Tehran University Medical Journal

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Survey of anatomic variations of coronary arteries is the most fundamental of researches in the field of these vessels. For performing this survey, coronary arteries (CA'S) of 463 human heart cases (gathered from three different surces: 1) Legal medicine center corpses, 2) Cadavers of dissection rooms in medical schools, and 3) CA'S angiographic films from hospital centers) were studied. After comparison between the statistical results in this research and the foreign ones, similarities and differentes from this subjects were ascertained as below, that, there were relatively considerable differences between: the number of CA'S (presence of 2 or 3 branches), origin of S.A. node artery, and type of main left coronary artery divisions (2 or 3 branches producing), but, in the other instances no considerable differences were observed

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The 3.4 million polulation of Isfahan province was evaluated by cluster sampling. In this study, 11230 cases had one or several medical complaints, 9818 had sought treatment in medical centers 146 were hospitalized. Only 74 of the latter were admitted to university hospitals. During the month prior to study, 945 cases had been resting at home. The ratio of cases resting at home to those who were hospitalized was 6:1. This study shows that the number and variety of outpatient cases is higher than hospitalized ones, and that university hospitals are not adequate for the training of medical students, and that attending community based outpatient clinics and training centers is essential for a good medical education

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Amount of environmental lead pollution is increased with progression of industry. This pollution is able to damage the living beings in many ways. Blood and Immune systems are more sensitive to toxic effects of lead. 30 female and 6 male rats from Sprague dawley race are chosen by simple random sampling. After copulation and vaginal plug observation, expectant rats are calssified in test and control groups. Since the first day of pregnancy, test group is given a drink containing lead acetate 0.13% in distilled water and control group is given distilled water. After delivery, for ultrastrectural studies, spleen specimens of newborn rats are fixed in glutaraldehyde solution 2% and after processing are studied by T.E.M. Sinusoidal endothelial cell show: morphological changes in mitochondria, appearance of primary & secondary lysosomes and multivesicular bodies and swelling in ER. It seems that these changes are caused by interaction of lead with enzymathic functions or lead accumulation in these cellular organels.

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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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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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Mullerian anomalies are one of the interesting but uncommon entities that gynecologists confront. The incidence is 1-6%, It is difficult to" anticipate the real incidence, because most of information is obtained from infertile or complicated patients with inadequate work-up. Recently endoscopic pocedures reveal more details about these anomalies. Today, classification of Buttram & Gibbons (modified by AFS [American Fertility Society]) is accepted. In this paper one patient with septate uterus, duplication of cervix and vaginal septum is introduced. According to information obtained, only one similar case is reported (by McBean et al). This entity is not conformed with AFS classification. Only in Toaff et al classification, there is a class similar to these patients. This entity is not explained by classic embryological theory of mullerian development

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The effect of some anthropometric factors and loading on paravertebral muscles was tested in this study. Thirty two healthy men with mean age of 25.25 years participated in this study. They didn't have history of low back pain since 12 months ago. The effect of weight, height, upper limb length, abdominal & chest circumference and upper body height and other factors e.g. body mass and functional capacity indexes on maximum isometric torque of paravertebral muscles and spinal range of motion in all planes of movement and effect of loading with 0, 5, 10, 15 kg loads on paravertebral factors e.g. dynamic torque, velocity, work, power, and slope of torque was examined with a dynamometer named ISOSTATION B-200. Correlation, analysis of variance and t-test was used in SPSS program. Results show that maximum isometric torque and functional capacity index increased with increasing weight abdominal and chest circumference and body mass index (P<0.05). Height, upper body height and upper limb length don't have effects on this factors, and anthropometric factors don't have effects on range of motion. Maximum dynamic torque, maximum velocity, work and power were significantly increased and time of movement & slope of torque were significantly decreased while load increased (P<0.05). This study showed that load-velocity relationship in limb muscles can not help the paravertebral muscles studies because paravertebral muscles histologically differ from limb muscles.

