Tehran University Medical Journal

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Persistent air leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent air leak causes longer patients hospitalization.

Materials and Methods: We used autologous blood pleurodesis in patients with persistent air leak for 30patients with more than 8 days air leaks, during a three years period 1377-1380 (1999-2002).

Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and /or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mis. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patient's complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients air leak ceased. In six patients because persistent air leak autologous blood pleurodesis repeated, two patients after 48hours air leak ceased, remaining four patients underwent for thoracotomies, success rate was 86.6%.

Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent air leak is a reliable, effective, and no complicated procedure for persistent air leaks.

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Persistent air leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent air leak causes longer patients hospitalization.
Materials and Methods: We used autologous blood pleurodesis in patients with persistent air leak for 30patients with more than 8 days air leaks, during a three years period 1377-1380 (1999-2002).
Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and /or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mis. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patient's complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients air leak ceased. In six patients because persistent air leak autologous blood pleurodesis repeated, two patients after 48hours air leak ceased, remaining four patients underwent for thoracotomies, success rate was 86.6%.
Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent air leak is a reliable, effective, and no complicated procedure for persistent air leaks.

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Persistent air leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent air leak causes longer patients hospitalization.
Materials and Methods: We used autologous blood pleurodesis in patients with persistent air leak for 30patients with more than 8 days air leaks, during a three years period 1377-1380 (1999-2002).
Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and /or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mis. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patient's complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients air leak ceased. In six patients because persistent air leak autologous blood pleurodesis repeated, two patients after 48hours air leak ceased, remaining four patients underwent for thoracotomies, success rate was 86.6%.
Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent air leak is a reliable, effective, and no complicated procedure for persistent air leaks.

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Persistent air leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent air leak causes longer patients hospitalization.
Materials and Methods: We used autologous blood pleurodesis in patients with persistent air leak for 30patients with more than 8 days air leaks, during a three years period 1377-1380 (1999-2002).
Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and /or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mis. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patient's complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients air leak ceased. In six patients because persistent air leak autologous blood pleurodesis repeated, two patients after 48hours air leak ceased, remaining four patients underwent for thoracotomies, success rate was 86.6%.
Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent air leak is a reliable, effective, and no complicated procedure for persistent air leaks.

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Listeria infection is still a dominant infectious problem in Iran, particularly in abortion. Looking for a paraclinical technique other than bacterial methods (which is not always available) lead to serological survey indicating estimation anti listeria antibody by Immunoflourescent test. Unfortunately the false positive results due to cross reaction between "listeria monocytogenesis" and certain gram positive cocci, made it an unacceptable technique. Here we performed a test to extract the Listeria M. (Stranin 4a and 1b) soluble antigen and detecting the antibody by counter immunoelectrophoresis (CEI). The results indicated that of four bacterial soluble antigen fractions F1 and F3 were significantly positive with patients sera. We will discuss using the soluble antigen by CEI technique may be helpful to omit the false positive reactions.

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Thyroid scintigraphy has been helpful in detecting and evaluation of thyroid nodules. Sodium pertechnetate Tc-99m is the most commonly used radionuclide for thyroid imaging because of its general availability, favorable dosimetric characteristics and low cost. But, there are reports of occasional disparity in isotope uptake in lesions compared with radioiodide. In order to determine percentage and clinical significance of this disparity, we screened 101 patients with solitary functioning nodules using sodium pertechnetate TC-99m in comparison with subsequent Iodine-131 scan in research institute for nuclear medicine. We conclude that sodium pertechnetate TC-99m is a reliable radiotracer for the detection and evaluation of thyroid nodules and there is no need for the subsequent Iodine-131 scan.

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Documented war experiences have provided early descriptions of different group of psychiatric features. A combat soldier with palpitation and chest pains was felt to have a functional cardiac disturbance, called soldier's heart. Anxiety and other symptoms indicating increased arousal were called shell shock and were thought to be related to lesions in the central nervous system (CNS). Describing analytically war events could operate with an enormous emotional intensity breaking through the ego defences and flooding it with an uncontrollable anxiety. Post traumatic stress disorder (PTSD) delineates a syndrome developing after a discrete traumatic event in a stress setting. Diagnostic conceptualization which tie PTSD to stress and trauma invariably involve two different approaches from two different theoretical bases: the concepts dealing with trauma on the one hand (which could effect on CNS) and those dealing with stress-response theory on the other. Author emphasizes on viewing the patients who complain of war psychiatric effects in three categories: (1) Non PTSD diagnoses that the patient ought to be treated accordingly (2) Traumatic neurosis which has overwhelming war stress related emotional aspects and is occurred in predisposed individuals. This category is suggested to be classified as post war stress disorder specifically, to be differentiated from other post traumatic psychiatric categories. (3) Author also suggests the third category as post traumatic war stress syndrome which is thought to have organic origin. Symptoms such as hyperacusis, hyperirritability, tinnitus and particular type of head aches which are mostly refractory to treatment confirm the hypothesis.

