Tehran University Medical Journal

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Since the heat-stable enterotoxin (ST) produced by yersinia enterocolitica is similar to enterotoxin production by E. coli, it is probably classified among toxinogenic bacteria. The culture filtrate of ST-producing strains of Y. enterocolitica is able to activate Guanylate cyclase and to increase fluid accumulation action of cylic Guanosin 3', 5' - monophosphate (cGMP) in sucking mouse intestine. For production of enterotoxin (ST), three strains of Y. enterocolitica (4052-6809-6810) were selected from the Institute Pasteur culture collection. All were serotype 3, biotype 4 and had been isolated from patients with diarrhea. After obtaining a suitable amount of enterotoxin (ST), the crude toxin was fractionated by various methods including: Ultrafiltration, gel filtration, high performance liquid chromatography (H.P.L.C) and isoelectric focusing. The results showed that the purified (ST) has a molocular weight of about 5000 to 10000 dalton. Moreover, isolectric focusing of the (ST) in a gradient pH of 6.3 to 2.5 indicated that the toxin has two fractions, designated ST1 and ST2, with isoelectric points of Pi = 3.1 and Pi 2.9, respectively. Further study revealed that both fractions had similar toxin effect in the gut of sucking mice

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This survey, evaluated the level of awareness and knowledge among the medical staff about conditions and methods of performing cardiopulmonary ressucitation. The study sampling comprised 497 subjects including 208 residents and 262 interns of ten university hospitals in Tehran. In regard to the basic principles, this has been 43.54% (SD = 13.36%), in drug and fluid therapy 31.22% (GD = 13.22%), in electroshock 43.6% (SD=21.12%), in appropriate approach to the problem 34.73% (SD=13.42%) and in complications of CPR 17.7% (SD = 15.25%). Considering the results of the project, the medical staff have insufficient knowledge of CPR md it does not improve significantly during internship and residency period. Therefore, there is a great necessity for the medical students to attend basic and advanced CPR courses during their study

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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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Congenital cyst of the pancreas is an uncommon problem in the pediatric patient. The common symptoms at the time of diagnosis have been abdominal mass and pain or fullness, nausea and vomiting. Despite of various paraclinic methods for diagnosis, ultrasound is now recognized as the most effective and best noninvasive method for diagnosis of pancreatic cyts. Surgical intervention is the best mode of therapy. Upper abdominal cystic mass are seen in the fetus and newborn infants. In Amirkabir Hospital, during 12 years from 1981 to 1993, 8 pancreatic cysts have been operated on and only in this case it was congenital.

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The pre-eclampsia/eclampsia is one of the commonest conditions peculiar to pregnancy, to describe the occurrence of hypertension, proteinuria and edema in pregnancy. It is about seven times more frequent in first gestation and uncommon before 20 week's gestation. Serum BhCG levels were prospectively determined in 260 midtrimester singleton pregnancies where admitted from October 1999 until September 2000 at Mirza Kouchak Khan hospital, prenatal clinic. Obstetric chart review was undertaken after delivery to identify cases in which pre eclampsia developed. The median maternal age was 26.0 years, and the median gestational age at the time of blood collection was 19.0 weeks. Of these, 17 cases (6.5 percent) had pre eclampsia. The median level of the BhCG was 35060.5 mlu/ml in those with pre eclampsia, whereas that in those without pre eclampsia was 33755.1 mlu/ml. The difference was not significant (P=0.28). Although elevated midtrimester serum BhCG levels in clinically normal patients was reported in severaly pre eclampsia women, this is not a good test for early detection of mild pre eclampsia.