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Variation of recurred branch of median nerve in relation to the median and flexor retinaculum are significant for both hand surgeons and specialists always. In this study, 64 cadaver hands (32 men) have been dissected. The median nerve was identified at the proximal edge of the flexor retinaculum, and in order to expose carpal tunnel the ligament was divided, and the above subjects were studied. The results are: 1) The relation of recurrent nerve to the flexor retinaculum was classified into 4 types: A) In (53.1%) of subjects, this branch arises from the median after the flexor retinaculum. B) In (31.3%) of subjects, it arises from the median in the carpal tunnel and the moves around the lower edge of flexor retinaculum and enters the thenar region. C) In (14.1%) of subjects, it arises from the median in the carpal tunnel and pierces the flexor retinaculum. D) In (1.56%) of subjects it arises, in the carpal tunnel and it divides into two subbranches here. One follows pattern A and the other pattern C. 2) In this step, the relation of the recurrent branch to the median nerve was studied. The results show that inspite of this image even though most often the recurrent branch arises from the lateral side of median, in (68.75%) of subjects it arises from it's anterior surface. The MC Nemar test reveals that there is no relation between manifestation of mentioned patterns with right or left hands.

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Two hundred charts of infertile patients who admitted from April 1995 until March 1996 at Mirza Koucha Kkhan Hospital, retrospectively were reviewed. In this study, the results of hysterosalpingograms and laparascopy of all patients were evaluated. The goal of this study was: whether polypoid alterations and endometrial hypertrophy were a cornerstone sign for endometriosis. Among 32 patients who showed endometrial hypertrophy or polypoid hypertrophy only 3 has had endometriosis in laparascopy which were proved by histopathology, while 22 out of 168 with normal hysterosalpingograms revealed endometriosis. In conclusions: hypertrophic alternations and polypoid changes of endometrium could not be a good sign for endometriosis, and normal hysterosalpingograms do not rule out the endometriosis.

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Gentamicin was evaluated for developmental toxicity in pregnant Sprague-Dawley rat. Gentamicin was administered subcutaneously on days 6-15 gestation at dose of 100 mg/kg. On gestation day 21, all live fetuses were examined for external and skeletal malformations and variations. Increased resorptions and dead fetuses, and reduced fetal body weight were observed at dose of 100 mg/kg. Gentamicin caused severe skeletal anomalies, such as: wavy ribs, incomplete ossification of sternebrae, tail vertebra, metacarpus, metatarsus and calvaria. These results indicate the nature and extent of embryotoxicity and teratogenicity of gentamicin in Sprague-Dawley rats.

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It is generally assumed that local muscular fatigue predisposes the individual to injury. Despite the significance of muscular fatigue and endurance, there are not much dynamic endurance studies for trunk muscles in the literature. Most of them have used isokinetic dynamometer which keeps the velocity of movement constant. In this studies with the help of an isoinertial dynamometer we have assessed the effect of repetitive and fatiguing flexion-extension movements patterns and motor output. 38 female subjects with no history of low-back pain for the 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position, velocity impulse, work and power of each axis. Resistance were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a saggital plane resistance equal to 50% of their maximum isometric extension strength in the upright position. The minimum resistance in the coronal and transverse planes were set-up at 5-7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Immediately after dynamic test another isometric test was performed. A paired T-test procedure was performed among the selected parameters of the 1st middle and last 3 repetition cycles. The selected parameters are range of motion, velocity, torque, impulse, work, power, time interval and time of movement. Also, a paired T-test was performed between maximum isometric strength before and after dynamic test. All the selected parameters were significantly reduced in the saggital plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction of the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structures is located in a more injury prone position, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.

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Clomiphene critrate is an effective and safe treatment for anovulation, but in some cases resistance occurs. To evaluate the efficacy of Dexamethasone in resistant anovulatory normal Dehydroepiandrosterone patients, we prospectively studied 57 infertile resistant anovulatory women. Each woman received 100 mg daily clomiphene critrate from cycle days 3-7 and 0.5 mg Dexamethasone from cycle days 3-12 at night. Serial ultrasonography was performed and hCG (5000-10000 IU) was administered when the follicles reached 17-18 mm in diameter. Ovulation in 80.7% and clinical pregnancy in 29.3% patients were achieved in 92 treatment cycles. The average dominant follicles>16.1 mm was 2.42. The endometrium thickness in 61.4% was greater than 8 mm. Nor adverse reaction of clomiphene critrate neither hyperstimulation were encountered. Ovulation and pregnancy rates were similar in both primary and secondary infertile groups. According to low cost, less side effects and effectiveness, we recommend combination of clomiphene critrate and Dexamethasone in patients with normal DHEAS resistant anovulation.

