Tehran University Medical Journal

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Thyroid scintigraphy has been helpful in detecting and evaluation of thyroid nodules. Sodium pertechnetate Tc-99m is the most commonly used radionuclide for thyroid imaging because of its general availability, favorable dosimetric characteristics and low cost. But, there are reports of occasional disparity in isotope uptake in lesions compared with radioiodide. In order to determine percentage and clinical significance of this disparity, we screened 101 patients with solitary functioning nodules using sodium pertechnetate TC-99m in comparison with subsequent Iodine-131 scan in research institute for nuclear medicine. We conclude that sodium pertechnetate TC-99m is a reliable radiotracer for the detection and evaluation of thyroid nodules and there is no need for the subsequent Iodine-131 scan.

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Documented war experiences have provided early descriptions of different group of psychiatric features. A combat soldier with palpitation and chest pains was felt to have a functional cardiac disturbance, called soldier's heart. Anxiety and other symptoms indicating increased arousal were called shell shock and were thought to be related to lesions in the central nervous system (CNS). Describing analytically war events could operate with an enormous emotional intensity breaking through the ego defences and flooding it with an uncontrollable anxiety. Post traumatic stress disorder (PTSD) delineates a syndrome developing after a discrete traumatic event in a stress setting. Diagnostic conceptualization which tie PTSD to stress and trauma invariably involve two different approaches from two different theoretical bases: the concepts dealing with trauma on the one hand (which could effect on CNS) and those dealing with stress-response theory on the other. Author emphasizes on viewing the patients who complain of war psychiatric effects in three categories: (1) Non PTSD diagnoses that the patient ought to be treated accordingly (2) Traumatic neurosis which has overwhelming war stress related emotional aspects and is occurred in predisposed individuals. This category is suggested to be classified as post war stress disorder specifically, to be differentiated from other post traumatic psychiatric categories. (3) Author also suggests the third category as post traumatic war stress syndrome which is thought to have organic origin. Symptoms such as hyperacusis, hyperirritability, tinnitus and particular type of head aches which are mostly refractory to treatment confirm the hypothesis.

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The treatment of choice for bladder tumors is TUR, but because of high incidence of recurrence in these tumors, various treatments are suggested. In one study, 32 patients involved with superficial T.C.C. of bladder selected and divided in two equal groups. In the first group, after T.U.R, 10 million IU of a alpha-interferon was injected into the bladder through a catheter and in the other group, after TUR, they treated with injection of BCG into bladders. The results of these two drugs in prevention of recurrence and their side effects were studied and compaired

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In this work, we tried to know something more about the embryotoxicity effects of the doses of 50, 200, 400 mg/kg/day of ranitidine of (H2 antihistaminic agent) by intraperitoneal administration on mice. The studies were performed on albino mice kept under specific conditions and a constant dark-light cycle at 24+1C and 55+5% relative humidity. Generally, the animals were acclimatized for four weeks before mating. Two female mice at 12-14 weeks of age were placed overnight with a male of proven fertility. The day on which a vaginal plug was found, was taken as day one of pregnancy. Also the vaginal smear was prepared for further proof. Treatment of pregnant females was started from day 7 and continued up to the 15th day of gestation and then on day 18 they were necropsied for routine teratological observations. The live fetuses were weighed and inspected for gross external abnormalities under a dissecting microscope. Resorption plus dead fetuses less than 6mm of length were designated early death and dead fetuses of more than 6mm of length were consequently called late death. The statistical study was done by student t-test. One-third of the fetuses were fixed in bouin's fluid to detect visceral malformations by the rasor- section technique. There was no significant difference in the frequency of late death between the control groups and the groups given ranitidine. Differences were observed in the number of implantation sites except for 400 mg/kg/day. Data pooled from all experimental groups clearly show that pig tail, deformed cranium, low body weight and skeleton, unshaped external ear and jaw and polydactyly are the most common external abnormalities. Results of this study show the hazards o the ranitidine used during early pregnancy.

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We report our experience with 124 patients were referred 70 our urology clinic in Sina hospital for urinary retention. Serum PSA analyzed by using a monoclonal assay. All patients underwent digital rectal examination. The patients devided in 3 groups: Group 1 (87 men) with a serum PSA level less than 4 ng/ml, group 2 (26 men) with a serum PSA level 4-10 ng/ml and group 3 (11 men) with a serum PSA level greater than 10 ng/ml. After prostate biopsy and trans urethral resection or open prostatectomy, of the 87 men in group 1, one man had cancer of the prostate, of the 26 men in group 2, 2 men had cancer of the prostate and of the 11 men in group 3, 9 men had prostate cancer.

