Tehran University Medical Journal

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A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

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Sixty-nine children with phenylketonuria (PKU) under coverage of Tehran Genetic Research and
Consultation Center, fed Lofenalac and Phenylfree were studied. The 24-hour dietary recall method was used
to determine food intake and blood samples were analyzed for iron parameters. The results showed that over
7% of the children had a low intake of energy, protein and iron. In addition, hemoglobin and hematocrit were
lower than normal in 3.1% of the children, while in 24.2% of them there was decreased serum transferrin
saturation percent. There was a statistically significant relationship between lenght of diet therapy and iron
parameters. The findings show that inadequate nutrient intakes may, over time, cause appearance of anemia signs in the children with PKU dependent on special formulations

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Between 270 patients complaining of symptoms of vaginitis, bacterial vaginosis was diagnosed in 68 women (%25) based on at least three of four criteria: 1. Homogenous vaginal discharge 2. Positive amine test 3. pH more than 4.5 4. Clue cell in wet smear. The results were compared to 55 normal controls.
Clue cell with more than %20 of epithelial cells was seen in %87 of cases and %5.5 of controls. A pH more than 4.5 showed the greatest sensitivity (%100) and the smallest specificity (%47). The most frequent complaints included increased discharge, bad odor, and sensing bad odor after coitus.

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Helicobacter pylori (H.Pylori) is the most common human infection in the world. This agent has a strong role in pathogenesis of chronic gastritis and peptic ulcer. Therefore introducing of simple and cost effective tests are important for diagnosis of H.Pylori infections. ELISA has been considered as an alternative test compare with biopsy, histological staining, culture and urease test in diagnosis of H.Pylori infection. In this investigation, 111 patients referred to GI endoscopy department of Imam Khomeini Hospitals for U.G.I problems which were evaluated for H.Pylori infection. Culture and histological staining (GIMSA and H & E) were used as a gold standard test compare with ELISA-IgG and urease test. Sensitivity and specificity for ELISA were 90%, 93% respectively. This report suggests that ELISA is a cost effect and valid test in diagnosis of H.Pylori infection

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A retrospective study was conducted to investigate about breast cancer in Tehran from 1985 to 1995. All breast pathological records at five General District and Teaching Hospitals (18 general surgical wards) were reviewed and data were extracted. Overall, 3085 records were found (7291 female and 294 male). The final diagnosis was made for 2436 female records including 903 breast cancer (37.1%), 1430 benign breast disease (58.7%), 45 breast skin disease (1.8%) and 58 normal pathological report (2.4%). The dominant group age for breast cancer in women was age group of 40-49 years. The most frequent pathological stage was stage III. Breast cancer was also seen in 2.3 percent of women of 25 year old or younger. The diagnosis was also made for 278 men showing 32 breast cancer (11.5%), 23 benign breast disease (86%), 3 breast skin disease (1.1%) and 4 normal pathological report (1.4%). The results suggest that 3.5 percent of the overall breast cancer were men's, all having over 40 years of age with 60 years or older as the most frequent age. The most frequent pathological stage was stage III. The findings have some implications for public health professionals in terms of breast cancer screening in Iran.

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In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1 550: with history of one spontaneous abortion (G2A1), group 2 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000), but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003) and placenta previa (RR=8.5, P=0.03). These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.

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The object of this study was to find a suitable staining method for P.carinii. This parasite is not easily stained and clinical signs are not specific for the diagnosis of P.carinii pneumonia and therefore optimal laboratory methods for observing the organism are extremely valuable. In all 17 new conventional and modified staining techniques were used on lung impression smears and tissue section of sprague Dawley Rat treated with cortisone. Of these methods modified methylene blue 1 & 2, modified cresy violet 1, 2, 3, 4 modified Gram, modified Giemsa 2 and modified Griedley techniques have not previously been reported. After comparing readability of the slides, ease of performances, rapidity, availability and sensitivity of these 17 techniques for the diagnosis of P.carinii pneumonia, modified toluidine blue 01 & 2, modified methylene blue 1 & 2 and modified cresyl violet 3, 4 are suggested as the methods of choice for the rapid diagnosis of P.carinii pneumonia.