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The objective of this study was to examine the correlation between both midfollicular FSH/LH ratio and number(s) of follicles with ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovarian syndrome (PCOS). This was carried out in IVF unit at Mirza Kouchak Khan Hospital. To induce ovulation, PCOS patients were stimulated with gonadotropines. Fifty four PCOS patients with normal basal level of FSH, LH were studied prospectively. 22 patients did not receive HCG and stimulation cycle was canceled due to OHSS. 32 patients received HCG and stimulation cycle was completed. In all patients mid-follicular (day 8 of stimulation protocol) serum FSH/LH ratio was measured. On the same day number of ovarian follicles were also counted using vaginal sonography. In canceled cycles, LH on day 8 was shown to be low along with increased number of follicles. The risk of cycle cancelation raised twice with one increment of FSH/LH ratio. Also, with increase of one follicle the risk of cycle cancellation increased 1.3 times. To induce ovulation by gonadotropine stimulation in PCOS patients, the dose should be carefully monitored. Measuring FSH/LH ratio and number of follicles on day 8 of stimulation protocol are reliable guides in order to predict those patients prone to develop OHSS.

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The aim of this investigation is to compare the effect of applying two transcutaneous electrical nerve stimulation (TENS) current with different frequencies (2 Hz & 100 Hz) on Hoffmann reflex recorded from gastrosoleus muscle of healthy people. Forty female subjects between 20 to 30 years of age were participated in this quasi-experimental design. Twenty of them were exposed to the 100 Hz current and the remaining 20 to 2 Hz current on dermatome S1 root. The excitability of the alpha motoneurone was measured by H-reflex amplitude (peak to peak max/2) before and after the application of the TENS current for 30 minutes. The reflex was recorded and at measured before (TO) and after the application of TENS at different times (T1, T% and T10) up to 10 minutes. The mean values were compared by multiple paired T test (alpha=0.00825). The results indicate a considerable decrement in Hoffmann reflex amplitude after application of 100 Hz current in comarison with that of before the application. The effect last for 10 minutes after the TENS application, whereas the application of 2 Hz current results in increment of the Hoffmann reflex amplitude. The 5 and 10 minutes interval test dose not show any significance and the results were attenuated befor 5 minutes. As a conclusion high frequency of TENS (100 Hz) has an inhibitory effect on excitability of alpha motor neurone reflex lasting for 10 minutes, while low frequency of TENS (2 Hz) has an facilatory effect on the same motoneurone with short lasting effect.

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In this study, chromosome analyses were performed on 70 infertile Azoospermic and Oligospermic (<20 million/ml) men, and also cultures of peripheral blood lymphocytes by high resolution banding method were analysed as well. It is revealed 8 (11.43 percent) men with chromosomal abnormality. There were 31.4 percent patients with azoospermia and 68.6 percent with oligospermia from several thousands to 20×10^6 million/ml and their duration of infertility was at least 2 years. All patients with numerical chromosome anomalies had azoospermia and the most frequent anomaly was 47, XXY chromosomal constitution (klinfelter's syndrome), found in 8.57 percent of patients. We found that chromosomal anomalies found in this study were sex chromosome anomalies and an increased rate of numerical chromosomal abnormalities was among men with azoospermia. As a conclusion, we suggest that all men with azoospermia be considered for cytogenetical evaluation.

 

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The aim of this investigation is to compare the effect of applying two transcutaneous electrical nerve stimulation (TENS) current with different frequencies (2 Hz & 100 Hz) on Hoffmann reflex recorded from gastrosoleus muscle of healthy people. Forty female subjects between 20 to 30 years of age were participated in this quasi-experimental design. Twenty of them were exposed to the 100 Hz current and the remaining 20 to 2 Hz current on dermatome S1 root. The excitability of the alpha motoneurone was measured by H-reflex amplitude (peak to peak max/2) before and after the application of the TENS current for 30 minutes. The reflex was recorded and at measured before (TO) and after the application of TENS at different times (T1, T% and T10) up to 10 minutes. The mean values were compared by multiple paired T test (alpha=0.00825). The results indicate a considerable decrement in Hoffmann reflex amplitude after application of 100 Hz current in comarison with that of before the application. The effect last for 10 minutes after the TENS application, whereas the application of 2 Hz current results in increment of the Hoffmann reflex amplitude. The 5 and 10 minutes interval test dose not show any significance and the results were attenuated befor 5 minutes. As a conclusion high frequency of TENS (100 Hz) has an inhibitory effect on excitability of alpha motor neurone reflex lasting for 10 minutes, while low frequency of TENS (2 Hz) has an facilatory effect on the same motoneurone with short lasting effect.

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Introduction: The bone mass density (BMD) may vary in different countries due to different genetic and environmental factors. This study was performed to determine the BMD of the normal population in Iran.

