Tehran University Medical Journal

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Background: The purpose of this study was to identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuver (CRM).

Methods: This interventional study was conducted on 58 patients (14 males, 44 females, mean age 48.12+13.22) referred to the Vertigo Rehabilitation Clinic of the Rehabilitation School of Tehran University of Medical Sciences from 2002 to 2004. All patients were treated with CRM. According to the treatment efficacy the patients were allocated in three groups: completely treated, partially treated, and not treated. The effect of factors including age, sex, etiology, duration of BPPV, unilateral or bilateral disease, number of maneuvers, and number of sessions on outcome in patients was evaluated.

Results: Forty-nine patients (84.5%) were completely cured. Age, sex, etiology, and duration did not significantly affect the treatment outcome. Unilateral BPPV can be treated significantly better than bilateral BPPV. Forty-seven patients who were completely treated needed 1 session and thirty-seven of them required 2 maneuvers.

Conclusion: CRM is significantly effective for BPPV treatment. Treating unilateral BPPV is expected to be easier. As most of the patients will be cured by 1 or 2 maneuvers or in 1 session, patients who required more sessions or more maneuvers may not be completely treated.

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Background: Management of acute abdomen usually does not necessitate accurate pre-operative diagnosis but the surgeon should make a decision about the need for emergent laparotomy. This fact is somehow different for localized peritonitis (e.g. acute appendicitis) in which the clinical presentation directs straightly to the diagnosis. However, acute appendicitis has lots of differential diagnoses, finding the normal appendix during laparotomy is just a start point to look for other diagnoses. Omental torsion is a rare cause for acute abdomen that is usually missed. Knowing about this rare condition and its frequently encountered presentation at the operating room (sero-sanguinous fluid coming out of peritoneal cavity) may prevent missing the diagnosis and doing a malpractice.
Case report: Report a 9 year- old boy presented with acute abdomen which turned out to be an omental torsion after the operation.
Conclusion: Knowledge about this rare condition "omental torsion" and its clinical and intra operative presentations may prevent missing the diagnosis and a malpractice.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415).
Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis.

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Background: Microangiopathy and macroangiopathy frequently coexist in type 2 diabetes mellitus (T2DM). Both types of the vascular complications share traditional risk factors but it is not clear whether the presence of microangiopathy, such as diabetic retinopathy, constitutes a predictor of atherosclerosis in carotid arteries in patients with the disease. In this study we looked for the association between diabetic retinopathy and intima-media thickness in carotid arteries of patients with T2DM.

Methods: In this case-control study we examined 100 consecutive patients with T2DM in Rasoul Akram Hospital in Tehran, Iran during 2009-2010. We assessed intima-media thickness of carotid arteries by ultrasonography. All patients underwent ophthalmo-logic examination.

Results: Diabetic retinopathy was found in 50 (50%) patients. Intima-media thickness was higher in patients with diabetic retinopathy than those without it (0.77±0.17 mm vs. 0.71±0.2 mm, respectively, P=0.041). Moreover, intima-media thickness was more prevalent in patients with proliferative diabetic retinopathy than patients with non-proliferative form of the disease (0.87±0.16 mm vs. 0.68±0.1 mm, respectively, P<0.001).

Conclusion: Diabetic retinopathy seems to be associated with increased intima-media thickness of carotid arteries in T2DM. It may be a common denominator of pathogene-sis of microvascular complications and atherosclerosis in T2DM. Evaluations of carotid arteries are to be done by non-invasive methods such as color Doppler sonography for screening and preventing prospective cereberovascular accidents in patients with diabetic retinopathy, especially proliferative retinopathy, in routine ophthalmological examination of patients with T2DM.