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Hepatomegaly, decrease in the liver paranchymal echo and increase in the gallbladder wall thickness has been shown in acute viral hepatitis. The present study was done to determine sonographic changes in acute viral hepatitis. We performed liver and bile ducts sonography and specific tests on 42 patients (mean age: 31.5 and 61% male) with acute viral hepatitis. Gallbladder wall thickness was seen in 45.2% and hepatomegaly in 33.3% of patients and liver paranchymal echo was decreased in 19.3%. Age, sex, type of hepatitis, cholecystitis like symptoms, aspartate aminotransfrase, alanine aminotransfrase, alkaline phosphatase and bilirubin did not significantly corralate with these changes. Only raised prothrombin time was strongly correlated to the thickening of the gallbladder and decrease in the liver paranchymal echo and cholesistic like symptoms we can postulate that thickening of the gallbladder and decrease in the liver paranchymal echo is not dependent on the severity and speed of the paranchymal necrosis (as considered with ALT and AST) but they depend on the liver function disturbance (as considered with PT) because the thickening of the gall bladder is present in 45% of the patients and 10% of the normal population have gallbladder stones, one should not perform the diagnosis of acute cholecystitis, only on the basis of sonographic report without attention to the clinical and laboratory data.

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Inflammatory bowel diseases are one of the important reasons of the referral to GI practitioners in our country and Ulcerative Colitis is the more frequent type of these disease in Iran. In this study 200 cases of Ulcerative Colitis, which has been referred to Imam Khomeini Hospital during that last 5 year, were studied. Data was collected using the patient's records and face to face interview with them and their relatives. Majority of the patients were female (55 percent). Positive family history was seen in 28 percent of patients, autoimmune disease history in 8 percent, smoking history in 11 percent and smoking cessation history in 13 percent of patients. Most prevalent symptoms in the patients were nocturnal bleeding, rectal bleeding and bloody diarrhea. The most common involved area were recto sigmoid (58 percent) and descending colon (42 percent). Pan colitis was seen in 8 percent. Most people had complications and the most common complications was fissure (14 percent). Recurrence was seen in 83.5 percent of patients. With logistic regression analysis the only variable which showed significant relation with recurrence was male sex. According to the results of this study, it seems that ulcerative colitis clinical and epidemiological pattern in Iran is similar to many other countries, but the higher rate of recurrence and extra intestinal manifestations in patients shows that there is a growing need to reconsider the treatment efficacy in patients and correct the treatment methods.

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The newborn's weight at birth is an important measure for newborn's health in all communities. Among developed countries, 70 percent of low birth weight (LBW) newborns are preterm. The corresponding figure for undeveloped countries is only 30 percent, there are also evidence of intra-uterine growth retardation among these countries. Among effective factors on LBW, maternal related factors have important role in promotion and improvement of infants and mother's health. This study is a descriptive-analytic one and was conducted cross-sectionally through a questionnair. The study population determined by simple random sampling from newborns under coverage of urban health centers in Kohgiloye and Boyerahmad province. Necessary data collected from existing medical and health records filed in the health centers. Among 285 newborns, 88.4 percent considered with normal weight, 4 percent with IBW and 11.6 percent with more than normal weight. 7.4 percent of cases were immature. 85.3 percent of the mothers in study population were in immune range of age for pregnancy and 7.6 percent of them were illiterate. Except the sex of newborn (P=0.0008) and gestational age at birth (P<0.001) none of the variables demonstrated a significant statistical relation with the birth weight. The results of this study confirm other research's findings and reveal that with improving material factors such as mother's age, employment and literacy, the factors which are effective on birth weight, will be dependent on physiological factors such as sex of newborn and gestational age at birth.

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Anxiolysis and sedation with oral midazolam are common practice in pediatric anesthesia. Good or excellent results are seen in only 50% to 80% of cases, so we decided to investigate if addition of a low dose of oral ketamine to midazolam (ketamine2.5 mg /kg ^midazolam 0.25 mg/kg )resulted in better premedication compared with oral midazolam 0.5 mg/kg or ketamine 6 mg/kg alone.
Methods and Materials: in a prospective, randomized ,double -blind study we study 105 children (mean age 6 ,range 2-10 yr. ) undergoing non thoracic and non cardiac surgery of more than 30 min duration. The patients were in ASA 1, 2. After oral premedication the child's condition was evaluated by assigning 1-4 point to the quality of anxiolysis, sedation, and separation from parents in the induction room .The groups were similar in sex, age, weight, intervention and duration of anaesthesia.
Results: The score of sedation before transfer to the operation room was significantly better in the ketamine, midazolam combination group than in the ketamine or midazolam group. Success rates for anxiolysis and behavior at separation were grater than 90%with the combination, approximately 80% with midazolam and 70% with ketamine alone .The incidence of salivation, excitation, nausea and vomiting was grater in the ketamine group but were very low in other groups. During recovery there were no difference in sedation or time of possible discharge.
Conclusion: In summery, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children than with midazolam or ketamine alone. Duration of action and side effects of the combination was similar to those of midazolam.

