Razi Journal of Medical Sciences

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ABSTRACT Among the causes of ascites, there is two kinds, including cirrhotic and malignant ascites that conventional diagnostic method for them is Paracentesis. This method is invasive and time consuming, however sonography is an easy and available method for providing valuable results in a short period of time. The aim of this study is survey of valuability of gallbladder wall sonography in discrimination between cirrhotic and malignant ascites. During the period of 1.5 years, from the patients with complaint of cirrhotic and malignant ascites, who refered to educational hospitals of Iran university we selected 50 patients and gallbladder wall thickness and patterns in them were studied. In all cirrhotic patients, gallbladder wall thickness was more than 5mm, and in 69% of them the wall was thick and Double layered, and in 31% the wall was thick and single layered, However in 71% of patients with malignancy, gallbladder wall thickness was normal. The result of this study was: The use of Sonographic gallbladder wall thickness and patterns as a predictor of cirrhotic and malignant ascites has a significant sensitivity and specificity.

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ABSTRACT Low back pain is the most common musculoskeletal disease and has a high prevalence rate in community that causes a significant morbidity, mostly due to degenerative discovertebral disease. MRI is the best and noninvasive method for assessing degenerative discovertebral disease. This study was conducted to determine MRI findings in degenerative discovertebral disease. This descriptive study is done cross sectionally on 110 patients (60 men & 50 women) with the average age of 45 years that have degenerative low back pain without a history of trauma, neoplastic, inflammatory or spinal surgery. Degenerative findings including changes in signal of nuclear disk complex, size and shape of nuclear complex, intranuclear cleft, disk height, disk bulging, disk herniation, dural sac compression and osteophyte formation are analyzed and graded form zero to three based on their severity. The result shows %92.7 of patients have degenerative discovertebral findings. The most common age is 4-6 decades. Degenerative findings occur in men one decade earlier. The most common time for patients’ reference was 1-6 months after the disease commences. The most common disk level involvement is L4-L5 that affected men %82 and women %75. After that the fifth, the third the second and the first disks respectively. The most common degenerative findings are change in intranuclear cleft %58.2, change in signal of disk complex %41.6, disk height narrowing %25.9, change in shape and size of disk complex %23.2. Prevalence of degenerative discovertebral finding, except for disk herniation, increase from the first to the forth disk and then decrease partially. Dural sac compression in upper disk is mostly due to disk and then decrease partially. Dural sac compression in upper disk is mostly due to disk bulging and in lower disk because of disk herniation. Mild grading of degenerative discovertebral findings is more common than moderate or severe geading, except for changes of signal intensity of disk, intranuclear cleft and disk height narrowing whose moderate findings have greater prevalence. Thereis no sex difference in degenerative discovertebral finding. Signal intensity changes increases with age (P<0.05). Also there are increases in changes of size and shape of nuclear complex, intranuclear cleft, disk height narrowing in the first to the third disks (P<0.05). But there is no significant rise in disk herniation, disk bulging or dural sac compression with age. Increase in ostheophyet formation in the first and the second disk is seen (P<0.05). Degenerative discovertebral findings show that according to degenerative proces the first, the second, and the third disks might be categorized in one group and the forth and the fifth disks in another group.

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ABSTRACT Anatomical variations have great importance among various medical disciplins. The significance of these variations differ from some points of view including system, site and degree of variation. Vascular system is a common site of variations. The importance of this system in supplying the organs, specially the brain has made it to be in focus for its variations. The main source of the brain blood supplying is the circle of willis. Many anatomical variations of the adult arterial circle have been described. To our knowledge, despite of many documents of anatomical variations of willis circle in other population, no documents have been reported regarding to Iranian population. Thus, in order to determine the kind and the incidence of the variants of willis circle, by using cerebral angiography we studied the willis circle in Iranian race patients referred to department of radiology. Variants for the main branches of willis, including abnormal site of ramification, number of branching, agenesy and external diameter were noticed. In addition, other ones like internal & external carotid, basilar artery and middle cerebral artery were noticed too. Results of this study showed some variations in anterior and posterior communicating artery, middle cerebral artery and basilar artery. The recognition of anatomical variations of the circle of willis is important in diagnostic procedures, prognosis of the patients with cerebrovascular disorders and also allows the neurosurgeons to construct better and safer microdissection plan to save time on the one hand and to prevent postoperative neurological deficits on the other hand.

