Tehran University Medical Journal

---

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.

---

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.

---

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.

---

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.

---

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.

---

AVNRT, (Atrioventricular nodal reentry tachycardia), atrial tachycardia and atrial flutter are 3 kinds of supraventricular tachycardia, which their mechanism are explained based on reentry. A 60-years-old man is presented with all of the above-mentioned arrhythmias, responsive to intravenous injection of adenosine. Radiofrequency ablation of the slow pathway territories cured all of them. Therefore, we suggest that there was a common pathway among all kinds of these arrhythmias, which were ablated with single RF lesion.

---

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%.

---

Primary hyperaldosteronism is one of the few causes of hypertension that can be cured by surgery. Primary hyperaldosteronism is caused by adrenocortical adenoma or hyperplasia. It is important to differentiate between adrenal adenoma and hyperplasia because the preferred treatments are different. In all patients with new-onest or worsening hypertension the primary hyperaldosteronism should be considered as an etiology. Patients with primary hyperaldosteronism classically have hypertension with spontaneous hypokalemia. The serum sodium concentration is usually normal in patients with primary aldosteronism who are not taking diuretics. Weakness, fatigue, paresthesia, tetany and even paralysis may develop. Renin and angiotensin II are suppressed in both forms of primary hyperaldosteronism due to feedback. Polyuria may develop secondary to vasopressin resistance from chronic hyperkaliuria. Hypertension or eclampsia during pregnancy is common in women with primary hyperaldosteronism. Case report: A 42-years-old woman presented with headache, severe hypertension, general weakness, easy fatigability, vertigo, palpitation, visual disorders and nocturia. She had a past history of eclampsia 10 years ago. In laboratory investigation there was hypokalemia, elevated serum aldosterone, low renin activity and hyperkaliuria. In abdominal CT-scan there was a hypodense mass measuring 2 cm in diameter in her left adrenal gland. The patient had primary hyperaldosteronism due to aldosteronoma.

---

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.

---

Calcitonin Gene Related Peptide (CGRP) was first reported in 1982. This peptide contains 37 amino acids which could be found in Alpha and Beta forms. CGRP shows diversity both in its receptors and biological effects and up to now four different types of receptors have been reported. It can act like a neurotransmitter, local hormone and neuromodulator. They have a variety of effects on different organs such as a potent effect on vasodilation and smooth muscle relaxation. Ability of CGRP for induction of protein extravasation from blood vessels was uncertain. In this study intra-articular infusion of 10^-6 M CGRP to the rat knee joint induced significant protein extravasation into the rat knee joint space. The amount of protein was detected by modified Iawata method which could detect amount of protein between 5-500 mg/L. Higher and lower concentrations failed to induce protein extravasation. Failure in higher concentration was likely due to significant fall in blood pressure. In the presence of an arterial hypotension induced by an ? adenoreceptor antagonist, 10^-6 M of CGRP failed to produce protein extravasation. This effect of CGRP was a specific active effect and not a passive effect due to its potent vasodilation effect, as similar vasodilatory response induced by a ?-adrenoreceptor agonist failed to induce protein extravasation. There is more than 50% of sensory neurons which contain CGRP and they are spread in all over the body and joints, therefore CGRP induced protein extravasation can potentiate inflammation in different organs.

---

In this study we have selected in a simple random sampling, 391 diabetic women, among diabetic patients, who were attending to center of diabetes control in Yazd city in 1993. The patients were investigated in view of: Average of (age of marriage, number of marriage, age of the first pregnancy, number of pregnancies, the last fasting blood sugar), frequency and average of (early labours, alive borns, reminder alive borns, anomalous borns, history of abortions), and frequency of (diabetes in previous and next offspring, 15-49 years old women, the most common method of pregnancy prevention), and consideration of pregnant women situation. There were among under investigation patients, individuals who had more than 5 marriages, 25 pregnancies, 15 alive children, ten >4 Kgr born newborns, history of 14 times of abortions, and even 11 anormalous infants. The disease in every generation was common in females, and average of the last fasting blood suger in patients with >6 pregnancies was significantly more than patients with <6 pregnancies (P=0.0004). Finally, our principal purposes in this study were: Correct screening of pregnant women in view of diabetes mellitus, urgent follow up of the patients specially present patients, and more emphasis on specifc education about diabetes mellitus.

---

The purpose of this study was investigation of effect of cholestasis on bromocriptine-induced yawning in male rats. Bromocriptine, the agonist of dopamine receptors (especially "D2"), causes yawning in male intact rats. In the present study, cholestasis was produced in male rats by surgery and ligation of common bile duct. The number of yawning induced by intraperitoneal injection of bromocriptine (11 mg/kg) was compared in cholestatic rats with sham operated and control groups. Immediately after injection of the drug and putting animals on the frame of behavioral study, the number of yawning was determined in a period of one hour. Obtained results, indicated significant difference in the number of bromocriptine-induced yawning between cholestatic rats and the other two groups. There wasn't significant difference between sham and control rats. These results indicate that some changes occur in cholestatic rats which increase sensitivity and response of dopamine receptors. Since it is proved that dopamine agonist-induced yawning is mediated via nitric oxide, and also level of nitric oxide is increased in cholestasis, it can be supposed that the mentioned response may be due to elevated level of nitric oxide. On the other hand, increased number of yawning in cholestatic rats may be due to increased level of endogenous opioids in these animals.

