Tehran University Medical Journal

Evaluation of sperm superoxide anion production and Mitochondrial Membrane Potential: flowcytometry in rats with experimental varicocele

Sadeghiour HR

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Varicocele is a major cause of male infertility, but its pathophysiology is unclear. Recent studies declare that fertile varicocele people with normal semen analysis are also at risk of loss of infertility. The exact mechanism by which varicocele damages spermatogenesis is still unknown. Some studies have reported increased Reactive Oxygen Species (ROS) is a major factor in semen of men with varicocele. The aim of this study was to investigate whether the source of elevated ROS is intracellular or not. In addition, we studied Mitochondrial Membrane Potential (MMP), viability, antioxidant activity, sperm count and motility in these rats.
Methods: The study group consisted of 28 male rats divided in four groups: control, sham, varicocele 1, varicocele 2, Experimental varicocele was established by partial ligation of the left renal vein in last two groups. Animals were sacrificed two and six months after surgery and dilation of the internal spermatic veins was observed. Then, superoxide anion production and Mitochondrial Membrane Potential were evaluated by Flow cytometry sperm characteristics were evaluated by Flow cytometry. Sperm superoxide anion production was assessed by the dihydroethidium and Mitochondrial Membrane Potential with rhodamin 123.
Results: Our results showed intracellular superoxide anion production significantly increased and Mitochondrial Membrane Potential, viability, sperm count and motility significantly decreased in rats with experimental left varicocele. However, there was no significant difference for seminal plasma antioxidant activity between all groups.
Conclusions: Consequently, our findings suggest that one of the main sources of ROS production is intracellular and we must consider it in treatment.

T-138C and A-7G polymorphisms in the MGP gene and the association with coronary arthery disease: Iranian patients

Keramatipour M

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Coronary Artery Disease (CAD) is a major cause of death worldwide including Iran. The risk of developing disease in patients without symptoms is assessed in part by factors that are associated with disease. Among these factors family history points to the significance of genetic component in the risk of CAD. The identification of the genetic variants that confer risk for CAD is essential for detecting high-risk individuals, so preventative life style and therapeutic action can be taken before overt disease develops. So far more than 100 genes have been reported with possible role in developing risk for CAD. Matrix- Gla Protein (MGP) is one of these genes that association of its single nucleotide polymorphism (SNP) with CAD has been reported. Among the polymorphisms, there are two promoter SNPs at position -7 & -138 that their association with CAD has been reported before. Here we investigated the association of these SNPs with CAD in Iranian population.
Methods: 150 cases and 150 controls were selected on the basis of their clinical assessments and angiographic reports. DNA was extracted from blood samples. The genotypes for both SNPs were determined using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method with size fractionation on Polyacrylamide gel.
Results: The comparison of allele & genotype frequencies between patients and controls showed that there is an excess of A allele at position -7 and T allele at position -138 among patients, although these differences were not significant (p<0.2, and p<0.5 respectively).
Conclusions: This study suggests no association of these SNPs with CAD in Iranian population. Confirmation of this finding needs independent repeat of similar studies.
Keywords: Coronary Artery Disease (CAD), Matrix Gla Protein (MGP), Single Nucleotide Polymorphism (SNP).

Evaluation of airway: Introduction of class zero of mallampati

Hoseinkhan Z

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: The ability of a specific test to predict a difficult intubation is decreased by the variability of definitions of difficult intubation/laryngoscopy. The Mallampati classification system is a widely utilized approach for evaluating patients in the preoperative setting. Zero class of Mallampati is a new class of airway view that to add to the four modified Mallampati classes. This study estimates the incidence of class zero airway and determines the ability of Mallampati score, age and sex on the prediction of the larangoscopy grade.
Methods: This is a cross sectional study in which 376 patients aged 7-18 years and A.S.A physical status I or II were enrolled. They were scheduled for surgery under general anesthesia All the airway assessments were done in the sitting position, with the patient's head in neutral position, mouth fully open, tongue fully extended and without phonation. After induction of general anesthesia, laryngoscopy grade was assessed in sniffing position using the Cormak & Lehame grading scale.
Results: Class zero airways occurred in 0.3% of patients, and the patients with class zero airway had a grade I laryngoscopy. 49.5% of patient had class I, 37.2% class II, 13% of patient had class III and there found no patient with class IV airway. Grade II and III laryngoscopy were more frequent in females than in males but this correlation was not statistically significant.
Conclusions: Assessment of airway by Mallampati scoring system and attention to the age can be an important factor in the prediction of high laryngoscopy grade.

