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Objective: Although thiopental sodium (Nesdonal) is an almost ideal drug for induction of anesthesia, but it mostly cause hemodynamic changes such as hypotension. The objective of this study is to compare hemodynamic effects of thiopental sodium and Midazolam (From Benzodiazpine family) in order to replace it with thiopental when necessary. Methods: 50 patients in ASA I were divided into two groups (Each group 25 persons) randomly subjects in both groups were administered with premedication with an equal dose per patient’s weight. In first group anesthesia was started with thiopental sodium 4-5 mg/kg with succinylcholine and in the second group with Midazolam 0.25-0.3 mg/kg with succinylcholine and intubation was done after a given time. Heart rate and blood pressure were recorded for both groups at special times and data were compared with each other. Findings: In this study pulse rate of 20% of patients who received thiopental sodium were increased to 20 beats/min. It was 12% for Midazolam group the changes (P=0.000) were meaningful. An increase of systolic blood pressure more than 40 mmHg from base after intubation with thiopental sodium in 24% of persons (P=0.011) and 2 min after intubation in 20% persons (P=0.048) were meaningful. There were no such variations in Midazolam group. Data shows that any rise or fall in blood pressure and heart rate observed with thiopental sodium is more than that with Midazolam. Conclusion: Considering this research and the other studies show more record of hemodynamic condition of Midazolam than thiopental sodium. Therefore, in patients with dangerous hemodynamic variations, especially decreasing of blood pressure only induction with Midazolam or a combination of Midazolam and thiopental (For rapid onset action) as co-induction is useful.

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Objective: For several surgical procedures spinal anesthesia is preferred to general anesthesia. However some of its most important effects are reducing blood pressure (Hypotension) and heart rate. In this study, we evaluated the effect of prophylactic intramuscular ephedrine before spinal anesthesia. Methods: This study was conducted on 100 cases in ASA class I (American society of anesthesiologists) between 20-60 years old who had no co-existing disease. They were randomly divided into two groups (Each with 50 cases). The test group received 25mg (0.5ml) intramuscular ephedrine 10-15 minutes before spinal anesthesia and the subjects in control group received 5ml normal saline (0.9%) as placebo. After receiving 500ml Ringer’s solution, spinal anesthesia with 2cc lidocaine 5% was done. Heart rate, systolic and diastolic blood pressure have been measured seven times before ephedrine and placebo injection, before spinal anesthesia and during the procedure at the 2nd, 5th, 15th, 30th and 45th minutes. Then data were rerecorded and compared. Findings: In this study, those who received prophylactic ephedrine had a raised heart rate and blood pressure before spinal anesthesia, but this rise was not more than 10% of the baseline and there was no need to treat their hypotension or reduced heart rate during anesthesia or the operation. But 28% of control group have received ephedrine for treatment of hypotension and 36% of them received atropine to manage bradycardia. After statistical analysis and comparing of these two groups, we have seen that the range of fall of heart rate, systolic and diastolic blood pressure in the study group was narrower than that in control group and their differences were meaningful (P=0.000). Conclusion: The results show that the patients, who have received intramuscular ephedrine before spinal anesthesia, have a rather higher level of hemodynamic stability. Therefore, in patients for whom hemodynamic changes, specially a reduced blood pressure is dangerous such as those with a heart disease, old patients or those undergoing caesarean section using of this method could be useful.

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Objective: Arthritis is a common sign, which is almost one of the first manifestations of musculoskeletal diseases. With regard to a relationship between the prevalence of some rheumatic diseases with genetic and environmental factors, the causes of arthritis may be different among the racial and ethnic groups in any geographic area. The present study was conducted to determine the etiology of acute arthritis in Babol. Methods: Arthritis was confirmed clinically and etiological diagnosis was made according to the usual criteria for rheumatic disease. This study was done on patients aged over 16 and their disease duration was less than four weeks. Findings: From 133 patients under the study, 26% were referred with acute monoarthritis (AM), 56% with acute oligoarthritis (AO) and 18% with acute polyarthritis (AP). The most common cause of AM was gout, the most common causes of oligoarthritis were reactive arthritis (ReA) and rheumatic fever (RF). ReA, RF, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) were the common causes of AP. Conclusion: These findings show that gout, ReA, RA, RF and SLE are the common causes of acute arthritis in old, middle and young age in Babol.

