Tehran University Medical Journal

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Infection by M. tuberculosis can be demonstrated by tuberculin testing. On sequential PPD some person show a marked increase in the size of their skin reactions which may not be due to recent or past tuberculous infection. This phenomenon (booster effect) can occur as soon as a week after the initial test and persist for as long as a year.

Methods and Materials: The purpose of this research is studying the size of induration following repeated PPD tests (booster effect) that studied in children who came to our clinic or imbedded in pediatric unit and the group of student in grades 4 and 5 at elementary school (totally 80 cases) for one year.

Results: Increase of induration in 25% of all (20 cases) was 5 mm or more and in 75% of all (60 cases) was less than 5 mm and between these two groups, differences was meaning full (P< 0.05). The increase of induration in 12.5% was 7 mm or more.

Conclusion: Because there is not shown definite increase of induration (more than 5 mm) on sequential PPD in children, we must to consider to new infection.

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57 women affected by abortion or threatened abortion were investigated in view of antitoxoplasmosis antibodies by immunofluorscence. 11 women who have aborted for the first time have positive titer of polyvalent antibodies more than 1/400. 77.3% of these women have IgM titer greater than 1/20. The highest percentage of abortion was in the third month of pregnancy and this is probabley related to the increase in the percentage of women who have IgM titer greater than 1/20 and who were in the acute stage of the disease. The percentage of women with a positive titer of IgM titer greater than 1/20 and who were in the acute stage of the disease. The percentage of women with a positive titer of IgM of greater than 1/20 decreased from the third month of pregnancy. It seems that the care and follow-up of pregnant women with toxoplasmosis whether from antibody titer or from its type is of great importance. It is preferable to titrate antitoxoplasmosis antibody titers in the sera of women before pregnancy.

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Results of some cancer researches show that a number of hormones in ceratin tumors are growing up. Often, the majority of these hormones are produced by tumor cells or by an unknown origin in the neoplastic area. Also, it is clear that some of these ectopic hormones are produced only by specific tumors. In addition, different effects of these abnormally produced hormones on the immune system are shown in recent years. Thus, we decided to study the hormonal status of patients with chronic lymphocytic leukemia (CLL) patients. The results of this study showed that the LH and FSH levels in the majority of patients are rising above normal while testosterone level in many of them is decreased. In the next step, we are going to study the immunological effects of LH, FSH, and testosterone one the lymphocyte function in vitro.

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Alterations have been found to occur in every component of immune response during an anesthesia and surgery. These alterations represent the body's general physiological responses and are mainly depended on the extent of surery as well as on blood transfusion. Basically, the immune response to an anesthesia and surgery is a beneficial reaction needed in local defences, wound healing, and preventing the body from making auto-antibodies against its own tissues. The responses may, however, contribute to the development of post-operative infections and spread of malignant disease, and opporturistic agents.

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This article aim is to introduce a case of PAPVC (partial anomalous pulmonary venous connection). The patient was a 25-year-old women who had dyspnea and palpitation. She expressed no special disease, no past medical history, and no drug usage, but her brother and her aunt had the above-mentioned history. In the physical examination, lungs were clear and the heart had S2 splitting, and there was a systolic murmur in the pulmonary area. Her liver could be palpitated two centimeters below the costal edge, but she didn't have any hepatomegaly. In cardiac catheterism, she had PAPVC, atrial septal defect (ASD), and mitral valve prolapse (MVP). The patient underwent operation had left pulmonary vein was separated from the superior vena cava and anastomosed to the left atrial auricle. By means of the pericardial patch, the left atrium became enlarged and ASD was closed. She was in a good condition after surgery and left the hospital without any complication with a good condition and recovery and had no problem any longer.

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Studies were undertaken to evaluate content of IgG, IgM, C3, C4, CH50 and proteines of sera from 53 drug addicts by immunological methods. Results shows an increase of IgG and no significant variatrion in the level of other Ig(S). In the same time we have seen an augmentation of gamma globuline in the protein electrophoresis pattern. The level of C3 and C4 of complement component rest unchanged.

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Behcet disease (BD) is a systemic inflammatory disease of the unknown etiology. There is however, some evidence to suggest that immunological abnormalities are important in its pathogenesis, furthermore several T-cell abnormalities which may be quite relevant to autoimmune origin of the disease have been described. We report here our study of T-cell subsets, B and NK cells in 68 patients with BD in comparison to 30 normal controls, by monoclonal antibodies against CD3 (pan T-cell), CD4 (Helper) CD8 (Suppressor/cytotoxic), CD22 (B-cell) and CD16 (NK-cell) markers. The results show the increase (P=0.008) of T (CD3), T (CD4) (P<0.000001) and decrease of T (CD8) (P<0.000001) and reduction in ratio of CD4/CD8 cells (P<0.000001), but any alteration in B and NK cells number were not seen. In patients with BD 69.8% negative PPD test and above results suggests that the cellular immunity in these patients is anergic, which may be an important etiological factor.

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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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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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This is a study of depressive features in 51 Iranian combatants suffering from PTSD. DSM III-R considers depressive symptoms as associated clinical features of this condition. DSM III and DSM III-R both accepted the strong evidence that PTSD is a form of anxiety and included it in the anxiety disorders category. It is true that many PTSD sufferers present with anxiety features similar to these present in generalized anxiety disorder (The same authors reported anxiety features in 94% of Iranian combatants 1991), but this similarity is true: For depressive features, 92% was found in present study. The findings are discussed in relation to previous studies of combat-related PTSD, both done in Iran or elsewhere.