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Background: Stress Ulcer Prophylaxis (SUP) is important in patients in Intensive Care Units (ICU). In this study, we evaluated the efficacy of the American Society of Health System Pharmacists (ASHP) guidelines, for stress ulcer prophylaxis. Methods: In this Quasi experimental study, data of patients that admitted to the ICU of Imam Khomeini Hospital of Urmia was recorded for three months. Then our guideline that was selected on the basis of ASHP guidelines were presented to physicians for one month and then patients’ data were collected again. The patients that hospitalized due to acute gastrointestinal bleeding and died in the early hours of admission were excluded. The data were analyzed. Results: This study involved 234 patients, of them 112 patients (91.1%) in the pre- intervention period and 99 patients (89.2%) in the post-intervention period had received acid-suppressive therapy (AST) (P=0.632). Of 77 patients (62.8%) in the pre- intervention period and 88 (79.3%) in the post-intervention period had an indication for SUP according to our ASHP-based guideline (P=0.005). Of the patients without an indication for SUP, 39 of 123 (31.7%) received AST in the pre-intervention period versus 18 of 111 (16.2%) in the post-intervention period (P=0.006). of 112 (91.1%) cases in the pre-intervention period compared with 93 (83.8%) cases of the prescription drug order was incorrect (P=0.092). Gastrointestinal bleeding were in five patients (4.1%) found during the pre-intervention period and 8 (7.2%) cases in the post-intervention period (P=0.295). Conclusion: In this study the majority of cases not been in accordance with the ASHP-based guideline and our education did not affect the quality of stress ulcer prophylaxis. It seems that more attention to the training of physician in the prophylaxis of stress ulcer can be effective in improving the health status of patients and additional costs may be reduced.

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Background: Traumatic amputation of upper limb above the level of the elbow, are rare injuries that a surgeon may be faced with a handful of cases during his career. Even with advanced techniques in microvascular surgery, the survival of the transplanted limb that cut off completely from the arm is relatively weak. Case Presentation: Four injured people (patient) in Imam Khomeini Hospital during 1999-2013 in Tehran University of Medical Sciences were treated. Two patients had complete amputation of limb and other patients suffered from complete cutting in artery and vein along with neurological and soft tissue damages. There was not any ischemia or gangrene. However, efficiency of limbs with damages in peripheral nerves was not significant. The main reason was lack of immediate repair of the damaged nerves. In the recent examination, after discharge, the performance of the limb is firstly related to the conditions of the nerve system and secondly it depends on the severity of the injury in each of the muscles. However, none of the patients were dissatisfied of any situation and they were prepared to make any cooperation for improving the condition of their transplanted limb. Conclusion: Transplantation of the amputated limb can be done in spite of limited resources. Any delay in repairing damaged nerves will result great reduction of final organs’ performance. A limb, made from the own body, always take precedence to prosthesis, even when the efficiency is low.

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Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago. Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%). Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.

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Hemoglobinopathies are most common inherited disorders in the world; approximately 7 percent of the worldwide population and 5-6 percent of population of Iran are carriers. The hemoglobin disorders inherit as autosomal recessive and are very common in the Mediterranean area and much of the Asia and Africa. The control of this inherited disorders need to genetic counseling and accurate screening by more advanced and more accurate methods. This study explains features of current Iran hemoglobin disorders, nominates the accessible methods for screening them and introduces the capillary zone electrophoresis as a rapid and more accurate method. The required data were extracted of various articles and then for good explanation, current Iran hemoglobinopathies properties were showed in the tables and electropherograms of important hemoglobin disorders in Iran population were provided for help to interpretation results of blood tests by capillary zone electrophoresis method. Hemoglobin disorders are including thalassemias and hemoglobin variants; Disruption in the production and malfunction of globin chains cause types of hemoglobin disorders. We cannot introduce one of clinical laboratory tests as critical and basic method for screening and distinguishing types of inherited hemoglobin disorders as alone. For distinguishing the types of them must be prepared enough information and data of the hemoglobin disorders and for more accurate analysis must be used simultaneously different methods as gel electrophoresis, high performance liquid chromatography, isoelectric focusing, capillary zone electrophoresis or molecular tests. The capillary electrophoresis is an accurate and rapid method for screening types of the hemoglobin disorders. Other side this method cannot analyze all of them, so must be used biochemical, biophysical and molecular methods for confirmation the results. This review showed we can use the capillary electrophoresis and HPLC as two complementary methods for hemoglobinopathies screening. We can analyze by the methods more hemoglobin disorders and decrease more laboratory errors. Moreover, we must have patient history, hematological indices, information and data of types of hemoglobinopathies. The patient history and complete blood count results as red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration can be useful and helpful in screening the hemoglobin disorders and then distinguishing all of hemoglobin disorders.

