Tehran University Medical Journal

---

Background: The purpose of our study was to assess the potential of color Doppler (CD) and Power Doppler Imaging (PDI) to differentiate benign from malignant solid breast masses.

Materials and Methods: Seventy-one biopsy proven solid breast masses were evaluated with CD and PDI using 7.5 MHZ Transducer. Vascularity, Resistive Index (RI) and patterns of vascular distribution of masses were assigned before biopsy.

Results: There were 22 cancers and 49 benign lesions. All malignant masses had vascularity in some degrees, except 3 cancers which were less than 10 mm in diameter. Most of cancers were hypervascular (15 cancers) and had penetrating or diffuse vessels (14 cancers). Most of benign lesions and fibro adenomas were avascular (35 masses). 12 cancers, 2 fibro adenomas and all vascular benign lesions had RI>0.6. 7 cancers and 6 fibro adenomas had RI<0.6. By using hypervascularity to indicate malignancy sensitivity for CD and PDI was 68 percent and specificity was 90 percent and by using penetrating and diffuse vessels sensitivity was 64 percent and specificity was 82 percent. By using RI<0.6 sensitivity was 32 percent and specificity was 88 percent and by using these three criteria together sensitivity was 73 percent and specificity was 82 percent (P<0.00001).

Conclusion: The vascularity and pattern of distribution and morphology of blood vessels in solid breast masses seen at PDI and CD is a potentially important feature to predict the likelihood of malignancy. But RI appears to be of limited value.

---

Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients.
Materials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age>12 years), neutropenic (PMN<1000) patients with fever (Temperature, oral >38.5c) in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A) and Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B). Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever) were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result).
Results: During a twelve months period of study, a total of 57 patients (17female, 40male) were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent), the treatment was effective, compared to 15 of 29 (51.7 percent) in groups B. The duration of fever after initiation of treatment was 37.9 ± 17 hours in arm A and 40. 1 ± 20 h in arm B. Blood and / or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B).
Conclusion: Cefriaxon monotherapy is at least equally effective in low risk neutropenic patients with fever compared to combination of ceftazidim plus amikacin at a decreased cost and probably (expected) less adverse side effects in our patients.

 

---

Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The aim of this study was to evaluate the effect of autologous transfusion on patients' hematocryte value, intra and postoperative blood loss, hospitalization time, the development of infective complications and other factors.

Materials and Methods: Between June 2001 to April 2002, 208 patients were underwent cardiac surgery in cardiac surgery ward in Imam Khomeini Medical Center. One or more blood units donate from 104 Patients before cardiopulmonary bypass and heparin injection, and transfused to them after CPB and Protamin injection (autologous Group, group 1). 104 patients underwent cardiac surgery routinely (control group, group 2).
Results: Mean of age was 55.9±8.6 in group 1 and 56.6±9.3 in group 2 (P=NS). 73 male and 31 females were in group 1 and 79 males and 25 females were in group 2 (P=NS). Smoking, familial history, hyperlipidemia, diabetes mellitus, renal failure, hypertension, stroke, and history of myocardial infarction was similar in two groups.
Severity of angina, urgency operation, number vessels disease, duration of cardiopulmonary bypass, duration of aortic cross clamp time, use of internal thoracic artery graft, and number of grafts was similar in both groups. Mean of bleeding post operation was 548 cc in group 1 and 803 cc in-group 2 (P=0.003). Bleeding that need to operation was 1.8% in group 1 and 8.6% in group 2 (P=0.002). Wound infection, mediastinitis, renal failure, ventilatory prolonged, stroke, need to Intra-aortic Balloon Pump (IABP), intraoperative bleeding, and hospital stay was similar in both groups. Mean of extubationt time was 10.2 hours in group 1 and 14.8 hours in group 2 (P=0.001).
Conclusion: Preoperative and intra-operative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.

