Tehran University Medical Journal

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To improve visual disturbance, optic nerve decompression can be performed via transcranial or tran-sphenoidal approaches. Although the surgical exposure in transcranial approach is favourable, yet the optic nerve's presence in the field may make it vulnerable to damage. Of fighty patients with different types of pituitary adenomas, 35 cases with medium-sized (1-3 cm) tumors have been studied in a randomized clinical trial during a three year period, to compare the applicability of these approaches. While short hospital stay with better visual outcome was observed in fifteen trans-sphenoidal cases, in comparison to 20 trans-cranial cases, however the preoperative visual status and underlying disorders were similar in both groups. Decompressing the optic apparatus, trans-sphenoidally, seems beneficial, where there are no contraindications for the procedure in medium-sized pituitary adenomas

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Aim: It is believed that sampling of the lower airways by BAL in complicated patients with pulmonary infection is often contaminated with upper airways microorganisms. The aim of this study was to assess the value of this procedure and probability of contamination of samples by upper airways flora. Methods: In a prospective study 40 consecutive patients which were candidate for broncholaveolar lavage were choosen for the study, and cultures were obtained from oropharyngeal and peripheral pulmonary airways, respectively. Results: Data showed two different groups of patients, distinctive by wether they have normal flora (group one 55% of total) or they have pathogenic microorganisms (group two, 45% of total). Group one had the normal flora in their upper airway tract, while only half of these group showed the same organisms in their lower airway tract, and the rest had negative cultures of the lower airways. The majority of second group had pathogenic microorganisms in their lower airway tract, while only half of them had negative cultures of the upper airways. Conclusion: We assume that the origin of pulmonary infection in our patients is from the peripheral airways. Thus sampling of the lower airways is representative of the actual pathogen, and we recommend that in order to rule out the suspicion of contamination by the upper airway organisms, simultaneous sampling of the upper airways should be obtained. Thus the application of sophisticated sampling methods and their cost effectiveness must be more investigated in view of the efficacy of our simple and inexpensive and practical method

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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.

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This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) and right internal carotid arteries (38.4%). We measured peak systolic and end-diastolic velocities (PSA and EDV) and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio). Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%), accuracy (89.5%) Severe stenosis: Sensitivity (82.1%), accuracy (92.8%) Total occlusion: Sensitivity (93.8%), accuracy (96.5%). There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5%) but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%). EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86%) have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

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Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases.

Materials and Methods: To determine the efficacy of this method in Iran in patient's with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months.

Results: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement.

Conclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.

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Background: Pulmonary involvement is a common and serious complication of rheumatoid arthritis. This cross sectional study sought to determine the prevalence of pulmonary disease in patients with rheumatoid arthritis on the basis of history, physical examination, chest X-ray and PFT.

Materials and Methods: 103 patients (81 Women, 22 Men) fulfilling the ACR (American College of Rheumatology) criteria for RA (Rheumatoid arthritis) were consecutively included in a cross sectional study. Detailed medical (including respiratory symptoms and the disease activity symptoms) and drug and occupational histories and smoking were obtained. All patients underwent a complete pulmonary and rheumatologic examination and conventional chest radiography. All patients underwent PFT that comprised spirometry and body plethysmography.Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height.

Results: On the basis of history: Their mean age was 43.3 ± 2.6 years (range: 17-74) and the mean duration of the disease was 69.3 ± 15.6 months. Rheumatoid factor was positive in% 61.2. No patients were 0.5Pack/Year smoker in whole life. Prevalence of pulmonary involvement based on radiographic and pulmonary function test detected in 41 patients (39/7%). The most frequent respiratory clinical finding was dyspnea (33%), (NYHA grade I in 17.5% and NYHA grade II in 15.5%), Cough (with or without sputum) in 13.6 %, Crackle was the most sign in pulmonary examination (5.8%). Chest X-ray was abnormal in 13.3 % that the most common finding in this study was reticulonodular pattern in 20 patients (19.4 %), and pleural effusion detected in 7 patients (6.7%). PFT was abnormal in 30 patients (29.1 %). A significant decrease of FEF 25%-75% below 1.64 SD. Small airway involvements was the most abnormal finding of PFT. No relation between rheumatoid arthritis disease activity (ESR>30, Morning stiffness>30', Anemia, thrombocytosis) with pulmonary disease was seen.

Conclusion: This study suggests a high prevalence of lung involvement in patients with rheumatoid arthritis.Therefore we recommend a complete investigation in patients with RA with any respiratory symptom.

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Background and Aim: Tuberculous pleural effusion occurs in 30% of patients with tuberculosis (TB). Rapid diagnosis of a tuberculous pleural effusion would greatly facilitate the management of many patients. The purpose of this study was to determine sensitivity, specificity, and predictive values of clinical, laboratory, radiographic findings in patients with tuberculous pleural effusion.

Materials and Methods: The cross sectional study was performed between august 2002 and March 2004 at a referral teaching hospital. Major clinical, laboratory, and radiographic findings were evaluated in 88 cases of pleural effusion, 33 with confirmed TB pleural effusion (TBPE) and 55 with a diagnosis other than TB (NTBPE).