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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: Adolescence (10-19 years) is one of the most challenging periods in human development. A second period of rapid growth occurs during the teen years. Not much information is available on the effect of the socio-economic status on the outcome of nutrition education in teenage girls. Objective : The purpose of this study was to determine the effect of socio- economic status on the efficacy of nutrition education in promoting the nutritional knowledge, attitude and practice in first-grade guidance school girls in Tehran.

Material & Methods: A total of 300 students were selected from 11 guidance schools by simple sampling and divided into three groups: 1- guide-book, 2- group discussion, 3- control. The knowledge and attitude data were collected using pre-test and post-test questionnaires and the personal-socioeconomic data were collected using general questionnaires. The students in group 1 were given the guide-book and required to study it at home, while group 2 students were told to discuss among themselves the contents of the guide-book. The control group was given nothing to study or to do.

Results: Nutrition education did not have a significant effect on the increase in the attitude score in the students whose grade-point average and their mother’s education level were high. (p= 0.13, p=0.29). Only mother’s education level independently from the type of education was associated with the difference of knowledge score means (p =0.07).There was interaction between nutritional education and monthly pocket- money with regard to the increase in the knowledge score (p =0.03).

Conclusion: Overall, exception of monthly pocket money, the effect of education on the nutritional knowledge and attitude was independent from other variables. Only mother’s education associate with the difference of knowledge score means.

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Background: One of the most important concerns in orthopedic medicine is the low back. Considering the importance of muscle function in preventing LBT by controlling too much load and stress applied on the spinal joints and ligaments.

Materials and Methods: The aim of this research was to determine the timing and level of activities of lumbopelvic muscles in response to postural perturbations caused by unexpected loading of the upper limbs in standing on three different supporting surfaces (neutral, positive slope, negative slope) in 20 healthy females 18 to 30 years old ( = 23.20 SD = 2.55 ). The electromyographic signals were recorded from the deltoid, gluteus maximus, internal oblique abdominis and lumbar paraspinal muscles of the dominant side of the body to evaluate the onset time, end time, level of muscle activity (RMS) and duration of different muscles in one task and one muscle in different tasks.

Results: The results showed that the agonists (posterior muscles) activated at first to compensate the flexor torque caused by loading and then the antagonists (anterior muscles) switched-on to compensate the reaction forces caused by agonist activities. With regards to continuous activity of internal oblique and its attachments via thoracalumbar fascia to the transverse processes of the lumbar vertebrae, it can be considered as one of the major stabilizer muscles of the trunk .

Conclusion: Finally the results indicated that supporting surface type didn’t have any effect on timing and scaling of muscle activities in different tasks suggesting that probably spinal and trunk priprioceptors are just responsible for triggering postural responses and they don’t have any role in determining timing and scaling.

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Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management. But due to nonspecific signs and symptoms it&aposs diagnosis in children is difficult. Recently procalcitonin has been used for diagnosis of serious bacterial infections like bacterial meningitis. We conducted a prospective study in children for evaluation of procalcitonin in differential diagnosis of acute bacterial and viral meningitis.

Materials and Methods: In a prospective process research, we measured CSF procalcitonin levels in 43 children older than two months referred to Markaz Tebbi hospital. According to the results of universal PCR the patients were divided into two groups: bacterial meningitis (n=11) and nonbacterial meningitis (n=32). To analysis the results, Mann-Whitney test was used.

Results: CSF procalcitonin level in bacterial meningitis was significantly higher than viral meningitis (1.72±0.9 ng/ml and 0.71±0.04ng/ml respectively,Pvalue= 0.00). A serum procalcitonin level >0.5 ng/ml had high sensitivity and specificity ( 90.1% and 97.1% respectively) in the diagnosis of bacterial meningitis.

Conclusion: CSF procalcitonin level seems to be a valuable marker in differentiating between bacterial and viral meningitis.