 

---

Background: This study was designed to compare low-level laser therapy (LLLT) + exercise therapy with LLLT alone and exercise therapy alone, and to determine whether laser therapy is a useful treatment modality for chronic low back pain (LBP).
Materials and Methods: This study was a double-blind placebo-controlled randomized clinical trial. Patients with chronic LBP for at least 12 weeks were included. Visual analogue scale (VAS), Modified Oswestry Disability Questionnaire (MODQ), Schober test, flexion, extension and lateral bending were used to evaluate back pain, disability score and lumbar range of motion. Irradiation was performed with GaAlAs (=810 nm, power density=226 mW/cm2) laser, two times a week, over a period of 6 weeks. Subjects were evaluated before the first treatment, at week 6 and 12 follow-up.
Results: The reduction in pain related to motion was significantly greater in the exercise + LLLT group compared with the exercise alone group (P = 0.004) but was not significant, compared with LLLT alone (P = 0.982). Disability score in LLLT + exercise therapy reduced more than the other two groups, and the difference with exercise alone group was significant (p = 0.03). Comparison of reduction of disability between LLLT alone and exercise therapy alone was not statistically significant. Improvement of lumbar range of motion in patients treated with LLLT + exercise therapy was better than the other two groups significantly, especially by Schober test and Flexion and lateral bending.
Conclusion: This study clearly shows that LLLT alone and especially LLLT combined with exercise can lead to better improvement in chronic LBP.

---

Background and Aim: What constitutes adequate dialysis has been debated in the nephrology literature over the past years. We believed that short and infrequent dialysis session contributed to poor outcome. This result provides additional evidence that (KT/V) in a flawed concept upon which to based the dose dialysis in general. Base on published evidence from many source we proposed a new index of adequacy of hemodialysis to be called hemodialysis product (HDP).

Materials and Methods: The prospective study was performed on 100 dialysis patient in the Imam hospital dialysis ward in Tehran during 2002. delivered (KT/V) and (HDP) achieved for any patient separated. Results: 100 patients including 44 female and 56 male were studied. Result has shown (KT/V) d≥ 1 in 43% and (KT/V) d< 1 in 57%. HDP in patient with (KT/V) d > 1 were ≥ 36. HDP in patient with (KT/V) d < 1 were < 36. Correlation between (KT/V) d and albumin was significant (p< 0.03, Albumin ≥ 4 mg/dl). Correlation between (KT/V) d and cholesterol, hemoglobin, creatinine were not significant. Correlation between (KT/V) d and HDP was significant (p< 0.001).

Conclusion: Finding above has shown that higher weekly delivered (KT/V) correlate with dialysis result increase hemodialysis product (HDP). More frequent and session dialysis results increase in HDP, provide better weekly (KT/V) d with normal albumin (show good caloric and protein intake).

---

Background: We report a case with apparent resistance to local anesthetics. While regional anesthetics failure are often attributed to technical failure, the clinical presentation and medical history of this patient suggests a true resistance to local anesthetics.
Case report: A 28 years old man was scheduled for elective orthopedic surgery for right sided tibial bone fracture, and decision of spinal anesthesia was made. There was a questionable history of multiple prior episodes of local anesthetic unresponsiveness (Interscalan block, local infiltration for lipoma resection and dental surgery). Spinal anesthesia was performed and sensory or motor blockade was not obtained despite any evidence of technical problems. The surgical procedure performed under general anesthesia and skin analgesia (local infiltration of lidocaine 2% and bupivacaine 0.5% to forearm), did not achieve, the day after surgery.
Conclusion: While the failure rate of spinal anesthesia has been shown range from 4 to 13% and is often attributed to technical failure, this particular case showed a true resistance to local anesthetics.

---

Background: Septic arthritis in neonates can be difficult to diagnose and may be associated with severe morbidity and even mortality. A majority of apparent septic arthritis cases may have a negative culture, thereby creating a dilemma regarding treatment. The present study investigates demographic, laboratory and clinical variables of septic arthritis in neonates hospitalized over a period of 17 years.
Methods: The medical files of all neonates hospitalized in Imam Khomeini and Vali-e-Asr Hospitals in Tehran, Iran, from 1989 to 2005 were assessed and the files of 59 neonates with a diagnosis of septic arthritis were further evaluated. Variables such as age, sex, gestational age, birth weight, history of hospitalization, body temperature, involved joints, blood and joint fluid cultures, ESR, CRP, and WBC count were evaluated in this group of hospitalized patients. Results: Of the 59 neonates, 39 cases were male and 20 cases were female. At the time of hospitalization, 45.8% of the neonates were 20-28 days old and 52.2% were 10-20 days old, and 67.7% and 35.6% of cases had been preterm and had low birth weight, respectively. Histories of hospital admission were found for 30.5% of patients. The two most common joints involved were hip (30.5%) and knee (23.72%). The mean body temperature was 36.6oC. ESR was elevated in all patients (mean 85 mm/h) and CRP was positive in all cases. The WBC count was >15,000/mm3 in 39% of the neonates and was in the range of 10,000-15,000/mm3 for 47.4%. Blood and joint fluid cultures were positive in 51% and 91.5% of cases, respectively. The organisms isolated from joint fluid culture were Klebsiella (54%), S. aureus (37%) and E. coli (9%). Conclusion: Due to the rarity of septic arthritis in neonates and paucity of signs and symptoms, all neonates with a high index of suspicion should be examined carefully with septic arthritis in mind.

