Tehran University Medical Journal

---

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.

---

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.

---

We have studied the effect of amitriptyline, a tricyclic anti-depressant drug on several immune parameters of the Balb/c mice in order to evaluate its immunomodulatory effects. Results showed that amitriptyline will potentiates all of the immunocytes functions except for the production of PGE2 by LPS stimulated monocytes. We have also showed that amitriptyline can normalize the immunosuppressive effect of dexamethasone on mice (experimental stress). These results suggest that one of the mechanisms of action of the tricyclic anti-depressant drugs might be through the modulation of the immune system which has been suppressed by stress or distress

---

Midazolam (Dormicum) is a benzodiazepine in general anesthesia. Midazolam is very suitable for premedication, induction, and maintenance pronounced anxiolytic action, sedation and amnesia, rapid onset of the action, virtually no impairment of cardiovascular or respiratory parameters in therapeutic doses, short duration of action, and excellent local tolerance are among its most important effects. the rate of midazolam in intravenous anesthesia has been highly confirmed. The required dose for the induction between 0.15 and 0.6 mg/kg, depending on the intervention, patient status (age and condition of his/her health) and premedication.

---

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.

---

Studies were undertaken to evaluate content of IgG, IgM, C3, C4, CH50 and proteines of sera from 53 drug addicts by immunological methods. Results shows an increase of IgG and no significant variatrion in the level of other Ig(S). In the same time we have seen an augmentation of gamma globuline in the protein electrophoresis pattern. The level of C3 and C4 of complement component rest unchanged.

---

The Turkmans are one of the Iranian ethnic population. HLA typing (class I and II) was performed in this population. The data obtained from this study was compared with different populations of the world. We observed that the Turkman population is most similar to the Northern chinese and Uigur population. The distributions of HLA antigens in Turkmans are somewhat between Iranian population, Northern chinese and Uigur population. Natural selection and gene alteration select the people who could better adopt themselves with new conditions. Investigation of Turkman's HLA in comparison with Iranian's HLA reveals more details in genetics of Behcet's disease. Behcet's disease is very rare in Turkmans (index 0.5) whereas its frequency is high in other Iranians and Northern chinese. Distribution of susceptible antigens like B5 is the same in Turkmans and Northern chinese (19.5%) but much higher in other Iranians, whereas B35 have almost the same distribution in Turkmans and Iranians (37% and 33% respectively). DQW1 and CW4 antigens which were suspected to have a negative association with Behcet's disease are the most frequent antigens in Turkmans.

---

The incidence of failed intubation is higher in obstetric than other surgical patients. Failed intubation was the 2nd commonest cause of mortality during anesthesia. Bearing in mind that failre to intubate may be unavoidable in certain circumstances, it is worth reviewing. The factors, which may contribute to a disastrous out come. Priorities of subsequent management must include maintaining oxygenation and preventing aspiration of gastric contents. Fiber optic intubation is now the technique of choice with a high success rate and with least trauma to the patient.

---

The purpose of this study was the utilization of different methods of tissue culture in proliferation of epithelial cells and autologous graft to cover surface areas without skin specifically, which is due to thermal burns more than 50%. In this experience we performed from rabbits and success to cover almost 24 times original donor site with autograft.

---

In this study, counter immunoelectrophoresis (CIE) and latex agglutination (LA) were employed to evaluate rapid detection of streptococcus group B (GBS) specific antigens in sera, urines, CSF and patient's blood cultures of infants suspected of septicemia and meningitidis. Out of 530 specimens which were investigated 73 blood cultures were found to be positive, including 4 (5.5%) specimens from these infants were positive for strep group B. GBS was also detected in the CSF of 1 specimen from these 4 infants. CIE was conducted on sera, urines and CSF of these patients and the number of positive specimens were found to be 3, 3 and 1 respectively. LA was also conducted on the same specimens and the number of positive specimens were found to be 3, 4 and 1 respectively. Detection of GBS specific antigens by LA and CIE on the supernatants of blood cultures after 24 hours incubation showed that all the 4 specimens were positive an indication that the sensitivity of these two imunological methods in 100%.

