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Perichondritis and chondritis are rare disease of auricle than may be due to burns surgery or trauma and can present with severe pain erythema and edema. Herpes Zoster, that is due to reactivation of virus in nerve root that present with vesicular group in erythematous fild cranial or spinal nerve innervated zone can present with sever pain and some factors include stress-chemotherapy and really surgery can facilate activation of them. We report a case with perichondritis-chondritis and herpes zoster that had reaction to chromic material after tympanomastoidectomy and with medical treatment and debridement with some sequela healed. The importance of this case is multipathological that can mislead the clinication.

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Depression is a common disorder in the world. Depression may due to general medical condition disorder such as diabetes mellitus. This study explains the relationship between diabetes M and depression (Prevalence, age, duration, sex, type, control of disease) among diabetic patients. This is a analytical and cross-sectional study. Sampling has been done by random among out-patients diabetics in Gorgan 5th Azar Hospital, diabet clinic, during year 2000. About 100 NIDDM diabetic patients type and 50 IDDM type selected by randomization. They were assessed according to age, sex, FBS, HbA1c, duration, type and beck inventory standard test. The findings showed: 40.6% have moderate and sever depression with beck test over 21 points. There are a significant relationship between age of diabetic patients and depression (P<0.14). There are a significant relationship between duration and depression. There aren’t any relationship between sex and depression (P>0.81). There aren’t any relationship between type of diabet and depression (P<0.236). There aren’t any relationship between HbA1c and depression (P>0.85). Depression is more common among diabetic patients than general population and incidence have a direct relation with age and duration of disease.

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Cutaneous metastasis from carcinoma of the larynx are very rare. We observed a 75-year-old male patient with squamous cell carcinoma of the larynx who developed a subcutaneous nodule as an abscess presentation in the buttock. It was found to be a metastatic squamous cell carcinoma of the laryngeal cancer, histopathologically. The skin manifestations proceeded laryngeal metastases by 18 months after laryngectomy and radical neck dissection. After 3 months, the patient died. Cutaneous metastasis of laryngeal carcinoma should be considered in all patients with previous laryngeal carcinoma representing with cutaneous lesion.

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Background & Objective: Major ?-Thalassemia is the most common form of anemia, which has a relatively high prevalency especially in the northern part of the country one of this disease side effect the hearing abnormality. This study has been carried out in Gorgan for the determination of the hearing level of ?-Thalassemic patients, and its relation with the level of serum Ferritin, the rate and the duration of blood transussion and dyspheral. Materials & Methods: In this study 95 patients with major ?-Thalassemia have been studied for the rate of hearing level. The variation parameter include age, gender, Ferritin level, the rate and duration of disferal consumption. Audiometry, tempanometry and physical examination carried out on all the patients. The findings from this research gathered and were analyzed using the SPSS statistical software. Results: 95 patients (190 ears) with age 3-29 year of old were gone under this study and only 72 ears had the threshold over 15 decibel, from this 43.9% were from sensorineural type of hearing. The 80% of ears’s thempograms were type A. The results from this study showed that there is a meaningful statistical correlation between the hearing loss and serum Ferritin level. The rate of dyspheral consumption, in each time and its duration (P<0.05). Conclusion: This study showed that high serum Ferritin level and the increased length of dyspheral consumption lead to the hearing loss in major ?-Thalassemia, therefore clinical examination of hearing interrally has to be carried out.

