39 2228-7043 Iran University of Medical Sciences 191 Pharmacology EVALUATION OF DRUG INTERACTIONS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDs) IN SARI INSURED PRESCRIPTIONS DURING 1999-2001 Ebrahim Zadeh M.A Gholami KH Gharanjik U Javadian, Pharm S.M 1 12 2003 10 36 489 495 17 07 2005 Due to humid climate of the North, inflammatory problems are very common in this area. Since non-steroidal anti-inflammatory drugs(NSAIDs) are the most widely used therapeutic agents, it seemed necessary to do an investigation on drug interaction and polypharmacy of these drugs. This descriptive study was carried out on 7327 insured prescriptions collected from 11 pharmacies in Sari during 1999-2001. Drug interactions were analyzed according to their clinical importance. Based on Hansten’s drug interaction, there were 1927 prescriptions that contained at least one NSAID(26.3%). 564 cases(46%) of drug interaction were seen in general practitioners’ prescriptions and 359 ones(50.9%) in specialists’. It was also found out that the most prescribed NSAIDs was Diclofenac, 45.52% in general practitioners’ and 34.22% in specialsts’ prescriptions. In spite of different dosage forms such as suppository, injection was preferred. Therefore, it can be concluded that concurrent use of NSAIDs with aminoglycosides, diuretics and prednisolone should be avoided or a suitable NSAID has to be selected. Furthermore, high prevalence of NSAIDs interactions in prescriptions emphasizes that a proper attention should be paid to practical pharmacology by general practitioners and specialists.
192 Pediatric Cardiology ASSESSMENT OF CARDIAC COMPLICATIONS AND MORTALITY RATE OF BETA THALASSEMIA MAJOR IN HAZRAT ALI ASGHAR CHILDREN HOSPITAL IN THE PAST TEN YEARS Ansari SH Vosough P Razavi M.R Nojoomi M 1 12 2003 10 36 497 502 18 07 2005 Cardiac symptoms and premature death from cardiac causes are still major problem with beta thalassemia despite chelation therapy. Heart complications are the leading causes of mortality in the absence of effective iron chelation therapy. Many patients develop evidence of iron-induced myocardial damage with cardiac failure, cardiac arrhythmia, sudden death or death from progressive congestive failure. The characteristic lesion in the heart is caused by iron deposition in the myofibrils with myofibrillar fragmentation and diminished mitochondrial volume in myocyte. The basic cardiological assessment including 12-lead electrocardiogram, chest X-ray and echocardiogram is done from 7 years of age annually or more if it is needed. This study was undertaken on beta thalassemia patients who were under treatment in Hazrat Ali Asghar Children Hospital in the past ten years. In total of 1069 cases, 16 patients(1.5%) died from severe cardiac impairment(CHF) and 19 patients with severe cardiac problems, who were treated with monitoring cardiac function and intensive chelation therapy, are alive and relatively well. 106(9.9%) cases are asyptomatic with moderate cardiac impairment and 985(92.1%) cases of thalassemia are asymptomatic patients with normal heart condition. 193 Gynecology A CASE REPORT OF TWO CONJOINED (DICEPHALUS AND OMPHALOPAGUS) TWINS WITH MULTIPLE ANOMALIES Amini A Badakhsh M.H 1 12 2003 10 36 503 508 18 07 2005 Conjoined twins are one of the anomalies accompanying monozygotic monoamniotic pregnancies with a prevalence of 1 in about 100000 pregnancies and 1 in about 1500 twin pregnancies (1 in about 200 monozygotic twin pregnancies). The most common type is thoracopagus. Prenatal diagnosis is based on sonography and, more accurately, on magnetic resonance imaging. In this paper, two cases of conjoined pregnancy are reported. The first case had two heads: one of them anencephalus with cleft lip and cleft palate and the other with bilateral cleft lip and cleft palate in addition to spina bifida. They were delivered in 1988 vaginally and both were stillborn. In the second case the twins were fused in abdominal region and were delivered by cesarean in 2002. 