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Background and Objective: There are different diagnosis and therapeutic methods for meniscus tears. For obtaining optimal results, the characteristics of each one should be known. This study was performed with regard to epidemiology, causes, diagnosis methods, surgery and after surgery treatments. They were evaluated with regard to effective factors in prognostic. Methods: This descriptive and cross-sectional study was done according to information, which obtained from patients’ files, interviewing and physical and radiographic examination. Final evaluation was done according to the score of patients’ consent of treatment and average score of physical examination with regard to clinical symptoms. Findings: 77% of patients were under 35 years old. 88% of patients were male and 43% were sportsmen. Pain and locking were the most common complaint in 80% and 58% of cases respectively. Arthrography was the most common diagnostic procedure (72%) with accuracy rate of 93% for medical and 74% for lateral meniscus. The rate of pain, swelling, locking and instability before surgery were 80%, 15%, 52% and 33% respectively which after surgery reduced to 70%, 0, 13% and 10% respectively. Conclusion: In patients with trauma of knee especially young sportsmen, presence of meniscus should be considered seriously. Arthrography was known as an accessible, easy and effective method for diagnosis of meniscus. The ideal methods for treatment were repair of meniscus tear and partial menisectomy respectively. Postoperative Jones bandage immobilization for 2 to 4 weeks and postoperative physiotherapy for 10 to 25 sessions had the most effective results.

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Background and Objective: Midazolam is the only drug of benzodiazepine category that because of its fast effect and least cardiovascular complications is used for induction and maintenance of anesthesia. Also, halothane is the most common drug for maintenance of anesthesia with some complications that causes a tendency to use IV anesthesia. This study was done to determine the effect of midazolam and halothane on hemodynamic changes in maintenance of anesthesia. Methods: This study was conducted on 100 cases (16-60 years old) in ASA class I (American society of anesthesiologists). They were randomly divided into two groups (Each group 50 persons). Subjects in both groups were administered with premedication and induction of anesthesia with an equal dose according to their weight and then tracheal intubation was done. For the maintenance of anesthesia, control and case group received halothane (0.5-1%) and midazolam (1 µg/kg/min), respectively and both groups received N₂O and oxygen (50%) equally. Heart rate, systolic and diastolic blood pressure were measured and recorded after premedication, 1 min after induction and every 10 min during 90 minutes and then data was compared. Findings: According to the obtained results, the changes of heart rate and systolic and diastolic blood pressure in midazolam group was less than halothane group and there was not a statistically significant difference. The range of systolic and diastolic blood pressure changes in midazolam group in comparison to halothane group was less and it was statistically considered significant (P<0.05). Emergence from general anesthesia in midazolam group was less than halothane that this difference was meaningful (P=0.01). Conclusion: Hemodynamic changes in maintenance of anesthesia with infusion of midazolam in comparison to halothane were similar or less. If it is necessary, continuous infusion of midazolam can be used instead of halothane with regard to its some complications.

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Background and Objective: Skeletal complications are common in brucellosis. Early diagnosis of these complications may prevent surgical procedures. The aim of this study was to evaluate the skeletal complications of brucellosis in Babol town. Methods: This study was conducted on patients with skeletal complications of brucellosis referred to infectious diseases and orthopedic departments during 1998-2001. Skeletal complications and laboratory test results were recorded in questionnaire. Proportions were compared with X² and Fisher exact tests. Findings: From 431 cases, 161 (37.6%) were with skeletal complications (94 [58.4%] were male and 67 [41.6%] were female). Mean age±SD of adults and children were 34±17.6 and 9.5±4.2 years, respectively. Among 127 adult cases, 79 (62%) had peripheral arthritis which in 48 (37.8%) cases was as monoarthritis. Peripheral arthritis was seen in 32 (94%) of 34 cases of children, which in 26 (76.5%) was as monoarthritis. Peripheral arthritis and hip involvement in children were more common than adults (P<0.05), but spondylitis was more common in adult cases (P<0.05). In 14 (8.7%) cases, brucellosis was diagnosed after surgery. Normal erythrocyte sedimentation rate (ESR) and positive rheumatoid factor were seen in 80.7% and 15.5% cases, respectively. Conclusion: Since, skeletal complications of brucellosis is similar to septic arthritis and also rheumatologic disorders and monoarthritis are the most common form of these complications therefore, it is recommended that in endemic regions, brucellosis should be considered in differential diagnosis of all cases with monoarthritis.

