Tehran University Medical Journal

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Calcitonin Gene Related Peptide (CGRP) was first reported in 1982. This peptide contains 37 amino acids which could be found in Alpha and Beta forms. CGRP shows diversity both in its receptors and biological effects and up to now four different types of receptors have been reported. It can act like a neurotransmitter, local hormone and neuromodulator. They have a variety of effects on different organs such as a potent effect on vasodilation and smooth muscle relaxation. Ability of CGRP for induction of protein extravasation from blood vessels was uncertain. In this study intra-articular infusion of 10^-6 M CGRP to the rat knee joint induced significant protein extravasation into the rat knee joint space. The amount of protein was detected by modified Iawata method which could detect amount of protein between 5-500 mg/L. Higher and lower concentrations failed to induce protein extravasation. Failure in higher concentration was likely due to significant fall in blood pressure. In the presence of an arterial hypotension induced by an ? adenoreceptor antagonist, 10^-6 M of CGRP failed to produce protein extravasation. This effect of CGRP was a specific active effect and not a passive effect due to its potent vasodilation effect, as similar vasodilatory response induced by a ?-adrenoreceptor agonist failed to induce protein extravasation. There is more than 50% of sensory neurons which contain CGRP and they are spread in all over the body and joints, therefore CGRP induced protein extravasation can potentiate inflammation in different organs.

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The purpose of this study was investigation of effect of cholestasis on bromocriptine-induced yawning in male rats. Bromocriptine, the agonist of dopamine receptors (especially "D2"), causes yawning in male intact rats. In the present study, cholestasis was produced in male rats by surgery and ligation of common bile duct. The number of yawning induced by intraperitoneal injection of bromocriptine (11 mg/kg) was compared in cholestatic rats with sham operated and control groups. Immediately after injection of the drug and putting animals on the frame of behavioral study, the number of yawning was determined in a period of one hour. Obtained results, indicated significant difference in the number of bromocriptine-induced yawning between cholestatic rats and the other two groups. There wasn't significant difference between sham and control rats. These results indicate that some changes occur in cholestatic rats which increase sensitivity and response of dopamine receptors. Since it is proved that dopamine agonist-induced yawning is mediated via nitric oxide, and also level of nitric oxide is increased in cholestasis, it can be supposed that the mentioned response may be due to elevated level of nitric oxide. On the other hand, increased number of yawning in cholestatic rats may be due to increased level of endogenous opioids in these animals.

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This study is on different surgical techniques for repair of Co-arctation of aort and their effect for correction of systemic hypertension and lower extremity hypotension. In addition to these, the clinical and paraclinical data were noticed. 50 pt were operated in "SHARIATI" hospital during 1370-1377 with diagnosis of Co-arctation of aorta (30 men, mean age 19.4 years, 20 women, mean age 16.6 years). In addition to older age of our patients which results in more post-op sequela, there was suprrisingly a long-lag between onset of symptoms, diagnosis and operation (mean 4.36 years). 62% of Co-arctation were juxtaductal and the remainder were non-classical forms. 52% of our patients had co-existing cardiac disease which were very high in comparison with other studies (12%). This is due to older age of our patients and more valvular heart diseases. Among complicated cases of co-arctation, 71.9% were in men and 28.1% in women and this difference is due to high incidence of bicuspid aortic valve in men. The mean angiographic gradient were 57.5 mmHg which increases with age. CXR was abnormal in 91.7% and ECG in 74.2% of patients. The different applied surgical techniques include ee-A=26%, TIG=40%, TBG=18%, DPR=14%, FSCR=2%. There is no significant difference regarding post-op complications, BP in post-op period, and increase in pedal pulses, except in TBG group which HTN was more common. Two early deaths occurred which were in DRP group.

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In this study the effects of bromocriptine and apomorphine (dopamine receptor agonists) on electrical field induced twitch response of longitudinal muscle of guinea-pig illeum was investigated. Bromocriptine and apomorphine dose dependently inhibited illeal contraction. IC50 for this inhibitory effects were 6.22±0.645×10^-7 M and 5.48±0.647×10^-6 M, respectively. sulpiride (a specific D2 dopamine receptor antagonist) with concentration of 10^-5 M inhibited the effects of these agonists. Yohimbine (an ?2 adrenergic receptor antagonist) only blocked the inhibitory effect of bromocriptine but failed to block apomorphine inhibitory effects. L-NAME (nitric oxide synthetase inhibitor) with concentration of 10^-3 M blocked the effects of bromocriptine and apomorphine. These data suggest that there is inhibitory presynaptic dopamine receptors in cholinergic terminals of guinea-pig ileum and its function is related to formation of nitric oxide.

