Tehran University Medical Journal

---

Infection by M. tuberculosis can be demonstrated by tuberculin testing. On sequential PPD some person show a marked increase in the size of their skin reactions which may not be due to recent or past tuberculous infection. This phenomenon (booster effect) can occur as soon as a week after the initial test and persist for as long as a year.

Methods and Materials: The purpose of this research is studying the size of induration following repeated PPD tests (booster effect) that studied in children who came to our clinic or imbedded in pediatric unit and the group of student in grades 4 and 5 at elementary school (totally 80 cases) for one year.

Results: Increase of induration in 25% of all (20 cases) was 5 mm or more and in 75% of all (60 cases) was less than 5 mm and between these two groups, differences was meaning full (P< 0.05). The increase of induration in 12.5% was 7 mm or more.

Conclusion: Because there is not shown definite increase of induration (more than 5 mm) on sequential PPD in children, we must to consider to new infection.

---

Listeria infection is still a dominant infectious problem in Iran, particularly in abortion. Looking for a paraclinical technique other than bacterial methods (which is not always available) lead to serological survey indicating estimation anti listeria antibody by Immunoflourescent test. Unfortunately the false positive results due to cross reaction between "listeria monocytogenesis" and certain gram positive cocci, made it an unacceptable technique. Here we performed a test to extract the Listeria M. (Stranin 4a and 1b) soluble antigen and detecting the antibody by counter immunoelectrophoresis (CEI). The results indicated that of four bacterial soluble antigen fractions F1 and F3 were significantly positive with patients sera. We will discuss using the soluble antigen by CEI technique may be helpful to omit the false positive reactions.

---

Thyroid scintigraphy has been helpful in detecting and evaluation of thyroid nodules. Sodium pertechnetate Tc-99m is the most commonly used radionuclide for thyroid imaging because of its general availability, favorable dosimetric characteristics and low cost. But, there are reports of occasional disparity in isotope uptake in lesions compared with radioiodide. In order to determine percentage and clinical significance of this disparity, we screened 101 patients with solitary functioning nodules using sodium pertechnetate TC-99m in comparison with subsequent Iodine-131 scan in research institute for nuclear medicine. We conclude that sodium pertechnetate TC-99m is a reliable radiotracer for the detection and evaluation of thyroid nodules and there is no need for the subsequent Iodine-131 scan.

---

Carnitine is a water-soluble quaternary amine which increases the long-chain fatty acid metabolism by facilitation of their transport to the oxidation site (mitochondria). Carnitine most likely is present in all animal species, in many microorganisms, and in many plants. In this study, we determined the carnitine level of sera in pregnant and non-pregnant women by segade modified method. Average concentration of carnitine in the sera of fifty pregnant women was about 25/83 umol/I: First trimester-30.96 umol/I. Second trimester-29.11 umol/I. Third trimester-25.11 umol/I. concentration of cholesterol and triglyceride in the above-mentioned group was the following: Cholesterol: 258.84 mg/dl triglyceride: 267.02 mg/dl. The above values show that the carnitine level in sera of pregnant women decreases significantly and this decrease is tolerated well by pregnant women. According to our results, the serum carnitine concentration in pregnant women gradually decreases as gestation proceeds. So that the end of this period, is half of its concentration before conception. During pregnancy, there was an inverse correlation between carnitine level and that of cholesterol and triglycerides. Decrease in carnitine concentration and increase in cholesterol and triglyceride levels may be due to the following factors: 1) Increase in FFA oxidation in pregnancy. 2) Hormones. 3) Dilution of the blood. 4) Decrease in Fe storage in pregnant women.

---

Results of some cancer researches show that a number of hormones in ceratin tumors are growing up. Often, the majority of these hormones are produced by tumor cells or by an unknown origin in the neoplastic area. Also, it is clear that some of these ectopic hormones are produced only by specific tumors. In addition, different effects of these abnormally produced hormones on the immune system are shown in recent years. Thus, we decided to study the hormonal status of patients with chronic lymphocytic leukemia (CLL) patients. The results of this study showed that the LH and FSH levels in the majority of patients are rising above normal while testosterone level in many of them is decreased. In the next step, we are going to study the immunological effects of LH, FSH, and testosterone one the lymphocyte function in vitro.