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Results: According to results, of the 661 patients who were studied, 462 ones had positive and 273 had significant prick test results. The grasses group with 293 positive (44.3%) and weeds group with 259 positive results (39.2%) were more common than the other categories. Among the significant positive tests, these two categories with 161 and 142 significant positive tests were indicated as the most common allergens. Respiratory allergens were also more common in patients with a family history of allergies in weeds and trees categories, but there was no significant difference in sensitization pattern according to the history of tonsillectomy. Conclusion: Patients in Ardabil with allergic rhinitis and asthma were more sensitized to weeds and grass mixtures. It is recommended to provide preventive recommendations to allergic patients and the development of localized skin testing packages and additional studies should be conducted focusing on these two categories of allergens.

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Alzheimer’s disease (AD) is the most prevalent age-related neurodegenerative disorder worldwide, and no cure or prevention has been found for it. Extracellular senile plaque and intracellular neurofibrillary tangles are two important histopathological hallmarks of AD, which are both harmful for the cell. Senile plaques are composed of amyloid beta and neurofibrillary tangles are formed by hyperphosphorylated Tau proteins. In AD, several cellular changes also occur, including oxidative stress, neuroinflammation, accumulation of misfolded proteins, and mitochondrial dysfunction. These events promote neuronal death and finally decline memory and cognition. Lack of success of the available chemical anti-AD therapeutic agents has attracted attention to the concept of the administration of naturally occurring compounds in the treatment of AD. These compounds can be employed as a substitute for the chemical agents or complementary regimens. Several natural products are deemed capable of crossing the blood-brain barrier and are known for their central nervous system-related activity. Among the most important of them are flavonoids. Recent evidence has demonstrated their neuroprotective effects. These plant-derived compounds have strong effects on dementia-induced brain disorders because of their ability to produce antioxidants. Numerous mechanisms have been proposed for flavonoids through which they act for the prevention or recession of the disease process. According to evidence, flavonoids inhibit acetylcholinesterase (AChE), β-secretase (BACE1) and free radicals. They reduce the amyloid-beta toxicity and prevent the formation of neurofibrillary tangles. Also, they help to inhibit apoptosis induced by oxidative stress and neuroinflammation. These products have a role in synaptic plasticity and the generation of new neurons. They can affect various signaling pathways like Extracellular signal-regulated kinase (Erk), Phosphatidylinositol 3-kinase (PI3K)/AKT and mitogen-activated protein kinase (MAPK). Overall, these processes can prevent the progression of AD and improve cognitive symptoms. In the present paper, the effect of the most important plant-derived flavonoids is briefly reviewed in different models of AD. The mechanism of action and the important signaling pathways in reducing neuroinflammation, apoptosis, and oxidative damage are discussed. It is concluded that despite the beneficial effect of these compounds, future studies are needed before flavonoids can be used as a drug in the treatment of Alzheimer’s disease.

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Results: In the present study, the mean age in the two groups was similar (about 50-60 years). The distribution of sex, diabetes, weight, height and blood pressure was homogeneous in both groups. There was a statistically significant difference in the incidence of thrombosis and pain between the two groups. The results of this study showed that in the snuffbox angiography group, the number of uncomplicated cases was significantly more than the radial angiography group and in the snuffbox angiography group, the number of postoperative pain and thrombosis cases was significantly lower. The length of hospital stay in the Snuffbox group was shorter than the radial group, but there was no statistically significant difference. Conclusion: Snuffbox angiography has fewer complications compared to the usual transradial method, so it can be used as a safe method for angiography.

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