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CAD is one of the most common diseases in this era and coronary artery bypass surgery is a popular operation in Iran and other countries. This entity has multiple modality of treatment based on several factors. The most common invasive modality is cABG. This study is a retrospective one, on 500 patients (402 men and 98 women) who underwent cABG in "SHARIATI" hospital. The mean age was 52 for men and 57 for women. Hypertension, diabetes, hypercholestrolemia and hypertriglyceridemia were more common in women a marked difference. In men cigarette smoking was more common. Mean ejection fraction of left ventricle was higher in women, but the mean no. of involved coronary artries were the same in both sex. 10 patients died in 30 day post-operation including 7 men and 3 women.

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To examine the relation between oral contraceptive (OCPs) use, body mass index, parity, familial history of gallstone disease, history of diabetes, history of hyperlipidemia and gallstone disease in women, we have undertaken a case-control study. The study population comparison 80 hospital patients with diagnosed acute gallstone disease as case group and 200 controls who were patients in hospital with no history of gallstone disease. The data were analyzed by Chi-square and T-student test. The results revealed that: The use of OCPs in case group is higher than that of control group. But there is no significant difference between them. No relation was found between gallstone disease and body mass index, parity, history of diabetes, familial history of gallstone disease, use of OCPs of different types and duration of use. While there was a significant difference between the 2 groups regarding history of hyperlipidemia (P<0.05). Finally we found no correlation between the history of use, types and duration of use of OCPs and symptomatic gallstone disease. There was no indication of any interaction between oral contraceptive use and other risk factors and duration of OCP use and other risk factors in the production of disease.

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Since its introduction in 1988, laparoscopic cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1) Recurrent biliary colic (88.4%), 2) Non-specific manifestations of gallstone (5.8%) and 3) Asymptomatic gallstone (1.7%). Contraindications for LC are: 1) Acute cholecystitis 2) CBD stone and/or dilatation, 3) Gallbladder cancer, 4) Intra-abdominal malignancies, 5) The need for other elective abdominal operation, 6) History of upper abdominal, laparatomy, 7) Sepsis, 8) Ileus, 9) Peritonitis, 10) Pancreatitis and 11) Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision making is based on patient's general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: Severe adhesions, technical and enforced. There was no death after LC.

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This descriptive study is carried out to determine the effectiveness of family planning programmes in Iran for years 1991-96. The study revealed the following outlines: Contraceptives prevalence rates increased from 42% to 67% during years 1991-96. Zaro couples years of protection increased for norplant, injectable contraceptive, IUD, vasectomy and tubectomy, but for candom it is decreased in year 1996 (Comparing to earlier years of the study). A decrease in use failure rate of contraceptives was observed during the period of the study.

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Sepsis is one of the most critical medical emergency situations. Treatment with anti microbial drugs should be initiated as soon as samples of blood and other relevant sites have been cultured. Available information about patterns of anti microbial Susceptibility among bacterial isolates from the community, the hospital, and the patient should be taken in to account. It is important, pending culture results, to initiate empirical anti microbial therapy.
Materials and methods: In a descriptive study during 3 years (1377-1379), microbial and anti microbial susceptibility patterns evaluated in Amir alam clinical laboratory on 2000 specimen of blood culture received from 765 hospitalized patients at Amir Alam hospital wards.
Results: 113 specimens from 77 patient (10 percent) were positive for microbial growth. Enterobacter, S. aureus, S.epidermidis, Pneumococci, Ecoli, and Pseudomonas were the most common isolated etiologic agents(80 percent) . The most common organism was Entenobacter in 1377, S.aureus in 1378 and pseudomonas in 1379 There were significant change in patlern of organisms, increase resistance to some important available antibiotics and change in antibiotic susceptibility pattern during three years (disc diffusion method).
Conclusions: According to Results of this study due to change in pattern of organism and their antibiotic susceptibility, dynamic microbiological study provide important data for Ordering empirical and culture oriented treatment of patients with bacteremia, Sepsis, anti microbial Chemotherapy, anti microbial susceptibility empirical anti microbial therapy, microbial pattern.

