Razi Journal of Medical Sciences

---

---

Performing frozen section is a common intraoperative consult with the goal of determining the lesion as benign or malignant. Since frozen section needs specific technical requirements and costs a lot therefore, in some studies cytology is used as an alternative method. Most of these studies have been done on specific organs and a few of them on all organs of the body. Therefore, we prospectively studied the usefulness of intraoperative cytology and frozen section in the diagnosis of 100 consecutive cases. The study used sensitivity, specifity and accuracy as statistical tools for comparison. The intraoperative results were compared with final histopathologic diagnosis. For intraoperative cytology the sensitivity, specifity and accuracy were 95.8%, 92.5% and 95% respectively and for frozen section these were 97.2%, 96.3% and 97%. There were not any significant differences between these statistics(P>0.05). These data confirm the value of intraoperative cytology in diagnosis of all mass lesions. This method can also be use as an alternative technique to frozen section in case there is no technical requirements or as a complementary method in all specimens.

---

    Background & Aim: Acute rheumatic fever and its cardiac involvement is one of the most prevalent acquired pediatric heart diseases in developing countries needing long hospitalization, cardiac surgery, prophylaxis, and delicate management and causing death in some cases. A paucity of information about this disease in our country made us perform the present study in one of the largest pediatric cardiac centers of Iran. Patients & Method: 290 pediatric rheumatic cases with cardiac involvement admitted from April 1985 until March 1999(15 years) were assessed in terms of the age of first involvement and admission, sex, valvar involvement, type of surgery, recurrence of infectious endocarditis, and mortality. Results: There was no sexual predominance(51% male versus 49% female). The age of first involvement ranged from 4 to 16 years with the mean of 9.7. 65% of cases showed their first involvement between the ages of 7 and 12. The age of admission ranged from 4 to 18 years with the mean of 11.1. 80% of cases were admitted over the age of 11. cardiac valvar involvement was diagnosed by physical exam, electrocardiogram, chest x-ray, and echocardiography. Angiography was done for most patients. The results indicated isolated mitral disease in 49%, combined aortic and mitral involvement in 39.5%, isolated aortic involvement in 3.5%, and the involvement of 3-4 valves in 7% of the patients. In other words, mitral valve was involved in 90% and aortic valve in 44% of the patients(isolated or combined). Of 190 patients who underwent valvar surgery, 96(51%) had operation on mitral valve, 83(43.5%) on mitral and aortic valves, and 10(5.2%) on aortic valve. Recurrence of rheumatic fever occurred in 42 cases(14%), infectious endocarditis in 16(5.5%), and mortality in 4(1.3%). Conclusion: Afflicting girls and boys equally, rheumatic heart disease is most commonly found among children of school age. 65% of the studied patients underwent surgery and often needed valve replacement. Therefore, it is recommended that special attention be paid to diagnosis and early treatment of streptococcal infection so that its grievous complications will be avoided.

---

    Background & Aim: In childhood, dilated cardiomyopathy has a prevalence of 36 in 100000. Its prognosis is one of the most important matters. The chance of 5-year survival is reported to be around 50% and 10-year one around 25%. We aimed to study the prognosis, treatment, and mortality of dilated cardiomyopathy patients in Iran. Patients & Method: In this descriptive study, the medical records of all infants and children with dilated cardiomyopathy hospitalized between 1990 and 2004 were reviewed. Results: Among 115 patients, 67(58%) were boys and 48(42%) were girls, with a mean age of 8.4 years(ranging from 3 months to 16 years) and mean weight of 21.5 Kg. The most common clinical manifestation was respiratory distress in 71.3% and congestive heart failure(CHF) in 62% of the patients. Ninety-four(82%) were discharged after medical therapy with a combination of digitalis, furosemide and angiotensin-converting enzyme inhibitor(captopril). Twenty-one patients(18%) died in the picture of severe CHF and dysrhythmias during the first admission. A mean follow-up of 6 years(ranging from 0 to 13 years) revealed that 56% were still alive. Conclusion: The prognosis is still poor especially for those under 2 years of age or with CHF or dysrhythmias, but new attempts have been made to use different therapeutic modalities like L-carnitine, growth hormone, intravenous immunoglobulin, cardiac transplantation, and new surgical approaches in pediatric patients.

---

    Background & Aim: Tramadol is an analgesic with combined opioid agonist and monoamine reuptake blocker properties, which may be useful as a perioperative analegesic and antinociceptive adjuvant. The aim of this study was to evaluate the efficacy of Tramadol 50 and 100 mg in combination with 2% Lidocaine in epidural anaesthesia for lower limb orthopedic surgery. Patients and Methods: In this randomized, double-blind study, 50 patients undergoing lower extremity orthopedic surgery were enrolled. Patients were randomly assigned to receive either epidural 50 mg Tramadol + 2% Lidocaine(n=25) or 100 mg Tramadol + 2% Lidocaine(n=25). Level and duration of block, change of haemodynamic status and side-effects in each group were compared. Results: There were no differences between the groups in regard to level and duration of analgesia, demographic charecteristics and side effects(P>0.05). Although, systolic blood pressure was decreased significantly in both groups(P<0.05), it was not statistically significant. Conclusion: We suggest that a combination of Tramadol with 2% lidocaine can provide effective and safe preoperative analgesia. Increasing the dose of Tramadol to l00mg, as compared to 50mg dose, does not significantly affect the efficacy and/or side effeds .