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ABSTRACT As the price of film, chemical materials and amortization of the machines consist of the 80% out of the whole expenses in a radiography ward, thus failure in providing the desirable radiography films, economically, imposes much expence to the treatment and health system.to analyse the radiography damaged films or rejected ones, is introduction to perform the quality control plan. To reduse the role of technicians as the districting factors in sampling from the damaged and repeated films, some of the sinior radiography students were trained and were told how to chek the films. Then all the provided films, from patients referred to radiography wards in the morning shifts in 3 training hospitals in Semnan, were cheked, immediately, after going out the prossesor. During two month, 3067 film belong to 1670 patient were analysed, to analyse the data, k2 and Ratio test were used. The results indicated that 1.17% out of the whole provided images been repeated, while the rate of the rejected films is 5% and the real number of the damaged films with low quality were 7.98% in this study, it was determined that there is meaningful difference between the rejected images by men (3.7%) and women (6.2%), (Pv=0.0024). The most important factor in rejecting the films is to have bad position (29.3%) and the second factor is the exposure error (24.4%). Findings indicate that 2.9% of provided images, Lack the proper quality, but without rejecting or repeating them, they were used for patients as the safe films, chiefly in emergency ward, this observed a lot.

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Gliomas comprise about 50% of all primary central nervous system tumors that have defied treatment. Despite of improvement in treatment with surgery, radiotherapy and chemotherapy, the prognosis for these patients remains poor. Efforts to improve the treatment of malignant glioma have included Targeted Radiotherapy with [125I]-Iododeoxyuridine. 125IUdR, a thymidine analogue, is preferentially incorporated into the DNA of tumor cells, and the Auger electrons emitter [125I] is highly toxic to dividing cells. We have achieved comparative study of Targeted Radiotherapy and external beam therapy in treatment of glioma. Clonogenic assays formed basis of experiments to the human glioma cell line “A172” cultured as monolayers in the exponential and the plateau phase. In external beam radiation, the survival curves were exhibited a distinct shoulder, in comparison with, lack of shoulder (absence of repair) in Targeted Radiotherapy. In the treatment of cells in the plateau, the effectiveness of 125IUdR was attenuated by the presence of non-cycling cells. These finding suggest that Targeted Radiotherapy may be a useful method for treatment of glioma, in case we overcome non-cyling malignant cells.

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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.

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CT scan is the best method in the diagnosis of paranasal sinus diseases. The object of the present study was to show the efficiency of diagnostic endoscopy in diagnosing nasal paranasal sinus diseases and anomalies. If this method proves to be accurate, patients who refuse surgery can be diagnosed, managed and followed up through a reliable method that is cost-effective and decreases the unneccessary irradiation of patients. The frequency of some of the anatomical variations and structural anomalies of the nose and paranasal sinuses was determined. During a 14-month period, 70 cases(studying both left and right sides) those who fit out criteria, were used for the study. The clinical and radiologic stages were determined, separately. A correlation between the clinical stage and the radiologic stage or the opacification index scoring was found. Endoscopy alone is not a good method to detect the structural anomalies of the septum and turbinates. But with the absence of these anomalies a better correlation was found with CT scan. Frequency of these anomalies in our study were in the range of other conducted studies. The maxillary sinus was the most common diseased sinus in chronic sinusitis, and anterior ethmoid sinus was the second most common. However, in other studies the anterior ethmoid sinus is the most common and maxillary sinus is in the second place.

