Journal of Research in Medical Sciences1735-1995612001030133003300EN2001030120090330Introduction: Modified Mohs" Surgery (MMS) has not ever been performed for management of skin cancers in Iran. The aim of this study was evaluation of the efficacy of MMS in recurrence, metastasis rate and cosmetic results. Methods: Fifty one patients with known indications for MMS were selected. They were operated under standard method of MMS, followed and evaluated for a 12 months period about recurrence, metastasis and cosmetic results. Results: 58 tumors from 51 patients were operated. 27.5 percent of patients were females and 72.5 percent were males (57.4± 13.4 year). Eight percent had more than one tumor. In 84 percent, MMS was the first treatment procedure. Anatomically lesions of scalp and face, trunk, and limbs constituted 92.5 percent, 1.9 percent, and 5.6 percent, respectively. Mean size of lesions was 16.9 mm (range: 4-70). The number of layers to clear the tumors was 1-5 (mean: 1.5). Histologically 81 percent of lesions were BCC, 9.4 percent SCC. Immediate reconstruction was performed in all patients as follows: 37 percent primary simple closure, 5.5 percent secondary healing, 50 percent skin flaps, 3.7 percent skin grafts and 3.7 percent a combination model. The percent of relative frequency of recurrence was 3.7 with no case of metastasis. Cosmetic results were excellent in 35 percent, good in 50 percent, intertmediate in 11.5 percent and poor in 3.5 percent of cases. Discussion: Despite paucity of patients" number, higher incidence of tumors in males of 50 or more, higher occurrence on scalp and face and most frequently occurring as BCC is prominently evident. One year recurrence rate of 3.7 percent is probably due to paucity of patients. Cosmetic results were mostly favorable (85 percent), and unfavorable results were due to secondary healing and large facial lesions repaired with flaps. For more valid evaluations, long term studies with greater number of patients is recommended.http://jrms.mui.ac.ir/index.php/jrms/article/view/3300

Journal of Research in Medical Sciences1735-1995612001030133013301ENDep. of Dermatology, School of Medicine, Isfahan University of Medical Sciences, and Health Services2001030120090330<font><font color="#555555"><span style="font-size: 10pt; font-family: Tahoma">Introduction: Acne vulgaris is an inflammatory disease of pilosebaceous folicles. Tretinoin is used as one of the topical treatments for acne vulgaris. It has different cutaneous side effects such as erythema, scaling, irritation and photosensitivity. The aim of this study was to evaluate the efficacy of oral Vitamine E in preventing the cutaneous side effects of topical tretinoin in acne patients. <br />Methods: A clinical trial was performed in AI-Zahra Hospital in Isfahan for six months in 2000. 80 patients with mild to moderate facial acne were randomized into 2 groups. Group 1 (controls) received topical solution of tretinoin 0.05 percent nightly and group 2 (cases) received daily oral 100mg of Vit. E in addition. All patients were followed at 1, 4 and 6 weeks after initiation of treatment. Children under 12 years old, pregnant or lactating women were excluded. <br />Results: At the end of one week, no cutaneous side effects were observed in 25 percent (10) of group 1 and 15 percent (6) of group 2 (P > 0.05). At the end of 4 weeks, 25 percent (10) of group 1 and 60 percent (24) of group 2 were without any cutaneous complications, while at the end of 6 weeks, 35 percent (14) of group 1 in comparison to 75 percent (30) of group 2 were free of any cutaneous side effects (P < 0.05). The most common side effect in both groups was exfoliation. <br />Discussion: Daily oral 100 mg of Vit. E has been effective in preventing cutaneous complications of topical tretinoin in acne management, but there is a delay of one week in its onset of action. Meanwhile, Vitamine E is a safe modality with no undesirable effects in acne patients.</span></font></font>http://jrms.mui.ac.ir/index.php/jrms/article/view/3301