194 THE EFFECT OF SALBUTAMOL SPRAY ON BRONCHOSPASM AND HYPOXIA DURING GENERAL ANESTHESIA IN HEAVY SMOKERS Etemadi H Sotoodeh Khesal S 1 12 2003 10 36 509 515 18 07 2005 Heavy smoker patients who are candidates for general anesthesia with tracheal intubation have hyperactive airways and are in risk of bronchospasm hypoxia after intubation and during operation. They also have repetitive coughs after extubation and recovery. The purpose of this study was to investigate the effects of inhaled Albuterol before induction of anesthesia on preventing bronchospasm, hypoxia and repetitive coughs in heavy smokers. In this study 60 heavy smoker patients, who didnot have infection, cough & productive sputum, dyspnea on daily activities and wheezing on physical exam, were randomly divided into two groups: study and control group. All of the patients were intubated after induction of GA with similar drugs. Patients in the study group received 2 puffs of salbutamol 20 minutes before induction of GA and before extubation. Bronchospasm during GA with the signs of hardening of the anesthesia bag, wheezing in hearing the chest, reduction of O2 saturation during and after the operation and the rate of coughing in recovery were also studied. In the control group 17 out of 30 patients and in the study group 9 out of 30 patients had one of those complications. Thus, it seems prophylactic salbutamol spray, which is a local B2 Agonist, reduces the incidence of bronchospasm and coughing in heavy smokers. 195 Physiotherapy COMPARISON OF THE EFFECTS OF TWO PHYSIOTHERAPY METHODS FOR GRADES I&II TRAUMATIC UNILATERAL LATERAL ANKLE SPRAINS Akbari M Karimi H Farahini H Faghihzadeh S 1 12 2003 10 36 517 524 18 07 2005 Ankle sprains are among the most common athletic injuries. Even when treated, two third of the subjects experience it again. Physiotherapy is the chosen treatment for grade I & II ankle ligament sprains. Rehabilitation of such cases costs about two billion dollars a year in the USA. Inadequacy of the treatments and improper treatment protocols seem to be the main cause of recurrence. The present study was designed to compare the effects of conventional physiotherapy program with a new protocol concentrating on proprioceptive and balance training program. For this purpose 30 male subjects suffering from unilateral lateral ankle sprain, selected by convenience sampling, were recruited in the study and randomly allocated to 2 groups of 15. The first group received 10 sessions of conventional physiotherapy as suggested in the literature. The second group received 10 sessions of special proprioceptive and balance training protocol. Each group was tested before and after treatment. Both clinical and instrumented balance tests were performed in both groups to assess the dynamic and static aspects of their balance. Based on the obtained results, both groups were significantly better on all test items after treatment compared to before treatment. Subjects in the second group performed better in Limits of Stability test while standing on both legs as well as on the involved leg. The results also indicated that although both methods were effective in treating the patients, the protocol focusing on proprioceptive and balance training can be more successful in rehabilitation and faster return to the field of the injured athletes. 196 Biophysics DOSE VERIFICATION OF BREAST CANCER IN RADIOTHERAPY BY TLD Allah Verdi M Esfahani M Samiee F Ghera’ati H Sharafi A.A 1 12 2003 10 36 527 533 18 07 2005 In vivo dosimetry seems an appropriate method for quality assurance in radiotherapy with CO-60, which can be considered as a routine program in radiotherapy centers. In this study, entrance and exit dose in tangential fields were measured in phantom for 30 breast cancer patients by using TLD in radiotherapy section of Imam Khomeini Hospital. TLD crystals were calibrated against SSDL (Secondary Standard Dosimetry Laboratory) Farmer chamber of Iran Institute of Atomic Energy. An overall check of basic dosimetry, treatment unit parameter, planning and calculation methods and daily set up of the patients can be determined by combination of entrance and exit dose. Correction factors such as field size, SSD, thickness, angle of incidence and back scattered rays were obtained for difference between reference conditions and clinical