Tehran University Medical Journal

A simple, low cost and fast improved fluorimetric method for Histamine measurement

The well-known fluorimetric method for histamine measurement which is one of the common methods in diagnostic laboratories was modified to accelerate and facilitate measurement of serum histamine levels and decrease the costs and restrictions. The modified method needs only 1 ml of whole blood (or serum) instead of about 10 ml in original method which is difficult almost or impossible specially for children. In addition, very small amounts of the expensive materials are needed and the samples are saved for about 15 days in -20°C which makes no significant changes. Because in most cases, sample can not be read at sampling day, the saving possibility is an advantage for improved method.

Dorsal traumatic dislocation of first and second metatarsophalangeal joint (A case study)

Dorsal traumatic dislocation of metatarsophalangeal joint of great toe is a rare injury. Ability to reduce the dislocation by nonoperative measures depends largely on the type of dislocation and involvement of the sesamoid complex. There are three basic types of dislocations. Type I cases are usually irreducible on closed reduction, the metatarsal head being incarcerated by the conjoined tendons with their intact sesamoids. In type II, the sesamoid complex disruption usually pemits closed reduction. We present an irreducible dislocation of the first metatarsophalangeal joint with fibular sesamoid fracture in an 80-year-old man. In addition, he had a concomitant dorsal dislocation of the second MTP of the same foot, to our knowledge only one case with this injury was reported in the literature.

The study of suspicious cases to body smuggling in Loghman Hospital 1999-2000

One method of drug smuggling is body packing or body stuffing, placement of narcotics (opium, heroin, hashish, …) inside intestinal tract for transfer from city to city or country to country. Estimating of the methods for transferring, content of packets, packaging, cause of death and results of diagnostic and therapeutic methods can effectively decrease the number of body packer and law execution. This study is case series by randomized sampling. Several parameters such as sex, age, marital status, addiction, job, level of education, type of opioids and their weight and number of packets, result of abdominal X-ray, surgery needs, were collected from April 1999 to December 2000. Through this period of time, 32 male smuggler who had swallowed drug packets were detained. The average age was 41 years (max=62, min=20). The minimum weight of the opium carried by this smugglers was below 20 gram and maximum weight was 1000 grams (median=360 grams). The minimum number of packets were one packet and maximum number of packets were 54 (median=10 packets). In 84 percent of body smugglers the content of packets was opium, 13 percent was heroin and 3 percent was hashish. From the cases, 81 percent of smugglers were addicts themselves. Death occurred in 7 cases from which 3 were after surgery.

Study of newborn with pathologic hyperbilirubinemia after 5 days of birth in Children Medical Center Hospital

Hyperbilirubinemia is one of the common and major problems during neonatal period. Our propose was to determine the etiologic and predisposing factor in neonatal hyperbilirubinemia. We analyzed the patients record of 312 neonate including 184 male and 128 female with median age of 16.5 days (range 6-28 days) in children medical center hospital at 1998. The main cause of hyperbilirubinemia in our study was breast feeding (76.6 percent), followed by sepsis (11.5 percent) and hypothyroidism (10.6 percent). Also other uncommon etiology of hyperbilirubinemia that were seen in our patients were TORCH, G6PD deficiency and cephalhematoma. The age of 60 out of our patients (19.2 percent) was 6 days and others were 7 days (15.7 percent), 8 days (14.4 percent) and only 2 out of 312 patients were at age of 28 days. According to our study we suggest that role of breast-feeding should be considered in any neonate with hyperbilirubinemia.

Hardware breakage in spine surgery (A retrospective clinical study)

This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001). Other important causes were, age of patient at surgery (P value=0.04), pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04). Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

Initial success and in hospital results of coronary angioplasty of more than one lesion per procedure in patients with multivessel coronary artery disease

In the past, coronary artery bypass grafting was the treatment of choice for patients with symptomatic multi vessel coronary artery disease, but in recent years per cutaneous transluminal coronary angioplasty (PTCA) accepted as an alternative approach to revascularization. To assess the initial success and in hospital results of coronary angioplasty of more than one lesion per procedure in patients with multi vessel coronary artery disease, a retrospective analysis of patients who underwent selective coronary angioplasty at Imam Khomeini medical center from 1994-1997 were peformed. From 1994 to 1997 per cutaneous transluminal coronary angioplasty (PTCA) were done in 257 patients, that 201 (78.2 percent) were male and their age range 23-73 years. The numbers of patients with multi vessel coronary artery disease were 98 (38.13 percent), that complete revascularization (PTCA of more than one lesion per procedure) underwent in 34 (13.58 percent) of them (27 men, 7 women, age: mean±SD 48±9.8 range 30-70). A total of 71 lesions were tried, that 22 (31 percent) were type A, 45 (63.4 percent) were type B, and 4 (5.6 percent) were type C. Among patients 21 (61.8 percent) had unstable angina and 13 (38.2 percent) had stable angina. Procedures were successful in 68 (95.8 percent) of lesions and 31 (91.2 percent) patients were discharged fro procedural complications included 3 (8.8 percent) non-Q wave myocardial infarction and no mortality. Without any complication, (success defined as residual stenosis <50 percent). As a conclusion, in selected patients with multi vessel coronary artery disease PTCA of more than one lesion per-procedure is effective and safe.