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Background and Objective: Gout is a condition characterized by acute arthritis and hyperuricemia, but the prevalence of hyperuricemia and the level of serum uric acid (SUA) in acute gout is not known exactly. The present study was performed to determine the frequency of hyperuricemia in patients with gout and to compare the SUA level in acute gouty arthritis with control group. Methods: SUA level during the acute gouty arthritis diagnosed according to clinical criteria was measured by an enzymatic method in the fasting state and compared with age and sex matched controls. The frequency of hyperuricemia (SUA>7 mg/dl) was also determined during the acute gout attack. Findings: 57 patients (50 males, 7 females) and 57 controls (50 males, 7 females) were studied. The mean age of patients and control group were 54±16 years and 56±14 years, respectively. The mean of SUA level in patients was significantly more than controls (8.5±1.8 and 5.3±1 mg/dl respectively, P<0.0001). Hyperuricemia was found in 75.5% of patients during the acute gout attack. In patients without hyperuricemia, the mean of SUA level was 6.4±0.6 mg/dl that was significantly more than controls (P<0.001). Conclusion: Acute gouty arthritis is not always associated with hyperuricemia but the SUA level remains high in the majority of patients during the attacks.

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Background and Objective: Capsanthin is a main carotenoid pigment of hot (red) pepper with some therapeutic effects similar to capsaicin. This study was done to determine its effect as an ointment contained capsanthin and comparison of its effects with such effects of diclofenac gel in treatment of osteoarthritis. Methods: This double-blind clinical trial was performed on 34 patients referred to rheumatology clinic. Patients were divided into three groups. Effective material of red pepper (Capsanthin), diclofenac gel and ointment base (As placebo) were used in first (9 persons), second (15 persons) and third (10 persons) groups, respectively. Patients were evaluated regarding functional pain, resting pain and swelling of knee joint of baseline before and after two weeks of treatment. The severity of pain and swelling were assessed by Lickert scale from 0 (No pain or swelling) to 4 (Severe pain and swelling). Data were provided by examination and filling in questionnaire. Findings: Compared to baseline values, diclofenac gel or placebo were effective in reducing functional pain and resting pain (P<0.05). Whereas, only pepper ointment was effective on resting pain. No treated groups showed any significant difference in joint swelling. Comparison of each group in efficacy showed that the efficacy of diclofenac and pepper on joint swelling was not more significant that placebo, but diclofenac was significantly more effective than red pepper on functional pain (P<0.02). The efficacy of each treatment group and placebo on resting pain was not significant. Conclusion: The results of this study showed no preference in efficacy of red pepper ointment (Capsanthin) to diclofenac gel or placebo on functional pain and resting pain of knee osteoarthritis.

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Background and Objective: The variation of SPO₂ and HR is a complication that threatens patients under operation and general anesthesia. Continuous monitoring of SPO₂ and HR in al stages of anesthesia, especially induction and recovery stages due to early diagnosis of hypoxia. Fasciculation and shivering are also two common complications of general anesthesia. The aim of this study was to determine SPO₂ and HR variations during fasciculation and shivering in general anesthesia. Methods: In this study, 100 patients in ASA class I and II aged between 15 to 60 were selected for rapid induction of general anesthesia by using succinylcholine as a muscle relaxant. Premedication and induction of anesthesia were the same according to their weight. In the maintenance of anesthesia, halothane (0.5-1%), O₂ (50%) and N₂O (50%) were used. SPO₂ and HR of patients were measured and recorded at 1st and 3rd minutes after fasciculation and at 1st, 5th and 10th minutes after shivering and then data were compared. Findings: There were some changes in SPO₂ and HR in both process that the most changes related to 1st and 3rd minutes after fasciculation and 1st and 5th minutes after shivering. Also, these changes during shivering were more severe that was statistically significant (P=0.000). Conclusion: Results showed that the most decrease in SPO₂ and increase in HR were related to the first stage after fasciculation and shivering that these changes can make some problems for patients with heart or pulmonary diseases. So, it is recommended that anesthesiologists should decrease the probable complications in patients under general anesthesia by continuous monitoring of SPO₂, HR and necessary treatment.

