Tehran University Medical Journal

---

The papillary cystadenoma lymphomatosum (PCL), also called warthin's tumor, is a benign salivary gland tumor which primarily involves the parotid gland. These lesions are composed of a double layer of cuboidal or culmnar eosinophilic cells lining a cystic cavity which lymphoid tissue is present in the supporting stroma. The lesions shows a predilection for males, with peak incidence during the sixth decade of life. Bilateral lesions have been found to occur in 5 to 7.5 percent of the cases. Rarely, these lesions have been reported in the minor salivary glands and oropharynx. Case report: A 47-year-old woman presented with a red lesion on the hard palate between the midline and right maxillary side. The patient had awared of the lesion for one year. The clinical dignosis was a mucocele. An excisional biopsy was performed. Gross examination of the formaline-fixed specimen revealed three pieces of soft tissue measuring 1.0 x 0.3 x 0.3. Histologic examination revealed a nodular mass surfaced by keratinizied stratified squamous epithelium. The connective tissue stroma contained a papillary cystic area lined by a double layer of cuboidal cells with centrally placed nuclei

---

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

---

Levamizole hydrochloride (C11H12 N2 S.HCl) is a drug capable of being rapidly absorbed from the gastrointestinal tract and is also rapidly eliminated from plasma. It has a modulating effect on the immunesystem, and may be used in treatment of parasitic diseases and infections. Because of its toxicity to liver and its rapid clearance from plasma, this drug must be formulated in such a way so as to decrease its necessary dosage and thus its toxic effect on the liver while improving or at least maintaining its present tolerance to disintegrating factors in the surrounding and its ability to efficiently reach its target tissues (the immune system). Therefore, the liposomal form of levamizole hydrochloride can be helpful in achieving the stated goals. In this study, first a preparation of a multilayer liposome with hydrophilic coating was done. For this purpose, a mixture of phosphate buffer (soudium and potassium phosphate I, 4 mmol, pH =7.4) ethanol and lipid (100 mg phosphatidyl choline, extracted from soya) was used (buffer 200 mg, ethanol 80 mg, lipid 100 mg). Also levamizole hydrochloride with half a solubility in water was used. The above solutions from levamizole containing liposomes under a few cycles of freeze-thawing method (20-60°C). Ultracentrifugation (45 min, 60.000 rpm) was used to determining the extent of drug encapsulation in this method we can calculate the percent encapsulation using a control. In our method this percentage was calculated to be 92.7%.

---

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

---

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

---

One hundred and sixty preterm deliveries were done at our center in (1996-97). Classification according to etiology shows that 30% of these deliveries were due to PROM, and 13.75% had to be induced secondary to underling fetal or maternal indication, in 35.6% there were maternal or fetal pathology, and in 20.6% there were no recognized reason (idiopathic). The various etiologic factors were evaluated in 160 term deliveries as control group. The preterm deliveries had significantly higher rate. There were 40 cases of perinatal mortality that included 77% of total perinatal mortality in (1996-97). Acute lack of neonatal intensive care unit in Iran requires closer attention in the future.

---

Hysteroscopy is a new and precise method for evaluating of uterus, so it is valuable in evaluating infertile women. In 18 months, 363 hysteroscopies were done on patients who were visited in IVF center of Shariati Hospital for treatment of infertility. Incidence of abnormal hysteroscopy was 18%. 32% of these abnormal hysteroscopies was endometrial hyperplasia. In evaluating of laparoscopy and other factors of these patients there was a statistically significant relation between diagnosis of PCOD (polycystic ovary disease) and endometrial hyperplasia (P<0.008), but there is no significant relation between other diagnoses like endometriosis and endometrial hyperplasia (P<0.4).