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100 patients (93 females and 7 males) in ages ranging between 23 and 65 years were subjected to laparoscopic cholecystectomy for biliary colic (92 pts), acute cholecystitis (7 pts) or asymptomatic gallstones (1 pt). None had a history of icterus and in every case choledocholithiasis was excluded by means of serum alkaline phosphatase assessment and sonography (In addition to ERCP in 3 pts). 3 operations were converted to open cholecystectomy (Because of uncertainty about anatomy in 1 pt, extensive adhesions in 1 pt, and persistent bleeding in 1 pt). Mean operation time was 80 min. 90 patients were discharged on the 2nd post-operative day. Apart from 2 pts who were readmitted (For omental evisceration in 1 pt and sub hepatic hematoma in 1), complications were limited to minor complaints. Laparoscopic cholecystectomy is a safe procedure in the hands of a skilled surgeon who is aware of anatomic variations and is always prepared to liberally convert the operation to an open cholecystectomy

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This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70). Ultimately, these datas have been compared with those in the reputable books and new medical papers And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males And also their most common chief complaints are neurological manifestations, and headache (82%) is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%), excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass) was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

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Failed back surgery syndrome (FBSS) is many a times an intractable problem confronted in patients with surgical disease of lumbar spine and at the same time is a pressing problem for the physicians as well. This clinical entity is defined as continuation of pain in the lumbar region and lower extremities following surgery of the lumbar spine. Knowledge of the etiological factors and their prevention is the best line of treatment to overcome the evolution of this syndrome. During this study, which was conducted in Imam Khomeini hospital Tehran from the year 1989 till 1990, 43 out of 114 patients developed "FBSS". 23 cases responded to conservative treatment and psychotherapy whereas medical treatment failed to achieve fruitful results in the rest. The latter underwent extensive radiological investigations and repeat surgery. According to this study, we recommend that in the initial management of these patients. The surgeon should observe the dictum of "5-mis" to overcome and minimize the "FBSS" entity

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To evaluate the tolerance and effectiveness of conjugated Estrogen for women with established post-menopausal Osteoporosis and hot flushes, with the use of paired comparison, randomized, we tested during an 10 month period the bone mineral contents and plasma glucose in subjects who afforded by premarin in dosages of 0.625 mg for days 1 to 25 and oral medroxy progesterone acetate for days 15 to 25 of a 29 days cycle. All subjects received supplementation to ensure a minimum of 800 mg calcium per day. 25 subjects completed at least 10 month follow up serum calcium, phosphate, glucose and urinary calcium and phosphatae measurements by colorimetric, method. We compared women with herselves, the median change in biochemical studies showed significant decrease in serum calcium, phosphate an urinary excrition of calcium, but significant increase in urinary excrition of phosphate. Fasting plasma glucose did not change significantly. Decrease serum calcium (9.6 compared with 9.16 P<0.005) decrease, serum phosphate (3.77 compared with 3.39 P<0.005), decrease uri calcium (149.81 compared with 121.46, P<0.005), increase uri phosphate (625.83 compared with 676, P<0.005), FBS (92.03 compared with 91.45, 0.1>P>0.05). Regarding the effects of conjugated Estrogen on plasma and urinary calcium and phosphate levels and amelioration of clinical symptoms, we concluded that conjugated Estrogen treatment in effective in post-menopausal Osteoporosis, but we did not find relation between exogenous Estrogen in post-menopausal women with FBS and hot flush

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Beta Thalassemia major patients receive repeated transfusions in order to compensate anemia and use desferal to remove iron overload. Comparing immunoglobulins and complement components in the serum of these patients with normal range shows a significant increase (P<0.001) in IgG, IgA and IgM and a decrease in C3c and C4. The regression analysis confirms a relation between the numbers of transfusions and the mentioned immunological factors that means increasing the number of transfusions, increases immunoglobulins and decreases the complement. Also, this evaluation shows that use of washed RBC and regular in take of desferal will prevent excessive increase of immunoglobulins or decrease of complement