Prominent Adam’s apple and laryngoscopic view: a study on 535 cases

Noyan Ashraf MA

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: The prediction of the probability of difficult intubation and the associated problems before Induction of anesthesia could be lifesaving. The aim of this study was the investigation of association between the stage of thyroid cartilage prominency and laryngoscopic view for predicting the difficult intubation.
Methods: Five hundred and thirty five patients aged 18-60 years old, with prominent thyroid cartilage, "Adam's apple", enrolled in a cross -sectional study based on the stage of "Adam's apple" and the relationship with laryngoscopic view. After induction of anesthesia, laryngoscopy performed and laryngoscopic view of larynx was recorded, and analyzed according to Modified Cormackand Lehane's Scoring.
Results: No significant association between laryngoscopic view and thyroid cartilage prominency staging was observed. There was no significant relationship in females and aged under 50 y.o. The relationship in males with poor correlation coefficient was significant. The results are as follows: [male :(p=0.028, r=-0.096), Female: (p=0.821, r=0.082), <50 yrs: (p=0.87, r=0.007) no significant association for age decades and thyroid cartilage prominency stages, were observed. In ages above 50 y.o, difference was significant. Thirty patients had a laryngoscopic view in which the tracheal rings were visible just bellow the vocal cords.
Conclusions: As the increased age was related to laryngoscopic view and thyroid cartilage prominency stage it seems that there is relationship between ages over 50 y.o and difficulty of laryngoscopic view or intubation. With the observation of a view different from the grade I Cormack and Lehane's scoring, we named it the "stage Ia" that the tracheal rings are visible bellow the vocal cords during laryngoscopy.

Hepatic vessel doppler indices: a study on non- Alcoholic liver disease

Ebrahimi-Daryani N

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Duplex Doppler ultrasonography (US) has newly suggested, being an important diagnostic technique in the non-invasive evaluation of hepatic vasculature and some hepatic parenchymal diseases. New findings suggest that diffuse fatty infiltration of liver can alter normal hepatic vein and artery doppler indices. The following study has been performed to evaluate the effect of fatty infiltration on hepatic artery resistance index and hepatic vein waveform patterns.
Methods: Sixty patients with various degrees of fatty infiltration on liver biopsy and twenty normal subjects without any sign of hepatic fat infiltration in ultrasonography examined using standard colour and spectral doppler sonography. The waveforms of Hepatic Vein were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. The hepatic artery resistance index was calculated as the mean of three different measurements.
Results: The mean BMI in Nonalcoholic fatty liver disease group and normal subjects was 26.9(SD=3.3) and 22.4(SD=1.7) Kg/m², respectively with a range of 22 up to 44 Kg/m². Abnormal Hepatic Vein waveforms (biphasic and monophasic) were found more frequently in doppler sonography (p<0.001) in patients with Nonalcoholic fatty liver disease (12 biphasic and 17 monophasic) compared to normal subjects. Hepatic artery resistance index was significantly lower in Nonalcoholic fatty liver disease patients [0.7(SD=0.1)] compared to normal ones [0.8(SD=0.0)] (p<0.001).
Conclusions: The incidence of abnormal hepatic vein waveforms is significantly higher in patients with fatty infiltration compared to those who had no abnormality in liver ultrasonography and these patients had a significant lower hepatic artery resistance index. supportFields]> ADDIN EN.CITE ADDIN EN.CITE.DATA l> 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Effect of vaginal estrogen on post menopausal mood & sleep disturbance/ and sexual satisfaction

Eftekhar T

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Mood disturbances, such as anxiety, depression and psychological distress, are common among women in menopausal period. Effect of long term estrogen replacement on post menopausal mood disturbances is curative but specifical studies has not done on the effects of vaginal hormonal therapy in mood disturbances in menopause. The aim of this study was objectives to clarify the effect extended by Hormon Replacement Therapy (HRT) in improving post menopausal mood disturbances.
Methods: In a single blinded clinical trial, the effects of a four months application of vaginal esterogen (premarin) versus placebo (n=20) in each groups were evaluated on mood status and sexual satisfaction, using the Hamilton depression score (HDS score), and self assessment of sexual function and pleasure. Four months after treatment completion (half applicator of nightly vaginal premarin or lubricant vaginally) collected and analyzed with Statistical tests.
Results: Decline of the mean HDS scores (depression score) was observed in the premarin group. The mean HDS score (depression) after vaginal premarin decreased from (14.6±4.7) to (3.4±2.3). (p≤0.001) also, The HDS score in placebo group increased from (10.6±3.1) to (11±3.3), that significant difference between two groups before and after treatment is seen. (p≤0.01). Vaginal premarin induced a greater improvement of HDS score (p≤0.006). Mean anxiety score decreased after vaginal premarin (p≤0.000), but is not significant difference in placebo group. (p=0.08). Sexual Satisfaction in Vaginal premarin group is significantly higher (p≤0.001).
Conclusions: Vaginal Estrogene directly or indirectly improved menopausal related mood and sleep disturbances, increased and sexual satisfaction.