---

Failed back surgery syndrome (FBSS) is many a times an intractable problem confronted in patients with surgical disease of lumbar spine and at the same time is a pressing problem for the physicians as well. This clinical entity is defined as continuation of pain in the lumbar region and lower extremities following surgery of the lumbar spine. Knowledge of the etiological factors and their prevention is the best line of treatment to overcome the evolution of this syndrome. During this study, which was conducted in Imam Khomeini hospital Tehran from the year 1989 till 1990, 43 out of 114 patients developed "FBSS". 23 cases responded to conservative treatment and psychotherapy whereas medical treatment failed to achieve fruitful results in the rest. The latter underwent extensive radiological investigations and repeat surgery. According to this study, we recommend that in the initial management of these patients. The surgeon should observe the dictum of "5-mis" to overcome and minimize the "FBSS" entity

---

The World Health Organization estimates that approximately 400.000 new cases of Leishmaniasis occur worldwide each year. Cutaneous Leishmaniasis is an endemic disease in Iran. CL is caused by several species of Leishmania. Physical and Chemical Modalities have been used to treatment of cutaneous Leishmaniasis. Cryotherapy is a physical and interalesional glucantime is a chemical modality. In this study cryotherapy and interalesional glucantime were compared. In the first group 35 patients treated with cryotherapy. 91.4% had complete cure both clinical and parasitological. In the second group 30 patients treated with interalesional glucantime. 63.33% had complete cure both clinical and parasitological. Results: Our study show that cryotherapy is better than interalesional glucantime in treatment of CL (P=0.003). Further studies are recommended

---

To improve visual disturbance, optic nerve decompression can be performed via transcranial or tran-sphenoidal approaches. Although the surgical exposure in transcranial approach is favourable, yet the optic nerve's presence in the field may make it vulnerable to damage. Of fighty patients with different types of pituitary adenomas, 35 cases with medium-sized (1-3 cm) tumors have been studied in a randomized clinical trial during a three year period, to compare the applicability of these approaches. While short hospital stay with better visual outcome was observed in fifteen trans-sphenoidal cases, in comparison to 20 trans-cranial cases, however the preoperative visual status and underlying disorders were similar in both groups. Decompressing the optic apparatus, trans-sphenoidally, seems beneficial, where there are no contraindications for the procedure in medium-sized pituitary adenomas

---

A 16 year old woman with Tangier disease in palatine tonsils is reported. She has recurrent sore throat. In physical examination the palatine tonsils are hypertrophied and has very yellowish points. The facial skin is yellowish but the skin of another areas of body is normal. After tonsillectomy the pathologist report Tangier disease in palatine tonsils

---

In this research 20 specimen from human whole milk and whey were studied with respect to lipoproteins, cholesterol and triglycerides, 2-8 months after parturition. The whey was separated by means of ultracentri fugation. Also the 24 hour diet history was recorded. The average lipoprotein components in normal human milk were, chylomicron 16.19%±11.98%, beta lipoprotein 36.71%±9.33%, pre beta-lipoprotein 8.61%±3.03% and alpha lipoprotein 38.49%±9.97%. These components were also measured in whey and the results were as follows: chylomicron 6.91%±1.55%, beta lipoprotein 47.32%±10.5%, pre beta lipoprotein 11.48%±4.4% and alpha lipoprotein 33.87%±7.84%. The percent average of the total lipoprotein content and its free forms were estimated in human milk. The average percent chylomicron content was 6.48%±1.43%, beta lipoprotein 33.85%±13.1%, pre beta lipoprotein 12.88%±2.78% and alpha lipoprotein was 47.25%±10.63%. The average ratio of alpha to beta lipoprotein (HDL/LDL) in human milk was found to be 1.10±0.51. Thus, we conclude that breast-feeding can be considered as a potential preventive factor against future cardiovascular diseases.

