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Introduction: Hemorrhoid is a common disorder causing pain, and its standard treatment is Hemorrhoidetomy. Also, pain is a common problem after surgery and control of it prevents physiologic and psychiatric complications. Kegel exercise is one of the relaxing and none invasive methods for reduction of pain. In this study the effect of kegel exercise on pain relief post hemorrhoidetomy is investigated. Materials and Methods: This study is a single blind randomized clinical trial. Samples were patients admitted for hemorrhoidetomy to Shahid Sadooghi hospital of Yazd. They were randomly divided in two experiment and control groups (each group 30 persons). Before operation, Kegel exercise was educated to experiment group and after surgery pain range were recorded. Data was analyzed using descriptive and analythic statistics (t and Pearson correlaton tests). Results: Findings showed that the mean score of post surgery pain in the first 48 hours after operation in experimental group was 26.50±5.82 and in control group 31.26±5.94, that have meaningful difference (P=0.003). Regarding the amount of analgesics, the mean use of analgesics after surgery in experimental group was 18.9±14.83 and in control group 52.83±29.89 which has meaningful difference (P=0.00001). Type of analgesics in the two groups 18, 24 and 48 hours after surgery with p=0.04, p=0.04 and p=0.05, had significant difference. There were not any correlations between pain intensity and numbers of Kegel exercise. Conclusion: Based on results, Kegel exercise decreased post hemorrhoidetomy pain and using analgesic drugs was decreased in experimental group. Preoperative education of this method is useful in pain management postoperatively.

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Introduction: Diabetes mellitus is a chronic disease that has well known effects on most organs, but there have been controversies in few different studies about the effects of diabetes on hearing. So this study was carried out in 2003-2004 in Kermanshah Diabetes Research Center to assess the effect of diabetes on hearing. Materials and Methods: This is a case-control study. 82 diabetic cases (26 types I and 56 type 2 cases) were studied along with 82 controls matched both in age and sex. Cases were selected randomly, their range of age was 15 to 55 years and their duration of diabetes was more than 3 years. After completing questionnaires, all cases and controls undergone autoscopic examination. Those with other ear disease with hearing impairment were omitted. Audiometery including pure tone audiometery, speech audiometery, and impedance audiometrey with well tone AD19 formed was done on 164 (diabetic and control) persons. Data was analyzed using t-test. Results: Audiometric findings with different frequencies in the two groups revealed that there was a significant relationship between diabetes and hearing impairment (p<0.001). This relationship was more significant in high frequencie, older age and type 2 diabetes, but there were no relationship between control of blood sugar (HbA1c), duration of diabetes, sex, microvascular and macrovasculur complications with hearing loss in diabetic patients. Conclusion: These finding demonstrate that diabetes can cause mild to moderate hearing impairment especially in high frequencies. The mechanism of this effect is unknown. Complementary studies with more patients and with more accurate devices such as Otoacustic Emission (OAE) and Audiometric Brainstem Reflex (ABR) are recommended

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Introduction: Children with reflux who fail prophylaxis management or reflux which do not resolve spontaneously are candidates for sugery. Delay in surgery increases the development of new renal scars. Finding a modal factor for prediction of reflux resolution likelihood can decrease complications of treatments. Regarding that sacral bone anomalies have a direct influence on the final function of urinary and bowel systems, this study is done to investigate the relationship between sacral ratio and reflux. Materials and Methods: This is a case-control study. The case group included 76 children less than 9 years old refered to Vali-e-Asr and Amir Kabir hospital clinics with urinary tract infection and according to voiding cystouretrograply (VCUG) results, children with III, IV and V grade vesicoureteral reflux (VUR) entered the study. The control group included 76 children with previous urinary tract infection and normal VCUG. Sacral ratio in the two groups was measured and was compared by student t, Chi square and Mann Whitney tests. Results: The case group included 24 males and 52 females with average age of 2.7 years old and the control group included 23 males and 53 females with the average age of 3 years. The percent of sacral ratio abnormality were 40% and 23.7% in the case and control groups respectively, which was significantly different (p=0.001). The difference between the mean sacral ratio in case group with the value of 80% and the control group with the value of 84% was not different. The ratio distribution pattern in the two groups was not different. Conclusion: The percent of sacral ratio abnormality in children with vesicoureteral reflux were more than children without reflux.