---

Background: Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemia, and bone marrow failure (aplastic anemia). FA has been reported in all races and ethnic groups and affects men and women in an equal proportion. The frequency of FA has been estimated at approximately 1 per 360,000 live births. In some populations, including Ashkenazi Jews, Turks, Saudi Arabians and Iranians, this frequency appears to be higher, probably as a result of the founder effect and consanguineous marriage. Because of extensive genetic and clinical heterogeneity (the age of onset, clinical manifestations and survival), diagnosis of FA on the basis of clinical data alone is unreliable and its molecular diagnosis is difficult. The diagnosis of FA exploits the hypersensitivity of FA lymphocytes and fibroblasts to bifunctional alkylating agents such as mitomycin C (MMC), diepoxybutane (DEB) and nitrogen mustard and differentiates it from idiopathic aplastic anemia. In this study, in addition to the patients' clinical profiles, a cytogenetic test using MMC was implemented for an accurate diagnosis of Fanconi anemia.

Methods: In this study, the lymphocytes of 20 patients referred for FA, and those of their normal sex-matched controls, were treated with three different concentrations of mitomycin C (20, 30, 40 ng/ml). Slides were prepared and solid stained. In order to determine the number and kind of chromosome abnormalities, 50 metaphase spreads from each culture were analyzed. Clinical information was obtained from patient files.

Results: Five patients manifested increased chromosome breakage with MMC, confirming the FA diagnosis. Two different concentrations of MMC (30, 40 ng/ml) were most effective.

Conclusion: The chromosomal breakage test is important for the accurate diagnosis of Fanconi anemia. DNA crosslinking agents used to treat idiopathic aplastic anemia may be lethal for patients with FA. Thus, aplastic anemia patients with unknown etiology, infants with congenital abnormalities involved in FA and siblings of FA patients should also be cytogenetically tested.

---

Background: Helicobacter pylori (Hp) infection often occurs in childhood and adolescence, with the frequency increasing with age. Hp infection is associated with insufficient hygiene, overcrowding and low socioeconomic status. Although declining in developed countries, children in the developing countries continue to have a high prevalence of Hp infection. As the association of Hp infection with chronic abdominal pain is not ubiquitously accepted, in this study we investigate the significance of endoscopic finding associated with Hp infection in children with abdominal tenderness.

Methods: This cross-sectional study included 1,665 healthy children, aged 6 to 12 years, in whom Hp infection was evaluated using the IgG anti-H. pylori test. Hp-positive children with epigastric tenderness underwent upper gastrointestinal (GI) endoscopy. Urease activity of gastric mucosal biopsies was measured. The presence and density of Hp organisms, the presence of follicular gastritis, and the nature of inflammation and gastritis activity were assessed by histologic examination.

Results: Of 1665 children, 429 (26%) subjects (51% girls, 49% boys) were seropositive for H. pylori. There was a significant association between Hp infection and older age (p<0.001) and male/female ratio (p<0.05). Epigastric tenderness was detected in 39 children (1%), 29 of whom underwent upper GI endoscopy. Nodular gastritis with antral erythema was the most common endoscopic finding (26/29 89.7%). Histological findings revealed that, in all cases with endoscopic nodularity, lymphoid follicles were present. Bacterial density was low in 13 (44.8%), moderate in 14 (48.2%) and high in 2 (7%) subjects.

