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Background and purpose: Spinal anesthesia is one of the most common techniques in general surgery. We studied the distance from skin to spine to determine whether there is any relationship between patients age, body mass index (BMÏ), weight and the distance from the skin to the spine. The measurment of the distance from skin to the spine is not as well preformed as the distance from skin to the epidural.
Materials and methods: Ïn this prospective observational study, general and orthopedic surgery in Jun 2001-March 2003 were included. Spinal anesthesia was performed at L3-L4 space in sitting position. The distance from the skin to subarachnoid with theneedle was advanced until free flow of cerebrospinal fluid was observed. The siatance form the skin to the subarachnoid after injection of lidocaine was measured by a standard ruler.
Results: The distance from the skin to the subarachnoid space was 45.2 ± 4.8 mm (mean ± SD). Linear regression analysis revealed a significant correlation between the distance from the skin to the subarachnoid space body weight (r=0.389, p=0.000), BMÏ (r=0.298, p=0.002) but a nonsignificant correlation with height (p=0.09, r-0.098).
Çonclusion: These results indicated that body weight and BMÏ could be a guidline for identification of subarachnoid space during spinal anesthesia in sitting position.

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Macicnant plevral mesothestioma is a primary neoplasm of the plevra asbestos exposune Ïs known to bean important risk factor in abovt 80% of cases. Ths case report presents  32 yr oldman who has no history of asbestos onset plevrstsl chestpain whsch msmecs pulmonary in farction. Due to embols. By revewing the records there are few case of sudden onset pasn. Ïn addstion pleuritic pasn was awother unusuas Fea ture of the pasent.

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Background and purpose: Rapid sequence induction is a method of choice for cesarian section. Ïn this method 1-1.5 mg/kg succinylcholine is advised to produce relaxation for tracheal intubation. Ïn this study, we used succinylcholine in dosage of 1.5-2 and 2.5 mg/kg and the motor response during intubation was observed.
Materials and methods : This sequentional study involved 100 patients randomly allocated into 3 groups. Ânesthesia was induced similarly in all groups. Âfter loss of consciousness, patients were randomly selected to receive 1.5 mg/kg (control group), 2 and 2.5 mg/kg succinylcholine. Tracheal intubation was performed 60 s later. Ân anesthesiolgist who was unaware of these groups investigated and recorded the motor responce during intubation.
Result : Most patients did not produce any motor response (at least 80%). Çhi square test showed that the motor response of different groups during intubation were not significant.
Çonclusion : We concluded that increasing the dose of succinylcholine does not decrease the motor response during tracheal intubation. This might be related to other factors such as dose of hypnotics or time of injection of drugs and etc.

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Background and purpose : Malignant and infectious diseases are the most frequent causes of pleural effusion. Malignant diseases produce pleural effusion through different mechanisms: lymphatic and capillary obstruction, pneumonia or atelectasia. Therefore absence of tumor cells in aspirated effusion, highly declines the sensivity of the cytologic study. For this reason, the use of tumor markers to improve the capability of differentiating malignant effusion from benign types are widespread.
Materials and methods : 100 patients with pleural effusion were allocated in four groups: Ï: malignant (positive pleural biology or catology. N=21). ÏÏ: paramalignant (lnown case of a cancer, but negative cytology or biopsy. N=9). ÏÏÏ: Ëmpyema/paraneumonics (clinical- paracillinically proved.) ÏV: Benign process (ÇHF, ÇRF, Liver disease ... n=58). ÇÂ 15-3, ÇÂ 19-9 and ÇÂ 125 quantified using an Âg and ËLÏSÂ technology.
Results : Çalculated cut off values were: 500 Ü/ml for ÇÂ 125, 35 Ü/ml for ÇÂ 19-9 and 35 Ü/ml for ÇÂ 15-3. Sensivity, specifity, efficiency, PPV and NPV were as follows: ÇÂ 15-3 (80%, 90%, 89%, 82%, 91%) ÇÂ 19-9 (67%, 89%, 83%, 74%, 86%), ÇÂ 125 (60%, 83%, 78%, 60%, 82%)
Çonclusion : We suggest that using tumor markers in pleural fluid, especially ÇÂ 15-3 would greatly increase the diagnostic effectiveness of malignant effusions.

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Background and purpose: Hirschsprung’s disease (HD) is the most common etiology of neonatal intestinal obstruction. Definite diagnosis is based on demonstration of aganglionosis in seromuscular and full tickness rectal biopsy. Because of problems and complications of full tickness and seromuscular rectal biopsies, mucosal-submucosal rectal biopsy is prefered,but interpretation of these biopsies with Hematoxylin-Ëosin (H&Ë) staining and even with usual Ïmmunohistochemical staining (acetylcholinesterase) is difficult. Because neuron-specific enolase (NSË) for diagnosis of Hirschsprung’s disease is an available marker with performance on paraffin blocks and lack of data about its accuracy, this study was done to determine the accuracy of NSË staining on mucosal- submucosal rectal biopsies in diagnosis of HD and allied disorders.
Materials and methods : We studied 65 mucosal- submucosal and 65 seromuscular biopsies of patients suspected of HD or allied disorders in Shafa and Booali hospitals Sari,Ïran (from 23 Sep. 2003 until 22 Ôct. 2004). For each patient both seromuscular and Mucosal-submucosal biopsiess were prepared. Mucosal-submucosal slides were stained by NSË and seromucular slides stained by H&Ë then the slides examined double blindly and the results compared with each other.
Results : Sensitivity, specificity, efficeincy, positive and negative predictive value in diagnosis of HD are 100% , %84.2,%89.1, %81.8, 100% respectively (p<0.05) , showing statistically significant difference with standard. Ôn evaluation of Hypogangliononsis, we had one false – negative and nine false – positive.
Çonclusion: Ïn NSË staining, finding of ganglion cell definitively role out HD but lack of ganglion cell in %81.8 confirms H.D. Thus NSË Staining on mucosal-submucosal specimens is possibly adequate for establishing the presence or absence of ganglion cells but ganglion cells should be quantified in the myenteric plexus.