Methods and Materials: Subjects were selected randomly from different works and social classes in Tehran (from the lowest to the highest). For each decade and sexes, 20 normal subjects were selected (140 men and 140 women). BMD was measured with a Hologic 1000 plus machine by dual energy x-ray absorptiometry (DEXA) method for the lumber spine (L1, L2, L3, L4, L1-L4) and the femoral neck (neck, trochanter, intertrochanter, ward, total). Data were treated by polynomial approximation (3 rd degree). The obtained curves were compared with the standard Hologic curves for Caucasians.

Results: In female the peak bone mass (PBM) was 1.019 g/cm² for the lumbar spine and 0.832 for the femoral neck. In male the peak bone mass (PBM) was 0.987 g/cm² for the lumbar spine and 0.907 for the femoral neck. The BMD of both lumbar spine and femoral neck were lower than the Hologic standards. For the lumbar spine the mean difference was 6.5 percent (2 to 21 percent, CI=1) for women and 13.8 percent (2 to 36 percent, CI=1.45) for men. In femoral neck the mean difference was 5.4 percent (2 to 16 percent, CI=0.96) for women and 4.6 percent (1 to 14 percent, CI=0.96) for men.

Conclusion: The BMD of the lumbar spine and the femoral neck was lower in Iranian compared to the Hologic standards for Caucasians. This was seen in all age groups and in both sexes. It was less pronounced for the PBM in spine was lower in men than woman. The lower BMD of the spine in men was also seen in a cohort of patients with different diseases (inflammatory and non-inflammatory).

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The aims of this study were to determine incidence and types of observable congenital abnormalities among births of Mirza Kochak-Khan, Imam Khomeni and Shariatti hospitals between first of Novermber 2000 to the end of September 2001.
Materials and Methods: We used neonates that survived for 24 hours after delivery. A questionnaire was specially designed to explore each of the objectives for our study. A group of experts that were thoroughly trained to completed questionnaires by interview to mothers and evaluation of neonates. Data analysis was performed and by Excel and SPSS.
Results: Results showed that congenital abnormalities were present in 205 (3.2 %) of 6424 neonates, from 3 hospitals. The most frequent abnormalities consisted of musculoskeletal defects (37.3 %), Nervous system defects (24.7 %), urogenital defects (24.3 %) head and neck defects (13.6 %).
Conclusion: The result of this study showed that incidence of visible congenital abnormalities ratio in contrast to other countries have not significant difference but the types abnormalities were significant.

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Background: Total Intravenous Anesthesia (TIVA) compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia.

Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C) in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group) or alfentanyl plus midazolam (midazolam group)

Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05), also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05). After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P<0.05 ) following this, there was an increase in heart rate in both groups that it was modest in propofol group (98 Beat/Sec versus 118 Beat/Sec, P<0.05). There was no significant difference in mean infused alfentanyl (P>0.05) also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05). Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05).

Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies using other narcotics and other narcotics-anesthetic compounds with various dose can be mentioned.

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Background: In order to evaluate bone induction and repair in cranial bone defects by the use of combination of Octacalcium Phosphate/Bone Matrix Gelatin (OCP/BMG), this study was conducted.

Materials and Methods: We used 40 young male Sprague dawley rats (5-6 weeks age). A full thickness standardized trephine defect, 5mm in diameter, was made in the rat parietal bone and OCP combined with BMG was implanted into the defect. No OCP/BMG particles were implanted in control group that was otherwise treated identically. On the 5th, 7th, 14th, and 21st days after implantation, the rats were killed and bone samples collected. After processing the tissues by routine histological procedures, 5mm thick sections of bone were cut and stained with Haematoxyline and Eosin (H& E) and alcian blue and examined by light microscope.

Results: On the 5th day after implantation, inflammatory cells were seen around the implanted materials, especially around the OCP particles. A few clusters of cartilage cells were observed between the BMG particles in the central position of defects on the 7th day after implantation. On the 14th day after implantation, osteogenesis was seen at the margins of the defects. In addition to bone formation from the margins toward the center, interstitial growth of new bone tissue was seen around the implanted materials. By the end of 21st day, almost all of the OCP/BMG particles were absorbed and bone trabeculae, bone marrow cavities and bone marrow tissues were seen. In the control group, at the end of 21th day, a few areas of new bone were seen near to the defect margins and host bone, but much less than in the experimental group.

Conclusion: Therefore, implants of OCP/BMG appear to stimulate new bone growth in bone defects and these biomaterials could be used in the repair of cranial bone defects and injuries in clinical situations.