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88 patients with drug addition were evaluated for HBsAg, HBeAg, anti-HBC, anti HIV syphlisis and anti-toxoplasma antibodies. 48 of them were male and 40 were female. The range of their ages was between 19 to 49 years and their addiction time were between 6 month to 30 years. The results show that 5.6% of the patients have HBsAg in their blood serum and 40.9% of them have anti-HBe antibodies. All of them lacked anti-HIV antibodies. 17% of patients were positive on FTAabs test and 37.2% of them have anti-toxoplasma antibodies. There fore we can say that the drug addicts could be attacked by some opportunistic disease such as toxoplasmasis and hepatitis, and so their health control are very important because in this way we could reduce incidence of these disease

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Nelson's syndrome is usually characterized by hyperpigmentation, elevated level of ACTH, and pituitary adenoma, which is frequently available as macroadenoma. It is usually occurred in the patients suffering from Cushing's syndrome. Growth of tumor has been revealed in 10-30% of the patients following adrenalectomy. Tumors are often benign in Nelson's syndrome. The selected treatment of Nelson's syndrome are transsphenoidal or transfrontal microsurgery. The role of radiation as prophylactic effect in the patients following adrenalectomy is unknown. In this research Nelson's syndrome have been studied on the patients records who have been hospitalized in Dr.Shariati hospital during the last 10 years. The achieved results show that, among the 49 patients suffering from Cushing syndrome who have referred after operation, 11 patients (22.4%) of them have been affected with Nelson's syndrome. The syndromes have been appeared after 3-9 months and with regard to occurrence of Nelson's syndrome in some patients immediately after bilateral adrenalectomy, it is recommended that selecting of the patients for bilateral adrenalectomy should be studied accurately

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Radiolucent lesions of the vertebrae, especially the cervical vertebrae are commonly encountered by the orthopedic surgeons and neurosurgeons dealing with spinal column disorders. Considering the unavailability of highly sophisticated and reliable facilities to reach the exact diagnosis before starting appropriate therapy. Trial of medical therapy is suggested to be worthy before attempting for wide surgical intervention. Presenting a very interesting case, we have reviewed the lesions presenting as radiolucent areas in plain X-rays and planned a step by step discussion for differential diagnosis. Special stress has been done on the endemicity of tuberculosis and brucellosis in Iran.

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The Behcet disease (BD) is a systemic inflammatory disease of unknown etiology. Evidences suggest that at least some of the clinical aspect of the BD may be due to autoimmune responses, these includes elevated levels of immunoglobulins (Igs) and immune complexes. To clarify the molecular basis of the changes in the level of different classes of Igs in BD, we have detected the amount of IgG, IgM, IgA, IgE and number of B-cells (CD22+) in 68 patients with BD, 28 patients controls (PC) and 30 normal controls (NC). The amount of IgA (P=0.0007), IgM (P<0.000001) and IgE (P=0.005) shows a significant chages in BD to comparied with the NC. But IgG levels don't show any difference. The number of B-cells (CD22+) have not show any changes in BD in comparied to NC and PC. It seems that the elevation of different Igs levels in the serum of patients may be due to unknown polyclonal stimulations then the elevation of Igs caused the CIC formation and complement activation which followed by tissue damages in BD patients.

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Some of the endocrinologic diseases, especially Acromegaly, Cushing and Pheochromocytoma have multiple effects on blood glucose metabolism and regulation in non-diabetic patients. In this retrospective survey, records of patients of Tehran Medical Sciences University hospitals have been reviewd. Of 124 Acromegals, GTT was performed for 51 patients, being impaired in 18%. To evaluate diabetes, FBS and BS of 90 patients were checked, overt diabetes was detected in 27%. Among 90 Cushing patients, blood glucose was checked in 60 cases, 47% of these patients had levels above the normal range, and 39% had glucosuria. Among 80 Pheochromocytoma patients, 16 cases (26.5%) had overt diabetes. In comparison with other studied, we have obtained a little different results concerning diabetes and impaired GTT prevalence

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Pheochromocytoma is a rare disease. A retrospective study of the signs and clinical course of this disorder was performed by evaluating medical records. Our fidings indicate that the prevalence of pheochromocytoma was equal in men and women, and most patients (56%) were in their second and third decades of life. In 10% of the cases, the disease was bilateral, and in 13% it was outside the adrenal (totally para-aortic). The tumor was more common on the right side (8%), and 3.5% were familial. Almost all cases had a history of hypertension and hypertensive crises. Attack-like episodes of clinical symptoms and signs and hypertension were observed in 98%, headache in 71% and profuse perspiration in 68% of the cases. An abdominal mass was palapated in 13% of the cases, 26% had overt diabetes, 23% had ECG changes. Malignancy was observed in 4%, with metastases to the liver (n=2) lung (n=1) and spine (n=1). In the latter four cases, the metastic lesion was histologically proven to be pheochromocytoma. In three of the 28 female cases, the first hypertensive crisis occurred during pregnancy causing abortion in one case.

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A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

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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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Organochlorine pesticides are a group of persistant compounds which have been used for a long time. Due to their stability, some of them such as DDT, BHC and their derivatives are still used in the areas with malaria epidemic condition, hence the chance of food contamination always exists. The present survey demonstrated that human milk is one of the best indicator substances in monitoring the environment and human body contamination by organochlorine compounds. We studied the level of residues in the milk of nursing mothers who could be exposed to these compounds through food chain in their contaminated environment. In this investigation, we collected 40 samples from the nursing mothers of two hospitals located in the north and south of Tehran. Detection was carried out by Gas chromatography (GC) with 3% OV17 column and Ni63 ECD (Electron Capture Detector). Reference substances were obtained from WHO. Results are discussed in the text.