situations. Measured dose by in vivo dosimetry was compared with the expected values for entrance, exit and midline points. The obtained mean values for these points were 1.95%, 4.3% and 6.87% with standard deviations of 5%, 11% and 6.5% respectively which showed no significant difference between these points except for entrance and midline points. The more spread of errors in exit point than in entrance point is due to more sources of errors in this point. Analysis of the results, field by field, (medial and lateral tangential fields) showed that this deviation was significant for exit point (P-value=0.01). This is due to calculation algorithms and set up uncertainties. Based on the results of in vivo dosimetry in this work, the sources of uncertainties were due to calculation algorithms, in particularly, around inhomogeneities and patient curvature, set up, mobilization, output and data transfer. The aim of this work was to quantify and determine the uncertainties at the end of treatment stage it is therefore concluded that in vivo dosimetry can be used as a valid tool for quality assurance in radiotherapy centres in order to improve the quality of treatment. Key Words: 1) Radiotherapy 2) Quality Control 3) TLD 4) Breast Tissue 197 Pediatric Disease DETERMINATION OF THE MAIN EPIDEMIOLOGICAL FACTORS IN CHILDREN WITH BRAIN TUMOR ADMITTED TO HAZRAT ALI ASGHAR CHILDREN HOSPITAL Ansari SH Vosough P Mo’udi S 1 12 2003 10 36 535 539 18 07 2005 Brain tumors are the second common malignancy after leukemia in patients who are under 15 years and their metastatic form is rare in children. This study was undertaken on 100 patients with brain tumor who were admitted to Hazrat Ali Asghar Children Hospital during 1990 to 2000. Through this study, information about type of pathology, treatment and patients’ five-year survival was gathered in order to have better treatment and follow-up. This study was carried out as a cross-sectional survey and the obtained data was analysed via SPSS software. In this survey a questionnaire containing information about age, incidence, pathology type, clinical signs, neurological side effects and the amount of complete recovery was filled. The findings showed that the mean age of patients was 6.22±0.83(female 47%, male 53%) and male/female ratio was 1.12. Pathologically, 47% of the tumors were medulloblastoma, 18% were ependymoma, 9% were cerebellar astrocytoma, 63% inferatentorial, and 33% supratentorial. Headache(50%), nausea and vomiting (54%) were the most frequent clinical symptoms. Focal neurological sings were: hemiparesis(9%), seizure(12%), alteration in personality(10%) and ataxia(22%). 70% of the patients were treated with surgery, radiotherapy and chemotherapy, 7% were only treated with surgery, 13% with surgery and radiotherapy and 9% with surgery and chemotherapy. Post-treatment side effects in our patients were neurological complications(52%) and five-year survival(15%). For diagnosis of brain tumor CT scan was used in 78% of cases and MRI in 3%.In general, 22% of the patients were expired and only 11% of cases were alive. No information is available about 40% of the patients because of not having any address from them and 27% of the patients have just been under treatment for about 5 years. 198 ENT Surgery THE STUDY OF INDICATIONS AND COMPLICATIONS OF TRACHEOTOMY IN HAZRAT RASOUL-E-AKRAM HOSPITAL FROM 1996-2000 Javadi M Arbabi M.J Sedghi M Haghdad A 1 12 2003 10 36 541 545 18 07 2005 Tracheotomy is a traditional procedure described since 2000 BC. Significant decrease in upper airway obstruction caused by infection was the most common indication of tracheotomy in the past, whereas presently its primary indication is in the long-term intensive care unit patients. Although tracheotomy is often beneficial in the selected patient, it has some related complications. Increasing knowledge about indications and complications as well as their causes is helpful in selection of the proper patient and decreasing morbidity and mortality due to tracheotomy. This descriptive (existing data) study has reviewed indications and complications of this surgical procedure. A total number of 140 patients including 103 men and 37 women, who had undergone tracheotomy, were evaluated. The range of their age was between 20 days to 85 years old. Indications of tracheotomy were: prolonged intubation 32.1%, laryngeal tumors 26.4%, head and facial trauma 11.4%, subglottic stenosis 7.9%, predictable prolonged intubation period 7.9% and other indications were: thyroid tumors, tracheotomy for clearance of air way sanitation, laryngeal web, Ludwig angina, face and neck surgeries, esophageal tumors, peritonsillar abscess, laryngomalacia, miasthenia gravis and head truma. 