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Background & Objective: Peritonsillar space infection can be occurred either as cellulitis or abscess formation. Antibiotic therapy, needle aspiration insicion, drainage and finally tonsillectomy are among the types of treatment, which may be carried out in this disease. When tonsillectomy was not done, the recurrence of peritonsillar abscess may be observed. The present study was set up to find out the recurrence rate of peritonsillar abscess with the type of treatment the patient is received. Materials & Methods: This study was done on 52 patients with peritonsillar space infection, 45 cases of these patients were presented with peritonsillar space abscess. The primary procedure such as recording personal demographic and previous medical treatment on this patient was done. These patients were home visited by doing that, the rate of recurrence, re-hospitalization, the possible duration of recurrence and elective tonsillectomy were evaluated, these patients were also clinically examined. The gathered informations were analyzed by statistical software (SPSS). Results: From 45 peritonsillar space abscess, 8 cases (17.7%) were recognized as recurrence, from these numbers of patients 6 cases (13.3%) and 2 cases (4.4%) had once and twice recurrence respectively. The highest recurrence was seen among the patients with drug treatment. There was a meaningful correlation between the method of treatment and the rate of recurrence incidence (P<0.05). The highest rate of recurrence was among 20-29 years of age. The prevalence of peritonsillar space abscess in women and men were 28.9% and 71.1% respectively. Winter and spring were the seasons with highest incidence. The rate recurrence of this abnormality among men and women were 15.6% and 23% respectively. Conclusion: It is recommended the patient with peritonsillar space abscess to have tonsillectomy especially later in adulthood, because of high incidence of recurrence. In cases where that abnormality is controlled by drug treatment alone, the tonsillectomy should be taken into consideration.

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Background & Objective: The most common disorders in psychiatry are anxiety disorder. The onset is from adolescence through early adulthood. Some people due to various reasons are susceptible to these disorders, such as airport tower’s controller. This study was done in order to determine anxiety level and its relationship with some variables such as age, length of employment, gender, education, marital status, cigarette consumption, physical training and employment satisfaction. Materials & Methods: This was a cross-sectional descriptive analytical study, which was performed on all of the controller personals (101 samples) during spring 2003, at Tehran Mehrabad Airport, control towers controllers. They were studied by using an anxiety questionnaire. The relationship between anxiety level was determined by 8 independent variables. Results: The findings from this study indicated the following results: Undetectable minor anxiety (22.8%), mild intermediate anxiety (52.5%) and high-very high anxiety (24.8%). Conclusion: According to the results from this study. The employment satisfaction could play an important role, in preventing the anxiety. In this sensitive job, the personal attention and concentration is of upmost importance, any factor that disrupts, this concentration should be prevented, otherwise unwanted accidents may happen. Therefore it is suggested that the responsible authorities select, the appropriate persons and provide them with a good and satisfactory job conditions to pave the way for the up grading the level of immunity in air flight.

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Background&Objective: The scale of depression and the cost of prevention in some disease such as chronic renal failure is high. The present study was set up to determine the scale of depression among the haemodialysis patients. Materials&Methods: The present study a cross-sectional research. The sample population was all of the haemodialysis patients in the Golestan province (129 patients with the age group 11-77 years). The infromation gathered using, two questionairs included demographic characteristic and Beck depression inventory (BDI). Results: It showed that 37.2% of patients suffered from low to modrate depression and 31% from severe depression. Among different variable there was only significant correlation between depression and etiology of chronic renal failure (P<0.05). Conclusion: This study showed that depression is a serious problem in haemodialysis patients and a threat for their health. It is suggested that periodic psychiatric clinical examination should be carried out to have early diagnosis and subsequent treatment of haemodialysis patients.

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Background&Objective: Nowadays epidemiologic paterns of the diseases are verifying rapidly non-contagious diseases like mental disorders are replacing contagious one. Several people, unaware of their psychiatric problems seek medical advise and treating. College students are susceptible to mental disorders because of their conditions. This research was done to evaluate mental health state in students of Golestan University of Medical Sciences. Materials&Methods: 218 students of Golestan University took part in this research. SCL-90-R was the test for evaluation, after collecting the questionnaires and entering into SPSS-10 software, data were analyzed with chi-square and Fisher-exact test. Results: The momental prevalence was estimated 72%. 157 persons had disorder, at least in one dimension, and 16 persons (7.34%) had severe disorder at least in one. Marriage and psychosis, paranoid & anxiety had meaningful relations (P<0.05), residental site and paranoid had meaningful relations (P<0.05), higher levels of father’s education and interpersonal sensitivity had meaningful relation (P<0.05), Family history of mental disorders, moderate interest in education, field of study and phobia had meaningful relationships (P<0.05), females had higher scores in depression (P<0.05). Conclusion: According to this high prevelence of mental disorders it seems that mental health’s problem is critically high in this region, much more attention should be paid to prevent further complications.