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Introduction: Familial adenomatous polyposis (FAP) is a rare disease with hundreds to thousands adenomatous polyps in large intestine which inherits in the form of autosomal dominant, but 25% of patients have no positive family history. Rectorrhagia and rectal prolapsus are the most prevalent symptoms. Diagnosis is based on clinical findings and results of colon investigation, and prompt colectomy prevents carcinoma in patient. In this article a case report of familial adenomatous polyposis is presented. Case: The patient is a 17 years old teenager, a known case of familial adenomatous polyposis, who was refered with severe obstruction signs of gastrointestinal tract. The disease was diagnosied when he was 5 years old. In 6 years old he was treated by partital colectomy and in 11 years old by total colectomy and ileorectal anastomosis. The patient was investigated by endoscopy and small bowel transit. Because of many polyps in stomach, duodenum and jejunum polypectomy, gastrectomy and duodenotomy were done. Diffuse carcinoma in situ was reported in pathology. Conclusion: Rectal and colonic polyps are rarely obsereved below 10 years old, but rectorrhagia and rectal prolapsus suspects the diagnosis of FAP in children. In the case of dysplasia and carcinoma abdominal pain, anemia and weight loss will be presented. In children with suspecting FAP, screening of extracolonic manifestation and dysplasia should be considerd and elective surgery should be done.

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Introduction: Hypomagnesemia hypercalciuria nephrocalcinosis (HHNC) is a rare syndrome due to mutation defect in CLDN-16 gene. Its product is paracellin, a protein in henle loop paracellur area which acts in magnesium and calaium reabsorption. In this article a case of HHNC is reported. Case: The patient is a 3 years old boy presented with tetany, polyuria and polydipsia. Imaging study revealed medullary nephrocalcinosis. Laboratory investigations showed hypomagnesemia, hypercalciuria, hypermagnesiuria and normal arterial blood gases. In 2 years follow up, no neurological diseases, growth failure, or rickets were seen. He was treated with Hydrochlorothiazide and Potassium polycitra for prevention of nephrocalcinosis and progressive renal failure. Conclusion: HHNC is a rare syndrome presenting with hypercalciuria, hypo- magnesemia nephrocalcalcinosis, tetany, polyuria and polydypsia which progresses to end stage renal failure in 2nd or 3rd decades. Early diagnosis and some treatment modalities like Hydrochlorothiazide or polycitra-k can delay this process.

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Introduction: Diabetes is the most important metabolic disease in human. The prevalence of both types of diabetes is rapidly increasing ocross the world. Diabetes causes many complications including End Stage Renal Disease (ESRD). Diabetes is responsible for 30% of ESRD. The prevalence of diabetic nephropathy in Iran is also high. Many of these patients are becoming dialysis dependent. Many studies have shown the changes of trace metals’ levels in diabetic patients including Copper, Zinc, Manganese and Chromium. This study evaluates the correlation between urinary Copper and diabetic nephropathy Materials and Methods: This is a case-control study. Samples were selected among type 2 diabetic patients attending to diabetes clinic in Vali-e-Asr hospital in Arak. Diabetic patients were divided in two groups based on microalbuminuria, 42 patients in case and 40 patients in control group. Then the patients were classified based on duration of diabetes into 4 groups and based on the HbA1c into two groups. Then urinary Copper was determined with atomic absorption spectophotometry and compared. Independent t-test was used to analyze data. Results: Patients were 28.1% male and 69.9% female in case group and 37.5% male and 62.5% female in control group. The mean Copper level was 36.14µg /L (14.54-57.74) in case group and 14.77% µg /L (10.17-19.37) in control group. There was a statistically significant difference between the two groups (p=0.003). Conclusion: The results show a positive relation between urinary Copper and diabetic nephropathy and confirmed the results of other studies that reported the elevation of Copper in microalbuminuria. This study also showed that age, gender, duration of diabetes and HbA1c level have no effect on urinary Copper.