---

In this study we review 82 infants under two months with bacterial meningitis admitted in Tehran University's hospitals during a 14 year period. Male to female ratio was 1.4 to 1. The patterns of predominance among bacterial pathogens changed during the period of study. During the first six years the most common pathogens were Salmonella-SP., but during the later years E.coli became the predominant pathogen, and also meningitis caused by GBS and Staph. epidermidis was observed. The case fatality rate was 37.8 percent. The antibiogram revealed that E.coli were hundred percent resistant to ampicillin and 50% resistant to gentamicin, 40% of all bacteria isolated were resistant to ampicillin and gentamicin. These findings provide guidelines for the selection of empiric antimicrobial agents in our country

---

Tuberculos Gumma is one of the various clinical manifestations of cutaneous TB that is characterized by non tender, undolent subcutaneous nodules which progressively involve the skin and take the appearance of an ulcer. In this article, we present two young patients, affected with tuberculos gumma. One of them, presented with multiple abcesses on the face and extremities, associated with pulmonary involvement and arthritis of the left wrist. The other one had just one subcutaneous nodule on the face, with positive familial history of pulmonary TB and tuberculos lymphadenitis in her two brothers. Both patients were cured with anti TB treatments

---

Congenital cyst of the pancreas is an uncommon problem in the pediatric patient. The common symptoms at the time of diagnosis have been abdominal mass and pain or fullness, nausea and vomiting. Despite of various paraclinic methods for diagnosis, ultrasound is now recognized as the most effective and best noninvasive method for diagnosis of pancreatic cyts. Surgical intervention is the best mode of therapy. Upper abdominal cystic mass are seen in the fetus and newborn infants. In Amirkabir Hospital, during 12 years from 1981 to 1993, 8 pancreatic cysts have been operated on and only in this case it was congenital.

---

Some of ICU patients with Acute Renal Failure (ARF) require dialysis. Conventional or intermittent hemodialysis (HD) may cause hypotension and insufficient loss of fluids and toxins from blood. Peritoneal dialysis also my cause peritonitis and has lower efficiency than HD. We did continuous Venovenous Hemodialysis (CVVHD) for three ICU patients with ARF in Saint-Zahra Medical Center for the first time in our country. Method and Material: With a polysulfone membrane, blood pump, peritoneal dialysis solution, heparin, and a fix nurse, HD was done for 12-24 hours. Results: 1) Urea clearance was 18-50 ml/h. 2) Ultrafiltration was 160-1000 ml/h. 3) With dialysis, hemorrhage, coagulation disorder, and oxygenation recovered. 4) All of patients developed hyperglycemia and hypothermia. 5) All of patients died (two with septicemia and one with hypotension). Conclusion: In the absence of hemodialysis or peritoneal dialysis, CVVHD with present preliminary equipments is suitable and can excrete more toxins and fluids.

---

Intrauterine insemination (IUI) has been practiced since the late 1800's primarily for idiopathic infertility, and in men with deficient semen parameters. The procedure is done by placing washed sperm in uterus a few hours before ovulation. The records of 427 couples receiving IUI for treatment of infertility at Shariati hospital in 1370-74 were reviewed retrospectively. These patients had IUI in 574 cycles. Eighty patients became pregnant and delivery rate was 14% per cycle. Pregnancy rate is impressive when ovulation induction is combined with insemination timed just before ovulation. The success rate in Shariati hospital is comparable to other infertility centers in the world and cost of a cycle of IUI with HMG superovulation is approximately one third the cost of IVF-ET or GIFT cycle and avoids invasive oocyte retrieval and extracorporeal fertilization. So we suggest that women with refractory infertility without anatomic distortion of pelvis can have at least 3-6 cycles of IUI before IVF or GIFT.

---

Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

---

Food, it's production and preserving has been one of the most important problems in human life. Limitation of production due to climatic, geographic and papulational situations and conservation due to providance and prosecting for solution of one of the most fundamental human needs, has been discussed much. Difference between the lands, temperature, humidity and rainfall on one hand and texture and accumulation of papulation on the other hand, not only has limited the amount and kind of food production but also has improved the preserving methods as much as possible. Extra production in fertile lands and confirmed need for receiving food in deserts and dry areas, makes the need of exchanging and transfer of food inevitable because of economic and ethical matters and sanitation of food. Avoidance of being contaminated and resistance against decay seems very important and vital. So process of preserving and conserving of eaw or cooked food became a fundamental problem. In previous 200 years, many advanced methods have been designed for preserving food in which the role of conserving and packing in vital often. Because of industrial production, conserved food have a great influence on sanitation of people nutrition, and herefor the rate of diseases from consumption of contaminated food has been reduced in industrial countries and the tensancy of people to use conventional food has been decreased gradually. Because of high cost of industrial conserved food production some people produce conserved foods in the way which is not hygienic. That may have a high risk when ingested. In this article we discuss about unwarranted conserved foods productions.