---

Only orchiectomy is still commonly used today either as a single therapy or in combination regimens. Hypophysectomy & adrenalectomy showed such devastating effects on the endocrine equilibrium as to be inconsistent with an acceptable quality of life or even with survival. Chemical adrenalectomy was also tried with drugs (eg. aminoglutethmide, spironolactone) leading to consequences superimposable to those of surgical adrenalectomy. Along with orchiectomy, three groups of substances are commonly used today for the hormonal therapy of prostate cancer: estrogens, LHRH agonists & anti androgens. Bilateral orchiectomy removes 90-95% of circulating testosterone. Clinical studies document 60-80% of positive responders to castration, on continued evaluation, relapse occurs usually within 6-24 months in responders, with a death rate of 50% within 6 months. The androgenic activity still remaining after castration may explain the partial & progressively decreasing effectiveness of this & other testosterone reducing therapies. Antiandrogens define substances that act directly at the target site, where interacting with steroid hormone receptors, they impede the binding of androgens. A trend towards the combination of testosterone-reducing & androgen-blocking treatment is developing in modern therapy of prostate cancer. This is due to the complementary characteristics of the two different pharmacological mechanisms that are involved. In this study castration+antiandrogen is compared to castration alone. The results demonstrate a significantly greater percentage of positive objective & subjective responses with antiandrogen than with placebo. In addition survival time was increased in patients treated with castration+antiandrogen than castration+placebo.

---

In an evaluation of nine cases (5 females, 4 males, 2.5 to 22 years old) with congenital torticollis who had been treated by bipolar release of sterno-cleido-mastoid muscle at Emam Khomeini Hospital, department of orthopedic surgery between 1981-1994, all of the patients were satisfied with cosmetic and functional results. In spite of palpable soft tissue remaining in some patients, limitation of bending to the opposite side was below ten degrees. Facial asymertery improved in older and resolved in younger children with no recurrence and occurrence of diplopia. Recommendations: 1) Operative treatment of congenital torticollis should be considered beyond the age of 12 months and even over 19 years old. 2) Bipolar tenatomy, cephalad and caudal release of the sterno-cleido-mastoid has better results than limited procedures in older children, especially beyond 3 years old. 3) Postoperatively, early range of motion exercises in extension, and not in flexion is highly recommended.

---

The growth and developmental status of 252 children with low birth weight (<2500 gr) born from 1988 to 1989 as cases were compared with 312 children with normal birth weight (>2500 gr) at the fifth birthday. The results of comparing these two groups of children show that: 1) In relation to weight for age of survivors, with increasing of age, weight gaining is higher in the control group in comparison with the case group (P=0.00). 2) In relation to height for age the study revealed, that this indicator differs in two groups but the difference is not significant. 3) In regard to Gomez classification: The percentages of all grades of malnutrition (mild, moderate, severe) is grater in the case group than controls. 4) By considering the developmental criteria (skipping, drawing triangle from copy, naming 5 colors, repeating sentences of 10 syllables, counting of 10 coins correctly and respectively): The study showed that developmental indicator of the case group differs from controls. The test statistic "t" showed, there is a significant difference between two variables (P=0.005). 5) By using the Riven test for evaluation of IQ, our findings characterized that, the IQ mean of the LBW and NBW are not truely different.

---

Perinatal mortality rate is an import health index. In this study, we have attempted to determine the causes and rate of perinatal mortality, in 18885 randomly selected newborns, in all the obstetrics and delivery centers of Tehran, during one year (1994-1995). The mortality rate was approximately 21/1.000. Cesarean section was performed in 42.2%, and vaginal delivery in 57.8% of cases. Prematurity was observed in 11.3% and 8.4% weighted less than 2500 gr (low birth weight : LBW). Perinatal mortality was significantly more frequent in the presence of prematurity (p = 0,000), LBW (p = 0.000), mothers who were older than 35 y (as compared to the 20-29 y age group p = 0.01), high parity (> 5 p = 0.00001), and high gravida (> 5 p = 0.04), low educational level (less than high school diploma p = 004), twin or multiple pregnancies (p = 0.000), congenital malformations (p = 0.000), low Apgar score (< 4 in 1 and 5 p = 0.000), and in the absence of perinatal care (p - 0.000 002)

---

Mullerian anomalies are one of the interesting but uncommon entities that gynecologists confront. The incidence is 1-6%, It is difficult to" anticipate the real incidence, because most of information is obtained from infertile or complicated patients with inadequate work-up. Recently endoscopic pocedures reveal more details about these anomalies. Today, classification of Buttram & Gibbons (modified by AFS [American Fertility Society]) is accepted. In this paper one patient with septate uterus, duplication of cervix and vaginal septum is introduced. According to information obtained, only one similar case is reported (by McBean et al). This entity is not conformed with AFS classification. Only in Toaff et al classification, there is a class similar to these patients. This entity is not explained by classic embryological theory of mullerian development