---

Four patients were studied for intercostals nerve blockade in cholecystectomy. All of the patients were poor risks (Class 4) and received premedication before the procedure. Intercostals nerve blockade (ICNB) of the 7th and 10th thoracic nerves on the right side was performed with lidocaine 1% plus adrenaline 5 ml. at each segment, T7-T10 (a total dose of 20 ml). Ventilation was controlled using intermittent positive pressure throughout the observation period. Heart rate and arterial pressure remained within normal limits in all patients.

---

Of 14 cases who underwent this operation only in one of them because of infection in operation site, we had to extract the expander. Also, in the first day of the operation that we injected serum inside the expander of two other patients, the wound opened up and the expander appeared and came out automatically. The remaining ten patients have tolerated the operation after treatment period without any complications and good result was achieved. This method in covering up skin lesions and in eliminating burn as well as old wound scars was very effective and the patient become satisfied because there was no need to remove skin from other parts of the body and thus no new scars would have been created. The only problems in this method of treatment were its duration which is needed for injection inside the expander as well as bad appearance in operation region and these problems cause the patients to become depressed and to become isolated from the public for a long period. For the past three years that we used this method for covering skin lesions in different parts of the body and even in treating extensive spots and the hemantrium we achieved excellent results and the report will subsequently be submitted.

---

Documented war experiences have provided early descriptions of different group of psychiatric features. A combat soldier with palpitation and chest pains was felt to have a functional cardiac disturbance, called soldier's heart. Anxiety and other symptoms indicating increased arousal were called shell shock and were thought to be related to lesions in the central nervous system (CNS). Describing analytically war events could operate with an enormous emotional intensity breaking through the ego defences and flooding it with an uncontrollable anxiety. Post traumatic stress disorder (PTSD) delineates a syndrome developing after a discrete traumatic event in a stress setting. Diagnostic conceptualization which tie PTSD to stress and trauma invariably involve two different approaches from two different theoretical bases: the concepts dealing with trauma on the one hand (which could effect on CNS) and those dealing with stress-response theory on the other. Author emphasizes on viewing the patients who complain of war psychiatric effects in three categories: (1) Non PTSD diagnoses that the patient ought to be treated accordingly (2) Traumatic neurosis which has overwhelming war stress related emotional aspects and is occurred in predisposed individuals. This category is suggested to be classified as post war stress disorder specifically, to be differentiated from other post traumatic psychiatric categories. (3) Author also suggests the third category as post traumatic war stress syndrome which is thought to have organic origin. Symptoms such as hyperacusis, hyperirritability, tinnitus and particular type of head aches which are mostly refractory to treatment confirm the hypothesis.

---

This study has been conducted on the path reports of diagnostic curettage carried out in Mirza koochek-khan hospital during the 6 months of the year 1989 (April to September). The reports examined have been further classified into incompelete abortion, diagnostic currettage and others. A total number of 645 women have had D&C according to the above criteria. In this period of time, incomplete abortion had the highest rate (34% of all D&C's), of which 62.5% were under 20 years of age and 22.6% were primigravida. The ratio of total abortion to the number of deliveries was 9.8% and post-delivery retention of placenta constituted 4.8% of all D&C's, with the highest rate amongst the age group of 15-19 years old, who mostly had home deliveries. The incidence of hydatidiform mole was 3.07 per 1000 deliveries, out of this number, the highest rate (50%) belonged to the age group of 20-24 years old. The above incidence is 6.4 times more than the U.S. incidence and 0.9 times less than the incidence reported in other Asian countries (6, 8, 10). Knowing the complication of unplanned abortion such as perforation of the uterus, infection, hemorrhage, adhesions (synechiae) and secondary sterility, special attention should be paid to the diagnosis of high-risk pregnancies in prenatal clinics.