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Background and Objective: Wart’s disease is one of the common skin diseases, which is due to human papilloma viruses. The peak incidence is at the age of 12-16. Warts occur commonly on the back of hands and feet. The aim of this study was to determine the prevalence of wart’s disease in scalp, face hands and feet among school girls in Babol in educational year of 1999-2000. Methods: This cross-sectional study was done with randomly sampling, clinical examination and filled questionnaires in Babol girl guidance schools during 1999-2000. Findings: Out of studied 300 girls, 45 cases (15%) had warts and 76 (25%) had past history of warts disease. The higher frequency was common wart and the commonest sites were hands. The peak incidence of this disease was at the age of 14. Conclusion: Determination of prevalence of wart disease can be effective in improvement of prevention and treatment protocols.

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Background and Objective: The increase of serum level of FSH accompany with increasing age indicated a decrease in ovary response and fertility in ART (Assisted Reproductive Technology) cycles. This study was done to evaluate the relationship between age of women and FSH level with the number of oocyte and the rate of fertilized oocyte. Methods: This study was done on 111 infertile couples who were in cycle of IVF in Babol Fatemeh Zahra infertility center during 1996-2001. The number of oocyte, fertilized ovum, serum level of FSH and LH were evaluated. Data was analyzed by SPSS software. Findings: The mean age of women was 30.2±6.4 years and mean of the numbers of oocyte and fertilized oocyte was 7.2±4.5 and 2.8±3.1, respectively. The mean of FSH and LH was 9.2±3.92 IU/ml and 10±4.1 IU/ml, respectively. There was a significant relationship between the number of oocytes and fertilized oocyte with the age of women. Fertilization rate was 70.3% and there was not a significant difference in fertilization rate among age groups. Conclusion: According to the results, the age of women can be a predictive factor for ART (IVF) programs.

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Background and Objective: Propofol is an intravenous anesthetic for induction and maintenance of anesthesia, which its usage is increasing owing to produce a general state of post operative well being, antiemetic effect, rapid onset and recovery. This study was done to compare the effect of halothane and propofol on blood pressure and heart rate in maintenance of anesthesia. Methods: One hundred patients in ASA class I and II (American Society of Anesthesiologists) 16-60 years old were randomly divided into two groups. Halothane and propofol with continuous IV infusion were used for maintenance of anesthesia in group 1 and 2, respectively. Hemodynamic changes were measured after premedication, 1 minute after intubation and then every 5 minutes but it was recorded to 30 minutes after beginning and end of surgery. In the end of surgery, the patients were taken to recovery room and observed for evaluating nausea and vomiting for one hour and duration of recovery was compared on the basis of visual and verbal response. Findings: Systolic blood pressure during maintenance of anesthesia was similar in two groups, but systolic blood pressure changes (0.037) and heart rate (P=0.009) were different in both groups. Relative frequency of nausea and vomiting was one in propofol group and four in halothane group. First and second recovery time in propofol group were 9.60, 10.52 min and in halothane group were 20.20, 22.90 min, respectively that there was significant difference between them (P=0.000). Conclusion: With regard to cardiovascular changes in maintenance of anesthesia with propofol, halothane and recovery time, propofol is a better choice in cases that rapid recovery time is need or inhalational drug usage is contraindicated.