70 patients had developed some kinds of complications. Complications of tracheotomy in this study in order of decreasing frequency were: hemorrhage, sub-cutaneous emphysema, pneumothorax, problems related to tracheotomy tube, infection, tracheal stenosis, development of granulation tissue at the site of tracheotomy, tracheoesophageal fistula, difficult decanulation, atelectasis, stenosis of tracheotomy stoma, aspiration pneumonia and pneumomediastinum. No mortality from tracheotomy was seen in this study. Indications of performing tracheotomy were similar to that of other studies but rate of complications was much higher. Key Words: 1) Tracheotomy 2) Indications 3) Complications 199 Pharmacology COMPARING TWO EMPIRIC ANTIBIOTIC REGIMENS IN TREATMENT OF FEBRILE NEUTROPENIC CANCER PATIENTS Soroush J Razavi S.M Nojoomi M 1 12 2003 10 36 547 552 18 07 2005 Since patients with hematologic malignancies and some solid tumors have prolonged periods of severe neutropenia due to the disease itself or its intensive chemotherapy, they often develop life-threatening infections which can be controlled by using appropriate empiric antibiotic regimens. The variety and combination of antibiotics is to the extent that a more common one can be replaced by the others. Therefore, this study was conducted to investigate whether a regimen like Piperacillin and Amikacin could be as useful as a routine regimen such as Ceftazidime and Amikacin or not. In a randomized multicenter clinical trial, 73 patients were randomly treated by two different regimens. The first group(37 patients) was treated with Ceftazidime (2gr/TDS/IV) plus Amikacin (15 mgr/kg/IV infusion daily) and the second group (36 patients) with Piperacillin (4gr/q4 hr/IV) plus Amikacin. Becoming afebrile in 48 or 72 hours after beginning antibiotic regimen was the response criterion to treatment. 27 patients(73%) in the first and 23(63.9%) in the second group responded to the treatment. Statistically, there was no significant difference between the responses to treatment in both groups. As a whole, 50 out of 73 patients (68.5%) responded to our initial treatment and the two regimens were statistically & equally effective. So we recommend that the combination of Piperacillin plus Amikacin can also be used as a suitable treatment in febrile neutropenic cancer patients in our country. 200 Radiology MEASUREMENT OF NORMAL INDICES OF CELIAC ARTERY DOPPLER ULTRASOUND IN PERSONS OVER 20 YEARS OLD Saedi D Haddadpour A.R 1 12 2003 10 36 553 559 18 07 2005 Doppler ultrasound is one of the non-invasive methods for blood flow assessment in cardio-vascular system and celiac trunk as the first branch of abdominal aorta is an important splanchnic artery. According to the relative differences in the reports of normal indices from doppler ultrasound of the celiac artery in the different medical centers of the world, it was decided to evaluate this issue in the department of sonography of Hazrat-e-Rasool-e-Akram Hospital in Tehran. 84 normal persons (42 men and 42 women over 20 years old) were selected by quata convenience non probability sampling method with no exclusive criteria and with the use of doppler ultrasound scanner (HITACHI: EUB-525). Different variables such as PSV(Peak Systolic Velocity), EDV(End Diastolic Velocity), MV(Mean Velocity), d(celiac trunk diameter), RI(Resistance Index), PI(Pulsatility Index), VF(Volume Flow) and doppler spectral wave forms were studied. This study was performed in the fasting and resting(supine) state. Exclusive criteria have been indicated in subject of methodology. This research had the following general conclusions: 1- Mean and standard deviation(SD) of PSV of celiac artery were 96 cm/s and 20.354 cm/s respectively. 