Results: The sensitivity of culture of pleural effusion and tissue were 3% and 9.1% respectively. The mean of adenosine deaminase (ADA) values in TBPE was 36.7 U/L (±18.72), and the mean in the NTBPE was 28.2 U/L (±17.0). Both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were 55%. The sensitivity of PCR was 3% with specificity of 12.7% (positive predictive value, 50% negative predictive value, 70%). Younger age (p<0.024), positive history of exposure to TB patient (p<0.02), and the combination of fever, weight loss and sweating (p<0.01), were associated with tuberculous pleural effusion. There were also significant association between Positive sputum smear (p<0.001), positive sputum culture (p<0.006), positive pleural biopsy (p<0.001), pleural LDH>200 (p<0.005), pleural lymphocytes>50% (p<0.015) and TBPE.

Conclusions: In our region with a high incidence of tuberculosis, the most frequent cause of exudative pleural effusion is tuberculosis. We suggest that the diagnostic planning of pleural effusion should be determined in each region with a view to the adoption of regionally optimized diagnostic and therapeutic facilities.

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Background and Aim: Anxiety is the most common psychological distress in cancer patients. Many studies have been conducted to assess the prevalence of anxiety and depression and the predisposing factors of psychological morbidity in cancr patients. Patients knowledge of disease, their desire for more information, their satisfaction of given information and their attitudes’ towards communication of information about cancer are among issues that have not been well anddressed in assessment of psychological morbidity of cancer patients in Iran.

Materials and Methods: 250 cancer patients of 15-75 age group who were referred to Cancer Institute entered the study. The patients’ knowledge of disease, their desire for more information, their attitude and satisfaction were assessed by Questionnaire n1. patients’ anxiety and depression scores were assessed by Hospital Anxiety and Depression Scale (HADS).

Results: 30 of patients had severe anxiety symptoms and 17% suffered severe depression most patients’ knowledge of disease was “low” (32%) and “intermediate” (54%). There was no significant correlation between knowledge and anxiety and depression. Most patients (69%) believed that the information given by physicians had been “insufficient”. Depression score was significantly higher in this group of patients compared to other patients. Most patients (59%) had a high level of desire for gaining more information and 64% believed that physicians should inform patients of different aspects of disease as much as possible. There was no significant correlation between patients’ desire and attitude and anxiety and depression. Level of satisfaction was “low” in 29% of patients and “intermediate” in 39%. Depression and anxiety scores were significantly higher in patients who were less satisfied with given information.

Conclusion: Low level of knowledge in most cancer patients, their high desire for gaining more information, their dissatisfaction of given information and their positive attitudes towards full disclosure of information about cancer in this study, all indicate that complete and honest disclosure of information to cancer patients by physicians should be improved and encouraged. Although it seems that amount of information given doesn’t influence the psychological morbidity in cancer patients the patients’ satisfaction of given information, which has implications for the quality of patient-physician communication, plays a far more important role in occurance of psychological morbidity in cancer patients. Meanwhile, negative public opinion of cancer and its prognosis greatly influences the physicians functions and the quality of communication process, and also has negative effects on cancer patients’ psychological adjustment.

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Background: Occlusive disease of lower extremity arteries are so common and cause severe stenosis or complete local obstruction in arteries as it need treatment. The treatment could be surgery or interventional procedures like angioplasty or implant of stent. Sometimes such treatments are impossible because of severity or location of complication and cause amputation.The purpose of this study is an assessment about more common locations of arterial obstruction in lower extremities which is necessary for treatment planning and prediction for efficient supplements.

Methods: In this descriptive study from 2000 until 2005, 100 patients with occlusive disease of lower extremity arteries who underwent angiography in medical imaging center of Imam Khomeini hospital in Tehran had been studied according to location of arterial obstructions. In the point of view of homodynamic conditions, obstructions over 70% consider important, so all of these patients had arterial obstruction over 70% up to 100%.

Results: Our findings show that the most common locations of arterial obstruction in lower extremity are superficial femoral artery (47%), arteries of leg (21%) and iliac arteries (19%).

Conclusion: This study can show appropriate assessment of the most common locations of arterial obstruction in lower extremity to predict supplements that may be needed for treatment of these patients.

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Background: Simple bone cyst is a common benign lesion in the proximal humerus, especially in prepubertal children. Up to 75 percent of patients with the bone cyst have a pathologic fracture and the most significant complication is recurrent pathologic fracture. Since the process of spontaneous healing of these fractures is rare, treatment is required. Ideal treatment for simple bone cyst should stabilize pathologic fractures, assist healing and provide a quick return to normal activity with reduced complication and recurrence.
Methods: In this descriptive case series study, 24 patients with simple bone cysts of the humerus were selected for retrograde flexible intramedullary nailing from the lateral cortex of the distal humerus, since 2000 to 2005 at Imam Khomeini Hospital, Tehran. The mean age of the patients was 14.4 years, ranging from 6-39 years. Results were evaluated by plain radiography using the classification system of Capanna et al.
Results: The mean duration of follow up for 23 of the patients was 31 (9-51) months. One patient with short-term of follow-up was excluded. Of these patients, 91.3% were healed either completely (65.2%) or with residual minor defect (26.1%). Only one cyst (4.3%) persisted with no response to treatment and one patient (4.3%) had a recurrence of the cyst. However, there was no instance of recurrent pathologic fracture among these patients.
Conclusion: This study shows that flexible intramedullary nailing is an effective treatment for humeral simple bone cysts that reduces the chance of complication, recurrence of cyst or pathologic fracture. This technique provides sufficient stability for quick return to normal activity.