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The objective of the present study was to compare the maximum width of the third ventricle(V3) in brain computed tomographic (CT) scans of patients with Major Depressive Disorder (MDD) and normal healthy controls in psychiatry clinics and wards of Iran University of Medical Sciences and radiology Department of Hazrat Rasoul Hospital. First, during a pilot study, interrater and intrarater reliability of the researcher in obtaining CT values were assessed. Then, patients consequently admitted to the psychiatry clinics were included if they met MDD and inclusion criteria, and if they had filled informed consent. Controls who met inclusion criteria were selected from healthy persons admitted to CT department using planimetric and densiometric methods. CT scans of 30 patients and 30 age and sex matched controls were assessed and linear values and ventricular brain ratio(VBR) were measured. Data was assessed by using independent sample, two-tailed t-test and Pearson’s correlation coefficient. The mean width of V3 showed significant difference between all age and sex subgroups of patients and controls(P<0.5). There was a significant difference between patients and controls younger than 40 in linear values of frontal lobe, Huckmann number and VBR(P<0.5 in all cases), but no difference was observed in older groups. Correlation assessment showed that the sooner the illness began and the longer its duration was, the greater the maximum width of V3 (r=-0.37 and 0.37 respectively) and interhemispheric fissure(r=-0.39 and 0.39 respectively) were. Also, number of episodes was positively correlated with VBR and maximum width of V3 (r=0.5 and 0.52 respectively). Based on the findings, it could be hypothesized that there is an enlarged third ventricle of the brain in patients with MDD. Also, MDD can accelerate age-related decrease of the brain tissue of the fronal lobe, but does not increase it.

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Cerebral aneurysms are of clinical importance regarding their fetal outcomes. The prevalence has been estimated between 2.4% and 6.8% of outopsies. Regarding the epidemiological differences of populations, the present cross-sectional study was undertaken to assess the angiographic findings of ruptured aneurysms. 50 patients with the diagnosis of ruptured cerebral aneurysms were admitted to Haftom-e-Tir Hospital in Tehran, from 2001 to 2002. Data about sex, age, risk factors, clinical presentations and angiographic findings of DSA(site, size and number of lesions) were collected and analysed via SPSS 11.5 software (presuming α=0.05). Mean age was 52±3.4 and 52% of the patients were women. Hypertension(65.3%) was the most prevalent risk factor. 64% of the patients suffered from headache and 58% presented with loss of consciousness. The first ranked site of aneurysms was Anterior Communicating Artery(63%). The mean size was 6.9±0.9mm(±2SE). 60% of aneurysms were of 6-10mm size and 8% of patients had multiple aneurysm. The findings of this study about sex, site, size and risk factors, are in accordance with other studies. Higher prevalence of aneurysms in patients younger than 30 years old, fewer cases with multiple aneurysms and more than half of patients with loss of consciousness are the main considerable differences.

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The aim of the present study was to evaluate the correlation between gestational age and the length of fetal’s kidney in order to be able to have access to the size of the fetal’s kidney at any age. This assessment is helpful to diagnose the anomalies of the fetal’s kidney and makes it possible to consider the length of the fetal’s kidney as a biometric criterion to estimate the age of pregnancy. In order to substantiate this, the length of the fetal’s kidney in 138 normal pregnancies which were between 20 to 40 weeks old was gauged. Scrutinizing the information made it clear that there was a direct and signficant relationship between the age of pregnancy and the length of fetal’s kidney (r=0.95, P<0.001). In this study the average length changes spectrum of the fetal’s kidney was calculated according to any age at the second half of pregnancy. The fetal age was approximately estimated according to the length of the fetal’s kidney. However, the exact spectrum of the changes of the fetal age could not be achieved in this study therefore, more comprehesive and fully directed studies are needed.

 

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    Background & Aim: Doppler ultrasonography is important in diagnosis of renal diseases by demonstrating vascular anatomy and hemodynamics. There is not any fix doppler indices in all of the references and it is suggested that each center should have its own standards. Also it is proved that biologic indices are not the same in different societies. The present study was performed on normal Iranian population to measure normal limits for renal doppler indices. Patients & Methods: In this research ultrasonography was done on 256 healthy people including 126(49.2%) female and 130(50.8%) male. The mean age was 31.1 years with standard deviation of 8.64. The minimum age was 14 years and maximum age was 57 years. Doppler indices were measured in all of the cases and normal limits were calculated. Results: In main renal arteries PSV mean was 86.01(87.80, 84.25) cm/s and EDV mean was 39.01(40.40, 37.80) cm/s. In intrarenal arteries mean PSV was 75.32(77.12, 72.89) cm/s, mean EDV was 32.23(33.41, 31.45) cm/s, mean RI was 0.55(0.56, 0.54) and mean AT was 29.35(30.75, 28.35) ms. Conclusion: The obtained values are normal renal doppler indices in healthy Iranian population and we suggest that it should be used in clinical studies.

