Tehran University Medical Journal

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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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Yersinia enterocolitis causes a wide spectrum of human diseases including gasteroentritis, which is the most frequent of its manifestation. Other diseases and clinical syndromes resulting from Yersinia enterocolitica are septicemia, mesenteric lymphadenitis, apendisitis, exudative pharyngitis, reactive artiritis, nodosum erythema and rarely Reiter's syndrome. In many countries such as western European, Scandinavian and north American countries, Australia and Japan the role of Yersinia enterocolitica particularly the 0:3, 0:8 and 0:9 serotypes in human diseases have been clearly identified. In spite of significant development in the field of separating Yersinia enterocolitica from feces as well as from the environmental specimens during the last decade, there has been only one documented report of isolating Yersinia enterocolitica in Iran in 1977. Thus we decided to test 300 samples of feces within 5 months. In this method, CIN agar as a selective and special medium and Mac conkey agar as classic medium were used. Also cold enrichment method in PBS (pH=7.8) was used. In order to determine importance of enterocolitica, we separated other pathogens of intestine such as salmonella, shigella and entropathogenic E.Coli. The achieved results from abundance points of view are as follows: 17 strains of EPEC (5.66%), 9 strains of shigella (3%), 8 strains of Yersinia enterocolitica (2.66%) and 6 strains of salmonella (2%)

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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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Proximal weakness specially in extremitas is a common neurologic symptom of patients, for which the physician should consider toxic, metabolic, infectious and paraneoblastic diseases affecting muscular system as well as primary myopathies. Osteomalacia is one of the most common considerations which is treatable but disabling as its natural course. Osteomalacia is the most often due to VITD or calcium deficiency but work up is necessary to find other primary defects that cause this disease. Renal tubular acidosis is one of these primary defects and osteomalacia secondary to it dose not respond to classic treatment of osteomalacia, so specific management is necessary. In this article we report six patients who have been referred to the clinic of neurology of Imam Khomeini Hospital since 1370 to 1374 with proximal weakness for whom RTA has been diagnosed

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Post partum haemorrhage (PPH) and retained placenta are the most common serious abnormalities encountered during the third stage of labour. PPH is one of the most common causes of mortality in childbirth, particularly in developing countries. The incidences of PPH and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction (CCT). Weather such treatment is valuable is open to question because of the lack of clinical and physiological studies. Unfortunately, oxytocic drugs are not available to about half the women of developing countries, who do not deliver under the care of a trained midwife. We know that sucking stimulates uterine contractions in lactating women. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast-feeding and again within 3 min of the start of sucking. Traditional birth attendants (TBAs) do not have the skill to administer injectable oxytoxics. It has become the practice in some TBA training programmes to teach that the risk of PPH can be reduced if the mother puts her baby to the breast immediately after delivery. Objective: To determine the effect of sucking immediately after childbirth on the length of 3rh stage and amount of bleeding in the first day. This is a semi-experimental study. It was done in Tehran'e Mirzakochak hospital. 100 women received oxytocin intramuscularly and 120 women were placed in sucking group. Then the lenghth of 3rd stage and amount of bleeding in the first day was compared between two groups. Results: The duration of the third stage and number of pads different between oxytocin group and sucking group (4.42 vs 6.08 min) and (10.58 vs 11.72 number). As for the, parity, gestational age, maternal systolic and diastolic blood pressure, infant weight and hight, the results showed no significant difference between the groups. As for the, maternal age, the results showed differed significantly between the groups. As for the gestational age, the results of the research showed that between the gestational age and the duration of the third stage, there was a reverse correlation in multipare women. So when gestational age decreases the duration of third stage will be longer. As for the maternal age, parity, systolic and diastolic blood pressure, infant weight, infant hight, infant sex, the results showed that there was no correlation between these and the duration of the third stage.

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To determine circumcision prevalence and complications in under 5 year old boys. We assessed 181 boys in a cross sectional study at a rutal area in Tehran suburbs, in Jan 1997. Data were collected by an interview about age, circumcision age and method, type of complications, nationality and parent literacy. 126 boys (69%) were circumcised, (mean 12 months). Only 27 of them (21.4%) were circumcised in neonatal period. 62 boys (49.2%) were circumcised with ring methods (plastibell or clamp), 54 boys (42.9%) with surgical methods and the others (7.9%) with nonmendical methods (traditional). Complications were 9.5% (16) and the higher circumcision age was related significantly with higher complications (P<0.04). In our study was no complication in the boys who circumcised under six months. Complications prevalence were high (9.5%). In neonatal period 34% (9) and in postneonatal period 53% (52) of boys were circumcised with inappropriate methods with age. The most common complications were local infection (43%)

