Tehran University Medical Journal

---

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.

---

This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70). Ultimately, these datas have been compared with those in the reputable books and new medical papers And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males And also their most common chief complaints are neurological manifestations, and headache (82%) is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%), excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass) was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

---

Pseudomembrane colitis (PMC) and antibiotic associated colitis (AAC) are acute disease of the colon. In the case of in adequate treatment, the disease will often become chronic and my lead to the dysplasia of the epithelial cells of the infected areas. Previously because of poor knowledge. Treatment in this case, one of the method for treatment was surgical ablation of the large intestine while the patients could have been treated with oral vancomycin. In this study the following results were obtained: Out of 2517 enterocolitis patients under study, 1384 were men and 1133 women. By anaerobic culture method, 132 cases C.Difficile were isolated from the total samples and Hela cell culture method, toxin was determined in 36 samples (1.43%).

---

Nelson's syndrome is usually characterized by hyperpigmentation, elevated level of ACTH, and pituitary adenoma, which is frequently available as macroadenoma. It is usually occurred in the patients suffering from Cushing's syndrome. Growth of tumor has been revealed in 10-30% of the patients following adrenalectomy. Tumors are often benign in Nelson's syndrome. The selected treatment of Nelson's syndrome are transsphenoidal or transfrontal microsurgery. The role of radiation as prophylactic effect in the patients following adrenalectomy is unknown. In this research Nelson's syndrome have been studied on the patients records who have been hospitalized in Dr.Shariati hospital during the last 10 years. The achieved results show that, among the 49 patients suffering from Cushing syndrome who have referred after operation, 11 patients (22.4%) of them have been affected with Nelson's syndrome. The syndromes have been appeared after 3-9 months and with regard to occurrence of Nelson's syndrome in some patients immediately after bilateral adrenalectomy, it is recommended that selecting of the patients for bilateral adrenalectomy should be studied accurately

---

A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

---

Petrous apex lesions of temporal bone progress slowly. Most of the time not only destruct this area but also involve neighbouring element. The symptoms of the neighbouring neuro-vasculare involvement we can recognize these lesions. The most common symptoms of involvement of the petrous apex are: headache, conductive hearing loss or sensorineural type, paresthesia and anesthesia of the trigeminal nerve, paresia and paralysis of the facial nerve, abducent nerve. In retrospective study which has been in the ENT and HNS wards of Amiralam hospital, 148 patients have been operated due to temporal bone tumor from these numbers, 21 (13.6%) patients had petrous apex lesions of temporal bone. Eleven (52.9%) patients of these 21 persons were men and the remaining 10 (47-6%) were women. The average age of the patients was 37 years. The common pathology of these patients were glomus jugulare tumors, hemangioma, schwannoma, meningioma, congenital cholesteatoma, giant cell granuloma. The kind of operations that have been done on these patients were: infratemporal, translabyrinthine and middle fossa approaches. The conclusion of this study shows that petrous apex area is an occult site. The symptoms of this lesion are not characteristic, meticulous attention to the history and physical examination are very helpful to recognition of these lesions and it's extention.

---

To study the lead effect, we selected 14 females rats in which we had observed vaginal plague after mating, and divided them into a group of 8 female rats as the case group and 6 females as the control group. As drinking water the case group was given 0.13% lead acetate solution and the control group pure distilled water. Immediately after parturition the pups were killed and their livers removed. A small part of the liver was fixed in glutaraldehyde and osmium tetroxide in order to be studied with transmission electron microsope. The fixated parts were dehydrated and embed in Epon 812. using ultramicrotomoe, we prepared semithin seclions of the tissues, stained them with toludine blue, and studied them under light microscope. Further more we prepared thin sections of the tissue to be placed on grids coated with formvar. These sections were stained by uranyl acelate and lead citrate. Electron microscopic study was performed on them. Results: T.E.M. study showed the swelling and blebbing of nuclear envelop and endoplasmic reticulum and mithochondria of hepatocytes.

---

With the intention of research of various methods of epithelial tissue culture we've studied five French Albino rabbits with an average of 8 weeks. In order to evaluate and control growth and proliferation of autologus cultured tissue samples were obtained on 1st, 5th and 8th days. After fixation of these samples and passing them through various processes, histologic sections were prepared. These sections were stained with H-E and studied by light microscope, we succeeded in developing the original donor surface by 18 times.

---

Different aspects of the effect of trauma on the health status of populations have been studied annually 35 millions deaths, 3.5 millions disabilities and a sum of 500 billions $ cost. Evaluating different modes of prevention, a comprehensive study was carried out in the US during the 7th and 8th decades, introducing the TRISS method for the purpose of comparing the outcomes of trauma cases among multiple centers. This study has been carried out during 1996-97 in there hospitals of Tehran. After entering the hospital, all trauma cases were traced by trained interviewers until leaving the hospital. Based on the TRISS model, probability of survival was calculated for each patient and compared with the results of the MTOS study. Among 4863 cases evaluated, 300 (6.2%) deaths were observed, which is significantly more than the expected number (222 deaths, 2.7%) calculated under TRISS model. This difference may indicate a difference in the quality of trauma care.