Etiologies of chronic liver disease in children

Chronic Liver diseases in children is the result of many different diseases including: metabolic, genetic, infectious, toxic and idiopathic causes. This was a case series study on 133 infants and children with age range 6 month to 12 years old, who presented clinically with manifestation of chronic liver disease and were admitted to Children Hospital Medical Center from year 1999 to 2000. In this study, 32 (24.5 percent) patients had autoimmune chronic hepatitis, 15 (11.3 percent) Glycogen storage diseases, 12 (9 percent) extrahepatic biliary atresia, 11 (8.2 percent) willson disease, 10 (7.5 percent) cryptogenic cirrhosis, 6 (4.5 percent) chronic hepatitis C, 5 (3.8 percen) chronic hepatitic B, 5 (3.8 percent) galactosemia 3 (2.25 percent) congenital hepatic fibrosis, 3 (3.8 percent) histiocytosis X, 3 (2.25 percent) sclerosing cholangitis, 2 (1.5 percent) byler’s disease 2 (1.5 percent) primary tuberculosis, 1 (0.75 percent) choledocalcyst, 1 (0.75 percent) Alagyle syndrome. According to our data, chronic liver disease should be considered in infants and children. In our study, the most common causes are found to be: metabolic and genetic diseases (37.5 percent), chronic autoimmune hepatitis (24 percent) and biliary disorders (14 percent), that encompass 86 percent of the patients.

Diagnostic value of frozen section study for thyroid nodules in patients referred to Shariati Hospital 1997-2000

Frozen section is a useful method in the diagnosis of different malignancies including those of thyroid origin. However, there are still controversies about its application, sensitivity and specificity for thyroid neoplasm. In this study, diagnostic value of frozen section (FS) was compared with permanent histopathologic and Fine Needle Aspiration (FNA). In this study, which was conducted in process research method, permanent sample, FNA, and frozen section results in 214 patients was compared. All of these 214 patients had been seeking medical evaluation for thyroid nodules between years 1997 and 1999 in Shariati hospital. All pathologic evaluations were performed by pathology staff of this hospital. Permanent pathology was considered as the gold standard so the specificity, sensitivity and diagnostic precision of FNA and FS were evaluated on the basis of its results. We use Macnemar test for this purpose. The number of patients during this period were 214 (160 women and 54 men). Mean age of our patients was 42.3±5.4 and their age ranged between 12 to 84 years. Pathologic results revealed that 163 of the patients (76 percent) had benign lesions, and 51 of them (24 percent) had malignant lesions. Thyroid malignancies comparised papillary carcinoma (70 percent), follicular carcinoma (13.5 percent), papilofollicular carcinoma (6 percent), medulary carcinoma (6 percent), Hurtle cell carcinoma (4 percent) and anaplastic carcinoma (5 percent). FNA was done in all of the patients before surgery and was able to determine the status of nodules in 150 patients. Sensitivity, specificity and precision of FNA in these 150 patients were 72, 96 and 90 percents respectively. When FNA was unable to determine the status of a nodule (64 remaining patients), FS was applied to do the job. A sensitivity of 36 percent, specificity of 85 percent and precision of 73 percent was found in this group of patients. Macnemar test showed that there is no significant difference between FNA and FS methods. This study showed: when FNA is not conclusive, FS will not bring any further benefit. It seems that only in suspicious cases of papillary, undifferentiated and medulary carcinomas, FS can be useful in certifying the results of FNA and choosing the appropriate surgical plan. We should wait for permanent sample reports in the case of follicular or Hurtle cell carcinoma.

Prevalence of respiratory tract infection due to respiratory syncytial virus in 145 children below 5 years old, from January to May, 1999 in Imam Khomeini, Markaz Tebbi and Baharami Hospitals

Respiratory syncytial virus (RSV) causes recurrent upper and lower Respiratory tract infections (especially pneumonia and bronchiolitis). Detection of the infection with respect to its morbidity seems to be a nessecity. In this research nasopharyngeal secretions of 145 patients with respiratory symptoms from Imam Khomeini, Markaz Tebbi and Baharami hospitals were analyzed with direct immunofluoresence (DIF) test using monoclonal antibodies. The purpose was to determine the frequency of RSV infections with respect to age, sex, geographical considerations and clinical symptoms and signs. Finally 56 patients in our study were positive in DIF test and RSV is the causative agent for 38.6 percent of all respiratory tract infections. Beside the propensity to RSV infection was significantly greater in patients with bronchitis [OR=2.36 (0.99-5.67)] Bronchitis was the most frequent disorder in our study group