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Introduction: Due to the absence of frozen section in the majority of hospitals, malignant breast masses are being operated in two admissions first for biopsy and second for mastectomy. With simple and rapid technique of touch imprint (intraoperative cytology) both operations can be done in the same time. In this study the diagnostic accuracy of intraoperative cytology (touch imprint) in malignancy of breast masses is evaluated. Materials and Methods: During 2003 to 2006, reports of touch imprints of 70 patients with breast masses were compared to reports of their permanent section. Based on gathered data, positive and negative predictive value, sensitivity and specificity, and positive and negative likelihood ratio of the test were determined. Results: In 70 patients, 39 cases had malignant and 31 cases had benign masses. In 39 patients with malignant masses, 36 patients had malignant and 3 patients had benign cytologic reports. In 31 patients with benign masses 2 patients had malignant reports in cytology. Therefore sensitivity, specificity and accuracy of touch imprint in diagnosis of malignant breast masses were 92.3%, 93.5% and 92.9% respectively. Conclusion: Because of high specificity of touch imprint, it seems that this test can be done in centers that do not have frozen section for intraoperative diagnosis of malignant breast masses.

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Introduction: Peptic ulcer is a condition in which there is an ulcer in the stomach or duodenum. The incidence of peptic ulcer is 5 to 10% and is more prevalent in men. Infection with helicobacter pylori, NSAIDS, smoking and alcoholism are of the most important risk factors. Another risk factor is the O blood group. Since most research in this field are done abroad this study is done with the aim of determining the relation between ABO blood group and Rh with peptic ulcer. Materials and Methods: In this case-control study, 325 persons with dyspepsia were investigated. These individuals were referred for endoscopy. The case group consisted of 110 persons in whom endoscopy had revealed a peptic ulcer and control group 215 persons in whom endoscopy had showed no sign of ulcer. Blood grouping was performed by slide and tube methods .Chi square test was used for data analysis. Results: Based on the results, patients’ age was between 18-75 years. 68.6% of samples were women because they had more referrals. There was a significant relation between age and sex with peptic ulcer. 25.5% of patients were single and 72.5% married. Among all samples 32.9% had A blood group, 18.5% B, 11.1% AB and 37.5% O and 88% were Rh positive and 12% Rh negative. There was no significant relation between ABO blood group and Rh with peptic ulcer. The gathered data was analyzed using odds ratio, relative risk and Chi square test. Conclusion: Although some investigations have showed correlations between ABO blood group and peptic ulcer, our data showed no correlation. This may be due to the prevalence of helicobacter pylori infection among patients with peptic ulcer which needs more investigations. Other effective factors may be life style and nutrition.

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Introduction: Endocrinopathy is a known consequence of external beam radiotherapy to the brain tumors. The aim of this study was to find out the incidence of hyperprolactinemia in brain tumor patients treated with radiotherapy, when radiation portals included whole hypothalamus and pituitary glands. Materials and Methods: This descriptive study was conducted from December 2004 to February 2006 on about 42 patients with brain tumors. They were referred to radiation oncology center of Hamadan to be treated with external beam radiotherapy, whose radiation portals included whole hypothalamus and pituitary glands. Serum prolactin levels were measured at the beginning of treatment, and at one month, three months, six months and one year after completion of radiotherapy. Data was introduced using descriptive statistics. Results: Of 42 patients 6 were excluded one because of previous hypothalamus and pituitary radiotherapy, three because of nonadherence to follow up program and two because of previous endocrinopathy Of the patients attending the follow up clinic, 11% were found to have hyperprolactinemia at six months, and 22 at one year. This condition in women and men was 37% and 15% respectively. Conclusion: Abnormality in Prolactine secretion is a late complication of brain radiotherapy and a significant number of patients develop hyperprolactinoma following radiotherapy to the brain (hypothalamus and pituitary region). It seems this complication increases by increasing the radiation dose and is more prevalent in women.