---

Recently, small incision cataract extraction by phaco and implantation of a foldable intraocular lense with topical anesthesia has used in an attempt to decrease the complication of general anesthesia and peribulbar injection. To compare effects and complications of topical, local and general anesthesia, 92 patients admitted to Imam Hosein hospital for cataract surgery, were randomly assigned to three groups and surgery was done under different methods of anesthesia. During routine ECCE, lid and globe movements, miosis and viterous bulg were observed more in topical anesthesia than the other techniques, but serious complications such as posterior capsular rupture and viterous loss were not seen. Because of less systemic and local complications and rapid return of vision and possibility of outpatient surgery, topical anesthesia should be considered as an alternative to local and general methods.

---

Infection is one of the important causes of morbidity and mortality in diabetic patients. It has been reported that poorly controlled patients are more susceptible to infection, hence we examined the chemiluminescence of leukocytes from Insulin dependent diabetic patients in response to a soluble (Phorbol meristate acetate) and particular stimulus (Opsonized zymosan). The patients were divided into 2 separate groups, only controlled and well controlled, in regard to their blood glucose. Using PMA as a stimulus leukocytes from both groups, patients showed no significant difference comparing with healthy controls, but that of the 2 groups of patients were significantly different (P<0.05). When opsonized zymosan was used as the stimulus, no statistically significant difference was observed between all of the coupled groups. However, the chemiluminescence of leukocytes from poorly controlled patients was lower than the other groups.

---

The arthroscopic study of knee joint is of outstanding interest in assessment of knee complaints. The present article describes the results of arthroscopic examination of 100 patients (Mean age 29.4 years 82% male) evaluated from 1996 to 1997 in Imam Khomeini hospital of Tehran. Sport injury was the most prevalent cause of referral (40%). The 2 most frequent complaints were knee pain (94%) and tenderness (63%). Arthroscopic findings were pathologic changes of synovial fluid in 8, changes on articular surface of patella in 23, pathologic findings of femoral condyles and changes on articular surface of tibial plate in 24 cases. Other findings included plica in 18, tears of meniscus in 49, complete or partial tears of anterior cruciate ligament in 23 patients. Diagnostic accuracy of pre-arthroscopic clinical diagnosis was 88% and 93% for tears of meniscue and anterior cruciate ligament respectively. Arthroscopy of patellofemoral joint is an important adjunct to clinical and radiographic examination in diagnosis of knee complaints.

---

A 4.5 years old boy with left postero superior lateral neck mass admitted to Shahid Rahnemoon hospital in Yazd. The mass had been noticed 2 years ago and there was no improvement after three times antibiotic therapy. On physical examination there were two masses on the neck. One of them was approximately 3×4 cm and the other was 2×2 cm. On of the masses was located in the left posterior auricular area and the other one in anterosuperior border of SCM. Both masses were mobile, non adhesive, with slight tenderness and without inflammatory signs (ie, redness, warmness etc). In surgery, the parapharyngeal deep neck space was filled by the yellowish-white color tumor with it's «worm-like» projections, extended into the jugular foramen superiorly, lateral oropharyngeal wall medially and supra clavicular area inferiorly. Total resection of tumor was done. The patient was discharged after 5 days with good general conditions. Pathologic report was «Plexiform neurofibroma».

---

It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

---

Pruritus is an unpleasant sensation that provokes the desire to scratch. It has long been recognized as a presenting or concomitant symptom of many systemic diseases. Indeed, generalized pruritus is reported to be associated with underlying diseases in 10-50 percent of cases. This study was conducted to investigate the underlying diseases in pruritic patients without primary skin lesion. Seventy-five patients with at least one-month history of pruritus with no primary skin lesions, presenting to dermatological clinics of Razi Hospital, from April 97 until December 99 were evaluated. The work up procedure consisted of medical history, physical examination, laboratory findings (CBC, ESR, blood chemistry, thyroid function tests, urinalysis, stool exam), chest X-ray and in selected cases, additional specific tests. Fifty-four patients were female, and 21 male the mean age was 45.7y±16.41, and the mean duration of pruritus, 21.8m±21. In 43 patients (75.4 percent), no abnormal finding was detected. Five patients (6.66 percent) had atopy. In the remaining 27 patients (36 percent), the following abnormalities were found: Iron deficiency in 6 patients (8 percent), diabetes mellitus in 6 patients (8 percent), hyperthyroidism in 4 patients (5.33 percent), hypothyroidism in 2 patients (2.66 percent), lymphoma in 3 patients (4 percent), chronic hepatitis, hypocalcaemia, cholelithiasis, psychosis and chronic renal failure each in one patient (1.3 percent). Evaluation of patients with pruritus may be a valuable tool for early detection of underlying systemic diseases.