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Background and Objective: Determination and modification of cardiac risk factors with early detection of coronary artery disease (CAD) have important role in control of mortality and morbidity in the world. It is necessary to increase the knowledge and attitude of people for better practice and decrease in morbidity and mortality of cardiac disease. This investigation was done to determine the KAP study of people living in Babol (As one of the large cities in North of Iran) for CAD. Methods: This cross-sectional, descriptive and analytical study was performed on 1500 persons aged 20-70 years old in Babol. Data were gathered by a questionnaire with 32 questions in five different regions of the city and then the results were statistically analyzed. Findings: From all cases, 58.6% were male and 41.4% were female. About symptoms of CAD: 62.7% and 4.2% had poor and good knowledge, respectively. 27.9% and 36% had poor and good attitude, 37.7% and 14.6% had poor and good practice, respectively. About risk factors of CAD: 65.3% and 0.9% had poor and good knowledge, 43.5% and 6.5% had poor and good attitude, 53.7% and 0.9% had poor and good practice, respectively. Conclusion: In conclusion, people of Babol city have poor knowledge, moderate attitude and poor to moderate practice about symptoms of coronary artery disease and its risk factors. Planning for increasing KAP for prevention of CAD is necessary.

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Background and Objective: Sarcoidosis (Sa), a multisystem disease of unknown etiology presents protean manifestations. Triad of Sa-gout-psoriasis has been reported in a few patients but coexistence of Sa and gout has not been reported. Case: A 36-year-old man presented with acute polyarthritis, bilateral hilar adenopathies and erythema nodosum. Diagnosis of acute gout was established with regard to clinical findings, refusing other causes of acute arthritis and identification of monourate crystals from synovial fluids. Diagnosis of Sa was confirmed by extensive exploration including CT scanning of thorax, bronchoscopy and biopsy of epitrochlear adenopathies. Conclusion: Development of gout may be due to hyperuricemia (Caused by granolumatous tissue destruction) or release of inflammatory cytokines from granolumatous tissue destruction of Sa.

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Background and Objective: Applying the growth curve is the most powerful way for monitoring the growth in children and through this method it would be possible to recognize in time the deviation from the natural growth pattern in children. Falling the data and missing values are general problems in analyzing the growth longitudinal data. Therefore, it is important that by computing the missing values, the data should be completed and directed towards the proper path for analysis. Methods: This 2 year longitudinal study was done on 317 infants (153 boys and 164 girls) in Shiraz during 1996. The information related to growth (Weight, height, round the head, round the arm, and round the chest) at the birth time were collected and 11 visits from the infants’ living houses were done. In order to influence the missing values on the growth charts, 4 methods (Ignoring the missing values, general and individual models of growth curve and multiple imputation) were considered to study. Mean, 3rd, 50th, 97th centiles of raw and smooth weight were computed in boys and the smooth growth charts of their weight were determined and compared based on the four methods. Findings: There was no noticeable difference in the boys’ mean weight at age under study according to growth curve methods and multiple imputation while missing values were ignored. However, the smooth growth charts showed that applying the individual growth curve model (Second level) and multiple imputation causes the noticeable difference between the values of 3rd, 97th centiles and the traditional analysis (Ignoring missing values). Conclusion: Regarding the existence of missing values in growth longitudinal studies, ignoring the missing values for analyzing is not acceptable. Applying the growth curve model method could be considered important in making desirable the analysis and the proper growth path.

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Background and Objective: Nowadays, arterial cannulation for continuous and direct monitoring of arterial blood pressure has a wide indication especially in cardiac surgery. However, this method is useful but it may have some complications. The aim of this study was to determine the incidence of some complications of radial arterial cannulation such as arterial thrombosis, hematoma, and sensitivity of cannulation site. Methods: This prospective study with consequential sampling study was performed on 139 cases who referred to Dr. Heshmat hospital in Rasht from November 2002 to May 2003 and arterial cannulation has been carried out on all of them. The mentioned complications were studied according to observation form and Allen’s test. Data were analyzed statistically by T-test. Chi-square test and McNemar test. Findings: From all cases, 68.3% were men and 31.7% were women. Incidence of radial artery thrombosis on the 3rd day after cannulation was 43.9%, incidence of hematoma and sensitivity of cannulation site on the same day were 38.8% and 16.5% respectively. These complications reduced on 7th day after cannulation to 7.2%, 5% and 1.4%, respectively. There was a significant difference between incidences of complications on different days after cannulation (P<0.05). The findings indicated that there was a significant relation between incidence of thrombosis and time of Allen’s test and also between the incidence of hematoma and thrombosis (P<0.05). But there was no significant relation between incidence of hematoma and thrombosis, but there was no significant relation between incidence of complications under study and sex and also between radial thrombosis and size of artery (Given wrist circumference). Conclusion: Despite high incidence of these complications, they are declining rapidly and no serious side effect is found. Radial arterial cannulation is still considered as a safe and suitable method.