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According to our experience, the best treatment for operable supracondylar fractures of the adults' humerus is surgery via open reduction following internal fixation and early mobilization. The preferred approach is olecranon because of its observable fragments of the fracture and easy fixation without damaging ulnar nerve and triceps muscle. In this article, we review several cases treated by this method whose results were quite satisfactory

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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

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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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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.

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The cyclical changes in the gonadotropins stimulate ovarian follicular development either to the ovulatory stage or to undergo atresia. One such intrafollicular factor may be inter-cellular communication via gap junctions. We have examined the effects of two agents (retinoids and alkanols), known to disrupt or uncouple gap junction, on FSH-stimulated LH receptor induction and progestrone synthesis in granulosa cells. Granulosa cells from diethylstilbestrol-treated immature rats were isolated and cultured in serum-free medium containing either FSH (15 ng/ml) or FSH and estradiol (30 nM), various doses (0.1-1000 nM) of either retinoic acid were added to the cultures at the time of seeding. Additional cultures containing the same concentrations of either FSH, or FSH and estradiol, were treated with 0.01-10 nM heptanol or octanol. The results of this study showed that: 1) Retinol, at all of the concentrations tested, had no effect on either FSH-stimulated LH receptor induction or progesterone accumulation by the granulosa cells. 2) Retinoic acid suppressed both LH receptor induction and progesterone accumulation by the cells. 3) Heptanol and octanol suppressed LH receptor induction but did not have inhibitory effect on the progesterone accumulation.

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Association of Helicobacter pylori with pathogenesis of gastrointestinal disorders (including gastritis in children with special endoscopic anteronodular) have significant importance in prognosis of infection resulting from this bacteria in children. However, in this research it was found that there is significant and clear correlation between nodular anteritis (in endoscopy) and active presence of lymphoid follicle (in histology findings with replacement of H.pylori) was noticed in children. In this research 14 persons (34.1%) out of total patients were positive. The average age of positive H.pylori patients was clearly higher than negative H.pylori patients. So increase of possible infection occurrence together with increase of age in children was confirmed. Meanwhile, there is significant relationship between presence of bacteria and clinical symptoms particularly epigastric pain, vomiting, and nausea. One of the other results of this study was confirming the relationship between history of gastrointestinal disorders in immediate family members and infection resulting from H.pylori in patients.

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Alpha-interferon therapy has been approved for treatment of chronic hepatitis C and B. Candidates for treatment are patients with well-compensated liver disease and histologic evidences of chronic hepatitis who have demonstrated abnormal aminotransferase levels for more than 6 months. From 30 patients with chronic hepatitis with diseases prolonged more than 6 months, we selected only 16 patients with necessary criteria for interferon therapy (10 patients with chronic HBV and with evidence of viral replication, and 6 patients with chronic HCV). Dose of interferon used for hepatitis B was 5mu TIW for 16 weeks and for hepatitis C was 3mu TIW for 24 weeks. At the end of treatment, HbeAg was eliminated from 3 patients. From 10 patients chosen, from none of them the HBsAg was not eliminated at the end of 4 months treatment. In comparison with 10% elimination of HBsAg in treated groups that have been reported in other countries, our results demonstrated that interferon therapy is less effective in Asian patients in comparison with western patients.

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Three hundred and seventy seven patients with different degrees of heat stroke were treated by the haji medical team of the Islamic Republic of Iran in 1371 (1992). Studies were carried out on sex of the patients, time and intensity of occurance and the vital signs after a medical examination. The most important method of treatment employed for intense heat stroke was iced bath. This procedure leads to 64.5% of patients being treated in te specific heat stroke unit and 35% were sent to a general hospital ward for furthur treatment. Morbidity and mortality were seen in less than 0.5% of the patients.

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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.

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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%).

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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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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

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To evaluate the tolerance and effectiveness of conjugated Estrogen for women with established post-menopausal Osteoporosis and hot flushes, with the use of paired comparison, randomized, we tested during an 10 month period the bone mineral contents and plasma glucose in subjects who afforded by premarin in dosages of 0.625 mg for days 1 to 25 and oral medroxy progesterone acetate for days 15 to 25 of a 29 days cycle. All subjects received supplementation to ensure a minimum of 800 mg calcium per day. 25 subjects completed at least 10 month follow up serum calcium, phosphate, glucose and urinary calcium and phosphatae measurements by colorimetric, method. We compared women with herselves, the median change in biochemical studies showed significant decrease in serum calcium, phosphate an urinary excrition of calcium, but significant increase in urinary excrition of phosphate. Fasting plasma glucose did not change significantly. Decrease serum calcium (9.6 compared with 9.16 P<0.005) decrease, serum phosphate (3.77 compared with 3.39 P<0.005), decrease uri calcium (149.81 compared with 121.46, P<0.005), increase uri phosphate (625.83 compared with 676, P<0.005), FBS (92.03 compared with 91.45, 0.1>P>0.05). Regarding the effects of conjugated Estrogen on plasma and urinary calcium and phosphate levels and amelioration of clinical symptoms, we concluded that conjugated Estrogen treatment in effective in post-menopausal Osteoporosis, but we did not find relation between exogenous Estrogen in post-menopausal women with FBS and hot flush