---

The papillary cystadenoma lymphomatosum (PCL), also called warthin's tumor, is a benign salivary gland tumor which primarily involves the parotid gland. These lesions are composed of a double layer of cuboidal or culmnar eosinophilic cells lining a cystic cavity which lymphoid tissue is present in the supporting stroma. The lesions shows a predilection for males, with peak incidence during the sixth decade of life. Bilateral lesions have been found to occur in 5 to 7.5 percent of the cases. Rarely, these lesions have been reported in the minor salivary glands and oropharynx. Case report: A 47-year-old woman presented with a red lesion on the hard palate between the midline and right maxillary side. The patient had awared of the lesion for one year. The clinical dignosis was a mucocele. An excisional biopsy was performed. Gross examination of the formaline-fixed specimen revealed three pieces of soft tissue measuring 1.0 x 0.3 x 0.3. Histologic examination revealed a nodular mass surfaced by keratinizied stratified squamous epithelium. The connective tissue stroma contained a papillary cystic area lined by a double layer of cuboidal cells with centrally placed nuclei

---

During April, 1991 and September, 1993, eighteen patients with major thalassemia admitted to Shariati BMT center. Seventeen patients were transplanted were from HLA identical siblings and one from. his HLA identical father. Eleven of the donors were the known cases of minor thalassemia. The range of patients' age was within 3-10 years (with the average of 5 years and 11 months). Among them, seven patients were male and eleven were female. As the other international BMT centers, we classified our patients into three classes. Our criteria for this classification were hepatomegaly, ferretin, and liver fibrous 60% of our patients were put in class I and 40% in class II. All of our patients revealed a GVHD (severe graft vs. host disease) three weeks post-BMT as pruritus, diarrhea, and skin erythema especially in hands and feet. Two of the patients showed severe GVHD. One of the patients had chimerism after BMT. Although one year after BMT has passed, the patients is still depended on blood transfusion. One patient, despite graft rejection, died nine months post-BMT another one died after +70 due to GVHD. During 2.5 years, the overall graft survival rate was 88% in our center

---

The treatment of choice for bladder tumors is TUR, but because of high incidence of recurrence in these tumors, various treatments are suggested. In one study, 32 patients involved with superficial T.C.C. of bladder selected and divided in two equal groups. In the first group, after T.U.R, 10 million IU of a alpha-interferon was injected into the bladder through a catheter and in the other group, after TUR, they treated with injection of BCG into bladders. The results of these two drugs in prevention of recurrence and their side effects were studied and compaired

---

In this survey, 55 patients were studied in a period of six years for having the anesthesia in the sitting position. In this position, the surgeon will had a better access to the location, whose damages have been sustained, so less damages would be given to the healthy tissues. For the patients, due to their critical general conditions, one week prior to giving anesthesia to the posterior fossa, operation in the sitting position the right ventriculoatiral shunt was placed. For preventing the fall of blood pressure, a bandage was placed in the lower limbs after inducing anesthesia and changing supine position to sitting position. Before the induction, central venous pressure was measured for treating the air embolism. The head of catheter was placed inside the right atrial. Premedications such as atropine, pethidine, and inductive agents like thiopenton, and muscle relaxants, maintained with halothane and nitrous oxide. All of the patients endured this condition without the fall of blood pressure and air embolism

---

Ito cell (Fat Storing Cell=FSC) is one of the cells which forms the liver sinusoidal wall it also forms the connective tissue of the liver. The cell was first identified in 1963 by a scientist named Ito. It will get damaged due to the plasma fat increase which is resulted from a diet of corn oil 10% and fish oil 10% the damage wil be in form of fat storing cell. The FSC morphology may represent the damage to the liver tissue. The biopsy of an infant's liver reveals that, Ito cell has a very small cell body which contains a core in the middle occupying 2/3 of the area of cytoplasm its basal cytoplasm is hollow and very clear. This study indicated that not only the ultrastructure of Ito cell is circular and three dimensional, but also its presence may show the damage to the liver tissue.

---

201 blood samples were collected by cluster sampling from 7-11 years old children and measles antibody titer was measured by hemagglutination inhibition test. Despite testing all the sera, the results were analysed on the 139 samples that had documented vaccination records and no history of measles. Among 139 children 44 had received 2 doses of vaccine one dose before 12 and one after 15 months, 64 had one dose after 15 months, 29 had only one dose before 12 months and 2 had not received vaccine. The antibody titer of the first two groups had no significant difference with those that had received one vaccine dose, before the age 12 months (P<0.001). There were no significant differences in the titer of antibodies with time elapse in none of the vaccination histories. This may be due to efficacy of vaccine and also circulation of wild virus in the community. Regardless of the history of vaccination, 95.5% of children had immunity to measles (titer?3). Considering the results if the current strategy of vaccination implemented completely, the status of immunity would be satisfactory.