2- Mean and SD of EDV of celiac artery were 31 cm/s and 2.967 cm/s respectively. 3- Mean and SD of MV of celiac artery were 65 cm/s and 11.566 cm/s respectively. 4- Mean and SD of diameter of celiac artery were 0.54 cm/s and 0.0767 cm/s respectively. 5- Mean and SD of RI of celiac artery were 0.66 cm/s and 0.0508 cm/s respectively. 6- Mean and SD of PI of celiac artery were 0.98 cm/s and 0.1189 cm/s respectively. 7- Mean and SD of VF of celiac artery were 877 ml/min and 145.745 ml/min respectively. 8- Doppler spectral wave forms had low-pulsatility pattern with forward continuous flow in diastole. 9- Between different age groups, there was a significant difference in PSV, EDV, MV, d, RI, PI and VF (P< 0.05), so PSV, EDV, MV, RI and PI increased with aging, while d and VF decreaed with aging. 10- Finally, there was not any significant difference between men and women in indicated variables. 201 Anesthesiology THE EFFECT OF INTRAVENOUS SUFENTANIL IN ENHANCEMENT OF ANALGESIA LEVEL OF INTRATHECAL BUPIVACAINE Sadri B Naser Nejad SH Entezari S.R Hassan Yazdi R 1 12 2003 10 36 561 565 18 07 2005 One possible problem with spinal anesthesia is failure to attain an adequate level of analgesia. In order to assess a method which could prevent this problem, the present study was conducted to investigate the effect of the systemic opioid on the spinal anesthesia with local anesthetic. In this study 118 ASA-I, II patients were allocated randomly to two groups. In group 1 spinal anesthesia was induced with bupivacaine 0.5% and after fixation of the analgesia level, Sufentanil 10μg was injected intravenously and ten minutes later the analgesia level was tested again and recorded. In the second group, intravenous normal saline 2ml was injected instead of sufentanil. The results showed that in all subjects of the first group the level of analgesia enhanced whereas this was not the case in the second group. 202 Pediatric Nephrology THE ASSESSMENT OF ACUTE RENAL FAILURE FREQUENCY DURING NEONATAL SEPSIS AMONG NEONATES ADMITTED TO NEONATAL WARD OF BAHARLOO HOSPITAL(1998-1999) Atighpoor F Javanbakht M.H 1 12 2003 10 36 567 571 18 07 2005 Neonatal sepsis is common specially in developing countries and is the main cause of neonatal mortality. Among the organs which are influenced during sepsis kidney is associated with mortality rate.This study was undertaken to determine the association between acute renal and sex, age, birth weight, type of treatment, gestational age, duration of treatment and the history of asphyxia. In this cross-sectional descriptive and analytical study the information of neonates who had been admitted to Baharloo Hospital between 1998 and 1999 was registered on questionnaires and then analyzed. Among 500 studied neonates, 320 had inclusive criteria. Based on two standard deviation increase in creatinine level, which is higher than blood creatinine level adjusted to age, 72 neonates were considered to have acute renal failure(22.5%). The males were 55.5% and females were 44.5%. The mean age of the population was 8.4 days and the mean age of acute renal failure cases was 11.6 days. The mean duration of the treatment of acute renal failure group was 6.2 days. The mean birth weight of the population was 2813 grams. Only 20% of neonates with the history of asphyxia were affected with acute renal failure during sepsis. The two groups were treated with nephrotoxic drugs. In this study the association between gestational age, sex, birth weight, history of asphyxia, nephrotoxic drugs and acute renal failure was not significant, whereas the association between neonate age, duration of treatment and acute renal failure was significant. Therefore, it is recommended that the duration of the treatment should not be prolonged and renal function should closely be monitored in septic premature neonates. 