Conclusion: The findings of the present study demonstrated that antral nodularity is the most common feature in children with Hp infection and epigastric tenderness was significantly associated with histological findings of lymphoid follicles.

---

Background: Relaxation of the corpus cavernosum plays a major role in penile erection. Nitric oxide (NO) is known to be the most important factor mediating relaxation of corpus cavernosum, which is mainly derived from nonadrenergic noncholinergic (NANC) nerves. The aim of the present study was to investigate the effect of biliary cirrhosis on nonadrenergic noncholinergic (NANC)-mediated relaxation of rat corpus cavernosum as well as the possible relevant roles of endocannabinoid and nitric oxide systems.

Methods: Corporal strips from sham-operated and biliary cirrhotic rats were mounted under tension in a standard oxygenated organ bath with guanethidine sulfate (5 µM) and atropine (1 µM) to induce adrenergic and cholinergic blockade. The strips were precontracted with phenylephrine hydrochloride (7.5 µM) and electrical field stimulation was applied at different frequencies (2, 5, 10, 15 Hz) to obtain NANC-mediated relaxation. In separate precontracted strips of the sham and cirrhotic groups, the concentration-dependent relaxant responses to sodium nitroprusside (10 nM-1mM), as an NO donor, were assessed.  

Results: The NANC-mediated relaxation was significantly enhanced in cirrhotic animals (P<0.01). Anandamide potentiated the relaxations in both groups (P<0.05). The cannabinoid CB1 receptor antagonist AM251 (10 µM) and the vanilloid receptor antagonist capsazepine (10 µM) each significantly prevented the enhanced relaxations in cirrhotic rats (P<0.01). The CB2 receptor antagonist AM630 had no effect on relaxations in the cirrhotic group. In a concentration-dependent manner, L-NAME (30-1000 nM) inhibited relaxations in both the sham and cirrhotic groups, although cirrhotic groups were more resistant to the inhibitory effects of L-NAME. The degree of relaxation induced by sodium nitroprusside (10 nM-1 mM) was similar in the two groups.

Conclusions: Biliary cirrhosis enhances the neurogenic relaxation in rat corpus cavernosum probably via the NO pathway and cannabinoid CB1 and vanilloid VR1 receptors.

---

Background: Dermal- respiratory reactions to latex glove is a common problem and sometimes life threatening. Among health care workers, dental working personnel have extensive use of latex gloves. A few numbers of researches have been done in Iran about prevalence of these reactions but there is no comprehensive study for dental workers. The purpose of this study was to evaluate reactions to latex gloves amongst dental workers in military dental health centers.
Methods: In this cross-sectional descriptive survey, dental workers with a minimum of three months length of employment and most often use of latex gloves were asked to fill standard questionnaire (derived from South Carolina Medical University) regarding latex related clinical manifestation and personal medical history and predisposing factors Data analysis was done by χ2 and Student's t test.
Results: In our study 330 personnel were assessed. The mean age and length of employment was 31.6 and 8 years respectively. The most occupation was dentistry. A total of 232 subjects (70.3%) reported latex gloves-allergic symptoms. 72 (21.8%) of persons have history of atopy and food allergy was seen in 114 (34.5%). 63 (19.1%) of subjects reported history of hand dermatitis. All of these predisposing factors had positive regression with dermal and respiratory reactions.
Conclusion: In this survey the prevalence of allergic reactions was higher than similar studies which may be due to type of gloves, lack of preemployment assessments and other factors. Use of diagnostic methods such as serologic measures, SPT and pulmonary function testing (such as spirogram) could be considered as tools for confirmatory and differential diagnosis and important complementary for these studies. Because of relationship between allergic reactions to latex gloves and some medical histories, it seems to be necessary for preemployment evaluation and periodic health surveillance of dental workers.