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Background and Objective: Hemodynamic changes following laryngoscopy and intubation of trachea is one of the main problems in anesthesia. Different methods and drugs are used to lower this problem. The aim of this study was to survey the effect of Alfentanil, which is a short acting opioid on hemodynamic changes. Methods: 100 patients with ASA class I were divided into 2 groups of 50 patients. Both groups received diazepam 0.1 mg/kg, morphine 0.1 mg/kg and faxedil 20 mg/kg as premedication. 3 minutes before induction, Alfentanil group received 10 mg/kg Alfentanil and control group received normal saline as placebo. Both groups received sodium thiopental and succinyl choline for induction. Blood pressure and heart rate were recorded before and after premedication, 1, 3 and 5 minutes after intubation of trachea. The data were compared together. Findings: Changes in heart rate and blood pressure (Systolic and diastolic) before and after premedication had no meaningful difference in both groups, but average of changes in heart rate and blood pressure in the patients in the Alfentanil group after laryngoscopy and intubations were less and there was statistically significant difference. Hemodynamic features in both groups after 5 minutes were stable. Conclusion: According to the results, Alfentanil is effective in reducing heart rate and blood pressure (Systolic and diastolic) after laryngoscopy and intubations of trachea. So, using Alfentanil before laryngoscopy in general anesthesia is recommended.

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Background and objective: With regard to the extensive use of digoxin in patients with heart disease and its high prevalence of toxicity, this study was done to measure the digoxin serum level (DSL) in patients with or without symptoms of poisoning and determine its relation with age. Methods: This study was performed on 441 patients who used digoxin in Babol Shahid Beheshti hospital in 1999-2003. Digoxin has been used for a long time by these patients and the cause of hospitalization was symptoms related to digoxin and primary disease. DSL was measured after history taking and information about the presence of poisoning symptoms. Finding: From 441 patients, 63 cases were toxic and 378 cases were non-toxic. Among 63 toxic cases, DSL in 27 cases was more than 2 ng/dl in serum that 82% of them were under 70 years old and DSL in 36 cases was less than 2 ng/dl in serum that 95% of them were over 70 years. From 378 non-toxic cases, 42 cases (11%) were over 70 years that DSL in all of them was less than 2 ng/dl and 336 (89%) were under 70 years that DSL in 3 (4%) and 323 (96%) was more and less than 2 ng/dl, respectively. Conclusion: Although, the most DSL in non-toxic patients was more than 2 ng/dl but DSL less than 2 ng/dl can also cause digoxin toxicity (Especially in patients more than 70 years).

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Background and objective: The congenital pseudarthrosis of tibia (CPT) is a rare congenital malformation with unknown etiology. Several methods of surgery were used for therapy of this abnormality that often is associated with failure of treatment or amputation. The purpose of this study was to assess the treatment of congenital pseudarthrosis of tibia by free vascularized fibula transfer. Cases: This study was performed on 11 cases (Mean age=4.5 years) with congenital pseudarthrosis of tibia who referred to Hazrat Fatemeh, Akhtar and Mostafa Khomeini hospitals in Tehran during 10 years. From all, five cases had been already operated with different orthopedic methods that associated with unsuccessful results. All patients treated with free vascularized fibula graft. Anti-coagulant agent was administered to patients for one week to prevent thrombosis after surgery. All patients were followed up and no failure of therapy was found. Conclusion: With regard to good outcome of therapy of this congenital disorder with free vascularized fibula graft, it is recommended using this method of surgery for therapy of this congenital abnormality.