203 Pathology CERVICAL MYELOPATHY CAUSED BY FUNGAL INFECTION: A CASE REPORT Abbas Nejad E.A Sheibani Nejad SH Ramak Hashemi S.M Mollahosseini R Hashemi F.S Raei Hedayat M 1 12 2003 10 36 573 578 18 07 2005 In fungal infections that cause spinal cord compression, there is often bony involvement(Osteomyelitis). Rarely do epidural, subdural or intramedullary abscesses cause myelopathy without osteomyelitis. This is a rare case report of extra-spinal fungal infection which caused cervical myelopathy without osteomyelitis or epidural abscess. Also, no infectious damage was seen in its differencial diagnosis before surgery. 204 Microbiology CAMPYLOBACTER FETUS MENINGITIS IN AN ADULT: A CASE REPORT Foruhesh Tehrani H Shams Shahrabadi M Raeessi Dehcordi H Sarraf Nejad A.F Jafari Nejad K Talebi M Moradi M 1 12 2003 10 36 579 583 18 07 2005 Campylobacteriosis is a zoonosis that occurs worldwide. Among 17 species in the genus of campylobacter, campylobacter fetus has special characteristics. In contrast to other species, which frequently cause diarrhea, C.fetus is primarily associated with extra intestinal infections such as septic abortion, septic arthritis, abscesses, meningitis, endocarditis, thrombophlebitis and salpingitis. Meninigitis in adults due to campylobacter fetus is a rare entity and only nine cases of it have been reported in the literature since 1983-2002. This is a case report of a 60-year-old woman who was hospitalized in Kasra Hospital due to having C.fetus.meningitis. 205 Clinical Psychiatry ASSESSING PSYCHOLOGICAL STATE OF PREGNANT WOMEN ADMITTED TO HEALTH CENTERS IN TEHRAN(2002) Ghasemi A Taghipoor Anvari R Birashk B Moradi Lakeh M 1 12 2003 10 36 585 596 18 07 2005 Multiple studies have demonstrated more common psychological disorders in women than in men, but it is worth mentioning that these studies have been done generally and they are not specific to pregnant women. This study was conducted to assess psychological state of pregnant women and its related factors. It was carried out as a cross-sectional survey in 4 health centers(under supervision of north, south, west and east health centers of Tehran) and in Shahid Akbarabadi Hospital center on 1452 pregnant women. Psychological evaluations were performed using SCL-90-R self-administered questionnaire. The mean score of each dimension was calculated and respondents were classified as having no, mild, moderate or severe symptoms. To determine the related factors, logistic regression method was applied. The moderate or severe symptoms (cut off >2) in pregnant women were ranked, due to their prevalence, as somatization(10.6%), depression (10.5%), paranoid view(10.1%), anxiety(9.5%), interpersonal sensitivity (8.8%), hostility(6.6%), obsession & compulsion (5.4%), phobia (4.7%) and psychotic thinking (3.2%). The prevalence of moderate to severe mental disorders(GSI>2) was estimated 5%. Among fertility factors (gravity, nulliparity, history of abortion and history of infertility) infertility was the most relevant factor with mental symptoms. Although prevalence of psychological disorders among pregnant women can be due to several factors like age and sex, part of it may be due to their pregnancy state. This is especially important in high-risk cases with a history of infertility or abortion. In general, pregnancy provides an appropriate opportunity for evaluation and screening of mental disorders in women who have not referred to any medical centers for this purpose. Therefore, integration of psychological counseling in prenatal care programs is recommended. 206 Infectious Disease TUBERCULOSIS OF POSTERIOR OROPHARYNGEAL WALL: A CASE REPORT Ghasemi SH Chehrei A Sadigh N Akhavanfard S 1 12 2003 10 36 599 603 18 07 2005 Upper respiratory tract is a rare site of tuberculosis infection. (1.9% of all tuberculosis cases). There are a few reported cases of nasopharyngeal and palatine tonsil infection, but posterior oropharynx is extremely a rare entity. The patient of the present study was a 67-year-old woman who referred to Shohadaye Haftom-e-Tir Hospital with progressive dysphagia and odinophagia from which she was suffering for about two months before being admitted to the hospital. She also had a history of productive cough without hemoptisis, which was associated with fever, chill, night perspiration and weight loss. Clinical examination revealed an exudative pharynx