Tehran University Medical Journal

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Within the past few years, neat scheme has been overturned by the discovery that RNA can act as an enzyme. What does the starting finding of RNA enzymes imply? Thre first implication is that one can no longer assume a protein lies behind every catalytic activity of the cell. It now appears that several of the operations that tailor an RAN molecule into its final form are at least in part catalyzed by RNA. The finding that RNA can be a catalyst as well as an informational molecule suggests that when life originated, RNA may have functioned without DNA or proteins.

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This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70). Ultimately, these datas have been compared with those in the reputable books and new medical papers And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males And also their most common chief complaints are neurological manifestations, and headache (82%) is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%), excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass) was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

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Nelson's syndrome is usually characterized by hyperpigmentation, elevated level of ACTH, and pituitary adenoma, which is frequently available as macroadenoma. It is usually occurred in the patients suffering from Cushing's syndrome. Growth of tumor has been revealed in 10-30% of the patients following adrenalectomy. Tumors are often benign in Nelson's syndrome. The selected treatment of Nelson's syndrome are transsphenoidal or transfrontal microsurgery. The role of radiation as prophylactic effect in the patients following adrenalectomy is unknown. In this research Nelson's syndrome have been studied on the patients records who have been hospitalized in Dr.Shariati hospital during the last 10 years. The achieved results show that, among the 49 patients suffering from Cushing syndrome who have referred after operation, 11 patients (22.4%) of them have been affected with Nelson's syndrome. The syndromes have been appeared after 3-9 months and with regard to occurrence of Nelson's syndrome in some patients immediately after bilateral adrenalectomy, it is recommended that selecting of the patients for bilateral adrenalectomy should be studied accurately

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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%.

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Some of the endocrinologic diseases, especially Acromegaly, Cushing and Pheochromocytoma have multiple effects on blood glucose metabolism and regulation in non-diabetic patients. In this retrospective survey, records of patients of Tehran Medical Sciences University hospitals have been reviewd. Of 124 Acromegals, GTT was performed for 51 patients, being impaired in 18%. To evaluate diabetes, FBS and BS of 90 patients were checked, overt diabetes was detected in 27%. Among 90 Cushing patients, blood glucose was checked in 60 cases, 47% of these patients had levels above the normal range, and 39% had glucosuria. Among 80 Pheochromocytoma patients, 16 cases (26.5%) had overt diabetes. In comparison with other studied, we have obtained a little different results concerning diabetes and impaired GTT prevalence

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Pheochromocytoma is a rare disease. A retrospective study of the signs and clinical course of this disorder was performed by evaluating medical records. Our fidings indicate that the prevalence of pheochromocytoma was equal in men and women, and most patients (56%) were in their second and third decades of life. In 10% of the cases, the disease was bilateral, and in 13% it was outside the adrenal (totally para-aortic). The tumor was more common on the right side (8%), and 3.5% were familial. Almost all cases had a history of hypertension and hypertensive crises. Attack-like episodes of clinical symptoms and signs and hypertension were observed in 98%, headache in 71% and profuse perspiration in 68% of the cases. An abdominal mass was palapated in 13% of the cases, 26% had overt diabetes, 23% had ECG changes. Malignancy was observed in 4%, with metastases to the liver (n=2) lung (n=1) and spine (n=1). In the latter four cases, the metastic lesion was histologically proven to be pheochromocytoma. In three of the 28 female cases, the first hypertensive crisis occurred during pregnancy causing abortion in one case.

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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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The major Lipoprotein classes are heterogenous. Human serum High-Density-Lipoproteins (HDL) are separated into two major subfractions (HDL2, d=1.063-1.125 g/ml, HDL3, d=1.125-1.210 g/ml) by a simple double precipitation method. There was a strong inverse relation between HDL-Cholesterol (HDL-C) and subfractions HDL2-C and HDL3-C with atherosclerosis. This study demonstrated that HDL-C (P<0.001) and both HDL2-C (P<0.001) and HDL3-C (P<0.01) levels are significantly lower (HDL-C=-35%, HDL2-C=-52%, and HDL3-C=-26%) in the atherosclerosis patients (Coronary-Heart-Disease) than normal subjects. This data supports the proposal that the latter surfation is the major contributor to the anti atherogenic role of serum HDL-C, HDL2-C and HDL3-C.

