Tehran University Medical Journal

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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

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Intrauterine insemination (IUI) has been practiced since the late 1800's primarily for idiopathic infertility, and in men with deficient semen parameters. The procedure is done by placing washed sperm in uterus a few hours before ovulation. The records of 427 couples receiving IUI for treatment of infertility at Shariati hospital in 1370-74 were reviewed retrospectively. These patients had IUI in 574 cycles. Eighty patients became pregnant and delivery rate was 14% per cycle. Pregnancy rate is impressive when ovulation induction is combined with insemination timed just before ovulation. The success rate in Shariati hospital is comparable to other infertility centers in the world and cost of a cycle of IUI with HMG superovulation is approximately one third the cost of IVF-ET or GIFT cycle and avoids invasive oocyte retrieval and extracorporeal fertilization. So we suggest that women with refractory infertility without anatomic distortion of pelvis can have at least 3-6 cycles of IUI before IVF or GIFT.

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Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

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The present research is a quasi-experimental prospective study to determine usefulness of stripping the fetal memberanes at term for preventing of postterm pregnancy. 212 pregnant women with firm gestational dates entered the study, 112 underwent stripping of the membranes and 100 controls did not. The difference between the number of patients who advanced beyond term (>290 days) was statistically significant between groups (P<0.01). The mode of delivery and neonatal APGAR score were similar in both groups.

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In order to evaluate the role of idiopathic hypercalciuria (IH) in causing hematuria, nephrolithiasis and recurrent urinary tract infections we studied two groups of children for idiopathic hypercalciuria. 1) Patients group: children with hematuria, nephrolithiasis and recurrent urinary tract infections (n=452). 2) Control group: children with no urinary tract problem (n=100). In control group 3% of children had IH. In patients group 27.5% of patients with hematuria, 37% of patients with nephrolithiasis and 7.9% of patients with recurrent urinary tract infections had IH, P values=0.001, 0.005 and 0.2, respectively. This study confirms that there is a positive association between IH and hematuria or nephrolithiasis, but there is no significant association between recurrent urinary tract infections and IH

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Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.

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This is a mortality study in internal medicine wards of Amir-Alam Hospital, since the beginning of 1374 to end of 1376. Here, we reviewed, prevalence of disease lead to death, the ward and invasive interventions and duration of admission of patients before death. In this study, records of 85 patients were reviewed. 68.2% of patients were men and 31.8% women. Mean of age was 61.6% with minimum of 18 and maximum 95 years. The most prevalent diseases leading to death were cardio vascular (41.2%), cancer 29.4%, GI tract diseases (10.6%), pulmonary diseases (8.3%), CNS (7.1%), hemathologic (4.7%), DM (3.5%). Mean duration of stay in hospital before death was 6.6 days (max 30-min 1). This figure in different wards were: ward 1 (7 days), ward 2 (11 days), ward 3 (5.9 days) ICU (5 days) and CCU (4.7 days). 90.5% of patients died due to their diagnosed illnesses. Invasive tests and intervations were performed in 40% of them. As a whole 35 patient were died in CCU. This research and others like it showes the failures of our patient management system and can guide us in approaching to better medical care.

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In this study we tried to assess the incidence rate of shunt complications and it's association with age, sex, location of shunt, duration of surgery, and so on. For this purpose in a prospective study, 82 cases of hydrocephalus after shunt insertion, during the period of two years (1375-1377) in Shariati hospital were selected and all the complications were evaluated. From the patients, 39 cases were female and 43 were male. The range for age was 15 to 73 years with mean age of 16.67 years (SD=22.77). In 22 cases the complications of shunt surgery were observed. Shunt complications in our patients were infection (8.6 percent) and mechanical failure (17 percent). The mean duration of time for onset of complications was 3.11±4.3 months. The complication rate at the beginning (under two) and the end of life was much higher. In trying to reduce the rate of shunt complications, it is necessary to define and understand the causes of these problems they often arise from multifictorial etiologies.

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Maxillary sinus atelectasis is a rare and relatively unknown disease. Most patients present with non-sinonasel complaints. Negative intracavitary pressure due to ostial obstruction is suggested as the most probable etiology. Two patients with sinus atelectasis are presented in this paper: Case 1 presented with enophthalmus and maxillary sinus opacity and atelectasis in imaging. Endoscopic uncinectomy and midle antrostomy was done for this patient. Case 2 presented with mid-facial deformity and depression. Caldwel-Luc procedure with inferior meatal antrostomy was done. In 1 year follow up, they were asymptomatic and with no deterioration of facial deformity.

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Introduction: As spinal cholinergic receptors exhibit an action against somatic pain, this effect could be potentiated by intrathecal injection of cholinesterase inhibitor-neostigmine. This study was designed to evaluate the role of interathecal neostigmine on local back pain relief after single level lumbar disc surgery.