---

The present research is a quasi-experimental prospective study to determine usefulness of stripping the fetal memberanes at term for preventing of postterm pregnancy. 212 pregnant women with firm gestational dates entered the study, 112 underwent stripping of the membranes and 100 controls did not. The difference between the number of patients who advanced beyond term (>290 days) was statistically significant between groups (P<0.01). The mode of delivery and neonatal APGAR score were similar in both groups.

---

In order to evaluate the role of idiopathic hypercalciuria (IH) in causing hematuria, nephrolithiasis and recurrent urinary tract infections we studied two groups of children for idiopathic hypercalciuria. 1) Patients group: children with hematuria, nephrolithiasis and recurrent urinary tract infections (n=452). 2) Control group: children with no urinary tract problem (n=100). In control group 3% of children had IH. In patients group 27.5% of patients with hematuria, 37% of patients with nephrolithiasis and 7.9% of patients with recurrent urinary tract infections had IH, P values=0.001, 0.005 and 0.2, respectively. This study confirms that there is a positive association between IH and hematuria or nephrolithiasis, but there is no significant association between recurrent urinary tract infections and IH

---

Background: Gastric cancer (G.Ca) is significantly more prevalent in north western than central Iran. Growing evidence has related Helicobacter pylori (H.P) to G.Ca worldwide. We assessed the prevalence of H.P infection in high (Ardebil) and low (Yazd) prevalence of G.Ca provinces of Iran. Methods: Cluster sampling of healthy population aged less than 20 years was performed in Ardebil and Yazd provinces over 2 months. Ten cc blood was drawn from each person and H.P IgG was tested using ELISA (Diagnostic Corp., sensitivity 98%, specificity 96%). Results: 711 individuals (358 in Ardebil and 353 in Yazd) were enrolled. 170 individuals (47.5%) in Ardebil and 108 individuals (30.6%) in Yazd were positive for H.P (P<0.0001). Using logistic regression analysis, the predictive probability of H.P infection in different age groups was calculated. Conclusion: H.P infection is significantly more prevalent among individuals less than 20 years in areas with high prevalence of gastric cancer in Iran. Our data suggest a relation between H.P infection and gastric cancer in Iran

---

This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents

---

Iodine availability for the maternal thyroid is reduced during pregnancy as a result of the loss of the nutrient by increased renal clearance, and competition by the fetoplacental unit. So with a marginal iodine intake, pregnancy constitutes a stimulus for both the maternal and fetal thyroids. On the other hand, iodine deficiency in the first trimester of pregnancy results in impaired development of the central nervous system, lack of T4 then results in smaller brain size associated with fewer neurons which are also shorter in length. This cross-sectional study was undertaken to evaluate pregnant women and their newborns, these two susceptible groups to IDD in an endemic area such as Shiraz. Urinary excretion of iodine as iodine (µg/dl)/creatinine (gr) ratios in two groups of pregnant women, one group without goiter (52.88%) and the other with goiter (grade Ib and II 47.2%) and their newborns were compared. There was no significant difference in urinary excretion of iodine in mothers and newborns of the 2 groups. In all newborns even in those of mothers excreting <50 mg iodine/gr creatinine, there was a significantly greater excretion of iodine probably due to increased renal clearance of iodine by the immature kidney, and their excretion of iodine was not parallel to those of mothers. There was no significant difference between weight, height and head circumference of the two groups of newborns. It is concluded that iodine excretion in neonates can not be used as an indicator of iodine deficiency disorder. In iodine deficient areas pregnancy justifies monitoring thyroid function and volume and therapeutic intervention to avoid hypothyroxinemia and goiterogenesis in both mother and newborn. Likewise neonatal thyroid screening constitutes a valuable and sensitive index for detecting the presence of iodine deficiency.

---

Epidermolysis bullosa (EB) is the term applied to a group of disorders whose common primary feature is the formation of blisters following trivial trauma. Hereditary EB comprises 3 major classes: simplex, junctional and dystrophic, and includes more than 23 phenotypes. The albopapuloid pasini variant of dominant dystrophic EB is characterized by a distinctive clinical appearance. In this article, we report this disease in three members of a family (father and two sons).