---

In this study the effects of bromocriptine and apomorphine (dopamine receptor agonists) on electrical field induced twitch response of longitudinal muscle of guinea-pig illeum was investigated. Bromocriptine and apomorphine dose dependently inhibited illeal contraction. IC50 for this inhibitory effects were 6.22±0.645×10^-7 M and 5.48±0.647×10^-6 M, respectively. sulpiride (a specific D2 dopamine receptor antagonist) with concentration of 10^-5 M inhibited the effects of these agonists. Yohimbine (an ?2 adrenergic receptor antagonist) only blocked the inhibitory effect of bromocriptine but failed to block apomorphine inhibitory effects. L-NAME (nitric oxide synthetase inhibitor) with concentration of 10^-3 M blocked the effects of bromocriptine and apomorphine. These data suggest that there is inhibitory presynaptic dopamine receptors in cholinergic terminals of guinea-pig ileum and its function is related to formation of nitric oxide.

---

Introduction: It has been shown that repeated large volume paracenthesis associated with intravenous albumin infusion is a rapid, effective and safe therapy of massive ascites in cirrhosis. Our aim was to investigate wether IV infusion of albumin is necessary in large volume paeacenthesis therapy of cirrhotic ascites. Methods: 37 patients with tense cirrhotic ascites who were intractable to diuretic therapy were randomly assigned in two groups. 16 patients (group A) were treated with paracenthesis of 4 lit/day plus intravenous albumin infusion (7 gr/lit), and 21 (group B) with paracenthesis without albumin infusion. Hemodynamic status, liver and kidney function and serum lectrolytes were assessed before, while and after paracenthesis. Results: Paracenthesis without IV albumin did not induce significant changes in standard renal function tests, serum albumin, serum electrolytes and liver function tests. One patient from each group developed renal impairment. Two patients from group A and 3 from group B developed asymptomatic hyponatermia. One patient from group A died due to hepatic encephalopathy during paracenthesis. Conclusion: Intravenous albumin infusion is not necessary during large volume paracenthesis for treatment of tense ascites in cirrhotic patients.

---

Some factors such as: aging, obesity, hypoactivity, stress, urbanization, hyperlipidemia, hypertension, multiple pregnancies, smoking and so forth, are important factors that are always argued whether in disease production or in increasing morbidity and mortality in diabetic patients. In a descriptive, cross-sectional and correlational study, we looked for some important risk factors in 780 diabetic patients in Yazd city. The main objective in this study was to identifying the at risk cases. In this study, 54% of understudied patients were obese, 52.3% hypoactive, 80.7% urbanized, 21.5% smokers and approximately 11% were continiously or occasional alcohol users. 85% of all patients had no habit to sport, and the mean of their last fast blood sugar was significantly upper than those who had continiously physical exercises (P=0.01). Majority of understudied women (65.3%) had experienced 6 or more pregnancies during their life, and the last mean blood sugar in these patients was significantly upper than those with <6 pregnancies (P=0.0004). The age of majority of patients in either males or females was 50-70 years, and duration of disease in majority of them was <10 years. Increasing of the last mean blood sugar was significantly compatible with increasing of disease duration (P=0.00003). Regardless the type of diabetes, the disease in every generation was more frequent in female gender and totally, the mean of last fast blood sugar in the patients was 216 mg/dl which is not a controlled sugar. We have suggested the mean of last fast blood sugar in all of the referal cases as a performance indicator during evaluation of center of diabetic patients control

---

102 patients with ascites were enrolled in a sonographic study of abdomen and pelvis without awaring of history, clinical and paraclinical findings. So with only sonographic finding we suggested the diagnosis and etiology of ascites. All patients were hospitalized. Finally all the patients were diagnosed definitely and were compared with sonographic diagnoses done before. Results: In this survey 42% of patients had cirrhosis, 20.5% had malignancy, 14.7% had renal disease. Overall sensivity of sonography in diagnosing etiology was 91.1%, overall specifity was 97.8%, overall accuracy was 94.4%. Sensivity, specifity and accuracy of each group have also been determined separately.

---

Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.

---

Intestinal parasitic infections are found all over the world. With all the progresses made in the last decades which have resulted in reduction of infection and mortality, yet parasitic infections are one of the biggest public health problems in the developing countries. In this research children 2-5 years old of Saveh city were randomly chosen. Intestinal parasitic infections and the effect of medical treatment on the infected cases were assessed. In order to treat the infected cases. Iranian generic drugs were used in which for Giardia infection Metronidazole 87.5% and furazolidone (66.7%) were proved effective. Metronidazole in treatment of Entamoeba histolytica infection (88.2%) and Metronidazole+Paramomycin proved 100% effective. In treatment of children infected with Oxyuris, the two drugs, Metronidazole and Pyrvinium Pamoate were almost 100% effective. Metronidazole in Ascaris infection was about 88.9% effective. Niclosamide in treatment of Hymenolepis nana (100%) and in Tenia saginata were 75% effective. Reinfection after three months in treated children was about 20.9% which was the most prevalent intestinal parasitic infection related to Oxyuris. The successfully treated group had higher average body weight compared to the control group.

---

In the present survey all together 670 students were chosen randomly. The rate of goiter prevalence was 46.3% and 55.7% among the students of Ilam and Arkavas, respectively. Goiter prevalence rate among females was higher than in males. Prevalence of giother was significantly different between the two cities, also between females and males in Arkavas and females in two cities (P<0.05). In comparison the females had better physical growth than males. Although there was no significant difference between weight and height as well as socio-economic state in comparison with thyroid size, but physical growth and socioeconomic indicators in Arkavas were lower than in Ilam. There was no significant relationship between the size of thyroid and urinary excretion of iodine. The amount of iodine in drinking water was 3.2 and 0.65 Mic.gr/Lit, respectively. Low level iodine drinking water and protein-energy malnutrition are important factors for prevalence of goiter in two cities. According to our results although the value of urinary iodine is normal but prevalence of goiter rate related to the iodine deficiency is due to the past deficiency.