Methods and Materials: In an interventional-expremental study (Imam Khomeini Hospital, Jun. 2000 to sep. 2001), sixty-six patient with unilateral herniated lumbr disc at one lumber space were randomely allocated into two groups including, control (C) group and Neostigmine (N) group. Both groups underwent fenestration employing same anesthetic techniques. At the end of surgery 2 ml normal saline in groups C and 100 micrograms neostigmine methylsulfate (0.2 ml combined with 1.8 ml normal saline) in group N were injected intrathecally postoperative local back pain was measured with 10 cm chart method using Visual Analogue Scale (VAS) at 1, 4, 8 and 12 hours. Total dosage of morphine, as an analgesic rescue, used during the first 24 hours following surgery and observed complications were recorded.

Results: Mean VAS score postoperatively at 1st and 4th hours were 2.24 (Standard Error Mean, SEM=0.36) and 1.82 (SEM=0.28) in group N and 5.36 (SEM=0.39) and 5.61 (SEM=0.37) in group C respectively. Mean morphine used in the first 24 hours was 0.9 (SEM=0.4) in group N and 4.7 (SEM=0.65) mg in group C. All result were found to be statistically different in the two group (P<0.05). There was no neurologic deficit or CSF leakage in both groups postoperatively. Regarding nausea and vomiting, the difference between two groups C (15 percent) and N (24.2 percent) were not significant statistically.

Conclusion: In this study, we have found that injection of 100 micrograms hyperbaric neostigmine intrathecally is a safe and effective method with minimal complications or side effect for pain relief and curtails postoperative opiate demand.

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Kimura's disease (K.D) is an uncommon, benign, chronic inflammatory condition of unknown etiology and pathogenesis involving subcutaneous tissue presenting as a tumor like lesion with a predilection for the head and neck region. If parotid gland is affected clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnosis before tissue biopsy and fine middle aspiration (FNA) has only limited value. There is no evidence of malignant transformation and occasional spontaneous resolution occurs. Various treatment modalities have been suggested in the management of this condition but none is proved best and recurrence is common. we describe a 33 - year- old man with KD who presented with left parotid mass.

 

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Acute Pyelonephritis (APN) is one of the most common bacterial infections seen in children that may lead to renal scarring. Vesicoureteral reflux (VUR) is an important risk factor of renal damage but not the only one.

Materials and Methods: In order to determine the association between dimercaptosuccinic acid (DMSA) scintigraphic and voiding cystourethrographic findings, a retrospective study was performed on 50 children (100 renal units) with APN that had been admitted to Bahrami Hospital from 1995 through 1998. Voiding cystourethrography (VCUG) and DMSA scan were performed in all patients within 1 to 2 weeks after termination of treatment and a second scan was performed 6 months later in patients whose kidneys showed cortical defects in the first one. The grade of reflux was based on international reflux classification (I-V). The DMSA scans were considered abnormal if one or more areas of decreased cortical uptake were noted (cortical defect). The scar was defined as persistence of these defects in the second scan. DMSA cortical defect and VUR were demonstrated in 42 (42%) and 26 (26%) of renal units respectively.
Results: Fourteen out of 26 renal units (54%) with reflux had cortical defects and 28 out of 74 renal units (38%) without reflux had cortical defects (P=0.15). Permanent renal scarring was noted in 25/ 42 of renal units (62 %) in second scan.

Conclusion: It seems that VCUG alone is insufficient as a screening modality to identity those kidneys at risk of damage and DMSA scan may provide additional information about this.

 

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Background: The aim of this investigation is to evaluate the histologic results of biopsy in women with atypical squamous cells of undetermined significance (ASCUS) cytologic diagnosis.

Materials and Methods: We reviewed a series of cases with ASCUS pap smears from March 1999 to Feb 2002 in Imam Khomeini Hospital (n= 104), Who had cervical biopsy indirected colposcopy (103) and in Onec endocervical biopsy obtained without colposcopy. In 60 patients before colposcopy and biopsy repeat pap smear was tabled.

Results: Biopsy revealed 28.8% SIL (14 LSIL and 16 HSIL), 1 invasive carcinoma and 1 endometrial carcinoma. Pap smear repeated for 60 women before colposcopy examination, which 7 (11.7%) of them were normal. ASCUS persisted in 45 cases (75%) and 8 cases (13.3%) turned out to be SIL (6 LSIL, 2 HSIL) of 7 normal repeat smear, 2 marked as LSIL by biopsy. In colposcopic examination 22 of 103 (21.4%) had normal view which one of them was LSIL histologically.

Conclusion: Based on these findings, it seems immediate colposcopy and directed biopsy are appropriate procedures for management of ASCUS and to detect underlying SIL.

