Tehran University Medical Journal

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57 women affected by abortion or threatened abortion were investigated in view of antitoxoplasmosis antibodies by immunofluorscence. 11 women who have aborted for the first time have positive titer of polyvalent antibodies more than 1/400. 77.3% of these women have IgM titer greater than 1/20. The highest percentage of abortion was in the third month of pregnancy and this is probabley related to the increase in the percentage of women who have IgM titer greater than 1/20 and who were in the acute stage of the disease. The percentage of women with a positive titer of IgM titer greater than 1/20 and who were in the acute stage of the disease. The percentage of women with a positive titer of IgM of greater than 1/20 decreased from the third month of pregnancy. It seems that the care and follow-up of pregnant women with toxoplasmosis whether from antibody titer or from its type is of great importance. It is preferable to titrate antitoxoplasmosis antibody titers in the sera of women before pregnancy.

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Results of some cancer researches show that a number of hormones in ceratin tumors are growing up. Often, the majority of these hormones are produced by tumor cells or by an unknown origin in the neoplastic area. Also, it is clear that some of these ectopic hormones are produced only by specific tumors. In addition, different effects of these abnormally produced hormones on the immune system are shown in recent years. Thus, we decided to study the hormonal status of patients with chronic lymphocytic leukemia (CLL) patients. The results of this study showed that the LH and FSH levels in the majority of patients are rising above normal while testosterone level in many of them is decreased. In the next step, we are going to study the immunological effects of LH, FSH, and testosterone one the lymphocyte function in vitro.

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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

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88 patients with drug addition were evaluated for HBsAg, HBeAg, anti-HBC, anti HIV syphlisis and anti-toxoplasma antibodies. 48 of them were male and 40 were female. The range of their ages was between 19 to 49 years and their addiction time were between 6 month to 30 years. The results show that 5.6% of the patients have HBsAg in their blood serum and 40.9% of them have anti-HBe antibodies. All of them lacked anti-HIV antibodies. 17% of patients were positive on FTAabs test and 37.2% of them have anti-toxoplasma antibodies. There fore we can say that the drug addicts could be attacked by some opportunistic disease such as toxoplasmasis and hepatitis, and so their health control are very important because in this way we could reduce incidence of these disease

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A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

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Hypertension is one of the most important modifiable risk factors of vascular heart disease. Control of hypertension in different age groups has a significant effect upon the control and prevention of vascular heart disease. A familial pattern is observed in the distribution of blood pressure in different societies. Family history of hypertension has a profound effect on the future risk of developing hypertension. The blood pressure of approximately 8150 inhabitants of Isfahan aged above 18 years was measured during 1993-94. Blood pressure measurements were performed according to the standards set by WHO i.e., on two separate occasions, in the sitting position, and from both arms. A questionnaire was completed consisting of 26 questions, including questions regarding history of hypertension in first and second-degree relatives. Cases with a blood pressure of 140/90 mmHg or more, were referred to the Cardiovascular Research Center of Isfahan for further evaluation. Mean systolic and diastolic blood pressure was higher in cases with a positive family history of hypertension. In this study, 37.4% of the men with hypertension and 45.4% of hypertensive women had positive history of hypertension in first-degree relatives. The association between positive family history and hypertension was not significant in men (P=0.62), but it was significant in women (P=0.000). This difference was less pronounced in the older age groups, which could be explained by the illiteracy of most of the older cases and their ignorance of the existence of hypertension in family members. After correcting for the effects of confounding factors, it appears that positive family history has a stronger association with the development of hypertension in women. Moreover, positive family history is a strong prognostic factor in the likelihood of hypertension in the children of affected cases. These findings emphasize the importance of routine blood pressure measurement in children and adolescents.

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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).

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Manifestation of chorea in patients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APA synd.) is not common. Moreover, primary presentation of the disease with chorea is rare and only few such cases are reported in literature in recent years. We report here the case of a 28 year old woman who was first seen at the age of 10 with clinical manifestations of chorea. Later she developed deep vein thrombosis, thrombocytpenia, stroke, cardiac valve involvement and recurrent abortions. Laboratory investigations confirmed the diagnosis of SLE and the presence of antiphospholipid antibodies. We present this patient as a case of SLE and antiphospholipid antibody syndrome with chorea being her primary clinical presentation

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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.

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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.

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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.

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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

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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

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DNA typing is a new method with important applications in forensic medicine. In the present study, we evaluated application of DNA typing in Iran. Loci Hum LPL, Hum Tpox, Hum F13, Hum vw 31A, Hum TH01 and Hum FES/FPS of DNA short tandem repeats were studied. To determine sensitivity of the test, 85 mother-child couples (1020 chromosomes) that were referred to DNA section of legal medicine organization of Iran were included and for determination of it's specificity 42 brother-sister couples (1200 chromosomes) and 58 non-relative couples were examined. The results show lack of mutations in the studied loci and acceptable sensitivity of the test. Of 12 alleles of siblings, there were 2-6 differences, in contrast with 3-9 differences in non-relatives, so the test has 100% specificity in these loci. Considering polymorphism, power of exclusion of these 6 sites was 99%.