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Background&Objective: Addiction is one of major problems of today's world population. The first step on combating a social issue or disease is the proper re.organization. This study was done to determine the demographic characteristic, prototype of drug consumption and its relation with some personal and social variation in Gorgan (North-East, Iran). Materials&Methods: This study was a descriptive cross sectional research. The characteristics of 3005 addicts, was studied whom research voluntarily to the addiction clinic during 2001–2005 in the 5th Azar hospital of Golestan Medical Sciences University in Gorgan. The collected data was analyzed using the SPSS software. Results: From a total 3005 files which were studied, 2786 (92.7%) were male and the reminder were females. The meanSD of age was 36.9111.41. 4.8% of samples had university education, 21.3% high school diploma, and 61.7% were either unemployed or without any certain job. Opium with 66.7% was the substance with highest rate of consumption. In 40.2% of the cases, inhaling was the main route of consumption and in 30.9% of addict subjects taking the drugs orally. From the point view of type of drug, smocking cigarette, alcohol consumption, using cannabis and pill consumption, there was a meaningful correlation (P<0.05). The rate of addicted male subjects whom referred to the clinic to leave the addiction was 14.97% times of female subjects. 93.8% of the addicts persons had 20-50 years of age, which is an indicative of the real of age of addicted people in Gorgan. Conclusion: Unemployment can be considered as one of the main cause of high rate of addiction among the people in the society and in particular in this sample population. It seems that with education and creating employment in the region, to some extend the addiction can be controlled.

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Background&Objective: The ways of prevention of wound infections are too much, and some references mentioned that one of those ways is dressing. Dressing can cause a sort of spiritual transquility for patients, too. In the other side, doing it causes some kinds of limitations such as preventing of taking a bath or spending expenses. So, we decided to consider the influence of continuation of dressing, on the rate of wound infection, after first 48 hours post operation.
Materials&Methods: In this research, we studied on 150 patients who were under the same surgeries, So that in the half of them, after 48 hours dressing were removed, and in the half remaining, dressing were changed daily for one week. In both groups, in the third, seventh and thirtieth day after surgery were inspected and examined by surgeon, in the case for having or absence of symptoms and signs of infection. In subgrouping patients we considered some factors include age, sex, type of operation and predisposing diseases. The 30 th day post operation was the end of our study and information analyzed in the computer with SPSS software.
Results: The average age in the group of without dressing was 35.12±20.19 and in the group with full dressing was 37.61±18.78 years. There were 74 men and 76 women. There was Just one wound infection in our study, who had dressing for one week. The case was woman without serious disease, and a half day before surgery was admitted in the hospital. In the group without dressing, we did not have any wound infection. 5.3% were nervous in the no dressing group and the 17.3% of patients with dressing were anxious of having their bath with delay.
Conclusion: According to the no impression of dressing on the rate of wound infection in the clean surgeries after first two days and also lack of considerable anxiety in the non dressing group, we recommend picking up the clean wounds dressing after 48 hours and make patients feel guaranteed.

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Background & Objective: Propofol is one of the latest anesthetic agent which has many advantages with few side effects in patients. One of the application problems of this drug is pain at the time of injection. Several methods are investigated to reduce the pain, and one of them is the application of Lidocaine together with Propofol.

Materials & Methods: This randomized clinical trial study was done in 5th Azar teaching during 2007. 272 patients were selected randomly between age of 15-55 years with ASA Class I,II who were the candidates of elective surgery. We injected  Fresenius %1 to the first group with 91 patients, Lipuro %1 to the second group with 90 patients and Propofol drug Lipuro %1 mixed with 20 mg Lidocaine (2 ml of Lidocaine %1) to the third group with 91 patients. Injections was carid out on the supenlial vein of dorsal hand. Patients were asked about the severity of pain at the time of injection, 5-10 seconds after %25 of anesthetic induction doze. Data analyzed with using SPSS software and Chi-Squre test.