and cervical lymphadenopathy. Her chest roetgenogram showed a diffused reticulonoduler pattern and hillar lymphadenopathy of lungs. A pharyngeal fiber-optic examination showed an ulcerative mass in the posterior oropharyngeal wall. Also biopsy was taken and a culture for mycobacterium was positive. According to positive sputum staining for acid fast bacillus(AFB), oropharyngeal lesions and chest X-ray a diagnosis of tuberculosis of oropharynx with miliary tuberculosis was made therefore, the patient underwent anti-tubercular treatment. She was discharged with markedly decreased symptoms, but one month later she died because of stopping her medications. Upper respiratory tracts are generally resistant to tuberculosis, however, repeated exposure to infected sputum may overwhelm this defense. Pharyngeal tuberculosis should be included in the differential diagnosis of pharyngeal lesions, especially in endemic regions. The most important differential diagnosis of these lesions are neoplasms of pharynx. In conclusion, biopsies are indispensable for diagnosis and DOT (Directly Observed Therapy) is highly recommended. Key Words: 1) Tuberculosis 2) Oropharynx 3) Pharynx 207 Pathology INTRAOPERATIVE DIAGNOSIS OF WARTHIN-LIKE PAPILLARY CARCINOMA OF THE THYROID BY TOUCH PREP: A CASE REPORT Kadivar M Nasserzadeh H Hashemian H.R 1 12 2003 10 36 605 609 18 07 2005 Warthin-like papillary carcinoma of the thyroid is a recently described variant of papillary thyroid carcinoma characterized histologically by a papillary structure and oxyphilic tumor cells in a chronic lymphocytic thyroiditis background. In this article, a tumoral mass of a 19-year-old female was studied cytologically and histologically. The patient complained of neck mass and was operated as total thyroidectomy. The specimen was cytologically characterized by three distinct features. The first feature suggested the papillary carcinoma, the other suggested oxyphilic changes and the last one suggested chronic lymphocytic thyroiditis. The nuclei of neoplastic follicular cells had grooves & pseudoinclusion and some of these cells revealed Hurthle cell changes in cytoplasm with conspicious nucleoli in nuclei of the others. Chronic inflammatory cells were seen in the background and in sheets of neoplastic follicular cells. Numerous psammoma bodies were visible all over the smear. 208 Gynecology COMPARISON OF PULSATILE GNRH AND HUMAN GONADOTROPINS (HMG+HCG) FOR THE TREATMENT OF INFERTILITY IN HYPOGONADOTROPIC HYPOGONADIC WOMEN (17-YEAR EXPERIENCE) Memarzadeh M.T Moradi Lakeh M 1 12 2003 10 36 611 617 18 07 2005 This study was undertaken to compare the outcomes of treating hypogonadotropic hypogonadic women with pulsatile GnRH and gonadotropins (HMG + HCG) and to evaluate severity-dependent factors (FSH-LH, estradiol and and puberty level) on the results. The existing data about the outcomes of infertility treatment with pulsatile GnRH or gonadotropins was reviewed in 66 hypogonadotropic hypogonadic women during 1985-2002. Cases with other causes of amenorrhea were excluded from the study and then after approving the diagnosis via clinical and paraclinical criteria, the patients were treated with one of the methods non-randomly. Patients received 12-65 vials of ( 75unit/vial) HMG or pulsatile GnRH (20mg/2hr for 14-20 days in each cycle). Drug prescription was continued until follicular diameter reached 18mm, and then secretory phase was supported by HCG. The overall pregnancy rate in hypogonadotropic hypogonadic women was 69.7% per woman (17.2% per cycle). The rate of pregnancy was 17.9% per cycle in HMG treated cases and 15.5% per cycle in pulsatile-GnRH treated cases. Basic levels of FSH, LH and estrogen, which were abnormally low in all patients, were not significant related to the outcome of the treatment. The proportion of multiple pregnancies after pulsatile GnRH was significantly lower than that of gonadotropins (P = 0.03). The incidence of severe ovarian hyperstimulation was zero and 3 percent after pulsatile GnRH and HMG-therapy respectively which showed no significant difference. Thus, it can be concluded that the success of the treatment after both methods was relatively high, but the pulsatile GnRH treatment is associated with milder ovarian stimulation. 