Tehran University Medical Journal

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

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

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

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

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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.

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IgD myeloma is very rate. It differs from multiple myeloma of other classes in several aspects and its laboratory diagnosis may be difficult, as total plasma protein concentration is often normal, and a paraprotein peak may not be easily demonstrable by the conventional electrophoretic techniques. We report here two cases of IgD myeloma investigated in this laboratory. Immunochemical, biochemical, and hematological studies were carried out: Serum total protein values were within normal range. Quatitation of serum immunoglobulins revealed a decrease in the level of IgG, IgA, and IgM. Bence Jones proteinuria of l type was present in both patients. Serum immunoelectrophoresis, using specific antisera, showed the presence of IgD l paraprotein the diagnosis of IgD myeloma was made after further investigations. Our findings indicate that all patients who have been suspected to have multiple myeloma should be investigated for IgD and IgE myeloma

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Histiocytic syndromes have been studied and investigated in these recent years for their cell origin, morphology, pathology, histochemical, immuno-phenotype characteristic, and their nomenclature, but the results of all these studies are confusingly, vague and not acceptable for all scientists and pathologists. Histiocytes very in the morphology, duty and their immunological behaviour. In different lesion these cells are in the form of mononuclear, foamy cell, macrophages like plasma cell and giant cell with many nuclei. When considering malignant Histiocyte cells and benign reactive histiocytes are both present in malignant histiocytic lesion, one can recognize the diagnostic problems of the pathologist. Markers for recognizing histiocytes are numerous and are increasing rapidly, in spite of that monoclonal antibody investigation, and genetic molecular method, the results as yet are not satisfactory. We have to accept that the new method are not at all sufficient and we have to look for a better method which is more sensitive to histiocyte for diagnosis of numerous histiocytic syndromes. In this paper, we discuss the difficulties on encountered in the diagnosis, and problem in defining and nomenclature of these syndromes and, some efforts are made to present the most acceptable classification for them

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

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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.

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In this work, we tried to know something more about the embryotoxicity effects of the doses of 50, 200, 400 mg/kg/day of ranitidine of (H2 antihistaminic agent) by intraperitoneal administration on mice. The studies were performed on albino mice kept under specific conditions and a constant dark-light cycle at 24+1C and 55+5% relative humidity. Generally, the animals were acclimatized for four weeks before mating. Two female mice at 12-14 weeks of age were placed overnight with a male of proven fertility. The day on which a vaginal plug was found, was taken as day one of pregnancy. Also the vaginal smear was prepared for further proof. Treatment of pregnant females was started from day 7 and continued up to the 15th day of gestation and then on day 18 they were necropsied for routine teratological observations. The live fetuses were weighed and inspected for gross external abnormalities under a dissecting microscope. Resorption plus dead fetuses less than 6mm of length were designated early death and dead fetuses of more than 6mm of length were consequently called late death. The statistical study was done by student t-test. One-third of the fetuses were fixed in bouin's fluid to detect visceral malformations by the rasor- section technique. There was no significant difference in the frequency of late death between the control groups and the groups given ranitidine. Differences were observed in the number of implantation sites except for 400 mg/kg/day. Data pooled from all experimental groups clearly show that pig tail, deformed cranium, low body weight and skeleton, unshaped external ear and jaw and polydactyly are the most common external abnormalities. Results of this study show the hazards o the ranitidine used during early pregnancy.

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This is a study of depressive features in 51 Iranian combatants suffering from PTSD. DSM III-R considers depressive symptoms as associated clinical features of this condition. DSM III and DSM III-R both accepted the strong evidence that PTSD is a form of anxiety and included it in the anxiety disorders category. It is true that many PTSD sufferers present with anxiety features similar to these present in generalized anxiety disorder (The same authors reported anxiety features in 94% of Iranian combatants 1991), but this similarity is true: For depressive features, 92% was found in present study. The findings are discussed in relation to previous studies of combat-related PTSD, both done in Iran or elsewhere.

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Mycosis fungoides is virtually a kind of cutaneous T cell lymphoma. The wide spectrum of clinical, and histopathologial features of MF accessitated performing an exact study on it. During a retrospective survey, clinical findings of 115 in-patients and histopathological finding of 366 ontpatients and inpatients of MF in an 8½ years period were studies with special attention to the pathological Aspects: Males were affected more than females. Their ages ranges from 11-88 years. The most common symptom and sign were pruritus and scaling, respectively. The first involved areas in male were the limbs and females was the trunk. The role of environmental and occupational factors in pathogenesis deserves greater contemplation. There were four distinct histopathological pattern in the epidermis: 1) without significant changes, 2) hyperplasia, 3) poikilodermatosus and 4) pagetoid patten. Epidrmotropism with or without associated pauntrier's microabscesses and halo cells was noted in the majority of cases (233 patients). The inflammatory infiltrate with predominence of atypical lymphocytes and also fibrosis, edema and occasional grenz-zone were the prominent finding of papillary dermis. The major finding of hypodermis was septal panniculitis. In conclusion integrated correlation between clinical and wide spectrum pathologic features of M.F could be a gnide to early diagnosis and appropriate mangement.