Results: The rate (incidence) of pain (Score 1-3) has been 63.91 (%69.2) in the first group, 50.90 (%55.6), and 22.9 (24.2%) in the third group in which there is a significant difference (P<0.001). Moderate and sever intensity of pain (Score 2.3) was 42.91 (46%) For the first group, 18.90 (20%) for the second group and 2.91 (2.2%) for the third group (P<0.001).

Conclusion: On the basis of this study, it is recommended to use lidocaine, at the time of injection, to reduce pain.

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Endoscopic sinus surgery can cause orbital and intracraniol complications. Anisocoria is one of sings of orbital complication. We report a case with anisocoria during endoscopic sinus surgery. Patient was a 42 years old female that was operated because extensive polyposis in right nose and sinuses and retention in otherwise under general ansthesia. A half on hour after the surgery was started, we found dilatation of pupil in left eye which unresponsed to light. Also, as far as the eye symptoms returned to normal after 8-10h after and there was not any veridence of orbital trauma. It seems difiusion of local injection of adrenalin in surgery nasal cavity can probably case of pupil dilatation.

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Background and Objective: Today, drug abuse is one of the most important medical and social problems of world population, which can be a threat to human’s health. Cannabis as a common substance can create psychotic symptom, psychiatric disorders and antisocial behaviors. This study was designed to compare the prevalency of psychoticism and neuroticism among cannabis and non-cannabis abusers in this region of the country. Materials and Methods: This case control study was done on100 cannabis users whom seek for drugs in public gardens of Golestan province as case group and 100 non-abusers who spend their leisure time in this place as control group. Two groups matched with regard to age and education level. The data gathered by using self-reported adult version of Eysenck Personality Questionnaire (EPQ). The data was analyzed in the SPSS-13.5 software by Chi-square, t-test and Mann-Whitney. Results: The mean score of psychoticism and neuroticism in case and control group was 9.37 and 5.72 respectivley (P<0.05). The mean score of neuroticism in cases and controls was 15.9 and 12.19, respectivley (P<0.05). The relationship between psychoticism and patterns of cannabis consumption was significant (P<0.05). There was a relationship between cannabis consumption and the history of drug misabuse in other substances in cannabis users and in their families. Conclusion: The result of this study can clarify the importance of preventing intervention in substance abuse for improving mental health.

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Background and Objective: Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra abdominal organ injured more than others, related to mechanism of injury, size and location of organ in abdominal cavity. This study was carried out to determine the prevalence of intra abdominal injuries due to penetrating trauma. Materials and Methods: This retrospective descriptive study was done on 114 patients admitted to 5 Azar hospital in Gorgan, Iran due to penetrating abdominal trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitlalization period were obtained form patients files. Results: 92.1% of patients were male. The mean age of subjects was 24.8 years (9-70 years) with highest frequency between 20-24 years. Two (1.8%) deaths directly related to abdominal stab wounds related to hemorrhagic shock. The most common cause of penetrating abdominal injury was knife wound (78.9%). The mean time spent in hospital was 4.6±2.8 days. In 53 patients, cause of trauma were either related to pentration into peritoneum or passing through in. Small intestine injuries (14 %), rupture of diaphragm and concurrent lung injuries (7%) were the common damage organs. Conclusion: This study showed that the knife was the main cause of abdominal penetrate trauma and peritoneum was the most common damage tissue.