Journal of Research in Medical Sciences1735-1995612001030133023302EN2001030120090330Introduction: Reducing pain and enhancement of wound healing have several advantages. Wound healing is a complicated but regular process that includes synchronized and organized phenomena such as paranchyma cells migration, proliferation and synthesis of extracellular matrix proteins. Rate of wound healing is affected by various factors. The aim of our study was to investigate the effects of low power He-Ne laser radiation (630 nm), on metabolic process, cellular proliferation and finally wound repairment. Methods: In our research, about 50 healthy and mature rats were studied by experimental method. After shaving, small cuts (10 mm) were made at the neck. Then they were divided randomly into control and case groups. The rats of the case group were radiated by He-Ne laser in the wounds about 4 minutes each day. After a week, we did wound autopsy of both groups and all the specimens were studied microscopically. Results: The findings showed that there were significant increase in the fibroblasts and connective tissue fibers and also vascularisation in the case group compared with the control group. Discussion: Wound healing in the case group was accelerated and wound diameter was smaller significantly. So, low power He-Ne laser radiation accelerates wound healing process.http://jrms.mui.ac.ir/index.php/jrms/article/view/3302

Journal of Research in Medical Sciences1735-1995612001030133033303EN2001030120090330Introduction: Acceleration of wounf healing is intrested because of decreasing the risk of wound complication and infections as well as reducing the cost of treatment. In animal models, it has been proved that estrogen can accelerate wound healing. It has been also suggested that topical estrogen can eliminate effect of aging on wound healing and can increase the speed of wound healing in old people. Methods: We selected 16 young healthy people who developed symmetrical and ulcers (regarding size and depths) after dermabrasion, shave and electrocoagulouzon and CO2 laser. Primary lesions of patients were benign and noninfective. Identical and symmetrical lesions of each patient were randomly divided into two groups (A and B). Topical estrogen with concentration of 0.625 mg/g in the base of silver sulfadiazine cream was applied to A ulcers and silver sulfadiazine cream alone was applied on B ulcers. Ulcers were dressed by Telfa gauzes. The A ulcers of each patients were compared to counterpart B ulcers in regard of redness, size, depth, general appearance of ulcers and wound healing duration at three days intervals by a physician. Results: Average time of healing was 10.8 days and 8.5 days for B (n=29) and A (n=29) ulcers, respectively (P < 0.001). In 78 percent of cases, the A ulcers were judged better than B ulcers by physician (P < 0.01). Discussion: It seems that estrogen not only accelerate healing of acute ulcers but also it is efficient in young healthy people who don"t have any hormonal or wound healing problems.http://jrms.mui.ac.ir/index.php/jrms/article/view/3303

Journal of Research in Medical Sciences1735-1995612001030133043304EN2001030120090330n Iran. Many drugs have been suggested for treatment of CL but non of them proved to be effective. Recently ketoconazole has been used to treat CL patients and it has been reported that was effective. To compare the efficacy of ketoconazole cream with placebo in the treatment of CL. Methods: In a double-blind placebo-controlled study, patients with proven CL was treated with ketoconazole cream or placebo cream. The duration of the treatment was 21 days and the patients was visited on the days 7, 14 and 21. The patients were followed for one month after the end of treatment. Results: The study was complete in 73 patients (45 male, 28 female). The mean age of the patients was 19.9 years. 38 patients received ketoconazole and 35 patients were treated with placebo cream. At the end of treatment (day 21), complete healing occurred in 15.7 % of the ketoconazole group in comparison with 14.3% of the patients who were treated with placebo cream. One month of the end of treatment the lesions in 28.9% of ketoconazole group and 22.8% of placebo group were healed. Discussion: Although ketoconazole tablet has been reported to be effective in treatment of C but the low response rete in patients receiving ketoconazole cream indicate that it cannot be used as the single agent in treatment of CL patients.http://jrms.mui.ac.ir/index.php/jrms/article/view/3304

Journal of Research in Medical Sciences1735-1995612001030133053305ENDepartment of Surgery, School of Medicine, Isfahan University of Medical Sciences and Health Services, Isfahan2001030120090330Infection with echinococcus has a world-wide distribution. This parasite affection almost all body organs (such as brain, lungs, spleen, billiary tract, liver, thyroid, parotid, tongue, bone, prostate, bladder, tonsile, pulmonary arteries and inferior vena cava). The other important body organ which also is infected by this parasite is the heart. The patient is a 32 year old man without any symptoms who referred for the evaluation of incidental cardiac murmur on physical examination. All findings in ECG and Chest X ray were normal. Echocardiography showed a large moblie cystic mass in left ventricular outflow tract. Because of the dangerous site of the cyst and probability of rupture and anaphylaxis, he was operated emergently and the cyst was removed successfully. He was discharged from the hospital without any residual LV dysfunction, heart block and cardiac problems.http://jrms.mui.ac.ir/index.php/jrms/article/view/3305