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Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder (DBD). In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. Materials and Methods: This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after intervention (family training). The disruptive behavior of the child was assessed with child behavior checklist (CBCL). Cortisol levels and score of behavior were compared before and after intervention. Data was analyzed using descriptive statistics, paired t-test and pearson correlation. Results: Salivary cortisol before family training was 7.9±4.6 nmol/L and after that was 10.46±3.84 nmol/L which was significantly different (p<0.001). Behavior score before intervention was 72.05±10.10 and after that was 49.361±1.89 that was also significantly different (p<0.0001). Children with lower basal salivary cortisol had a better response to intervention. Conclusion: Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also a factor to assess the response to parent training in children with DBD.

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Introduction: Sodium arsenite is an environmental pollutant which its amounts in industrial cities are more than other places because of its use in chemical industry. Human populations are exposed to this chemical compound through food, soil, air and water which has toxic and histopathological effects on different body organs including kidney. The aim of this investigation is to study the quantitative histopathological effects of sodium arsenite on the kidney structure of rats. Materials and Methods: 12 male Wistar rats with mean body weight of 200±20 g were randomly divided into 2 groups (n=6). One treated with sodium arsenite (8 mg/kg/day in drinking water) and the other one (the control group) received drinking water only. 2 months after treatment the rats were weighed, anesthetized with ether and dissected. The left kidney was taken out, cleaned, weighed and then fixed in 10% formaldehyde solution. After obtaining 1mm thick slices, tissue processing was carried out, then 5µm thick sections were prepared and stained using H&E method. Slides were finally studied stereologically and data was statistically analyzed using paired sampled t-test and the means were considered significantly different at p<0.05. Results: The results of this investigation indicated significant reduction in the total mean volume of kidney (p<0.001), cortex (p<0.001), and medulla (p<0.003) in sodium arsenite treated group compared to the control rats. The mean volume of tubules and interstitial tissue as components of cortex reduced significantly compared to the control group (p<0.003).The mean volume of glomeruli and Bowman's capsule was significantly reduced in treated group (p<0.001), while the other components did not show a significant reduction in volume. A significant reduction was also found in the kidney (p<0.002) and the body weight (p<0. 01) in the treated group compared to the control ones at the end of the experiment. Conclusion: It was concluded that exposure to sodium arsenite leads to histopathological changes in kidney structure, however more studies are needed to determine the effects of these structural changes on the kidney function.

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Introduction: Homocysteinemia is currently regarded as an independent risk factor in venous thrombosis and vascular diseases. So noticing its causes and risk factors in high risk populations, such as elderly and chronically ill patients is of much importance. This research is designed, considering the important role of homocysteinemia and the lack of statistics and adequate information about the prevalence of this disease among hospitalized patients in Intensive Care Unit (ICU). Materials and Methods: The is a descriptive, cross-sectional study, done by census sampling method on patients admitted in ICU of Rasoul-Akram hospital, during a 6 months period. Epidemiologic data was collected from the patients' files. A blood sample was taken from the patient to measure homocysteine level. Data was introduced using descriptive statistics. Results: 52 patients with the mean age of 58.42 were included in this study. Among these, 12 (23.1%) had a high homocysteine level and the other 40 patients (76.9%) had a normal range of homocysteine. The mean homocysteine level in patients with normal levels was 9.28(3.08-15.48) micromol/dl and the mean in patients with homocysteinemia was 21.05(11.05-31.05). Among patients with homocysteinemia, 25% had renal failure and 25% were presented with cerebrovascular accident (CVA). There was no significant difference between homocystein level in patients with renal failure and those with CVA. Conclusion: According to the 23.1% frequency of hyperhomocysteinemia in hospitalized patients of our study, also considering the Folate and vitamin B6 and B12 role in homocysteinemia, and also due to previous epidemiologic studies, it seems that evaluating Folate, vitamin B6 and B12, creatinine clearance and plasma albumin level may clarify the role of these factors as the probable predictive factor in patients with homocysteinemia