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The use of Frozen-section during surgical procedures, gives the surgeon valuable information and guides him to perform the appropriate surgical procedure. In order to determine the accuracy of Frozen-section in gynecologic surgery, we compared the results of 172 gynecologic Frozen-section diagnosis with their final diagnosis in Mirza Kockak Khan Hospital, from 1378 to 1379. A total of 106 ovarian, 43 uterine, 10 lymph node and 13 other tissue samples were obtained. The Frozen-section diagnosis was compatible with the final diagnosis in 93.6 percent of cases. The sensitivity for non benign lesions was 82.5 percent and the specificity was 96.8 percent. The positive and negative predictive values were 84 percents and 98 percent respectively. 2.3 percent of cases were falsely positive, 1.7 percent falsely negative and 1.2 percent over estimated the degree of malignancy. There was no underestimation and 1.2 percent were uncertain. Frozen-section was found to identify correctly 8 of 8 metastatic ovarian tumors and 1 of 2 germ cell tumors. The accuracy of Frozen-section was 25 percent in ovarian borderline tumors, 60 percent in ovarian mucinous and 80 percent in serous tumors. With the exception of borderline and mucinous ovarian tumors, Frozen-section diagnosis is sufficiently accurate for clinical use. Performing multiple sections is recommended in the Frozen-section diagnosis of mucinous ovarian tumors.

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Backgroud: Measles, as one of the most contagious diseases, because of the risks of mortality, mental and physical disabilities which may afflict on the patients, has always been so important to the scientists and researchers. With respect to burden of diseases, numerous measures have been taken to control and eliminate measles. In our country, vaccination is considered as the most important strategy to control the measles, however, the surveillance on the patients is on the second place. Screening (Active & passive), prompt and appropriate control of measles in high risk areas can help to control the disease.

Materials and Methods: There are 1375283 people with a variety of demographic traits who live in southern Tehran. Southern Tehran covering 10th, 11th, 16th, 17th, 19th divisions of Tehran municipality consists of high risk areas. Because of too many immigrants, overcrowded areas, malnutrition and poverty, the south of Tehran is considered as one of high risk areas, predisposed to measles epidemics. So in 1999, a cross-sectional study was done.

Results: On 230 subjects suspected to be measles in south of Tehran, 147 subjects were diagnosed as measles by para clinic evidence, 121 subjects of which were men. Most of these were of the age 20 to 24 years old who lived in the eleventh part of Tehran municipality area. The majority of patients were found among soldiers who lived in dormitories in Horr garrison and military training college located on the above-mentioned area. Unfortunately, most of them did not have reliable history of vaccination. Most of these patients had been in close contact with the colleagues who were measled (61.2 percent). The rate of measles incidence during winter soars at most.

Conclusion: The most important factor to be researched is that, the age of these patients differs much from what is expected, due to unknown reason.

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Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced.
Methods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:tl 1.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%). Valve thrombosis was the common cause of mechanical valve replacement (32%). Age younger Than 50 (P= 0.01) and interval after the first implantation more than 10 years (P= 0.01) affected bio-prosthesis degeneration.
Results: Atrial fibrillation (P<0.01), Older age especially more than 40 (P<0.05) and mitral position (P<0.01) affected mechanical valve thrombosis. Cross clamp time (P= 0.005), Tricuspid insufficiency (P = 0.001), NYHA IV (P = 0.005) and emergent operation (P= 0.001) were independent determinants of hospital mortality.
Conclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.

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Background: Role of cytokines in regulation of immune system has been the subject of studies and clinical investigations. One of these cytokines, IL-2 has been well initially introduced as T cell Growth factor (TCGF), but subsequently it appeared that IL-2 is one of the important mediators affecting growth, development and activity of T, B, NK and LAK cells. Nowadays this cytokines has extensive use in clinical and research fields of immunotherapy of cancer and infectious disease.

Materials and Methods: In this study, we used Jurcat cell line for production and partial purification of IL-2 106 cell/ml were stimulated by PHA (1 µg/ml) and PMA (10 µg/ml) at the third day of the culture and then supernatant were collected after 22 hrs.

 Results & Conclusion: In order to obtain sufficient amount of IL-2 and eliminate interfacing materials, supernatants were concentrated using Amicon 10 and 30 PM filters. After concentrating, bioassay and Elisa were performed to detect the biological activity and amount of produced IL-2. Reversed phase-HPLC was used to confirm the IL-2 identity and purification.