209 Anesthesiology EVALUATION OF THE EFFECT OF USING INTRAVENOUS MAGNESIUM SULFATE IN GENERAL ANESTHESIA ON THE LEVEL OF STRESS, NEUROENDOCRINE AND ACUTE PHASE RESPONSES IN COMPARISON WITH SPINAL ANESTHESIA Naser Nejad SH Hassani V Farahini H Hosseini Gohari Mohaghegh Dolat Abadi Javanshir A.R 1 12 2003 10 36 619 626 18 07 2005 Reducing the stress neuroendocrine and acute phase responses to surgical trauma during anesthesia has always attracted the attention of anesthesiologists. In order to achieve this goal, different drugs and methods have been used for prevention. The goal of this study was to evaluate the magnesium sulfate effects on serum level changes of stress hormone, neuroendocrine and acute phase reactant and then compare these effects with spinal anesthesia induced changes. In this study, 60 patients who were candidates for diagnostic knee arthroscopic surgery were randomly allocated to three groups(Group 1, 2 and 3). In the first group the patients received total intravenous anesthesia(TIVA) with midazolam, fentanyl and atracurium plus magnesium sulfate. In group 2 the patients received total intravenous anesthesia in the same way but did not receive magnesium sulfate and in the third group only spinal anesthesia was performed. Pain was evaluated with visual analog scale(VAS) in the three groups and fentanyl intravenous was administered during 24 hours after the surgery in the condition that VAS was more than 3. Acute phase response indicators, stress responses and neuroendocrine (Norepinephrine) hormones were measured 24 hours after the surgery. Results obtained from ANOVA, T-test, X2 and SPSS software were analysed with significant Pvalue of 0.05 and in contrast to previously preformed studies the level of norepinephrine and some other hormones showed no significant difference. Comparisons made between the three groups using analysis of variance(ANOVA) showed significant differences in T3 (P=0.000), T4 (P=0.016), GH(P=0.045), BS(P=0.043), WBC(P=0.004) and CRP+(P=0.024). The results of this study have shown that magnesium sulfate has no significant effect and spinal analgesia has relative effect on the neuroendocrine, acute phase and stress hormone responses respectively. 210 Orthopedic LONG -TERM RESULTS OF GREATER TROCHANTERIC ARTHROPLASTY IN PATIENTS AFFECTED BY PREVIOUS SEPTIC HIP ARTHRITIS Yazdi H.R Behgoo A Aslani H.R Ghazavi M.T 1 12 2003 10 36 629 636 18 07 2005 Septic hip arthritis can result in several complications such as complete distruction of femural head and neck. For treatment of this problem greater trochanteric arthroplasty has been advised. In this study, long-term results of this treatment were assessed to identify its advantages and disadvantages. 15 patients with sequel of hip septic arthritis were operated at Shafa Rehabilitation Center from 1985 to 1991. 5 patients did not participate in follow-up study and were excluded. Out of 10 patients, 6 were females and 4 males with mean age of 3.5 years(2-10 years) at the time of surgery. 8 patients were operated with Wissman and 2 with Regult procedure, and were followed for 10-16 years(mean 12.4 years). All hips were at stage 4(2 were at 4A and 8 were at 4B). In 4 patients right hip and in 6 ones left hip was involved. Surgery was done in 6 patients with transfer of greater trochanter to acetabulum with proximal femur varus osteotomy only, and in 4 patients beside this surgery, peivic osteotomy was also done. After at least 10 years, 7 patients had no or little pain and they only had moderated or severe pain. Mean hip flexion was 83˚, internal rotation 15˚, external rotation 10˚ and abduction 25˚. 8 patients were suffering from limping. Shortening was 10-20mm in 3 patients and more than 20mm(mean 39mm) in 7 patients. In 6 patients affected hip was completely stable and in 4 was dislocated. Trendelenburg sign was positive in 7 and DJD was found in 4 patients. 9 patients were able to do their daily work and they were satisfied with their surgery. According to Hunka criteria the results were satisfactory in 4 and unsatisfactory in 6 patients.