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Primary Hyperparathyroidism is a fairly common disease that is much more predominant in females. Treatment is surgery and includes removing the parathyroid adenoma or the hyperplastic parathyroid glands. Considering the difficulty of this operation procedure, localization test are utilized including ultrasound, MRI, CT scan, Thallium-Technesium subtraction scan, MIBI scan and a series of other tests. According to the studies regarding these tests, MIBI scan is superior to all the others. In this survery we have studied 110 primary hyperparathyroidism patients that were operated on in Dr.Shariati Hospital between 1356 and 1376. In order to localize the adenoma ultrasound was used in ten patients, thallium-technesium subtraction scan in 38 patients. MIBI scan in 30 patients and CT scan in 3 patients. The sensitivity of MIBI scan was 86% and its specificity was 100%. In comparison, the sensitivity of thallium-technesium scan was found to be about 65%. Our results show that MIBI scan has had a high degree of sensitivity and specificity in our patients and has shown to be the best localization test. Therefore we suggest this test for the localization of all parathyroid adenomas.

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A retrospective study was conducted to investigate about breast cancer in Tehran from 1985 to 1995. All breast pathological records at five General District and Teaching Hospitals (18 general surgical wards) were reviewed and data were extracted. Overall, 3085 records were found (7291 female and 294 male). The final diagnosis was made for 2436 female records including 903 breast cancer (37.1%), 1430 benign breast disease (58.7%), 45 breast skin disease (1.8%) and 58 normal pathological report (2.4%). The dominant group age for breast cancer in women was age group of 40-49 years. The most frequent pathological stage was stage III. Breast cancer was also seen in 2.3 percent of women of 25 year old or younger. The diagnosis was also made for 278 men showing 32 breast cancer (11.5%), 23 benign breast disease (86%), 3 breast skin disease (1.1%) and 4 normal pathological report (1.4%). The results suggest that 3.5 percent of the overall breast cancer were men's, all having over 40 years of age with 60 years or older as the most frequent age. The most frequent pathological stage was stage III. The findings have some implications for public health professionals in terms of breast cancer screening in Iran.

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In a cross-sectional epidemiological study of headache disorders in neurology clinic of Fatemieh hospital of Semnan (August 22-November 20.1996), information on types of headaches, quality, severity, location, duration, frequency, precipitating factors, age of onset, influence of menstruation and pregnancy, positive familial history, use of oral contraceptive pills and other epidemiological factors including socioeconomic and age/sex composition was collected. The presence of any types of headaches was ascertained by a clinical interview and examination using the operational diagnostic criteria of the International Headaches Society. The prevalence of migraine and tension type headache was also analysed in relation to variables of life style (physical activity and sleep pattern) and associated signs and symptoms (nausea, vomiting, photophobia and phonophobia). In this study migraine and tension headache were also compared in variable aspects with each other. 1) Headache was more prevalent in women than men (F/M=3/1). 2) The most common types of headache included: tension type headache (41.4%), migraine (31.2%) and unclassified headaches (17.2%). 3) Migraine and T.T.H were more prevalent in early adult life and middle ages. 4) In both migraine and tension type headache the time profiles (duration, frequency, age of onset), quality and location were like that noted in textbook and previous studies. 5) In both migraine and tension type headache the most conspicuous precipitating factor was stress and mental tension and frequent headaches were accompanied with psychiatric problems (e.g depression and or anxiety). 6) Nausea, vomiting, phonophobia and photophobia were the most common associated symptoms in both of them. 7) Positive familial history and aggravation of headache in perimenstual period were more commonly seen in patients with migraine than tension type headache. In conclusion using the operational diagnostic criteria of International Headache Society in clinical practice, treating, teaching, clinical and epidemiological research is very useful and must also be applied for Iranian patients.

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Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm) and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular) and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

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Background: Gastric cancer (G.Ca) is significantly more prevalent in north western than central Iran. Growing evidence has related Helicobacter pylori (H.P) to G.Ca worldwide. We assessed the prevalence of H.P infection in high (Ardebil) and low (Yazd) prevalence of G.Ca provinces of Iran. Methods: Cluster sampling of healthy population aged less than 20 years was performed in Ardebil and Yazd provinces over 2 months. Ten cc blood was drawn from each person and H.P IgG was tested using ELISA (Diagnostic Corp., sensitivity 98%, specificity 96%). Results: 711 individuals (358 in Ardebil and 353 in Yazd) were enrolled. 170 individuals (47.5%) in Ardebil and 108 individuals (30.6%) in Yazd were positive for H.P (P<0.0001). Using logistic regression analysis, the predictive probability of H.P infection in different age groups was calculated. Conclusion: H.P infection is significantly more prevalent among individuals less than 20 years in areas with high prevalence of gastric cancer in Iran. Our data suggest a relation between H.P infection and gastric cancer in Iran