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Organochlorine pesticides are a group of persistant compounds which have been used for a long time. Due to their stability, some of them such as DDT, BHC and their derivatives are still used in the areas with malaria epidemic condition, hence the chance of food contamination always exists. The present survey demonstrated that human milk is one of the best indicator substances in monitoring the environment and human body contamination by organochlorine compounds. We studied the level of residues in the milk of nursing mothers who could be exposed to these compounds through food chain in their contaminated environment. In this investigation, we collected 40 samples from the nursing mothers of two hospitals located in the north and south of Tehran. Detection was carried out by Gas chromatography (GC) with 3% OV17 column and Ni63 ECD (Electron Capture Detector). Reference substances were obtained from WHO. Results are discussed in the text.

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A case-control study was performed by the Research Center of Isfahan University, to determine the predisposing factors of early atherosclerosis. Children of cases admitted to a university hospital in Isfahan with early myocardial infarction (MI) were considered for the study. The affeckted cases (n=116), had 120 children aged 2-14 years. The control group were selected from children of the neighbors of the cases. The two groups were similar in age of parents, children and socio-economic status. Mean cholesterol and triglyceride levels and the frequency of hypercholesterolemia and hypertriglyceridemia were significantly higher in the children of MI cases. The mean lipid concentration of the controls was significantly higher than standard levels. These results emphasize the importance of evaluating children of high risk cases for risk factors of MI.

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The function of Helicobacter pylori (H.pylori) is confirmed as one of the factors which motivates gastric and duodenal ulcer and gastritis. Various methods are used to diagnose the infection. Serological tests are the easiest and most harmless for the patients. Probably, H.pylori strains in Iran are different from the strains in other countries. Hence, it seems neccessary to design a specific serological test to recognize and identify different strains of bacterial antigenic proteins of Iranian patients.
Since the most manifest and specific to these bacterial antigens are the "Outer Membrane Protein" (OMP), therefore, the first necessary step is to separate and purify H.pylori OMP and then to identify antigenic proteins.
In this study, we received bacteria colony that belonged to 15 patients with gastric or duodenal ulcer, which had been growed in blood agar or brucella broth. After processing such as washing, freezing and defreezing, sonicating, centrifugation with high speed (10,000 g) and treatment with sarcosyl, the sarcosyl insoluble fraction was extracted. Sodium Dodecyl Sulfate - Poly Acrylamide Gel Electrophoresis (SDS-PAGE) was preformed. From all 15 OMP specimens, we isolated protein bands.
The first two bands with higher MW, were major bands and the two lighter bands were the minor bands. Approximate MW of these 4 proteins are equal to 67000, 61000, 30000 and 17000 dalton

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Disodium hemiphthalate Glycyrrhetinic acid (DHGA) possesses anti-inflammatory and analgestic activities. In our research, this agent was injected intraperitoneally to mice, according to the following schedule.
1) 25 mg/kg, 50mg/kg & 75mg/kg at 7th day of pregnancy.
2) 50 mg/kg & 75mg/kg at 8th day of pregnancy.
3) 50mg/kg & 75mg/kg at 9th day of pregnancy.
DHGA with doses of 50mg/kg and 75mg/kg at 7th, 8th and 9th day, delays the growth, decreases developing of ossification centers (specially in hand and foot middle phalanxes), decreases the number of caudal vertebrae of sacro-illiac joint and results in slight but important increases in fetus mortality.
Abbreviations
H & E=Haematoxylin & Eosin
CRL=Crown-Rump Length
BPD=Biparietal Diameter
W=Weight
ETS=Embryo Toxicity Score