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In our investigation, rabbit hyper-immune serum to V.cholerae ogawa was absorbed with V.cholerae inaba whole-cells and vice versa. Applying ammonium sulphate precipitation method, mono-specific g globulins were purified and concentrated from the absorbed whole serum. These antibodies were fixed on staphylococcus cowan 1 NCTC-8325 whole-cells, using different chemical fixatives. It was observed that maximum fixation of g globulin to protein-A was achieved by 1-propanol 50% at 3 hours, which revealed through single radial immuno-diffusion techniqe. The rectal swab samples were cultured in an enrichment bile-peptons broth. After 5 hours 37°C while agitations, one drop of each sample was mixed with one drop of vibrio-cholerae bivalent mono-specific coagglutination reagent (VBCR). The results were read after 2 to 3 minutes. Finally though statistical analysis sensitivity and specificity of coagglutination test were calculated to be 95.1% and 99.2% respectively, when compared to positive & negative controls and conventional culture methods. Using VBCR, coagglutination test can be therefore considered as a simple, reliable and rapid method to detect V.cholerae O1 in the stool of patients in endemic area and less equipped laboratories

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Bismuth salts and different antimicrobials including Metonidazole & Tetracyclines were used in the assessment of inhibition zone of Helicobacter pylori cultures on solid media. Antibiotics were used or in combined in order to find out their possible synergistic effects. It was showed that: only Bismuth substrate and not then salts have antibacterial effects on Helicobacter pylori and also on the other bacteria such as staphylococci salmonella and brulla. In addition, only Bismuth substrances showed remarkable synergistic effects with antimicrobial drugs against Helicobacter pylori. Therefore the data obtained from this investigation confirm previously known effect of combination antibiotic therapy including Bismuth compounds in eradicating Helicobacter pylori.

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D.I.P is a rare disease. The etiology is unknown. It is characterized pathologically by massive proliferation and desquamation of alveolar cells and thickening of the alveolar walls. In our studies from 1368-73 we have three patients hospitalized earlier the prognosis would be much better. Corticosteroid and other effective drugs would be helpfull in treatment of these patients.

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To improve visual disturbance, optic nerve decompression can be performed via transcranial or tran-sphenoidal approaches. Although the surgical exposure in transcranial approach is favourable, yet the optic nerve's presence in the field may make it vulnerable to damage. Of fighty patients with different types of pituitary adenomas, 35 cases with medium-sized (1-3 cm) tumors have been studied in a randomized clinical trial during a three year period, to compare the applicability of these approaches. While short hospital stay with better visual outcome was observed in fifteen trans-sphenoidal cases, in comparison to 20 trans-cranial cases, however the preoperative visual status and underlying disorders were similar in both groups. Decompressing the optic apparatus, trans-sphenoidally, seems beneficial, where there are no contraindications for the procedure in medium-sized pituitary adenomas

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Carpal tunnel syndrome (CTS) is considered by researchers because of its high prevalence, and several studies have been done to find the causes and factors which increase the chance for the syndrome. These studies have shown relationships between this syndrome with some physical parameters like wrist dimensions, weight and systemic conditions. There is no investigation on risk factors in CTS in our country. So the main goal of this research is to find and introduce predisposing factors for carpal tunnel syndrome. Methods: Seventy patients and 33 controls 22 to 70 years old were studied. Standard methods for median and ulnar nerve studies were used and questionnaires included physical measurements, history of diseases and personal information were completed for each person. Results: Patients had higher wrist ratio (mean difference, 0.0267, P<0.001), weight (mean difference: 6.098, P<0.001) and body mass index (mean difference: 3.376, P<0.001). Regression analysis showed strong positive relation between wrist ratio and median latencies. The strongest correlation was found between wrist ratio and median minus ulnar distal sensory latencies (Y2=0.4014, P<0.0001). No relation was found between weight and body mass index with median latencies. Seventy-nine percent of patients and 48.5% of controls had wrist ratio of 0.7 or greater (P<0.05). Seventy-two percent of patients with repetetive hand activities and 78% with associated conditions had wrist ratio of 0.7 or greater. Seventy-six percent had wrist ratio less than 0.7. No relationship was found between obesity, diabetes, thyroid disorders, rheumatoid arthritis, taking oral contraceptive, hysterectomy, oophorectomy, menopause and repetetive hand activities with involvement of carpal tunnel syndrome. Discussion: Wrist dimensions seem to be an important predictor for carpal tunnel syndrome also in patients with associated conditions. If individuals with squarer wrists are involved in special conditions, they may show symptoms of the syndrom. Carpal tunnel syndrome is caused by many factors but wrist dimensions seem to be a predisposing factor and provides an explanation for bilateral involvement or familial occurrence of it.