---

The main goal of this study is to determine the auditory feedback effects in improvement of speech production process in prelingual totally deaf children who used cochlear implant prosthesis. For this reason, we recorded speech of four prelingual cochlear implant children pre and post of operation. Then we extract some static features of vowels-such as fundamental frequency, formant frequencies, vowel duration and vowel energy-from their stable mid-section and analyze them using a longitudinal prosthesis-on/off analysis. These patients-where are in the range of 7-13 years old-were operated in the cochlear implant clinic of Amiralam hospital. At each session, patients read the sentences once in device-on condition and then after 30 minutes stay in device-off condition. Quantitative results show that at least for the features under study, the patient's reliance on the auditory feedback decreased consistently by time (about 65%-averaged on all three vowels under study and all patients). So we concluded that after a sufficient time of operation, the speech motor patterns of patients will be trained for the correct production of static features of vowels and the relation of patients to auditory feedback for the production of such features considerably decreased by time.

---

Background: Stereologic methods are used to obtain quantitative information about three dimensional structures from histologic sections. The aim of present study was using new and unbiased stereological techniques to investigated changes in volume and number of glomeruli after chronic lead acetate intoxication. Lead is one of the heavy metals that have adverse effects on renal function. Its effects can involve both renal tubules as well as glomeruli. So many studies based on observation and qualitative reports. Some of which report changes in volume and number of glomeruli.

Materials and Methods: Male Wistar rats were randomly divided to four groups (n=9). During a period of 8 weeks, the treatment groups were given 0.5 percent and 1 percent lead acetate in drinking water and the control and sham control were given distilled water and 0.4 percent acetic acid solution respectively. Stereological analysis based on Cavalierie's principle was performed to determine the reference volume (VRefrence), the fraction volume of glomeruli (VVGlom) and total glomerular volume (VTGlom). Furthermore, for estimating the numerical density (NVGlom) and total number of glomeruli (NTGlom), the physical dissector was utilized.

Results: Results showed that the number of glomeruli in treatment group which received 1 percent lead acetate in drinking water decreased significantly (P<0.05), but no changes occurred in 0.5 percent group (P>0.05). On the other hand glomerular total volume in both 0.5 percent and 1 percent groups increased significantly in comparison to control and sham control groups (P=0.000).

Conclusion: This experiment is in agreement with other qualitative reports by using unbiased method of stereological methods and showed changes in volume and number of glomeruli following lead acetate intoxication.

---

Ambiguous genitalia means difference between gonads morphology and external genitalia. Gender assignment and surgical correction must be done as early as possible to assure unambiguous bonding between the parents and the child. The purpose of this study was to evaluate Ambiguous genitalia in a referral children surgical center.
Materials and Methods: We retrospectively reviewed records of 200 patients admitted to children medical center hospital in a period of 16 years for Ambiguous genitalia surgery. Data about clinical and laboratory examination collected and analyzed.
Results: The prevalence of female pseudohermaphrodism, male pseudohermaphrodism, ture hermaphrodism and Mixed gonadal digenesis was 70.5%, 20.5%, 5% and 4%, respectively. 76.5% and 23.5% of the patients was converted to female and male, respectively. 29% had congenital Adrenal hyperplasia of whom 86.5%, 10.5% and 3% had 21-hydroxylase deficiency, 11-/? hydroxylase deficiency and 3/?HSD deficiency, respectively. 70.5% had 46xx karyotype and 21.5% had 46xy karyotype and the remainder were musaic. 52.5% had relative parents. The malformation were corrected by vaginoplasty (105 patient) and clitoral resection (51 patients). A variety of anomalies was seen.
Conclusion: Age of presentation ranged from 1 day to 13 years. 151 patients were diagnosed in infancy, but only 43 patient was brought for treatment in infancy to this center by parents.

---

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.

---

Background: Drug abuse has been known as a growing contributing factor to all types of trauma in the world. The goal of this article is to provide insight into demographic and substance use factors associated with trauma and to determine the prevalence of drug abuse in trauma patients.
Methods: Evidence of substance abuse was assessed in trauma patients presenting to Sina trauma hospital over a 3-month period. They were interviewed and provided urine samples to detect the presence of drug/metabolites of opium, morphine, cannabis and heroin by “Morphine Check” kits. Demographic data, mechanisms of injury, history of smoking and drug abuse were recorded.
Results: A total of 358 patients with a mean age of 28.4 years were studied. The Patients were predominantly male (94.7%). There was a history of smoking in 136 cases (38%). 58 cases (16.2%) reported to abuse drugs (91.5% opium). The commonest route of administration was smoke inhalation (37.2%). Screening by Morphine Check test revealed 95 samples to be positive (26.5%). The preponderance of test-positive cases was among young people (of 20-30 years of age) with a history of smoking. Victims of violence and those with penetrating injuries also showed a higher percentage of positive screens (P=0.038 and P<0.001, respectively).
Conclusion: These results suggest that drug abuse is a contributing factor to trauma especially in violent injuries and among the young. Regarding the considerable prevalence of drug abuse among trauma patients, it’s highly recommended that all trauma patients be screened for illicit drugs