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Xerostomia is one of the disturbing side-effects of the radiotherapy to the head and neck region. Pilocarpine has been approved for the treatmentof this condition in the chronic phase, but its use concurrent with radiation could also be beneficial for prevention or reducing the subsequent radiation-induced xerostomia. We undertook to test this hypothesis in a clinical trial.
Materials and Methods: All 18- to 70-year old patients who were to be irradiated to the head and neck, with both parotid glands in the radiation fields, were eligible for this study. Patients with any medical contraindications for pilocarpine were excluded. Randomization was performed at the start of radiotherapy to either pilocarpine 5 mg three times daily or placebo in a double-blind setting. The drug was started with irradiation and continued until 3 months after the end of radiotherapy. Serum pilocapine levels were measured in a randomly selected number of patients by high-pressure liquid chromatography (HPCL). Xerostomia was evaluated about 6 months after the end of radiation by an analog-scale questionnaire, and the objective grading of xerostomia was recorded by two separate observers.
Results: A total number of 60 patients were randomized into the trial (31 pilocarpine, 29 placebo), mostly with nasopharyngeal carcinomas. Mean parotid dose was 5, 818 cGy. Mean pilocarpine serum level was 14.65 ng/ml. No serous side-effect was observed. Thirty-nine patients were analyzed for xerostomia at a median time of 7 months after radiotherapy, 18 in pilocarpine and 21 in placebo groups (9 patients died and 12 patients did not come back for xerostomia evaluation). Mean subjective xerostomia was 40.3 mm in the pilocarpine group and 57 mm in the placebo group (p= 0.02). Also mean objective xerostomia grade was 2.2 in the pilocarpine group and 2.6 in the placebo group (p= 0.01). Subjective and objective xerostomia results were positively correlated (level 0.01). Age and the parotid dose did not have a significant effect on xerostomia.
Conclusion: Pilocarpine as prescribed in our trial produced the standard serum level required, and no serious side-effect. Compared to polacebo, pilocarpine used with radiotherapy could lead to a diminishment of subsequent radiation-induced xerostomia.

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Background: The role prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with benefits obtained from the use of prophylactic antibiotics in surgery for chronic otitis media.

Materials and Methods: The current study was designed to evaluate the role of prophylactic antibiotics in the wound infection and outcome of surgery for chronic ear disease. It was the authors' impression that there was no difference between topical and systemic antibiotics in such surgery. Patients who met the inclusion criteria (n=193) were randomly assigned to a topical treatment group or a control group receiving only intravenous antibiotics for 1 dose intra operatively and 3 dose there after. Patients were followed post-operatively and observed for clinical evidence of infection, graft failur and hearing status.

Results: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival.

Conclusion: The use of prophylactic antibiotics in surgery for chronic otitis media can be recommended as an alternative method.

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Wide variations in the prevalence of asthma, allergic rhinitis and eczema have been reported in the world, between regions and countries. The international study of asthma and allergies in childhood (ISAAC) was developed to provide standardized method to ascertain the prevalence of asthma and allergies in different regions. Comparisons of prevalence rates across geographic regions may help to identify factors that influence the development of these conditions in individuals.
Methods and Materials: For doing this descriptive study the ISAAC written questionnaire was completed by the parents of 3000 school children aged 6-7 years in Kashan, the central area of Iran, with different geographic and cultural characteristics, during the fall of 1998.
Results: The overall cumulative and 12 month prevalence of wheezing were 10.2 percent, 6.9 percent in the girls and 18.2 percent, 13.1 percent in the boys respectively. The prevalence of doctor diagnosed asthma were 1.3 percent and 2.2 percent in the girls and boys. Rhinitis symptoms were reported by 14,7 percent, 16.9 percent and chronic pruritic rashes by 5.1 percent and 8.3 percent of the girls and boys respectively.
Conclusion: Allergic disorders are common in this area and prevalence is comparable to other parts of Iran and many other countries. Prevalence of asthma by medical diagnosis is relatively low with respect to other studies performed with the same methodology.

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Essential hypertension is one of the risk factors of cardiovascular diseases. Hypertension etiology is not completely known, it seems that rennin-Angiotensin system has an important role in its etiology, Thus better recognition of this system and its activity changes or vascular reaction changes to different parts of this system during progressive hypertension can be more effective in better recognition of the disease progress and treatment.
Materials and Methods: In this study responsiveness of mesenteric vessels of Goldblatt two kidney- one clip (2k-lc) renovascular hypertensive rats to angiotensin / and II with and with out captopril during a time of two , four , six and eight weeks after hypertension induction was investigated and compared with control and surgical sham groups.
Results: This study shows that vascular responsiveness to angiotensin // in animals that passed four weeks of their hypertension , (p< 0.05) and in the sixth and eight week of post induction hypertension (p< 0.01 and p< 0.001) has a significant different with both sham and control groups. Also it has been observed that an increased reaction to angiotensin II with an increased significant rate of arterial hypertension in hypertensive group. In the other hand in spite of inhibition of angiotensin converting enzyme by captopril in animals that have been eight weeks hypertension , on the contrary to other groups reactive to angiotensin /.
Conclusion: Results of this study show that vessels reaction to angiotensin /and II increased due to six to eight weeks post induction renal hypertension. Captopril does not inhibite mesenteric vessels reaction to Angiotensin / in hypertensive Rats after eight weeks. Try to completely inhibit production of angiotensin II maybe a hopful way in controlling essential hypertension.