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This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents

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In this study, musculoskeletal disorders incidents have been found through NMQ. Then, with the OWAS method the results have been analysed. In this thesis, we have studied the case in two different workshops of Ballast Production Company. The jobs were classified according to static load caused by poor work posture and recommendations for reducing the hurmful load were made. The study of the questionnaire showe that there is meaningful relation between work experience and Low Back Pain (LBP) (P<3%). Meanwhile BMI (Body Mass Index) is closely related to LBP (P<2%). However a relation was found between low back and back and shoulder pain complaints during recent one year and last one week with that of the existence of the pains, respectively P<2% and P<5%. Jobs related with repair and maintenance rates the first as regards static load on the muscloskeletal system. Cooking, digging operations, driving bullodozer, operation of stone crushing device, loaders and lorries rank respectively in order.

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Thrombotic thrombocytopenic purpura is the result of multiple thrombus disseminated in small arterioles throughout the body. Principle damage is in the endothelium of small vessels and capillaries. From 1982 to 1999, 28 patients (16 female and 12 male) have been treated for TTP. The outcome was evaluated for risk factors and prognosis. These patients were 18 to 69 years old. All had neurological sings, fever, microangiopathic hemolytic anemia and thrombocytopenia. These patients did not have predisposing factors. All patients were negative for hepatitis C and B. Plasmaphoresis was the main treatment in all and was done. The patients had plasmaphoresis from 1.5 to 6 liters per day. Minimum requirement was 4.5 liters to 95 liters in all. Replacement was fresh frozen plasma in 16 patients. 12 patient had FFP and cryopoor plasma half-and-half for replacement. 22 patients completed the treatment and became well 6 patients died. Chronic head ache and progressive dementia was observed in 2 patients. 6 patients did not recover and died. Platelets count over 100000/mm LDH lower than 500 units and disappearance of neurological disturbance was the end point of treatment. This study showed the good result of plasmaphoresis in TTP ad graves outcome in patient with cerebral bleeding, cardiopulmonary failure, prolonged QT in EKG, hypotension, and increased CPK. We did not observe any chronic cases in these groups. The cause of death were cerebral hemorrhage in 2 respiratory failure in 3 patients. One of the these patients had adult respiratory distress syndrome and pneumonia in another patient.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases.

Materials and Methods: To determine the efficacy of this method in Iran in patient's with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months.

Results: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement.

Conclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.

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Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000.

Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing.

Results: From the cases, 64 patients (32 percent) referred without delay and 136 patients (68 percent) referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004), lower education level (P=0.002), and lower economic status (P=0.001). The frequency rate of single were lower among them (P=0.001), fewer percent were residual of big cities (P=0.01) and they had less rate of available physician (P=0.004). 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001). 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E) (P=0.002) and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01). 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference.

Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late.

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Background: Stereologic methods are used to obtain quantitative information about three dimensional structures from histologic sections. The aim of present study was using new and unbiased stereological techniques to investigated changes in volume and number of glomeruli after chronic lead acetate intoxication. Lead is one of the heavy metals that have adverse effects on renal function. Its effects can involve both renal tubules as well as glomeruli. So many studies based on observation and qualitative reports. Some of which report changes in volume and number of glomeruli.

Materials and Methods: Male Wistar rats were randomly divided to four groups (n=9). During a period of 8 weeks, the treatment groups were given 0.5 percent and 1 percent lead acetate in drinking water and the control and sham control were given distilled water and 0.4 percent acetic acid solution respectively. Stereological analysis based on Cavalierie's principle was performed to determine the reference volume (VRefrence), the fraction volume of glomeruli (VVGlom) and total glomerular volume (VTGlom). Furthermore, for estimating the numerical density (NVGlom) and total number of glomeruli (NTGlom), the physical dissector was utilized.

Results: Results showed that the number of glomeruli in treatment group which received 1 percent lead acetate in drinking water decreased significantly (P<0.05), but no changes occurred in 0.5 percent group (P>0.05). On the other hand glomerular total volume in both 0.5 percent and 1 percent groups increased significantly in comparison to control and sham control groups (P=0.000).

Conclusion: This experiment is in agreement with other qualitative reports by using unbiased method of stereological methods and showed changes in volume and number of glomeruli following lead acetate intoxication.

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Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors.

 Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain.

Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS.

 Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.