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Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high psychological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses’ health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care. Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress .The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers.

Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour’s workshop, all subjects were pre and post tested (one month later) for job stress and communication skills with the Karasek’s Job Content Questionnaire (JCQ) and communication skills test.

Results: Results revealed the following: (1) subjects in both groups after pretest were the middle level of stress and communication skills. (2) After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3) After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks.

Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel, thus. It is recommended to apply communication skills training programs for nursing personnel working at rehabilitation centers in order to assist them to coping with their job stress and improve the quality of nursing care.

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Background: The aim of this study was to determine the effect of two different regimes, containing different carbohydrate to protein ratios on performance, serum glucose and insulin after exercise in soccer players in Tehran Iran.

Methods: Nineteen male soccer players under training [age = 17/5 +/- 1.5 (SE) yr] were selected and completed two sequential trials separated by 1 week, in a paired cross-over study design. In each trial, subjects after running to fatigue received one of three regimes, using a random- order design as follows: HPRO ( CHO 56%, PRO 19% & fat 25% of total energy) HCHO ( CHO 64%, PRO 11% & fat 25% of total energy) or control ( CHO 60%, PRO 15% & fat 25% of total energy). The calorie of 3 regimes were equal. After consumption of meal up to120 min, blood was obtained before and at intervals. After 3 hours athlete performance was measured.

Results: The study indicates no significant difference in the serum insulin and glucose response among three regimes (P > 0.05). There was no difference in performance between three regimes after 3 h (p > 0.05).

Conclusion: The results suggest that post exercise regimes have no influence on performance, serum glucose and serum insulin. Thus total energy content and carbohydrate content may be important in recovery after exercise.

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Background: The objective of this study was to investigate the relationship between glucose-6-phosphate dehydrogenase inhibition in macrophages treated with 6-Aminonicotinamide, the amount of nitric oxide (NO) production and the resistance of infected macrophages against Leishmania major infection.
Methods: Peritoneal macrophages of BALB/c mice were isolated and treated with different concentrations (1.25, 2.5, 5, 10 mM) of 6-aminonicotinamide. After 24 hours, the viability of treated macrophages was measured by MTT assay at 540 nm. G6PD activity was measured in the cell extracts 24 hours later. Macrophages were then infected with leishmanial amastigotes and after 18 hours NO production was determined using Griess-reagent. In order to study the inhibition of macrophage activity, 5 mM concentration of 6-AN was used and number of leishmanial amastigotes was recorded in these cells from day 1 to7.
Results: Different concentrations of 6-AN were shown to cause a significant increase in cell death and decrease in G6PD activity and NO production in macrophages. Also, the number of amastigotes in macrophages was increased significantly (p < 0.05).
Conclusion: The concentration of 6-aminonicotinamide and G6PD activity affect the viability of BALB/c mice peritoneal macrophages through production of NO. Inhibition of G6PD activity leads to decreased leishmani-cidal activity of mouse peritoneal macrophages.

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Background: There is considerable professional debate over which technique is the best for lifting. The aim of this study is to compare three static lifting styles, the stoop, semi-squat and arm lift, using maximum isometric voluntary contraction (MIVC) as one indicator for recommending a lifting style.
Methods: Thirty healthy women (mean age: 22.37 years) participated in this quasi-experimental study. They performed the tests in static postures by standing on the platform of the Lift TrackTM and pulling the dynamometer of the instrument with maximum effort in three lifting styles: the stoop, semi-squat and arm lift. The subjects warmed-up by practicing the lifts first. The mean MIVC from the two other sets of lifts were used for statistical analysis by repeated measurements and SPSS (ver.10) software.
Results: There were significant differences between the MIVC of the three lifting styles in this study. The largest MIVC was for the semi-squat lift and was the least was for the arm lift (p<0.001). The MIVC of the stoop lift was larger than that of the arm lift (p<0.001).
Conclusion: The largest MIVC for the semi-squat lift suggests that this style is useful for lifting objects from the floor. The differences in biomechanical and muscle pattern activity changes could explain these results. It seems that activation of the quadriceps muscles in the semi-squat lift was a main factor for producing more MIVC, so when this style is recommended for lifting, attention to the power of the quadriceps is important.

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Background: Burns are a major cause of death and disability worldwide. Today biological dressings have become an integral part of modern burn care. Using this method, in otherwise healthy young adults, the size of burn relative to the total body surface area (TBSA) correlating with a 50% mortality rate has increased from 30% to 80%. Due to a lack of experience and an interest in using biological dressings in Iran, as a developing country, the aim of this study was to compare patient outcome using the biological dressing vs. conventional treatment in patients with massive burns.