Job stress and its related factors in Tehran firefighters in year 2000

Job stress results from a mismatch between job requirements and capabilities, resources, or needs of the worker. Physiological, psychological and behavioral outcomes caused by job stress not only hurt the person but also impose expensive costs on organizations. Firefighting is a job that exposes workers to job stress. The purpose of this study is to determine the level of job stress and some related factors in firefighters of Tehran safety services and firefighters organization. This cross sectional study includes 155 male firefighters whom had selected randomly. In this research we used Leiden University Questionnaire. Also Karasek Questionnaire is used for classification of workers according to karasek’s model. Collected data were analyzed by spss9 software. The final grade of firefighter’s job stress shows a significant positive relationship with second job and a significant negative relationship with age. The level of job satisfaction have a significant negative relationship with job insecurity and lack of meaningfulness, and a significant positive relationship with skill discretion, social support supervisor and social support co-workers. According to karasek classification this job is grouped in active not in high strain grup. The highest level of job stress was seen in physical exertion and hazardous exposure factors. Also in work and time pressure factor, job stress level is high. But job stress is in a moderate or low level in other factors. The level of job stress in younger firefighters and in individuals with a second job indicate a significant increase. However, in western country’s studies, this job is classified as high-strain but in this research it is classified as active group.

Adjusting the loading dose of Magnesium sulfate in preeclampsia according to BMI, serum level of creatinin and albumin

To determine the therapeutic dose of Mg according to BMI, serum level of calcium, creatinin and albumin a cross sectional study were carried on 150 cases of preeclampsia (100 mild, 50 sever type) in Valei-Asr Hospital through the years 1378-79. All of eligible patients had given a single dose of 4 gr Mg, sulfate intravenously, then had continued with 20 gr/lit, 28 drop/min through IV infusion. Mild and sever preeclampsia cases were similar about the mean serum level of calcium and Mg. Before beginning of treatment, but were significantly different about the mean of serum level of creatinin and albumin (P=0.0001). In univariat analysis there was significant direct correlation between serum level of Mg 6 hours after beginning of treatment with serum level of creatinine and albumin, and significant association with BMI (P<0.05). So the serum level of Mg in end of treatment, (P<0.05) in multivariate regression analysis, the serum level of Mg in 6 hours after and end of treatment was correlated positively with serum level of creatinine and albumin and negatively with BMI. Serum level of Mg 6 hours after=-0.2+0.8 (Alb. Level) +2.99 (creat level) –0.22 (BMI). Serum level of Mg in end of treatment=-0.2+0.8 (Alb. Level) +3.3 (creat level) –0.24 (BMI).

Neonatal septic arthritis and osteomyelitis. Evaluation of risk factors

Neonatal septic arthritis and osteomyelitis is not prevalent in first month of the life in new borne children. According to anatomic specifications of bones in this period, the manifestation of disease is different from other periods of life and the disability induced, will be serious and permanent. In this investigation, 31 infants with the diagnosis of septic arthritis and osteomyelitis were studied during 10 years. Hyperbilirubinemia (58.1 percent), emergency cesarean (25.8 percent), umbilical vessel catheterization (26.6 percent), permaturity (12.9 percent), perinatal asphyxia (9.7 percent), scalp laceration (6.5 percent), omphalitis & previous bone fracture (6.5 percent) were the most common findings among predisposing factors. Previous hospital admission was detected in 19 patients (67.3 percent) and multiple bone involvements demonstrated in 12 (38.7 percent). From those who had risk factors, 42.3 percent had multiple bone lesions. Only 5 patients (16.12 percent) had no predisposing factors. The mean age for diagnosis and seeking admission were 23 and 30 days respectively and the mean age of diagnosis at surgery was over 72 hours in 15 (48.38 percent) cases. All with delaying in requesting admission had destructive changes in their joints. Knee and hip were most involved (77.3 percent). The most common microorganisms found in this study were staphylococcus aureus and klebsiella. Of all, 47 percent were gram negative & 53 percent gram positive microorganisms. Existence of risk factors and previous hospital admission in the majority of cases accompanied by microorganisms such as methiciline resistant S.aureus and klebsiella as a causative agents who were also resistant to empirical antibiotics demonstrated the role of nosocomial infections as an important cause of infection.

Application of hight performance liquid chromatography with spectrofluorimetric detection for determination of human milk retinol

World health organization has introduced concentration of vitamin A in breast milk as a proper indicator for characterization of vitamin A deficiency in lactating mothers and their infants (<6 mo). A normal phase high performance liquid chromatography with spectrofluorometric detection as a specific and sensitive detector was used for characterization of all-trans retional from 13-Cis retinal. The method was sensitive (0.009 ppm) and accurate (1±0.054 µ mol/l) and had a good recovery percentage (99.36%). This method was more better than before methods and was compatible with the other useful methods. Effect of freezing and defreezing on all-trans retinol content of milk sample was investigated. The result was interesting, whatever all-trans retinol content was bigger, it’s destroying was bigger too. Because of that reseon, day today reproducibility wasn’t good. Standard of retinol was 95% all-trans and pure so we should use this method because two retinol isomers wasn’t separated from each other by reversed phase chromatography and UV detection.