---

This article aim is to introduce a case of PAPVC (partial anomalous pulmonary venous connection). The patient was a 25-year-old women who had dyspnea and palpitation. She expressed no special disease, no past medical history, and no drug usage, but her brother and her aunt had the above-mentioned history. In the physical examination, lungs were clear and the heart had S2 splitting, and there was a systolic murmur in the pulmonary area. Her liver could be palpitated two centimeters below the costal edge, but she didn't have any hepatomegaly. In cardiac catheterism, she had PAPVC, atrial septal defect (ASD), and mitral valve prolapse (MVP). The patient underwent operation had left pulmonary vein was separated from the superior vena cava and anastomosed to the left atrial auricle. By means of the pericardial patch, the left atrium became enlarged and ASD was closed. She was in a good condition after surgery and left the hospital without any complication with a good condition and recovery and had no problem any longer.

---

Association of Helicobacter pylori with pathogenesis of gastrointestinal disorders (including gastritis in children with special endoscopic anteronodular) have significant importance in prognosis of infection resulting from this bacteria in children. However, in this research it was found that there is significant and clear correlation between nodular anteritis (in endoscopy) and active presence of lymphoid follicle (in histology findings with replacement of H.pylori) was noticed in children. In this research 14 persons (34.1%) out of total patients were positive. The average age of positive H.pylori patients was clearly higher than negative H.pylori patients. So increase of possible infection occurrence together with increase of age in children was confirmed. Meanwhile, there is significant relationship between presence of bacteria and clinical symptoms particularly epigastric pain, vomiting, and nausea. One of the other results of this study was confirming the relationship between history of gastrointestinal disorders in immediate family members and infection resulting from H.pylori in patients.

---

The present survey covers a number of 91 Iranian repatriated war prisoners who, six months after their freedom, approached three psychiatric clinics in Tehran during 1989 and spring 1990. Of these, 34 persons (37.4%) who showed higher symptoms of disorders were hospitalized and 57 (62.6%) who showed milder signs of disorders were carefully diagnosed mentally and psychologically as outpatients. The prevalent disorders revealed by this study were adjustment disorders (48.3%), mood disorders (22%), schizophrenia (11%), anxiety disorder (9.9%) and organic mental disorders (7.7%). The survey showed statistically the existence of a meaningful relation between the disorder severity with such factors as negative opinion of the prisoner's family on his going to the war front, and observance of martyrdom of co-fighters by the patient. However, no significant relation was observed between the severity of disorders and such factors as being involuntarily dispatched to the front, duration of captivity, type of being captive (singular or in group), having a previous record of solitary imprisonment, observing the treason of co-fighters during his captivity.

---

Initial management, incidence and review of hydatidiform mole, chorioadenoma and destruens and chorio carcinoma in Mirza Kochek khan hospital department of ob.gyn and gynecology oncology of women's hospital Tehran-Iran school of medicin from September 1985 to March 1990, 209 patients received primary management for hydatidiform mole at oncology department of Mirza Kochek Khan hospital medical school of Tehran Iran. All of these women HAD complete record available for analysis, of these, 167 women bydatidiform mole, 12 patients chorioadenoma-destruens 30 patients chorio carcinoma a survey was made of factors likely to provide an important clinical perspective patient aye and the status of pregnancy were noted. 41 patient only sharp curettage and 55 patients suction curettage to remove the hydatidiform mole. 97 patient require chemo terapy, suction curettage of the uterus is clearly the best means of management in the most cases their eyperince documents that hydatidiform mole is an high risk pregnancy that requires prompt and in tensive management.

---

Forty-six cases of patients suffering from acne cystica (conglobata) were treated by low-dose dapsone plus folic acid (1 mg/day). This study has been performed on patients that had no response to other treatments. Several essential and careful tests and examinations were performed on patients before and during treatment. Ten patients of 46 above-mentioned cases were excluded from treatment protocol, because of the reasons that have been mentioned in this article. In 33 cases of 36 patients that recieved the treatment, the cystic lesions were disappeared without any exception and had satisfactory response to treatment.