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Unstable angina (UA) is situated in a spectrum with myocardial infarction (MI) at one end of it and stable angina at the other end. To determine the clinical and paraclinical characteristics of unstable angina this study was designed.
Materials and Methods: Two hundred patients with definite UA who were hospitalized at cardiac care units (CCU) in Yazd were enrolled in this cross- sectional study. Clinical and para-clinical characteristics including class of severity of angina, clinical circumstances, drugs, risk factors, changes in ECG, and patient's condition at the time of leaving hospital were evaluated.
Results& Conclusions: The average of age of patients was 61.85 years and 57% of them were female and 43% were male. The most prevalent risk factor among men was smoking (48.8%) and among women was hypertension (62.8%). According to Braunwald suggestion, patients were divided into 3 classes based on the severity of their diseases. Frequency distribution of patients in classes I,H and III were 24.5%, 4% and 71.5%, respectively. Normal ECG, was observed in 24.5% of subjects at the time of hospitalization and in 67% of patients when leaving hospitals. Frequency distribution based on the risk stratification was 22.5%, 58.5% and 19% in the low, medium and high risk groups, respectively. During hospitalization, acute myocardial infarction (AMI) was seen in 3.5% of individuals that majority of them belonged to class III of angina.

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Background: Tympanic membrane perforation as a sign of different otologic disorders have multiple causes, for example trauma .Traumatic perforations heal spontaneously in most cases but in large and stable perforation otolarngologist intervention is necessary . In the stable perforation of tympanic membrane , if there isn’t infection in the tympanic cavity , the paper patch or myringoplasty may be used. These procedures need remedy charge and time and may be with morbidity and other complications. Recently materials like hyaluronic acid and epidermal growth factors has been used to speed healing of tympanic membrane perforation, and their effect has been proved. Pentoxifylline an anti-thrombotic drug has positive effect on increasing perfusion and wound healing in pathological conditions. Alike we have used pentoxifylline to show it’s effect on the healing of guinea pig perforated tympanic membrane.

Materials and Methods: This study has been done prospectively, on 32 guinea pig ears.

  Results & Conclusion: Final otomicroscopic study after three weeks showing no significant difference in the healing rate of tympanic membrane in pentoxifylline group versus control group.

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Background: The damaging effect of exposure to loud noise on the structures of internal ear has been studied from many years ago. The effect of drill-generated noise on the non-operated ear is one of the problems that are less discussed. This study aims to evaluate the hearing loss that occurs in the non-operated ear in patients who undergo mastoidectomy by use of PTA (pure tone audiometery) and DPOAE (distortion product otoacoustic emission).

Materials and Methods: In this descriptive- analytic study, 49 patients who underwent mastoidectomy in Amir-Alam and Iman Khomeini hospitals, were evaluated for noise trauma generated by drilling on the non-operated ear. Patients were between 9-55 years old (mean age= 29) and they consisted of 25 males and 24 females. The patient's preoperative state were measured by PTA and DPOAE on the opposite ear also the postoperative state were re-evaluated by PTA and DPOAE.

Results: As a result, in 4 cases a significant change in PTA thresholds were observed, while two of them showed recovery after one month. Seven cases showed significant change in DPOAE amplitudes, of whom five cases recovered later.

Conclusion: In conclusion, the drill-induced hearing loss on the non-operated ear occurs in a few patients and it is often reversible.

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Background: Patellofemoral joint disorders are the most common cause of anterior knee pain in patients who referred to orthopedic clinics. Patellar lateralization cause anterior knee pain due to weakness of vastus medialis oblique muscle or tightness of lateral structures like lateral retinaculum or iliotibial band muscle.

Materials and Methods: For evaluation of this abnormality, plane radiography, CT scan and MRI are useful. In plane radiography only one view in a single joint position can be obtained, because of that it is not a good method to detect abnormal tracking during knee range of motion. The purpose of this study was to evaluate patellar tracking by kinematics MRI during five serial degrees of knee range of motion (40, 30, 20, 10, 0 degrees) in 30 patients with patellar lateralization and 10 normal subjects, aged 18-30 years.