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Background: In 2-4% of couples in fertile ages, recurrent pregnancy loss (RPL) occurs which consisted one out of 300 pregnancies. The aim of this study was to comparison insulin resistance (IR) in patients with RPL to normal individuals.
Materials and Methods: In a case-controlled, prospective study, 49 non-pregnant, non-diabetic women with early RPL as the case group and 49 non-pregnant, non-diabetic women without RPL who had at least one live infant as the control group, and were matched by age, weight, and height, were enrolled. In both groups fasting insulin and glucose levels were measured and insulin resistance, which was defined as a fasting insulin (FI) level ≥20 microU/mL or a fasting glucose to insulin ratio (FGI ratio) of <4.5, was calculated.
Results: The RPL and control groups were similar with respect to age, BMI, fasting glucose levels and glucose to insulin ratios. FI was significantly higher in RPL group than control group (15.20±5.82 vs. 12.23±5.64 microU/mL). Also the frequency of patients with high FI (FI≥20µU/ml) in RPL group was significantly higher than in control group (22.45% vs. 6.12%, Odds Ratio=4.44, Confidence Interval 95%=1.15-17.07). Among the RPL group, 24.49% demonstrated insulin resistance, whereas only 8.16% of the matched controls were insulin resistant (Odds Ratio=3.65, Confidence Interval 95%=1.08-12.26). The RPL and control groups had similar in frequency of low FGI ratio. Also there was no significant difference between mean of FGI ratio in patients with fewer than 12 weeks miscarriage compared to over 12 weeks in RPL group.
Conclusion: Women with RPL have a significantly increased prevalence of insulin resistance when compared with matched fertile controls. It's recommended that in all women with RPL the glucose and insulin measurement should be carried.

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Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.

Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test.

Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).

Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

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Background: Anti-dsDNA antibodies frequently found in the sera Systemic Lupus Erythematosus patients, particularly in active disease stage. Nowadays exploit different eukaryotic and prokaryotic dsDNA as antigen source and different reagents as binder. The aim of this study to compared two dsDNA different sources and tow different kinds of reagents for binder in ELISA test.

Methods: In this study bacterial genomic DNA from E.coli (ATCC 25922) and genomic DNA from calf thymus extracted with high purity and were used as antigens for IgG anti-dsDNA detection by ELISA. To coat dsDNA in microtiter wells, tow different kinds of reagents including methylated -BSA and poly-l-lysine (for pre-coating) are used. Sera from systemic lupus erythematosus patients and from normal blood donors are used to assess sensitivity and specificity of our ELISA test in compared with IF test and commercial kits.

Results: Our results displayed pre-coating of microtiter plates with methylated -BSA reduce nonspecific binding reaction and the relative sensitivity and specificity of ELISA increased when calf thymus DNA is employed as antigenic source in compared with IF test and commercial kits 80%, 88% and 100%, 98% respectively, but when E.coli DNA is used 73%, 69% and 85%, 79%, respectively.

Conclusion: The genomic DNA from calf thymus is a potentially useful source of antigen for detection of anti-dsDNA by ELISA. Also the use of methylatted- BSA could have an effective role in reducing of nonspecific binding reactions.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed.
Methods: Forty one healthy adults (age range: 18-55 years) with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of 10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint.  Duration of operation and volume of serum used for irrigation during the procedure pain and analgesics requirement, during and after arthroscopy VAS (Visual Analogue Scale) score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed.
Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in 80% of procedures had excellent or good satisfaction with intra-articular block.
Conclusions: Considering high level of satisfaction in both patients and surgeon and mean of VAS, complications of other modalities of anesthesisa and simplicity of the technique, intra-articular block can be used as an easy, safe and efficient method for knee arthroscopy.