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Introduction: Impressive research demonstrate the importance of essential fatty acids for many physiological and behavioral mechanisms in both humans and animals. Essential fatty acids must be supplied via the diet. In this study the dietary effect of cis and trans fatty acids on seizures induced by Pentylenetetrazol (PTZ) in second generation of rats is studied. Materials and Methods: In this experimental study animals were divided into four groups. In the three case groups cis, trans, or cis+trans fatty acids were added to the standard food of rats and in control group only standard food was dietary administrated. After one month, kindling was established in rats with PTZ in subconvulsive dose (45mg/kg i.p.). Convulsing activities were monitored for 20 minutes. Five stages of convulsing activities were observed. If after three consecutive sessions the animal was in the fifth stage, it was considered as a kindled animal. Data was analyzed using K-S, t, Tukey tests and analysis of variance. Results: Results showed that the convulsion stage in trans group was significantly more than the others. Also it was found that duration of the fifth stage in trans group was significantly more than control and cis groups. Conclusion: Results suggest that, administering sis and trans fatty acids have some effects on PTZ induced kindling in second generation of the rats who were kindled before. More severe seizure and longer duration of seizure was seen in trans group comparing to cis

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Introduction: In resent years, neuronal type Na+ channel is one of the important currents for action potential depolarization phase in heart cells. In this study neuronal type Na+ channel is blocked by low concentration of Tetrodotoxin (TTX) to compare the effect of TTX blocker on pacemaker activity of sinoatrial node (SAN) and atrioventricular node (AVN) of mouse heart. Materials and Methods: In this experimental study the pacemaker activity of distinct intact SAN and AVN, was recorded before and during consuming 100 nM TTX, and cycle length (CL) was measured. Data was analyzed using t-test. Results: 100 nM TTX increased CL on SAN preparations by 22.2±6% and on AVN preparations by 52.5±13.5 %. These changes were significant in the two nodes. Conclusion: It is passible to conclude that the neuronal type Na+ channel was present in the two nodes, and the effect of TTX on CL of the two nodes was different.

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Introduction: Previous investigations and available data demonstrate that there are different patterns of diseases distribution in developed and developing countries. While in developed countries the major cause of death are cancers, in developing countries the main cause of death are infectious diseases. Various factors may be responsible for different causes of death in two those groups of countries. There are raising scientific evidences that some infectious and parasitic organisms when enter the body may effect the tumor growth. In order to explore this presumption, in this work the effect of Leishmania major infection on fibrosarcoma tumor growth in mouse model has been investigated. Materials and Methods: In this experimental study a group of inbred mice (n=6) were infected with Leishmania major as case group. After one month both these mice and some more mice as control group (n=6) were challenged with fibrosarcoma cells. The size of growing solid tumors was measured in individual mouse every two days up to two weeks. This measurement was performed 5 times on days 5, 7, 11, 13 and 16. Tumor area was also calculated for every single mouse. T-test was used to analyze data. Results: Results of this work showed that the mean size of tumor in case group was smaller than that of control group only in the first week following challenge with fibrosarcoma cells but the tumor mass was bigger in days 13 and 16 in case group. However the difference between the tumor mass in case and control groups was not statistically significant. Conclusion: Results of this investigation revealed that there was no significant difference between the tumor mass in case and control mice. However to explore more about the hypothesis of this study, it is recommended that the research work be carried out using different tissue parasites and also different cell lines.

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Introduction: Oculogyric crisis which is a dystonic reaction, is commonly caused by neuroleptics and rarely occurs with atypical antipsychotics specially Clozapine. In this article a case of Clozapine induced oculogyric crisis is reported. Case: The patient was a 25 years old woman with auditory hallucination, loosening of association and persecutory delusion that was admitted and treated. Because of poor response to typical antipsychotics, Clozapine was prescribed. Then she experienced multiple episodes of oculogyric crisis and was treated successfully with anticholinergic medication (Artane). Conclusion: In this special case, Clozapine caused oculogyric crisis. This side effect is rare but should be considered as a possible adverse effect of Clozapine. On the basis of this report, Clozapine induced oculogyric crisis may be treated successfully with Artane