---

Background: Relaxation of the corpus cavernosum plays an important role in penile erection. Previous studies have suggested that nitric oxide (NO) appears to be the most important relaxant involved in the erection process. The aim of the present study was to evaluate the effect of cholestasis in nNOS and eNOS activity of corpus cavernosum.
Methods: forty-two adult male Sprague-Dawley rats were divided equally into seven groups: control, sham operated, 2-, 7-, and 14-day bile duct-ligated animals, 7-day bile duct-ligated chronically treated with L-NAME (3mg/kg/day, i.p.) and 7-day bile duct-ligated animals chronically treated with Naltrexone (20 mg/kg/day, i.p.). The animals in each group were killed and the cavernosal tissues analyzed histologically by light and transmission electron microscopy, with NOS activity detected on NANC nerves and endothelium using an NADPH-diaphorase staining technique.
Results: our results showed that NADPH diaphorase staining in corporal NANC nerves and endothelium of sham-operated and control group had equal intensity. The staining was more intense in 2-day cholestatic rats than in control group, the staining intensity increased in 7-, and 14-day groups too. There were no significant differences between control group and 7-day cholestatic rats that had been treated chronically with L-NAME or Naltrexone.
Conclusions: These results state that in corpus cavernosum of cholestatic rats there is a time-dependent increase in NOS activity of the corporal NANC nerves and endothelium. inhibition of nitric oxide and endogenous opioids by L-NAME or Naltrexone during cholestasis may play a key role in preventing the adverse effects of cholestasis.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Chlamydia trachomatis is a common and curable STI that may be symptomatic or asymptomatic. The few studies on C. trachomatis among Iranian women have had, for the most part, small sample sizes and are therefore unsuitable for epidemiological deductions. The aim of this study was to estimate the prevalence of urogenital C. trachomatis infections by PCR on urine samples of married women in their fertile years in order to determine the need for a C. trachomatis screening program for asymptomatic women in Iran.
Methods: This descriptive-analytical and cross-sectional study was performed on 991 married women. The research material consisted of questionnaires and urine samples, which were transported daily to Avesina Research Institute, Tehran, Iran, to extract their DNA and prepare them for PCR tests. The gathered data were analyzed by SPSS, version 13, and evaluated statistically by t-test, chi-square test, Fisher's exact test and logistic regression, considering p<0.05 as significant.
Results: Of all the subjects, 127 (12.8%) were positive by PCR for C. trachomatis. The mean age of the participants was 28.88± 6.19 years. Infection was more prevalent among those with lower levels of education, who were employed and not pregnant. This infection was more prevalent among those who were using contraception, especially condoms. Reproductive history revealed that infection was more prevalent among participants with a history of vaginal discharge, pelvic pain, infertility and low birth-weight infants, and less prevalent among those with a history of abortion, preterm delivery and ectopic pregnancy. However, these patterns were not statistically significant.
Conclusion: In populations with C. trachomatis prevalences higher than 4%, screening programs are recommended. Thus, Chlamydia screening should be part of the health care program in Iran to reduce the burden of this disease. 

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Infertility influences various aspects of a woman's personality and psyche, and affects her functions within her family and occupation, as well as her ability to communicate. Studies have shown that infertility is associated with depression, stress, anxiety, dissatisfaction with life and other psychological problems. The purpose of the present study was to compare the dimensions of neuroticism and androgyny in fertile, infertile and postmenopausal women.
Methods: This study included of 180 fertile, infertile and postmenopausal women (60 in each group) selected from inpatients at Imam Khomeini and Mirza Koochak Khan Hospitals, Tehran, Iran, during 2004. Data were collected using the NEO Personality Inventory Neuroticism Scale and Bem Sex-Role Inventory and analyzed using the one-way ANOVA technique.
Results: LSD test results show that mean neuroticism scores were significantly different between the three groups, with scores following the trend: infertile women > postmenopausal women > fertile women. The mean androgyny scores were also significantly different between the three groups, following the trend: infertile women < postmenopausal women < fertile women (p<0.01).
Conclusion: The results of this research are congruent with findings from other studies. These results may be useful for infertility counseling and therapy.

---

Background: It is well known that erectile dysfunction is most commonly associated with diabetes, affecting 35% to 75% of men with diabetes mellitus. Several studies have been carried out to find appropriate strategies for treatment of diabetes-induced erectile dysfunction. The aim of the present study was to investigate the ability of acute administration of the endogenous cannabinoid anandamide in vitro to alter the NANC-mediated relaxation of corpus cavernosum from diabetic rats and the possible role of nitric oxide in this manner.

Methods: Diabetes was induced by the administration of streptozotocin for eight weeks. Corpora cavernosa were isolated in organ baths for measurement of agonist-evoked or electrical field stimulation (EFS)-evoked smooth muscle tensions.