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Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.

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This is a mortality study in internal medicine wards of Amir-Alam Hospital, since the beginning of 1374 to end of 1376. Here, we reviewed, prevalence of disease lead to death, the ward and invasive interventions and duration of admission of patients before death. In this study, records of 85 patients were reviewed. 68.2% of patients were men and 31.8% women. Mean of age was 61.6% with minimum of 18 and maximum 95 years. The most prevalent diseases leading to death were cardio vascular (41.2%), cancer 29.4%, GI tract diseases (10.6%), pulmonary diseases (8.3%), CNS (7.1%), hemathologic (4.7%), DM (3.5%). Mean duration of stay in hospital before death was 6.6 days (max 30-min 1). This figure in different wards were: ward 1 (7 days), ward 2 (11 days), ward 3 (5.9 days) ICU (5 days) and CCU (4.7 days). 90.5% of patients died due to their diagnosed illnesses. Invasive tests and intervations were performed in 40% of them. As a whole 35 patient were died in CCU. This research and others like it showes the failures of our patient management system and can guide us in approaching to better medical care.

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In this study we tried to assess the incidence rate of shunt complications and it's association with age, sex, location of shunt, duration of surgery, and so on. For this purpose in a prospective study, 82 cases of hydrocephalus after shunt insertion, during the period of two years (1375-1377) in Shariati hospital were selected and all the complications were evaluated. From the patients, 39 cases were female and 43 were male. The range for age was 15 to 73 years with mean age of 16.67 years (SD=22.77). In 22 cases the complications of shunt surgery were observed. Shunt complications in our patients were infection (8.6 percent) and mechanical failure (17 percent). The mean duration of time for onset of complications was 3.11±4.3 months. The complication rate at the beginning (under two) and the end of life was much higher. In trying to reduce the rate of shunt complications, it is necessary to define and understand the causes of these problems they often arise from multifictorial etiologies.

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Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubation and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, ect. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and Cuffed Pharyngeal Tube (CPT). From the patients, 120 ASA: PS-I cases, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. Their operation were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used for one group and CPT for others. Immediately after operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P<0.001).

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Maxillary sinus atelectasis is a rare and relatively unknown disease. Most patients present with non-sinonasel complaints. Negative intracavitary pressure due to ostial obstruction is suggested as the most probable etiology. Two patients with sinus atelectasis are presented in this paper: Case 1 presented with enophthalmus and maxillary sinus opacity and atelectasis in imaging. Endoscopic uncinectomy and midle antrostomy was done for this patient. Case 2 presented with mid-facial deformity and depression. Caldwel-Luc procedure with inferior meatal antrostomy was done. In 1 year follow up, they were asymptomatic and with no deterioration of facial deformity.

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Introduction: As spinal cholinergic receptors exhibit an action against somatic pain, this effect could be potentiated by intrathecal injection of cholinesterase inhibitor-neostigmine. This study was designed to evaluate the role of interathecal neostigmine on local back pain relief after single level lumbar disc surgery.

Methods and Materials: In an interventional-expremental study (Imam Khomeini Hospital, Jun. 2000 to sep. 2001), sixty-six patient with unilateral herniated lumbr disc at one lumber space were randomely allocated into two groups including, control (C) group and Neostigmine (N) group. Both groups underwent fenestration employing same anesthetic techniques. At the end of surgery 2 ml normal saline in groups C and 100 micrograms neostigmine methylsulfate (0.2 ml combined with 1.8 ml normal saline) in group N were injected intrathecally postoperative local back pain was measured with 10 cm chart method using Visual Analogue Scale (VAS) at 1, 4, 8 and 12 hours. Total dosage of morphine, as an analgesic rescue, used during the first 24 hours following surgery and observed complications were recorded.

Results: Mean VAS score postoperatively at 1st and 4th hours were 2.24 (Standard Error Mean, SEM=0.36) and 1.82 (SEM=0.28) in group N and 5.36 (SEM=0.39) and 5.61 (SEM=0.37) in group C respectively. Mean morphine used in the first 24 hours was 0.9 (SEM=0.4) in group N and 4.7 (SEM=0.65) mg in group C. All result were found to be statistically different in the two group (P<0.05). There was no neurologic deficit or CSF leakage in both groups postoperatively. Regarding nausea and vomiting, the difference between two groups C (15 percent) and N (24.2 percent) were not significant statistically.

Conclusion: In this study, we have found that injection of 100 micrograms hyperbaric neostigmine intrathecally is a safe and effective method with minimal complications or side effect for pain relief and curtails postoperative opiate demand.