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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

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Amount of environmental lead pollution is increased with progression of industry. This pollution is able to damage the living beings in many ways. Blood and Immune systems are more sensitive to toxic effects of lead. 30 female and 6 male rats from Sprague dawley race are chosen by simple random sampling. After copulation and vaginal plug observation, expectant rats are calssified in test and control groups. Since the first day of pregnancy, test group is given a drink containing lead acetate 0.13% in distilled water and control group is given distilled water. After delivery, for ultrastrectural studies, spleen specimens of newborn rats are fixed in glutaraldehyde solution 2% and after processing are studied by T.E.M. Sinusoidal endothelial cell show: morphological changes in mitochondria, appearance of primary & secondary lysosomes and multivesicular bodies and swelling in ER. It seems that these changes are caused by interaction of lead with enzymathic functions or lead accumulation in these cellular organels.

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Dysplasia Epipysealis Hemimelica (DEH) is a rare disease, prevalence is one in 1000000. The incidence is unknown. Its characteristics is abnormal cartilage growth accompanied by ossification of cartilages of epiphyses of long bones, bones of foot ankle and wrist. A hereditary or familial factor hasn't yet been known. Occurrence in males is three times more than females. Our case is a girl observed from 7 months of age to 5 years. The progression of disease and symptoms are reported. Other names of the disease are: Tarsomegaly, Tarsoephiphyseal Aclasis, Trevor's Disease, Benign Epiphyseal Osteochondroma.

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In this study, we investigated variations of the angle between neck and shaft of femur after amputation of tigh above the knee. In amputated tigh the angle between neck and shaft of the femur is decreased than normal (nearly 90° degrees) (coax vara). The angle of the normal femur usually increases due to weight bearing (coax valga). In the patients that both tighs have been amputated the changes of the angle are equal.

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The culture results of 203 cases with different wounds were studies 150 of the latter were burn cases (mainly second and third degree burns), and 53 were of other types (surgical, traumatic, ect). Four subtypes of Bacillus cereus were isolated upon culture, and the different toxins produced in DHT broth with 0.1% glucose were assessed. The lethal toxin was injected intravenously to Syrian rats, none of whom died. VPR factor was assessed in the 4 subtypes. Three subtypes produced VPR in significant amounts.

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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.

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Disodium hemiphthalate Glycyrrhetinic acid (DHGA) possesses anti-inflammatory and analgestic activities. In our research, this agent was injected intraperitoneally to mice, according to the following schedule.
1) 25 mg/kg, 50mg/kg & 75mg/kg at 7th day of pregnancy.
2) 50 mg/kg & 75mg/kg at 8th day of pregnancy.
3) 50mg/kg & 75mg/kg at 9th day of pregnancy.
DHGA with doses of 50mg/kg and 75mg/kg at 7th, 8th and 9th day, delays the growth, decreases developing of ossification centers (specially in hand and foot middle phalanxes), decreases the number of caudal vertebrae of sacro-illiac joint and results in slight but important increases in fetus mortality.
Abbreviations
H & E=Haematoxylin & Eosin
CRL=Crown-Rump Length
BPD=Biparietal Diameter
W=Weight
ETS=Embryo Toxicity Score

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Cystic Fibrosis (CF) is an inherited disease that affects multiple organ systems. It is the most common cause of severe progressive lung disease and exocrine panceratic insufficiency. In our investigation 67 patients had CF. Of these, 79% had panceratic insufficiency and 92% had lung disease under 2 years age. Also 67% of patients were < 2 percentile and 28% between 3-10 percentile weight for age. Unfortunately 27% of them died because of respiratory problems

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This survey, evaluated the level of awareness and knowledge among the medical staff about conditions and methods of performing cardiopulmonary ressucitation. The study sampling comprised 497 subjects including 208 residents and 262 interns of ten university hospitals in Tehran. In regard to the basic principles, this has been 43.54% (SD = 13.36%), in drug and fluid therapy 31.22% (GD = 13.22%), in electroshock 43.6% (SD=21.12%), in appropriate approach to the problem 34.73% (SD=13.42%) and in complications of CPR 17.7% (SD = 15.25%). Considering the results of the project, the medical staff have insufficient knowledge of CPR md it does not improve significantly during internship and residency period. Therefore, there is a great necessity for the medical students to attend basic and advanced CPR courses during their study

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Mycosis Fungoides (MF) is a cutaneous T-cell lymphoma (2,5). Alopecia is rarely seen in this disease, and the reported cases are in the form of follicular mucinosis (1,2,4). In this case report a patient is presented whose lesions all showed alopecia without mucinosis. Furthermore there was a patch of alopecia without any epidermal changes, which was clinicaly identical with alopecia areata, and histologically identical with MF. After six months of treatment there is regrowth of almost normal hair on all of the lesions

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Migraine as one of the most common types of headaches with high intensity and prevalence, affects life significantly. This study was devised to determine the effects of migraine on economic status and life quality of Iranian surffcres.
"Pain database questionnaire", prepared by the International Association for the Study of Pain (IASP) in the year 1995, was translated to Farsi. Then we modified it regaiding cultural, geographical and social characteristics of Iran. 65 patients (55 women and 10 men) were recruited form neurology clinic consultants. Those patients who met the International Headache Society. (IHS) criteria for migraine, were interviewed using IASP questionnaire. Pain effects on sleep, marital life, social, recreational and sexual activities, quality and quantity of drug consumption as well as using paraclinic procedures were considered.
Significant decrease in sleep duration was seen during pain (7.4 ± 1.9 h) compared to pain-free conditions (6 ± 3.7 h) (P < 0.001). The effects of pain on marital life, social, recrealtional and sexual activities during pain were compared with pain-free conditions based on a zero to ten ranking schedule,. Wilcoxone test showed statistically significant (P < 0.02) differences.
We concluded that the economic effect of migraine and its impact on patients' quality of life are significant and should be considered in health planning and disease management