Results: The neurogenic relaxation of phenylephrine (7.5 µM) precontracted isolated corporal strips was impaired in diabetic animals. Anandamide (0.3, 1 and 3 µM) enhanced the relaxant responses to EFS in diabetic strips in a dose-dependent manner. This effect was antagonized by either the selective cannabinoid CB1 receptor antagonist AM251 (1 µM) or the selective vanilloid receptor antagonist capsazepine (3 µM). Concurrent administration of partially effective doses of L-arginine (10 µM) and anandamide (0.3 µM) exerted a synergistic improvement in EFS-induced relaxation of diabetic strips (p<0.001). The relaxant responses to the nitric oxide donor sodium nitroprusside of the subjects in the diabetic and control groups were similar.

Conclusion: For the first time, we demonstrated that acute administration of an endogenous cannabinoid, alone or in combination with L-arginine could improve the NO-mediated relaxation of cavernosal smooth muscle in diabetic rats and this effect was mediated by cannabinoid CB1 and vanilloid VR1 receptors within the tissue.
 

---

Background: Preeclampsia is a disorder of pregnancy with increased maternal and perinatal morbidity and mortality. An imbalance between free radical induced lipid peroxidation and antioxidant system has been suggested as possible pathogenesis of preeclapsia. It has been shown correlation of some serum antioxidant agents (for example ceruloplasmin) with preeclampsia and its severity. The purpose of this study was to evaluate of this correlation.

Methods: In a analytic case-control study, in clinic and delivery unit of Mirza Koochak Khan university hospital, Tehran, we evaluated 90 pregnant women of 19-38 years old with gestational age higher than 20 weeks in two groups, case (preeclampsia) and control (healty mother). Case group was devided into two groups mild preeclampsia (n=30) and severe preeclampsia (n=30). Patients with preeclampsia (n=60) had either early (n=41) or late preeclampsia (n=19). Control group included 30 normotensive pregnant women. Serum Ceruroplasmin level was measured. Then relationship between this factor and preeclampsia was studied.

Results: The mean level of serum ceruloplasmin in women with severe preeclampsia (390.83mg/dl) and mild preeclampsia (319.43mg/dl) was higher than control group (212.7mg/dl). Likewise it was significantly higher in severe preeclampsia than mild (P<0.001) and higher in early (373.28mg/dl) than late preeclampsi (298.34mg/dl) (P<0.01).

Conclusions: Our data suggest that serum ceruroplasmin level may predict preeclampsia occurrance and its severity. Likewise antioxidant theryapy before the onset of preeclampsia in an attempt to decrease its frequency should be considered.

---

Background: The incidence of UTI in neonates varies between 0.1-1% and among febrile infant less than eight weeks of life, the incidence is 5-11%. During the first two months of life, males are more commonly affected possibly because of an increased incidence of structural abnormalities. The non-specific symptoms of UTI in neonates include fever, poor feeding, vomiting, jaundice and poor weight gain. The incidence of urinary tract abnormality in infants with UTI is about 30-55%. Sixty percent of term infants and 80% of preterm ineonates develop jaundice during the first week of life. This study evaluates the frequency of UTI in neonates with jaundice.

Methods: In a descriptive analytical study, urinary tract infection were studied in 100 icteric newborns and compared with 100 nonicteric ones. A questionnaire containing the medical history, clinical findings and the result of urine culture, was completed for each one.

Results: Eleven cases of 100 icteric neonates had UTI. Nonicteric neonates however showed no UTI at all. The difference between the two groups was statistically significant (p=0.001). Imaging investigations performed for all of the infected infants detected urinary tract abnormalities in three of them (27.27%). The two cases were male newborns that had unilateral vesicoureteral reflux (VUR) G I and the third one was a female newborn wtith VUR and hydronephrosis GIII.

Conclusion: UTI is common in icteric neonates and jaundice is one of the first signs of this infection, hence investigation of UTI in these newborn is important. We suggest that US and VCUG should be performed routinely after initial UTI particularly in male neonates.