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Cesarean section (CS) is a relatively safe procedure, performed for different maiernal and fetal indications. Despite complications of general anesthesia, post-operative infections, and thromboembolic events, CS is being performed with increasing frequency. In this study, we have examined the indications and complications of CS's performed in Arash Hospital from December 1993 to November 1994. Of the total 3480 cases of chiidbrilh, 900 (24.45%) were performed by CS, most and last frequently in December/January and November/December respectively. However, Ute ratio of CS cases to all cases was equal throughout the year. The most common indication of CS was failure to progress in labor (38.54%), and the other causes were repeat CS (21.77%), meconium excretion (11.97%), malpresenlation (8.55%) and fetal distress (5.58%). The indication of CS varies with meternal age. Between 41-45 years, the most common indications were prior CS (42.5%), and request for concommitant tubal ligation (12.5%), whereas in the younger age groups, the most common indication was failure to progress in labor. In primiparous cases, 44.55% of the CS's were performed due to failure to progress in labor, while the latter was the indication of CS in only 14.5% of the multiparous women. Complications were observed in only 4.54% of CS cases

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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.

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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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Variation of recurred branch of median nerve in relation to the median and flexor retinaculum are significant for both hand surgeons and specialists always. In this study, 64 cadaver hands (32 men) have been dissected. The median nerve was identified at the proximal edge of the flexor retinaculum, and in order to expose carpal tunnel the ligament was divided, and the above subjects were studied. The results are: 1) The relation of recurrent nerve to the flexor retinaculum was classified into 4 types: A) In (53.1%) of subjects, this branch arises from the median after the flexor retinaculum. B) In (31.3%) of subjects, it arises from the median in the carpal tunnel and the moves around the lower edge of flexor retinaculum and enters the thenar region. C) In (14.1%) of subjects, it arises from the median in the carpal tunnel and pierces the flexor retinaculum. D) In (1.56%) of subjects it arises, in the carpal tunnel and it divides into two subbranches here. One follows pattern A and the other pattern C. 2) In this step, the relation of the recurrent branch to the median nerve was studied. The results show that inspite of this image even though most often the recurrent branch arises from the lateral side of median, in (68.75%) of subjects it arises from it's anterior surface. The MC Nemar test reveals that there is no relation between manifestation of mentioned patterns with right or left hands.

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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.

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Oxidation of low density lipoproteins (LDLs) is belived to be an important step in the pathogenesis of atherosclerosis. During oxidation, LDL particle undergoes a large number of structural changes that alters its biological properties, so it becomes atherogenic. To study atherogenic proteins, usually two forms of modified LDLs, including Cu2+-oxidized LDL (ox-LDL) and malondialdehyde (MDA) modified LDL (mal-LDL) are used. In this study, LDL was isolated from 72 ml freshly prepared plasma by sequential Floatation Ultracentrifugation (SFU), which resulted in separation of 12.5 mg LDL protein. LDL oxidation was accomplished in Phosphate Buffered Saline (PBS) with 2µM cupric sulfate, and mal-LDL was prepared by incubating LDL in PBS with 0.5 M solution of freshly prepared MDA. These modifications were evaluated by measuring optical density at 234 nm, Thiobarbitoric Acid Reactive Substances (TBARS), and electrophoretic mobility at pH 8.6. The increase of 234 nm absorption reflected initiation of LDL oxidation. TBARS of ox-LDL and mal-LDL was 80 Nm MAD/mg LDL protein and 400 nm MDA/mg LDL protein, respectively. Electrophoretic mobility of ox-LDL and mal-LDL, in respect to native LDL (n-LDL), were increased.

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Introduction: The regulation of neuroendocrine axis is one of the most important goals in the treatment of Rheumatoid Arthritis. Disease modifying drugs such as chloroquine with low dose steroid is the first choice in clinical practice by some physicians. This combination therapy is evaluated by this study. Methods: This survey is a prospective study on furty patients. Variables for determining the activity index of disease were joint tenderness, joint swelling, morning stiffness and erythrocytes sedimentation rate in two years follow up. Results: Decrementation of disease activity index was statistically significant before and after treatment, joint tenderness (X²=7.205, P=0.007), morning stiffness (X²=19.253, P=0.00001), joint swelling (X²=14.107, P=0.0001), ESR (T=2.428, P=0.02). Conclusion: The combination of chloroquine with low dose steroid is beneficial in the treatment of Rheumatoid arthritis

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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