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    Background & Aim: Measuring the length of kidneys is an important issue in diagnosis and treatment of renal diseases. In various diseases, kidneys become larger or smaller than normal. Ultrasonography is a suitable method for measuring renal length because it is accurate, noninvasive, available and with low cost. Nowadays, multislice spiral CT scanners are widely used for evaluation of renal diseases and are capable of making different reconstructions on images including multiplanar reconstruction(MPR) and in many situations, measurements like measuring renal length are done on these reconstructed images. Hence, knowing the accuracy of measurements on reconstructed images is very important. This research was done to evaluate the accuracy of renal length measurement on multiplanar reconstructed images of spiral CT scan. Patients & Methods: In a cross-sectional study, spiral CT scan was performed on all of the patients referred to CT scan department of Hashemi Nejad Hospital for abdominal CT scan during July and August 2004. Multiplanar reconstruction was carried out on all of the images and the maximum length of kidneys was measured. Then ultrasonography was done for all of the patients and the maximum length of kidneys was measured as gold standard. The lengths of kidneys obtained from these two methods were compared with each other. Results: 40 patients(80 kidneys) with the mean age of 42 years were evaluated. Analysis with SPSS and paired t-test revealed that the mean renal length at ultrasonography was 107.1 mm with standard deviation of 12.08 and the mean renal length at spiral CT scan was 110.18 mm with standard deviation of 11.93. The mean length of kidneys resulted from ultrasonography was 3.08 mm less than the mean length of kidneys resulted from multiplanar reconstructed images of spiral CT scan, and considering P<0.05, the difference was considered significant. Conclusion: Measuring the renal length on reconstructed images doesn’t have enough accuracy. Therefore, in situations when knowing the exact size of the kidney is important, measurements should be done on the basic CT images(without reconstruction) or on other methods like ultrasonography.

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     Background & Aim: In human environment, magnetic fields are created by electrical generators, power lines, and electrical instruments. These fields could affect learning and memory. This study was planned to evaluate whether short time exposure to magnetic fields has any significant effect on spatial memory. Material & Method: In this experimental study, we used 10 male Albino Wistar mice that were trained for spatial memory in a T-maze model within six days. Twenty-four hours after training, animals were tested for retention of discrimination in three stages(control, restrainer and magnetic field) at two-hour intervals and each of the animals was given 5 successive trials at one-minute intervals. The time of movement from the start area until they reached the criterion zone was measured by a chronometer. Magnetic field was induced by a round coil with an internal diameter of 8 cm and 850 turns of copper wire. Maximum intensity of 7.5 mT at the center of the coil was calibrated by a digital teslameter. Results: Evaluation of the results of the three stages indicated that the mean of time was 15.4 s, 11.5 s, 11.3 s respectively. Also, there was a significant difference between the time in the control stage and the other stages (P<0.05), but there was no significant difference between the restrainer stage and the magnetic field regarding the time measured. Conclusion: Research findings indicated that short time 7.5 mT, 50 Hz magnetic field did not have any significant effect on T-maze alternation tasks in mice and it would probably have no effect on spatial memory process either.