---

Background: Vascular endothelial growth factor (VEGF) has mitogenic effect for endothelial cells and is an important mediator of tumor expansion, metastasis and angiogenesis in vivo. Isosorbide dinitrate, as a nitric oxide donor, has been widely used in treatment of many cardiovascular diseases such as congestive heart failure and acute coronary syndromes. Furthermore this drug was found to have inhibitory effect on angiogenesis, tumor growth and metastasis in vivo. In the present study we evaluated the isosorbide effect on the VEGF production using some human leukemic cell lines.

Methods: Human leukemic MOLT-4, JURKAT and U937 cells were cultured in complete RPMI medium. The cells at the exponential growth phase were then incubated with different concentrations of Isosorbide (4´10^-7 -4´10^-4 M) in the presence or absence of PMA (25ng/ml) for 24 hours. The VEGF concentrations in the culture supernatants were measured by enzyme immunoassay kits (R&D systems) according to the manufacturer's instructions.

Results: The level of VEGF produced by the human leukemic cell lines which was treated with different concentrations of isosorbide, did not show any significant difference with untreated control cells.

Conclusions: The results of this study showed that isosorbide had no significant effect on VEGF production. Our findings suggest that anti-angiogenesis effect of isosorbide could be mediated through VEGF-independent mechanism(s). Further studies are warranted to determine definite isosorbide effect on VEGF and other angiogenic factors production in patients as well as animal models.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: It has been suggested that Q/R 192 polymorphism of paraoxonase1 (PON1) and 5A/6A polymorphism of matrix metalloproteinase-3 (MMP-3) might be associated with the predisposition to coronary artery disease (CAD). Therefore to investigate the significance of these polymorphisms in the pathogenesis of CAD we performed an association study of the polymorphisms with CAD and the number of diseased vessels in patients with CAD.
Methods: We studied the human PON1 and MMP3 gene polymorphisms in patients with CAD by polymerase chain reaction/ restriction fragment length polymorphism (PCR/RFLP). These polymorphisms were determined in 129 CAD patients and 115 control subjects who underwent coronary angiography. CAD was defined as the presence of one or more stenoses>50% in at least one major coronary artery and subjects with <10% stenosis served as controls.
Results: The frequencies of the PON1 192 RR genotype and MMP-3 6A6A genotype were increased among CAD patients compared with controls (p<0.05 and p<0.001 respectively). The combined genotypes of RR/6A6A had significantly higher frequency in the CAD patients compared with subjects who possess neither the MMP-3 6A6A nor the PON1 RR genotype (p<0.001) and finally in the study of relationship between genotypes and severity of disease, distribution of PON1 192 and MMP-3 5A6A genotypes were not associated with the number of diseased vessels (p>0.05).
Conclusion: The combined PON1 192 and MMP-3 5A6A polymorphisms are associated with CAD but don't have any effect on the number of diseased vessels.

---

Background: Scorpion envenomation is considered as one of the Public Health problems in some countries in the world including Iran. Annually, approximately 30,000 scorpion stings happen in Iran from which 12% belongs to Hemiscorpius lepturus (special small closely spaced, bead-shaped jointed tail, similar in the shape to a cows tail, and is locally called ‘‘gaodim'' (Gao, cow dim, tail)) with 95% mortality. The main treatment is antiserum therapy which is produced in horse and is the only way to neutralize the venom. Due to the anaphylactic shock of the horse antiserum in some of the stung patients other source of antiserum is recommended. In this study the ability of produced camel antiserum in neutralizing the scorpion venom of Hemiscorpius lepturus was performed in Balb/c model.

Methods: Camel is an animal model that genetically is compatible with human genome utilized in this research to produce antiserum against scorpion venom. Two camels were used for immunization with the venom of Hemiscorpius lepturus. ELISA method was used to confirm the immunity. Antiserum was produced and used for neutralizing test. The precipitated antiserum with saturated ammonium sulfate (SAS) was also used to perform the neutralizing test in mice.

Results: The results indicated that the amount of 200 µl of antiserum and 400 µl of SAS antiserum were able to neutralize the amount of 1 LD100 of the venom and the survived the mice from death.

Conclusion: The result indicated that camel antiserum against scorpion venom is capable to neutralize the crude venom in mice model. Due to the safety of camel serum in human, it is suggested that the produced antiserum in camel can be substitute with the traditional horse antiserum in scorpion stung patients.