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Background and Objective: Headache is one the most common compliant of patients and has different causes and the migraine and tension headaches are common. Personality is characteristics forming an individual distinctive manner. This study aimed to determine the frequency and association of different types of personality characteristics in patients with migraine and tension headaches. Materials and Methods: This descriptive-analytic study was done on 160 (12 male and 148 female) subjects with chief complaint of headache whome referred to 5th Azar clinics of Gorgan, Iran during 2007-08. Subjects were selected by simple random sampling and were examined by either a neurologist or psychiatrist patient with diagnosis migraine either of or tension headache were included. Selected patients evaluated by short form of Minnesota Multiphasic Personality Inventory (MMPI). Data were analyzed using SPSS-13 and Chi-Square test. Results: The mean age was 11.18±33.29 in women and 34.33±13.7 in men. 96 patients (60%) had tension headache and 64 (41.2%) had migraine. In tension headache, depressed personality (43.8%) and hysterical personality (16.4%) were more common but in migraine headache, depressed personality (48.9%) and paranoid personality (20%) were common but this difference was not significant. Conclusion: This study showed that there is no relation between personality characteristics with tension headach and migraine.

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Background and Objective: Impacted molars teeth, especially third molar, are important in most branches of medical sciences. The angular position of molar teeth is in side effects and therapeutic regiment. This study was conducted to determine the angle of the impacted mandibular third molars. Materials and Methods: This descriptive study was carried out on 429 patients (269 men and 160 women) selected for surgery on impacted mandibular third molar in the oral and maxillofacial surgery clinic in Gorgan, Iran during 2010-11. Pre-operative diagnosis was done by physical examination and OPG radiography. Demographic characterstics including age, gender, ethnicity, impaction angle were recorded for each subject. Data were analyzed using SPSS-16, independent t-test and chi-square test. Results: Totally, 480 impacted third molars were studied. Mean age of patients was 26.06±6.21 years. Impaction of the third molar was more prevalent among men (62.7%) than women (38.30%). Impacted mandibular third molar of 189 people (44.1%) were in left side in 200 people (46.6%) were in right side and in 40 people (9.3%) were bilateral. According to impaction angle, mesioangular (41.7%) and distoangular (3.5%) types had the highest and the lowest frequency, respectively. In bilateral cases, the mesioangular-mesioangular type (48.8%) was the most prevalent. The mesioangular type was the most prevalent in all ethnic groups. The most prevalent angular position of the impacted third molar was the mesioangular type in both sexes. Conclusion: This study showed that the most prevalent angular position of impacted mandibular third molar is the mesioangular type.

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Background and Objective: Otalgia is a complaint triggered from either ear disorders or adjacent structures due to common innervations between ear and adjust organs. This study was done to explore the causes of primary otalgia. Materials and Methods: This descriptive study was done on 770 patients with otalgia in Gorgan, Iran during 2009-10. After clinical examination age, gender, patient complaint and signs were recorded for each patient. Results: 668 patients (86.8%) had primary otalgia including 39.9% left, 41.3% right and 18.8% bilaterally. 63.9% were female and 36.1% were males. External otitis was the most common causes of primary otalgia with 64.8%. Other causes consist of acute otitis media (14.5%), serumen (14.1%), chronic otitis media (5.8%), foreign body (4%) and trauma (3%), respectively. Conclusion: The most common cause of primary otalgia was external otitis.

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Background and Objective: Foreign body ingestion is one of the most common problems in otolarygyology in the world. Many kind of foreign body is lodged in esophagus and cause symptoms and complication. Information about patient age and type of foreign bodies and symptoms can help in management and treatment of patients. This study was done to determine the Prevalence of esophageal foreign body and its complications in Gorgan, northern Iran.
Methods: This descriptive retrospective study was done on 145 patients (61 males and 84 females) with foreign body ingestion whom admitted in 5thAzar hospital in Gorgan, northern Iran during 2004-14. Age and type of foreign body and symptoms was recorded for each patient. X-Ray in 41.4% of patients detected foreign body and esophagoscopy in others were used for definitive diagnosis.
Results: Most common chief complaint was dysphagia (42.8%). The most common foreign body was chikenbone (25.5%). Under 15 year’s old patients, coine was the most common. Most common site of lodged was 1/3 upper esophagus (62.63%). In all causes rigid esophaguscopy was used for removal of foreign body. In 56 causes foreign body in esophagus had not any complication.Complications due to foreign bodies were erision (24.82%), ulcer (21.37%), rapture of mucosal layer (6.2%), recurrent refer (4.82%), perforation of esophagus (5 cases, 3.44%) and obsess esophagus(0.68%). Mortality was seen in one patient due to fish bone ingestion.
Conclusion: Dysphagia was the most common chief complaint and coine was the most common foreign body in children. Also, erision and ulcer were the most common complications and upper one third of upper esophagus was the most common site of lodged foreign bodies.