Results and Conclusion: tistical analysis showed that in patients group, patella had the most stability in 40 degree of knee flexion and this stability reduced when knee reached to full extension. At this point, patella moved laterally and the most instability was seen during 20 to 0 degree of knee extension.

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Background and Aim: In epileptic patients, behavioral disorders are the most important deficits therefore evaluation of deficits by animal model should be essential. The role of Zinc in behavioral disorder and its relation with hippocampus or serum zinc may help explain why some brain region is commonly facilitated while other did not harm. The main purpose of this study was to evaluate Zinc itself effect on changing behavioral disorder and control of brain seizure.

Materials and Methods: Type of this study is prospective, empirical and blind. The population was adult male Sprauge-Dawley rats and randomly assigned in six groups (n=8). Each group was treated two months before of inducing animal model of seizure by Zinc(248 mg/lit) or tap water and also in group 1 and 4 saline, group 2and 5 bicuculine(1mg/kg) and group 3 and 6 pentobarbital(10mg/kg) .epileptic model was induced by injection of Lithium chloride (127mg/kg)and 24 hr later ,pilocarpin(50 mg/kg) in to peritoneum. During this study, neurological deficits (behavior) was recorded at 1, and 2 hrs after sizuring.

Results: The results showed that Zn had a minus feature on neurological deficits. GABA A antagonists had the same effect as Zn on neurological deficits but GABA A agonists ameliorate it significantly. Serum zinc level didn&apost change significantly among the animals but hippocampus zinc was altered significantly in Zn treated animals compared with the controls.

Conclusion: This study shows that Zn deleterious effects on neurological deficits were carried out via GABAergic system.

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Background and Aim:-thalassemia is the most common inherited disorder of hemoglobin (Hb) synthesis in the world. Alpha thalassemia most frequently results from the loss of one (- ) or both (- -) of the duplicated  genes () on chromosome 16. Carriers of deletional forms of -thalassemia (-/- /-, or --/) are clinically normal but have a mild hypochromic, microcytic anemia. Compound heterozygotes (--/- ) called Hb H disease. Fetuses who inherit no  genes (--/--) (Hb Bart&aposs Hydrops fetalis syndrome) die either inutero or shortly after birth, More than 95% of recognized -thalassemia involves deletion of one or both  globin genes on chromosome 16.

Materials and Methods: The assay was tested on 114 Iranian individuals with low MCV and MCH levels but normal HbA2 who had not responded to Iron treatment. patients was referred to the Department of Biotechnology, Pasteur Institute of Iran by Health Centers. Genomic DNA was isolated from white blood cells by salting out method. We have developed a reliable, single - tube multiplex polymerase chain reaction (PCR) assay for the 7 most frequent - thalassemia deletions (-- SEA , --THAI, --FIL , -α20.5 , --MED, -α4.2 , -α3.7).

Results: DNA fromd thalassemia carriers was tested for the presence of different types of  globin gene deletion (s). The - 3.7 and - 4.2 single gene deletions, and the Mediterranean (-- MED and - 20.5) double gene deletions were found in some samples.

Conclusion: The - 3.7 deletion was found to be the most common cause of  globin gene deletion in our samples. Multiplex PCR for α gene deletion analysis is simple, rapid and sensitive.

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Background: Many studies have shown the efficacy of cognitive – behavioral therapy and psychological debriefing in treatment of post traumatic stress disorder (PTSD) and a few evidences are available for using these techniques in large scale disasters. This study aimed to asses the effect of some psychological interventions in reducing PTSD symptoms after Bam earthquake in different age groups.
Methods: In a before-after quasi experimental clinical trial, we compared the efficacy of one session of psychological debriefing and three sessions of group cognitive-behavioral therapy in bam earthquake PTSD symptoms in different age groups. We evaluated PTSD symptoms before and immediately and three months after interventions by CASP scaling system and analyzed data.
Results: one hundred and thirty persons entered in the study and 51 persons excluded during interventions because of migration. Interventions were showed to be effective only in short term period. The means of PTSD symptoms frequency and severity of avoidance symptoms were reduced during three months period of study which were statistically significant P<0.05. Interventions showed no efficacy for recall symptoms in long term and hyper arousal symptoms in short term and long term periods. There was no statistically significant difference among age groups.
Conclusion: Psychosocial supportive interventions may be effective on some of the PTSD symptoms but there is no difference in different age groups.