Renal parenchymal changes in children with acute pyelonephritis using DMSA scan and the relationship with certain biologic factors

Ataei N

Background: Early diagnosis of renal parenchymal involvement in children with acute pyelonephritis (APN) using isotope scan and early treatment may decrease or prevent development of renal parenchymal lesions. We designed this study to assess the diagnostic value of certain biologic parameters in children with first- episode of acute pyelonephritis (APN) documented by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy.
Methods: We compared the laboratory findings of leukocyte count, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels with the results of the DMSA scans obtained within three days of admission. One hundred-two children (93 girls and 9 boys aged 1 month–12 years (mean 2.85±2.92 years) were enrolled in the study. Of these patients, 203 renal units, were investigated using scintigraphy. Voiding cystourethrography (VCUG) was performed in 98 children (195 renal unit) when urine culture became negative.
Results: In all children one or both of kidneys had parenchymal involvement on scintigraphy. Changes on the DMSA scan were found in 178(88%) renal units during the acute phase. The extent of changes in DMSA scan were mild in 113/178(55.7%) renal units, moderate in 40/178(19.7%) and severe in 25/178(12.3%). When inflammatory markers were correlated with the development of the severe renal lesions, as assessed with DMSA scan, a highly significant correlation with both ESR (p=0.007) and leukocyte counts (p=0.02) were found.
conclusions: We conclude that the incidence of renal parenchymal involvement in Iranian children with APN is very high. Although increased ESR and leucocytosis may be valuable markers for determination of severe renal parenchymal involvement, but these parameters and also CRP, were inadequate in distinguishing mild to moderate renal parenchymal involvement.

The relationship between number of transferred embryos and pregnancy rate in ART cycles

Sohrabvand F

Background: The transfer of multiple embryos during ART procedures (IVF/ICSI) in order to maximize the chance of pregnancy, has resulted in increasing rates of multiple pregnancies with a 20- fold increased risk of twins and 400- fold increased risk of higher order pregnancies with significantly high maternal and perinatal morbidity and mortality in comparison with singleton. Since at present there is no limitation in number of embryos being transferred in ART cycles in infertility centers in Iran, in order to evaluate the relationship between number of embryos transferred, pregnancy rates and multiple pregnancy, this study was performed in a referral university center.

Methods: In a cross sectional descriptive analytical study a total of 536 ART cycles in infertile patients treated at the Infertility Department of Vali-e-Asr Hospital & Vali-e-Asr Reproductive Health Research Center from October 1999- March 2003 were evaluated using a questionnaire dealing with the parameters affecting ART outcome.
Results: There was a total pregnancy rate of 21% with a multiple pregnancy rate of 12%. Increased age had a negative effect on pregnancy rate with a significant difference over 40 years (p<0.05). Pregnancy rate was higher with increased number of transferred embryos but it was only statistically significant when three versus two embryos were transferred (p<0.008). When more than three embryos transferred, although there was an increase in pregnancy rate, the difference was not statistically significant, but there was a significant increase in multiple pregnancy rate.
Conclusions: The maximum number of transferred embryos in ART cycles should not precede three embryos especially in age groups less than 40 and also when good quality embryos are available.

Malignant pleural mesothelioma: Clinicopathologic and survival characteristic in a consecutive series of 40 patients

Bagheri R

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occures after prolonged exposure to asbestos. The aim of this study was to clinicopathologically evaluation of 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis.
Methods: In this study patients with definitive diagnosis, who had been followed up for at least three years were studied based on gender, age presenting symptoms, and clinicopathological patterns.
Results: Male to female ratio of the study patients was three to one any the average age of them was 55 years. Chest pain was the most common symptoms in 34(85%) patients. Most of the study patients were in Buchard stage I (37/5%) and the epithelial form was the most common pathological pattern 25(62.5%). 19(47.5%) of cases received only radiotherapy and chemotherapy. Extrapleural pneumonectomy was performed on eight (20%) patients, seven (17.5%) patients underwent decortication and pleurectomy beside adjuvant therapy and 15% of the cases rejected any type of treatment. Surgical mortality occurred in one patient and the most common surgical complication was wound infection. The average survival rate was 12±1.2 months and the main factors influencing it were the patient's physiologic status, pathological form, stage of the disease and the pattern of pleural involvement.
Conclusions: Because the low survival rate after multimodality invasive treatments in mesothelioma, aggressive therapeutic methods were recommended in selected patients

Total knee arthroplasty in patients with osteoarthritis: Results of 34 operations

Motaghi A

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Knee arthrosis is one of the most common and debilitating diseases in the advanced ages. Regarding the fact that knee arthroplsty is the definitive and ultimate treatment for this disease, we survey the short term result of this modality.
Methods: In this survey 34 patients with knee arthrosis who have been admitted in Dr ali shariati university hospital, Tehran, Iran in a five years period (2001-2006) and have undergone knee arthroplasty. The relationship between, gender and the operation results were evaluated using the system of knee society knee score before and after the operation, causes of arthrosis, prosthesis to be used and the complications of the surgery.
Results: patients included 20 females and 14 males with the mean age of 67.37±5.25 year and the age specterum (51-78). In 15 patients the operation was done only in right knee, in 5 patients in the left knee and in 14 patients both knees were operated. The mean of functional score of the operated knee reached from 32.68±4.14 before operation (26-45) to 68.67±6.45 after that (59-82) and the mean of knee score reached from 30.6±3.8 before operation (22-39) to 86.4±6.34 after operation (73-92).
Conclusion: Regarding significant improvement in the functional score and the knee score and the low complication rate of knee arthroplasty it is recommended that in case of indication this operation be done as soon as possible because late attendance increases complications.

Ultrasound-guided brachial plexus block: a study on 30 patients

Amiri HR

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics.
Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported.
Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.

Conclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.