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Background: Increased rate of oxidative stress have important role in diabetic nephropathy. Oxidative stress induces the synthesis of antioxidant enzymes. One of them, Extracellular- SOD (EC–SOD) is a major anti-oxidative enzyme and the only one that neutralizes superoxide ion, a precursor of reactive oxygen species (ROS). The aim of this study was to evaluate the correlation between diabetes- associated oxidative stress and antioxidative defense in macroalbuminuric type 2 diabetic patients.

Methods: One hundred and thirty three patients (74 women, 59 men) with type 2 diabetes were studied during 1385-86. According to level of urinary protein, two groups of patients normoalbuminuric (urinary protein excertion below 30mg/24h) and macroalbuminuric (urinary protein excretion more than 300mg/24) were recognized. In each group serum level of oxidized- LDL and EC-SOD were measured.

Results: The mean age of patients and the mean duration of diabetes was 59.09±8.26 years and 137.92±65.91 months, respectively. The plasma oxidized-LDL level and extracellular- superoxide dimutase level were significantly higher in macroalbuminuric than normoalbuminuric group (88.57±33.36 versus 78.24±27.59u/l, p=0.039 for oxidized-LDL and 87.60±21.18 versus 76.25±16.25mu/l, p<0.001 for EC-SOD). Oxidized- LDL was significantly correlated to EC-SOD in macroalbuminuric patients (r=0.425, p<0.0001). Oxidized-LDL and EC-SOD does not correlate to Fasting Plasma Glucose and HbA1c in each two groups.
Conclusion: The significantly elevated plasma oxidized-LDL in patients with macroalbuminuria suggests that, oxidized-LDL may play an important role in the progression of diabetic nephropathy. Besides severity of oxidative stress in macroalbuminuic patients, increase level of EC-SOD enzyme could be a compensatory mechanism to prevent tissue damage.

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Background: Behcet’s disease (BD) is a multisystemic inflammatory disease with unknown origin characterized by recurrent oral aphtous ulcers, genital, ocular and skin lesions. A single point mutation 1691G to A in the factor V gene increases the risk of venous thrombosis. This study designed to determine factor V Leiden mutation in Behcet’s disease, and to find out it's relationship with the clinical manifestations in Khuzestan province, Iran. Methods: One hundred patients with Behcet's Disease (44 males and 56 females) based on international diagnostic criteria and 70 healthy subjects were included in the study.Patients and controls were tested for the presence of factor V Leiden mutation using polymerase chain reaction method. Results: The prevalence of factor V Leiden mutation was significantly higher in BD (10 out of 100, 10%) compared with healthy control subjects (1 out of 70, 1.4%), (p=0.025). Vascular lesions in this study were deep vein thrombosis (DVT) (7%), subcutaneous thrombophlebitis (5%), stroke (1%) and retinal vasculitis (39%). It was found that there was no association between venous thrombosis and the factor V Leiden mutation in Khuzestanian patients. Also, no association between other vascular lesions and the factor V Leiden mutation was recognized. On the other hand there was a significant association between DVT and anterior uveitis (p=0.033). Conclusion: In this study we did not find any association between clinical manifestations in BD patients and factor V Leiden mutation in Khuzestan province, Iran but in BD patients with DVT, factor V Leiden mutation might be a risk factor for the development of anterior uveitis.

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Background: Coarctation of aorta is narrowing of proximal descending aorta. Interventional procedures such as balloon angioplasty & stent implantation has been progressively in use as alternatives for surgery in increasing number of children with diagnosis of coarctation of aorta. The aim of this study was to evaluate the use of endovascular stent in children with coarctation of aorta.

Methods: We evaluated effectiveness and safety of stenting in all patients younger than 18 years old with coarctation and re-coarctation of aorta which treated by stenting between years 2004-9 at rajaei - heart centre in Tehran, Iran.