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Background and Aim: Helicobacter pylori is the etiologic agent of chronic –active gastritis, gastroduodenal ulcers in humans, and a co-factor in the occurrence of gastric cancer and mucosa-associated lymphoid tumors, Adhesion of H.pylori to the gastric mucosa is a critical and also initial step in the pathogenesis of the disease. Bacterial adhesion inhibitory agents provide a novel pharmacologic approach to the management of infectious diseases.    

Materials and Methods: 22 H. pylori strains, isolated from the antral biopsies of 49 patients with dyspepsia, gastritis, gastric ulcer, duodenal ulcer,…were assayed by ELISA (UPR)to investigate the diversity of attachment to 7 mamalian cell lines.

Results: The concentration of H.pylori and cell suspention ,the condition and temperature, can alter the attachment rate.Best bacterial concentration was equal to 1 Mc farland,and for cell suspension was 5*10 cells/ml.90 minutes in 37C incubation period result in maximum attachment. H.pylori can attach to all 7 cell lines, there are no significant differences between 22 H.pylori strains in attachment to cells. The attachment pattern of H.pylori to the cells showed significant reduction respectly from HepII, HeLa, SW742, AGS,HT29/219, HT29 to Caco-2.Maximum attachment were seen to HepII, HeLa and SW742 cells, and among these HepII was the best cells for this purpose.

Conclusion: Our studies suggest that Hep II, HeLa and SW742 cells could serve as a suitable in-vitro model for the study of H.pylori adhesions, attachment, inhibition of attachment and detachment assays and among these Hep II cell is prefer recommended.

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Background: Injection drug use (IDU) in Iran is not rare and is one of the main factors in opioid overdose. The objective of this study was the qualitative assessment of overdose, related factors, and available interventions.

Methods: A qualitative method was employed. Six districts of Tehran with a population of 400,000 inhabitants were selected. The districts were different in socioeconomic characteristics, urban structures and prevalence of IDU and crime. A total of 81 key informants from different sectors and 154 injection drug users (IDUs) were selected by purposeful, opportunistic and snowball sampling, and interviewed individually or in groups. Ethnographic observations were done for studying the life situation of IDUs.

Results: In one district no cases of IDU were found. In other districts, overdose in IDUs was reported to be common. Heroin injection alone or in combination with other drugs was the main reported cause of overdose. Reportedly, wrong estimation of drug purity was the most important reason. Even in the districts with highest rate of IDU and overdose, most clinics and hospitals did not have enough facilities necessary for management of acute opioid overdose.

Conclusion: According to the high prevalence of overdose, provision of preventive education of drug users and their relatives and availability and accessibility of emergency services is highly recommended.

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Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory.

Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40), elective C/S under general anesthesia (n=35) and C/S under spinal anesthesia (n=25). Duration of anesthesia and its effect on blood gas and infants apgar were assessed.

Results: In the first group (vaginal delivery) mean blood gase parameters were pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia) mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia) mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05).

Conclusion: There was no significant difference between type of delivery and umbilical blood gas parameters. Neonatal apgar score in NVD is higher than the other groups. With increasing duration of general anesthesia in C/S, umbilical po2 is reduced.

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Background: In the year 2003, an earthquake in Bam led to death and injury of many of the inhabitants. The aim of this study was to the changes in opioid drug use in the survivers eight months after the earthquake in comparison with the month before the quake and its related factors.

Methods: An epidemiologic survey was carried out on 779 survivors, selected by desert sampling from the Bam citizens in the age of 15 and over. Bivariate and multivariate Logestic regression analysis were done for examining the relationship between an increase in opioid use and various factors.

Results: An increase in opioid use was reported in 18.3 percent of men and 2.3 percent of women. Odds Ratio (OR) for increase in opioid use was 9.4 times more in men than in women (95% CI=4.9-18.0). In men, increase in opioid use was related with the history of opioid use during the month before earthquake (OR=5.6, 95% CI=2.4-13.1), age (OR in age group 30 to 44 was 4.7 times more than age below 30, with 95% CI from 1.8 to12.1), and PTSD (OR=3.7, 95% CI=1.5-9.2). In women, it was only related to the history of opioid use during the month before earthquake (OR=43.8, 95% CI=12.5-154.0).

Conclusion: The findings show that following disasters, especially in the areas or groups that drug use is common, an increase in the drug use might occur. In these situations provision of preventive and treatment interventions particularly for at risk population is necessary.