Methods: In this clinical trial study, 118 burn patients (30 to 75% TBSA) were enrolled. The patients were divided in two groups. Those in the conventional treatment group had not accepted treatment with a biological dressing.  The second group agreed to treatment with biological dressing, a pig skin xenograft known as Xenoderm. Significant differences were evaluated using the unpaired Student's t test, the Mann-Whitney U test and the χ2 test. 

Results: Mortality rates in the conventional treatment group (n=53) and biological dressing group (n=65) were 35% (19) and 10.8% (7), respectively (p=0.001). Excluding those patients who died, the mean hospital stay was 31.3 days in the conventional treatment group versus 18.2 days in the biological dressing group (p=0.0005), and number of dressings was 22.1 versus 9.9 (p=0.0005), respectively. Three patients in the conventional treatment group were transferred to a tertiary-care hospital after three weeks of treatment. The most commonly burned areas were the upper limb, lower limb and trunk.

Conclusions: The results of this study indicate that biological dressings give a better outcome and decrease the hospital stay and the number of dressings. A randomized clinical trial is warranted.

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Background: Ureteral obstruction, leading to urinary stasis and elevated pressure in the proximal part of urinary tract, causes progressive renal dysfunction. This study was designed to evaluate the status of oxidative stress and metabolic defect in acute unilateral ureteral obstruction (UUO).

Methods: Experiments were performed on three groups of male Sprague-Dawley rats (n=10 in each group). In the UUO group, rats were lightly anesthetized by ether and the left ureter was occluded by means of a sterile surgical procedure. Twenty-four hours after UUO-induction, both kidneys were removed and stored at -70 °C. In the sham group, anesthesia and surgery were performed without ureteral occlusion, and the control group received no surgical procedure. The kidney samples were assessed to measure the levels of ATP and ADP by the luciferin-luciferase method for determining metabolic status. In addition, the levels of malondialdehyde (MDA) and ferric reducing/antioxidant power (FRAP) of the kidneys were measured to evaluate the redox state. Data are expressed as means ±SEM per gram of kidney weight (gKW). The comparisons were performed using paired t-test for intra-group analysis, and ANOVA followed by Duncan's post-hoc test and then LSD test for inter-group analysis. Significance was taken at p<0.05.

Results: The comparisons between the UUO and sham groups indicated that 24 hours of UUO increased levels of MDA (51.42±1.86 vs. 38.64±1.02 nmol/gKW, respectively p<0.001) and ADP (0.67±0.04 vs. 0.47±0.045 µmol/gKW, respectively p<0.01), but decreased levels of FRAP (2.44±0.18 vs. 4.28±0.27 µmol/gKW, respectively), ATP (1.09±0.10 vs. 2.26±0.19 µmol/gKW, respectively) and ATP/ADP ratio (1.64±0.14 vs. 5.11±0.56, respectively) in the obstructed kidneys, all p<0.001. In the non-obstructed kidneys, the levels of ATP and ADP were higher (p<0.01 and p<0.001, respectively), while the levels of MDA and ATP/ADP ratio were equal to those of the sham group.

Conclusion: Twenty-four hours of acute UUO induces oxidative stress and reduces the aerobic metabolism in obstructed kidneys, whereas non-obstructed kidneys with a normal redox state show the higher levels of metabolism.

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Background: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. The frequency of hyperhomocysteinemia is higher in hemodialysis (HD) patients than the general population. The objective of this study is to assess the efficacy of high-dose folic acid supplementation with and without vitamin B12 on lowering plasma total homocysteine (tHcy) concentrations in HD patients.

Methods: Thirty-six HD patients at Imam Hossein Hospital, Tehran, Iran, who had been given folic acid supplements (5 mg/d) for at least 3 months before, were enrolled in this clinical trial. Subjects were also checked for other inclusion and exclusion criteria. The subjects were divided randomly into four groups and underwent two months of supplementation as follows: 5 mg/d oral folic acid + placebo in group one, 5 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group two, 15 mg/d oral folic acid + placebo in group three and 15 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group four. Concentrations of plasma tHcy and serum folic acid and vitamin B12 were measured at baseline and after the supplementation period. Dietary intake of patients was also determined during the supplementation period.

Results: Of the folic acid supplemented patients, 27.8% had normal levels of tHcy at baseline and 72.2% had hyperhomocysteinemia. After the supplementation period, plasma tHcy increased by 1.35% in group one and decreased by 6.99%, 14.54% and 30.09% in groups two, three and four respectively. Changes in plasma tHcy and serum vitamin B12 were only significant in group four however, no significant changes were seen for serum folic acid. The percentage of subjects reaching normal levels of plasma tHcy was 5.6 fold higher in group four than in the reference group.

Conclusions: Supplementation with 15 mg/d folic acid together with 1 mg/d oral vitamin B12 is more effective in reducing tHcy levels in HD patients.