Results: we studied 53 patients younger than 18 years old with a follow up of six months. Totally 54 stents were implanted. Mean (±SD) age of the patients was 11.6±4.2yrs. Seventeen cases (32%) were younger than 10 years old, and 36 cases (68%) were 10 years and older. Mean (±SD) weight was 39.24±18kg. 16 cases weighting less than 25kg. Peak systolic pressure gradient (SPG) decreased from 46.26±17.07 to 1.03±0.19mmHg after procedure (p<0.001). There was no significant difference (p<0.001) in the gradient before and after stenting in the patients with native coarctation (Vs re-coarctation cases), less than 25 kg and under 10 years old groups. Complications developed in 44% of cases while dominantly were minor except in two cases re-dilatation of stent was not needed during six month of follow-up of the patients.

Conclusions: Stenting of coarctation of aorta can decrease complications and can be used safely in children weighing bellow 25kg and in children below 10yrs old.

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Background: Female genital tract sarcomas are rare but most aggressive tumors of mesodermal origin. Little is known about the pathogenesis, risk factors, optimal treatment and outcome of these diseases. Therefore, we aimed to evaluate the clinicopathologic characteristics of patients with genital sarcoma.

Methods: This is a retrospective, cross-sectional study. The medical records of 43 female patients with genital tract sarcoma, hospitalized during a 16-year period (from 1991-2007) were retrieved from the medical records office of Ghaem Hospital in Mashad, Iran. The demographic data extracted from the records.

Results: The mean age of the patients was 46.95 years (ranging from 3-77 years). The chief complaint of the patients was abnormal vaginal bleeding (69.8%). The mean interval between the onset of symptom to the pathological diagnosis of sarcoma was 8.53 months (ranging from 1-36 months). Histologically, the tumors included: leiomyosarcoma (79.1%), endometrial stromal sarcoma (18.6%) and embryonal rhabdomyosarcoma (2.3%). Three patients (7%) were in International Federation of Gynecology and Obstetrics (FIGO) stage I, 20(46.5%) in stage II, 6(14%) in stage III and 14(32.6%) in stage IV. 48.8% of the patients had undergone chemoradiotherapy.

Conclusions: In most cases, our patients were referred so late or the disease was recognized very late due to being rare. We should consider this disease for every patient with unusual vaginal bleeding especially in post menopause women who their sonography has reported uterine mass.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common form of hereditary cancer worldwide and is an important cause of morbidity and mortality. Approximately 5-10% of breast and ovarian cancers are due to the highly penetrating germline mutations in cancer predisposing genes. Two genes, BRCA1 and BRCA2, account for at least half of these cases. The demand for BRCA1 and BRCA2 mutation screening is rapidly increasing as their identification will affect the medical management of people at increased risk for the disease. Therefore, the aim of this study was to investigate BRCA1/2 mutations in 100 high risk Iranian families.
Methods:  One hundred families who met the minimal risk factors for breast/ovarian cancer were screened among the families referred to Kawsar Human Genetics Research Center for the diseases in 2009-2011. The entire coding sequences and each intron/exon boundaries of BRCA1/2 genes were screened for by direct sequencing and MLPA in both patients and the controls.
Results:  In the present study, we could detect the following novel mutations: p.Gly1140Ser, p.Ile26Val, p.Leu1418X, p.Glu23Gln, p.Leu3X, p.Asn1403His, p.Asn1403Asp, p.Lys581X, p.Pro938Arg, p.Thr77Arg, p.Leu6Val, p.Arg7Cys, p.Leu15Ile, p.Ser177Thr, IVS7+83(-TT), IVS8 -70(-CATT), IVS2+9(G>C), IVS1-20(G>A), IVS1-8(A>G), p.Met1Ile, IVS2+24(A>G), IVS5-8 (A>G), IVS2(35-39)TTcctatGAT, IVS13+9 G>C in BRCA1 and p.Glu1391Gly, p. Val1852Ile, IVS6-70(T>G), 1994-1995 (InsA) in BRCA2.
Conclusion: Ten mutations seemed to be pathogenic and the disease-causing mutations were seen in 16% of the families. In addition, from the total number of substitutions and reassortments (42), 80% related to BRCA1 and 20% to mutations in BRCA2 genes.

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Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.

Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.

Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3 P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5 P=0.001).

Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.