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Introduction: Sneddon syndrome is a combinaison of skin lesions (Livedo Reticularis) and acute cerebrovascular accident. The syndrome involves many organs such as kidney, heart, skin and brain. Some patients have a good prognosis when taking Aspirin and Diprydamol. In this article a case of this syndrome is reported. Case: The patient is a 40 years old woman with a history of 8 times intrauterine fetal deaths. She was admitted to the neurology ward with signs of weakness in left side of the body (hemiparesis), dysarthria, 7th central nerve paralysis, and skin lesions (Livedo Reticularis). All laboratory data such as serology and microbiology were normal. After skin biopsy from the lower limbs and rule out possible secondary etiologies, this patient was recognized with Sneddon syndrome and recieved antiplatelet treatment. Conclusion: Despite the fact that this syndrome is rare, it seems considering the probability of appearing this syndrome, especially in young patients who are suffering from acute cerebrovascular signs and skin lesions in the same time, early treatment can prevent the desease from developing to other organs.

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Introduction: Wilson disease is a hereditary disorder of Copper metabolism which can present with hepatic, neurologic or psychiatric symptoms and in rare cases as a hemolytic disturbance. Free Copper can result in red blood cell damage and hemolysis which is a rare feature of the disease affecting less than 10% of patients. In this condition the liver is usually involved and liver transplantation can be life saving. This article is a case report of acute hemolytic crisis as the initial manifestation of Wilson disease. Case: An 8 years old girl was admitted in pediatric ward of Golestan hospital because of abdominal pain, icterus, anemia and tea color urine. Hepatitis or Glucose 6 Phosphate Dehydrogenase deficiency was the first diagnosis. Because of unresponsiveness to transfusion, Wilson disease was considered and the diagnosis was established with the presence of Kayser-Fleischer ring. Conclusion: Chronic or acute hemolytic anemia is a rare or unusually presentation of Wilson disease. In any child especially older than 5 years with liver disease or hemolytic anemia, Wilson disease should be considered and appropriate diagnostic tests performed

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Introduction: Relationship between Multiple Sclerosis (MS) and primary headaches is not well recognized yet and the studies that have been done had different results. The aim of this study was to investigate the relation between primary headaches and multiple sclerosis. Materials and Methods: In this historical cohort study, 117 patients with actual MS were selected by convenience sampling as case group and 351 healthy subjects as control group. The incidence of primary headaches was assessed by a physician using a questannaire. Variables under investigation were age, sex, type of MS, Expanded Disability Status Score (EDSS), and characteristics of headache based on International Headache Society (IHS) classification. Data analysis was done using Chi-square, t-test, Fisher exact test, and logistic regression. Results: 53.8% of MS group and 27.4% of control group had chronic headaches (p=0.0001). Frequency of Migraine and tension type headaches among patients with headache in MS group were 73.1% and 26.98%, and in control group were 40.6% and 58.7% respectively. There was a statistically significant relation between Relapsing-Remitting MS and migraine headache (p<0.001).There was not any correlations between headache and using Interferone, MS duration, and EDSS. Conclusion: The results of this study indicate that primay headaches, especialy migraine without aura, are common in MS patients comparing to general population.

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Introduction: Many research demonstrate the effect of margarine trans fatty acids on many physiological mechanisms in both human and animals. The purpose of this research was to evaluate the effects of margarine oil on reproduction in Wistar rat. Materials and Methods: ‏This is an experimental study in which 46 Wistar female and male rats were divided into 4 groups. Male and female rats in group 1 were fed by 3% Margarine oil and standard food, in group 2 only female rats and in group 3 only male rats had Margarine oil with the standard food. Male and female rats in group 4 (as control group) had only standard food. Administration was started one month pre mating and continued during mating, gestation and lactation periods. After delivery, the pups were assessed for overall number, sex ratio, body weight, and mortality. One way analysis of variance was used for data avalysis. Results: ‏Results showed that weight and female ratio of pups were significantly increased in group 2 as compared to group 1 and control. Also the comparison of pups’ mortality in the four groups showed that pups mortality was increased in group 2 as compared to the other groups. On the other hand there was no significant difference in number of pups in the four groups. Conclusion: The results showed that dietary Margarine oil administration to female rats can significantly increase weight, ratio of female pups and mortality of pups.