Journal of Research in Medical Sciences1735-1995612001030133063306ENIsfahan University of Medical Sciences and Health Services, Isfahan.2001030120090330Background. Cervical cancer is a common female malignancy in developing countries. In our health care system, the screening program is performed by doing pap smears with the interval of three years. This study was designed to determine the prevalence and frequency disturbation of abnormal smears. Methods. This is a cross sectional study was done in 1997-1998. Sample group were all the under coverage married women aged 20-65 years who have a factor of referal criteria. Papsmears samples were interpreted by a pathologist. Papsmear results were documented by colposcopy and biopsy. Results. The prevalence of abnormal smears in under coverage women is 0.05 percent. Results of abnormal papsmears due to more investigations (colposcopy and biopsy) were: Normal 25 percent, ASCUS 57 percent, CIN 14 percent, CIN 2 1 percent, CIN 3 1 percent invasive cancer 2 percent. Conclusion. Refering of women with abnormal signs such as leukoplakia, cervical erosion, and history of contact bleeding is necessary. The number of false positive results in cytotechnologlsts diagtlosfs is high. This result shows that on-job-training for cytotechnologists is important.http://jrms.mui.ac.ir/index.php/jrms/article/view/3306

Journal of Research in Medical Sciences1735-1995612001030133073307ENDepartment of Infectious and Tropical Disease, School of Medicine, School of Medicine, Isfahan University of Medical Sciences and Health Services, Isfahan2001030120090330<font><font color="#555555"><span style="font-size: 10pt; font-family: Tahoma">Introduction. Central nervous system infections are among the most serious conditions in of medical practice. C-reactive Protein has recently been evaluated in terms of its ability to diffeccentiate bacterial from nonbacterial central nervous system inflammations. <br />Methods. We studied the frequency of positive CRP in 61 patients who had signs of meningitis. All the specimens referred to one laboratory and were examined by Slide method. <br />Results. Positive CRP was found in 97.6 percent of those who were finally diagnosed as bacterial meningitis. The frequency of CRP for other types of meningitis was 16.6 percent (P < 0.05).<br />Discussion. In the absence of infection, CSF is free of CRP. Positive CRP may help to the differentiate the different types of meningitis.</span></font></font>http://jrms.mui.ac.ir/index.php/jrms/article/view/3307

Journal of Research in Medical Sciences1735-1995612001030133083308ENDepartment of Infectious and Tropical Disease, School of Medicine, Isfahan University of Medical Sciences and Health Services, Isfahan2001030120090330Introduction. Tuberculosis is a wide spread disease in the world. It is a health problem in every where. The prevalence of tuberculosis have been increased since several years ago due to some factors such as AIDS. For management of this problem, we need to data about our identified patients. Then we can have a solution for disease control. We demonstrate the patients demographic characters in our province. Methods. All of 164 identified patients under treatment for tuberculosis in Isfahan province were studied (1998-1999). Demographic data such as age, sex, nationality and gender and some characters about their discase was collected. HIV screening was done for all patients by ELISA method and documented in suspicious patients by western blot test. Results. Male to female ratio was 21:20. About 70 percent of patients had primary lung tuberculosis. Skeletal TB was the most common type of extrapulmonary invasion. Seventy four patients were Afghanian and 90 patients were Iranian. Only one patient (a 14 years old boy) was positive for HIV infection. He was a hemophilic patient with history of infected blood transfusion. Discussion. Compared to developed and far east countries, in our country, HIV infection is not a frequent infection in tuberculosis patients. This study shows that migration from Afghanestan to Iran is a very important affecting factor in tuberculosis epidemiology in our region.http://jrms.mui.ac.ir/index.php/jrms/article/view/3308