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Background and Objective: A brief and short duration episode of ischemia is recorded in ischemic preconditioning (IPC). This latter condition provides a status in which large region of heart is protected when prolonged ischemia occurred. Levothyroxine play a protective role in IPC induction, and simultaneously with stress oxidative. This study was conducted to determine the protective effect of levothyroxine with oxidative stress reduction mechanism in ischemic preconditioning model in rat heart.
Methods: This experimental study was performed on 30 male Wistar rats in three groups of 10, as follows. In the reperfusion ischaemia group (IR), the heart of the animal was placed in a Langendorff apparatus. In the ischemic preconditioning group (IPC), prior to major ischemia, was exposed to 4 periods of 5-minute ischemia with reperfusion. In the intraperitoneally administered group, levothyroxine at a dose of 25 microgram per 100 g of body weight, the heart was exposed to reperfusion ischemia. The area of infarct and the level of malondialdehyde in the heart tissue were measured.
Results: The volume of Infarcted region in IR and IPC groups was 26.55 and 11.11 respectively. The same index for the Levothyroxine receiver was 12.56. Based on these findings it was demonstrated that Levothyroxine injection reduced the Infarcted region significantly similar with IPC (P<0.05). The MDA Levels in IR and IPC were 1328 and 777, respectively and in Levothyroxine group it was determined as 762. The size of Infarcted region in both IPC and treated with Levothyroxine groups significantly reduced in compared to IR group (P<0.05).
Conclusion: Injection of levothyroxine with ischemic preconditioning reduced the effect of reperfusion maladaptive ischemia in rat heart.

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Background and Objective: Electro convulsion therapy (ECT) is one of the most common ways for treatment of psychiatric disorders. The aim of this study was to compare the effect of Propofol, Etomidate, and Thiopental on seizure and recovery duration following ECT.
Methods: In this clinical trial study, 90 patients diagnosed with a psychiatric disorder by a psychiatrist, who need to be treated by ECT in 5 Azar hospital, Gorgan, north Iran. The patients were randomly divided into the three groups by simple random allocation method. Interventions included standard monitoring and pre-oxygenation with 100% FiO2 for 3 minutes for all patients in three groups. Anesthesia of the patients in the first, second, and third group was done with Thiopental (1.5 mg/kg), Propofol (0.6 mg/kg), and Etomidate (0.1 mg/kg), respectively. Administration of Succinyl Colin (0.5 mg/kg) as muscle relaxant and Atropine for prevention of bradycardia was uesd in all patients. Duration of seizure and recovery; changes in hemodynamic status including heart rate (HR) and mean arterial pressure (MAP); and amount of charge for ECT were recorded for each subject.
Results: Mean of seizure duration in Thiopental, Propofol, and Etomidate groups were 43.72±11.81, 35.74±10.58 and 45.81±17.26 seconds, respectively (P<0.05). Amount of charge for ECT in 3 sessions of treatment and changes of HR were not different between the 3 groups. Changes of MAP in the Propofol group was significantly less than other two groups (P<0.05). Recovery time following ECT was the least in Etomidate group in comparison with Thiopental and Propofol (P<0.05).
Conclusion: Ethomidate and Thiopental had the same effect on increasing seizure duration. However, due to the significant reduction in recovery time compared with Thiopental, Ethomidate may be considered as the best choice.