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A prospective study during 1990-1995 was conducted to assess the risk of rejection and infection in kidney-transplant recipients, who's original kidney had vesico-ureteral reflux (VER). Two groups of recipients with and without VER were followed for one month after transplant 24 and 250 cases respectively. The calculated relative risks for the effect of VER showed a moderate increased risk for rejection in VER group (RR=1.82, CI=1.12-2.95, P<0.05). No effect was found for VER being one-or two-sided. Hence, VER has a moderate effect on rejection, but no effect on infection.

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Primary hyperaldosteronism is one of the few causes of hypertension that can be cured by surgery. Primary hyperaldosteronism is caused by adrenocortical adenoma or hyperplasia. It is important to differentiate between adrenal adenoma and hyperplasia because the preferred treatments are different. In all patients with new-onest or worsening hypertension the primary hyperaldosteronism should be considered as an etiology. Patients with primary hyperaldosteronism classically have hypertension with spontaneous hypokalemia. The serum sodium concentration is usually normal in patients with primary aldosteronism who are not taking diuretics. Weakness, fatigue, paresthesia, tetany and even paralysis may develop. Renin and angiotensin II are suppressed in both forms of primary hyperaldosteronism due to feedback. Polyuria may develop secondary to vasopressin resistance from chronic hyperkaliuria. Hypertension or eclampsia during pregnancy is common in women with primary hyperaldosteronism. Case report: A 42-years-old woman presented with headache, severe hypertension, general weakness, easy fatigability, vertigo, palpitation, visual disorders and nocturia. She had a past history of eclampsia 10 years ago. In laboratory investigation there was hypokalemia, elevated serum aldosterone, low renin activity and hyperkaliuria. In abdominal CT-scan there was a hypodense mass measuring 2 cm in diameter in her left adrenal gland. The patient had primary hyperaldosteronism due to aldosteronoma.

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In an evaluation of nine cases (5 females, 4 males, 2.5 to 22 years old) with congenital torticollis who had been treated by bipolar release of sterno-cleido-mastoid muscle at Emam Khomeini Hospital, department of orthopedic surgery between 1981-1994, all of the patients were satisfied with cosmetic and functional results. In spite of palpable soft tissue remaining in some patients, limitation of bending to the opposite side was below ten degrees. Facial asymertery improved in older and resolved in younger children with no recurrence and occurrence of diplopia. Recommendations: 1) Operative treatment of congenital torticollis should be considered beyond the age of 12 months and even over 19 years old. 2) Bipolar tenatomy, cephalad and caudal release of the sterno-cleido-mastoid has better results than limited procedures in older children, especially beyond 3 years old. 3) Postoperatively, early range of motion exercises in extension, and not in flexion is highly recommended.

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Disodium hemiphthalate Glycyrrhetinic acid (DHGA) possesses anti-inflammatory and analgestic activities. In our research, this agent was injected intraperitoneally to mice, according to the following schedule.
1) 25 mg/kg, 50mg/kg & 75mg/kg at 7th day of pregnancy.
2) 50 mg/kg & 75mg/kg at 8th day of pregnancy.
3) 50mg/kg & 75mg/kg at 9th day of pregnancy.
DHGA with doses of 50mg/kg and 75mg/kg at 7th, 8th and 9th day, delays the growth, decreases developing of ossification centers (specially in hand and foot middle phalanxes), decreases the number of caudal vertebrae of sacro-illiac joint and results in slight but important increases in fetus mortality.
Abbreviations
H & E=Haematoxylin & Eosin
CRL=Crown-Rump Length
BPD=Biparietal Diameter
W=Weight
ETS=Embryo Toxicity Score

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Between 270 patients complaining of symptoms of vaginitis, bacterial vaginosis was diagnosed in 68 women (%25) based on at least three of four criteria: 1. Homogenous vaginal discharge 2. Positive amine test 3. pH more than 4.5 4. Clue cell in wet smear. The results were compared to 55 normal controls.
Clue cell with more than %20 of epithelial cells was seen in %87 of cases and %5.5 of controls. A pH more than 4.5 showed the greatest sensitivity (%100) and the smallest specificity (%47). The most frequent complaints included increased discharge, bad odor, and sensing bad odor after coitus.