis, we radiologically confirmed scaphoid ::::union:::: after the treatment. The total ::::union:::: rate was estimated to be 83% at the end of 24 months follow up (P<0.05).
Conclusion: The results showed that patients with scaphoid non::::union:::: have improved function after surgical treatment.

---

Background: Education is the main mission of teaching hospitals, but the residents’ learning in acquiring new techniques does interfere in the overall treatment process of patients. Studies pertaining to the effect of anesthesia residents’ training in operating room on treatment procedures have reported conflicting results. Therefore, this study was performed to investigate the effects of anesthesia residents’ training on start time operative delays. Methods: This cohort study was done in neurosurgical operating room, Imam Khomei-ni Hospital, Tehran, Iran during 2010-2013 on a population study comprising of sec-ond year anesthesia residents. Patients were classified into three groups with 30 cases in each one according to the anesthetic team. Group I: one anesthesiologist in charge of two operating rooms and two anesthesia assistants Group II: one anesthesiologist in charge of one operating room and one assistant Group III: one anesthesiologist with-out an assistant. Patients in these groups were compared in terms of American society of anaesthesiologists (ASA) class, induction difficulties and type of surgery. Studied variables included :1) Interval between the patient lying on the bed to till anesthesia, 2) the time devoted to teaching residents, 3) time from the start of anesthesia until the start of surgery. An observer that was blinded to the type of intervention and the study design, recorded the times. Results: ASA class (P= 0.94), induction difficulties (P= 0.66) and type of surgery (spinal cord or brain operation) (P= 0.41) were not statistically different between patients in groups. Preoperative preparation time for the first group (23.5±8.1 min) was longer than the other two groups (21.5±6.2 min and 15.8±9.1 min), respectively (P= 0.001). Differences between the times from start of anesthesia to surgeries in three groups, based on ASA class and type of surgery were not significant (P> 0.05). There was no re-lationship between the times devoted to teaching residents in the first and second groups (P> 0.05). Conclusion: Anesthesia residents’ training in neurosurgery operating room may in-crease the time required for preparing for surgery, but this time expended is hardly of any significance.

---

Background: Spinal Muscular Atrophy (SMA) is a neurodegenerative disorder caused by a mutation in the survival motor neuron 1 (SMN1) gene. It is classified into five types (from type 0 to 4) based on the age of onset of symptoms and maximum motor function. This autosomal recessive mutation results in progressive weakness and atrophy of the proximal muscles. Due to the high cost of treatment, the critical timing of intervention, and the varied responses of patients, many individuals do not sufficiently benefit from current therapeutic methods. This study evaluates the impact of resistance training on the quality of life and fatigue in patients with SMA type III, considering the potential benefits of such training.
Methods: The present study was developmental and semi-experimental. Fourteen ambulatory patients with SMA type III were randomly assigned to exercise and control groups. The exercise group engaged in lower limb resistance training at an intensity of 6 to 8 on an adult resistance exercise scale for 10 weeks (25 sessions). During this period, the control group maintained their usual daily activities. Patients in the exercise group did not engage in any exercise activity other than the protocol of the present study. Patients' quality of life was measured with the Short Form 36 (SF-36) questionnaire, and fatigue severity was measured with the Fatigue Severity Scale (FSS), both evaluated pre- and post-intervention. The assessments and exercises were conducted in the occupational therapy department of Shariati Hospital, Tehran, from July 2023 to September 2023.