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    Background & Aim: Varicocele is the dilation of the pampiniform venous plexus of testis more than 2 mm and is one of the most common causes of sperm abnormalities in infertile men. The main diagnostic test for varicocele is ultrasonography that evaluates the vein diameter in B mode exam and venous reflux in color Doppler exam, but there is no single agreement on the importance of these two findings in different references. This research was performed to evaluate the effect of these two factors on sperm analysis test. Patients & Method: This descriptive analytical cross-sectional study aimed to evaluate the relation of diameter and reflux to sperm analysis in patients with varicocele. With the help of sonography, maximum diameter of pampiniform venous plexus, presence and duration of reflux during valsalva maneuver were measured in 62 patients with varicocele. Then the patients were referred to the laboratory unit for sperm analysis(S/A). Results: The mean age of the patients was calculated to be 25.6 years(SD=5.08). 85.5% of the cases had left side involvement and 14.5% showed bilateral involvement. Mean diameter of left venous plexus and its mean reflux time were 3.62 mm and 2.30 seconds, while mean diameter of right venous plexus and its mean reflux time were 2.93 mm and 1.06 seconds respectively. Reflux was absent in 20.96% of them. Regarding routine criteria such as motility, morphology, sperm count, and the like, 54.66% was presented with abnormal S/A, of which abnormal morphology had the highest frequency(41%). The analysis of data revealed a direct significant statistical relationship between the diameter of left venous plexus and its reflux time, which means the reflux time increased significantly with increasing diameter of vein(PV=0.00, r=0.378). A reverse statistically significant relationship was observed between left side vein diameter and sperm motility(PV=0.019, r=-0.297) and between left side reflux time and sperm motility(PV=0.009, r=-0.325), which means motility decreases with increasing diameter and reflux time. In addition, the results of t-test showed a statistical difference between left side vein diameter and its reflux time for both groups with motility <50 and motility>50(PV=0.35, PV=0.002), which indicates that both vein diameter and reflux time were apparently more for the group with motility<50 than the normal group, but left side diameter and its reflux time showed no relation to other parameters of S/A such as abnormal morphology and sperm count, and the same was found about right side diameter and its reflux time. Moreover, no relation was detected between presence or absence of reflux and S/A abnormalities, and bilateral or unilateral involvement bore no relationship to sperm count, motility and abnormal morphology. Conclusion: We noticed that the presence or absence of reflux is not a suitable factor to determine prognosis or sperm abnormalities.

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    Background & Aim: Hemodialysis increases the survival of patients with chronic renal failure. However, prolonged hemodialysis causes some complications including abnormal bone changes. This research was done to evaluate the frequency of the radiological changes of osteoarthropathy in hand joints in hemodialysis patients referred to Hashemi-Nejad Hospital. Patients & Methods: In a cross-sectional study, 240 hemodialysis patients who referred to Hashemi-Nejad Hospital in Tehran were evaluated. Antero-Posterior radiography of hands from finger tips to distal bones of forearm was performed in all of these patients. Results: Prevalence of osteoarthropathy was 39.5%. The most common radiologic finding was osteopenia with frequency of 36%. Other changes included: bone erosion(15%), periarticular cyst(8%), and articular narrowing(2%). Osteoarthropathy was seen in males more than females and in individuals with more than 10-year dialysis. The prevalence of vascular calcification as an incidental finding was 24%. Conclusion: There was a high prevalence of osteoarthropathic changes in patients under hemodialysis. This prevalence increases with long duration of dialysis. Therefore, the early kidney transplantation is necessary for these patients. Also, the amount of aluminium in dialysis solutions should be controlled as much as possible.

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Abstract Background & Aim: Infertility is a relatively common problem, the prevalence of which is reported to be one in six couples. Among female factors, ovarian and tubal factors which are treatable are the most important ones. Laparascopy is the golden test for evaluation of fallopian tubes but because of its expensiveness, the necessity of general anesthesia and other problems, hysterosalpingography has been suggested as the screening test. The aim of the study was to assess the prevalence of fallopian tube abnormality in patients with primary and secondary infertility using hysterosalpingography. Patients & Method: In this case-control study 50 subjects were randomly selected from groups of primary and secondary infertility patients who were referred to the radiology department of Ghods Hospital for hysterosalpingography. After excluding pregnancy and genital infection, the patients underwent hysterosalpingography between the sixth and eleventh days of the menstrual cycle and the results were registered in proper forms. Results: Uterin abnormality was found in 10 patients(20%) with primary infertility, 7 of whom(14%) were related to fallopian tubes. 22 patients(44%) with secondary infertility were seen to have fallopian tube pathology. Acquired results were analysed. Using SPSS software(version 10) and t-test, a statistically significant difference in the prevalence of fallopian tube pathology was observed between the two groups(P<0.001). Conclusion: Fallopian tube abnormalities are more common in patients with secondary infertility. Considering the fact that pelvic inflammatory disease is the most common predisposing factor, on time diagnosis of genital infections, health care improvement and increasing the knowledge of society seem to be necessary.