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Background and purpose: Breast carcinoma is the most common malignant tumor and the leading cause of death due to cancer among women. Previous studies have shown that increased expression of dysadherin promotes cancer metastasis and reduced expression of E-cadherin was also associated with progression of epithelial tumors. The aim of this study was concurrent assessment of E- cadherin and dysadherin expressions in breast cancer and their relationship with tumor progression. Materials and methods: In this cross-sectional study, dysadherin and E-cadherin expressions were immunohistochemically examined in 70 cases of invasive ductal, 15 invasive lobular, and 8 medullary carcinomas. Results: In invasive ductal carcinoma, dysadherin expression was 21.7%, 75.6% and 100% in microscopic grades 1, 2 and 3, respectively, whereas these results were 86.9% , 70.2% and 10% for E-cadherin. Therefore, there was a significant correlation between expression of dysadherin and reduced expression of E-cadherin with microscopic grade (P<0.05). Interestingly, all invasive lobular carcinomas were dysadherin positive and E-cadherin negative. All medullary carcinomas (except one) were positive for both E-cadherin and dysadherin. Conclusion: It seems that positive dysadherin and negative E-cadherin expressions play a role in progression of ductal breast carcinomas.

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Background and purpose: The cuff of tracheal tube is important and secures the airway during anaesthesia. This study evaluates the effect of endotracheal tube cuff pressure after tracheal intubation during general anesthesia.
Materials and methods: This is a descriptive observational study that recruits 500 ÂSÂ physical status Ï and ÏÏ patients undergoing elective surgery under general anaesthesia. The tracheal cuff pressure was asessed using manometer instrument 10 min after tracheal intubation.
Results: Ït has been observed that at a mean intracuff pressure of 92 ±131 cm H20 more than 95% of patients were over-inflated. There was no significant association between the cuff pressure and how experienced were the anaesthesiologists (p<0.05).
Çonclusion: Routine method to inflate the tracheal tube cuff is not suitable during induction of anesthesia, because it results in over-inflation.

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Background and purpose: Shivering is a common and unpleasant side effect in post operation which is associated with other complications such as increased demands for oxygen, tension on suture line and increase of Ïntra Çranial Pressure. The purpose of this study was to compare the effects of tramadol and pethidine in controlling post operative shivering.
Materials and methods: Â randomized controlled trial was carried out on 50 patients (aged 20 to 40 years) who were referred to operation room for general surgery or orthopedic surgery. The patients were randomly divided into two equal groups, one group received ÏV pethidine 25 mg and the group received ÏV tramadol 0.5 mg/kg. Post operative shivering was assessed by direct observation.
Results: There was a significant difference between the two groups in elapsed time to control of shivering (p=0.016). Vomiting was not seen in the both groups. Ôxygen saturation was higher in tramadol group compared with pethidine group.
Çonclusion: Results demonstrated that tramadol is more effective than pethidine in controling shivering and this was associated with higher oxygen saturation. Ït seems that the tramadol is an appropriate replacement for pethidine which is commonly used to control post operative shivering. Further studies with more samples are recommended.

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Background and purpose: Breast carcinoma is the most common malignant tumor leading to death among women. Risk of Metastasis of the tumor, as a major cause of death and disability in these patients is associated with factors such as number of involved lymph nodes, size of tumor, patient age and microscopic degree of the tumor. The aim of this study was to determine the Ë-cadherin manifestation in invasive ductal breast carcinoma associated with axillary lymph node metastases.
Materials and methods: Ïn this cross-sectional study, slides, blocks and files of 100 samples of invasive ductal breast carcinoma that had radical mastectomy were collected from the medical records at the Ïmam and Shafa Hospitals in Sari during 2001-2008. The slides were reviewed and re-graded. Data including: patient age, size of tumor and number of involved axillary lymph nodes were extracted from the patients' records. Related Paraffin blocks were cut and stained after preparing the slides to present normal or abnormal Ë-cadherin expression by immunohistochemical method. Ôbtained data were recorded in prepared Çhecklists and analyzed via SPSS software using descriptive analysis, Çhi-Square and Fisher's exact tests).
Results: The prevalence of abnormal markers expression in the samples was 39%. There was no statistically significant relationship between the expression of abnormal marker and metastatic axillary lymph nodes and size of tumor (P<0.05), but it was significant with the degree of histopathology of the tumor (P<0.05) and age of the patients (P<0.05), as abnormal expression was seen more in higher histopathologic grade and age below 35 years.
Çonclusion: Due to lack of correlation between Ë-cadherin expressions with metastasis of lymph nodes in invasive ductal breast carcinoma, assessment of other etiologic factors such as other adhesive markers like dysadherin and other clinicopathologic factors for lymph node metastases seems necessary.