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Background: Sudden sensorinueural hearing loss (SSNHL) is a baffling condition for patients, and its etiology, audiologic characteristics, prognostic factors, and treatment are still controversial.
Methods: In this prospective study, we performed pure tone audiometry (PTA), impedance acoustics (IA), auditory brainstem responses (ABR), otoacoustic emissions (OAE), and transiently evoked otoacoustic emissions (TEOAE) before beginning treatment for 53 patients with SSNHL. We then entered each patient, randomly and alternately, in one of two treatment groups: oral steroids + acyclovir vs. intravenous urographin.
Results: In 22 (41.5%) of the 53 patients (22 female, 31 male), we found negative or no signal to noise ratio and overall correlation in TEOAE. Furthermore, 26 cases (49%) had positive overall correlations less than 50%, and five cases (4.4%) had overall correlations >50%. Although 15 cases (28.3%) responded well, 20 cases (37.7%) showed only a partial response, and 18 cases (33.9%) had poor or no response to our treatment. The mean value for overall correlation in the three subgroups of patients (no response, partial response, and complete response) was -3.5% (±1/16%), + 11% (±1.99%), and +36.6% (±3.07%) respectively (P = 0.01). From 52 cases, 20 had no reproducible wave in ABR (38.5%), three cases had abnormal ABR with normal OAE, all of which responded completely to treatments. Thirteen cases had abnormal ABR and OAE, none of which responded to treatment, and six cases had normal ABR with abnormal OAE, which often responded to treatment.
Conclusions: ABR and OAE may be useful in the diagnosis of SSNHL and determining the site of such lesions as ischemia or neuropathy. The overall correlation (and S/N ratio) in TEOAE is a valuable prognostic factor in SSNHL.

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Background: Bacillus cereus spores distribute widely in nature and can be isolated from different kinds of foods. This bacterium can produce diarrhea and emetic enterotoxins and syndromes. As infants are known to be more susceptible to B. cereus infection due to their incomplete intestinal flora and fast growth of this bacterium during consumption, it is very important to investigate the presence of B. cereus in infant formula and possible pathogenicity of this microorganism in infants. 

Methods: In this study, 60 samples of infant formula were examined for the presence of B. cereus. From a 1/10 dilution of each sample, a total amount of 1 ml was inoculated onto four phenol red agar plates containing mannitol, egg yolk emulsion and polymyxin B sulfate. The plates were incubated at 30°C for 24 hours. Confirmation tests were then performed on suspected colonies.

Results: Among the 60 samples, 11 samples had more than 10 cfu/g, four of which contained more than 102 cfu/g. The other 49 samples showed less than 10 cfu/g of B. cereus. 

Conclusions: We suggest that for infant formula the maximum microbial limit be reduced to less than 10 cfu/g to control B. cereus contamination and to prevent infection in infants. For this purpose, infant formula should be tested by the method and confirmation tests used in this study. In addition, susceptibility to penicillin, ß-hemolysis and growth rate at 45ºC could also be performed.

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Background: Headache is one of the most common problems that bring patients to doctors' offices. Many physicians order neuroimaging studies after taking the history of the patient and performing a physical examination. These neuroimaging studies are often requested due to the probable existence of an intracranial lesion. However, at times they are requested to allay the fears of patients or even doctors. Most of these studies are normal and the question arises whether there is any indication for requesting neuroimaging studies for a patient with an isolated headache.

Methods: We studied 146 patients with headache who had been referred for CT scan to the imaging center of Imam Khomeini Hospital during 2004-2005. For each patient, a questionnaire, including the medical history and accompanying neurological symptoms, was filled out and CT scan results were gathered.

Results: The mean of age of the patients was 37.8 years, and 69% were female. Only 10 patients (6.8%) had a brain lesion in the CT scan. Accompanying neurological symptoms were more frequent in patients with abnormal rather than normal CT scans. There was a meaningful correlation between abnormal CT scan and paresthesia, ptosis, paresia, diplopia, visual loss, convulsion, vomiting and vertigo. A statistical correlation existed between gender and positive CT scan.

Conclusions: Many patients with headache have normal brain CT scan results. Thus, better criteria are warranted for requesting neuroimaging including accurate patient history and neurological examination in order to prevent unnecessary radiation exposure. MRI instead of CT scan would be a better first step toward the evaluation of the possible existence of brain lesions.

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Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH), cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI) as well as the neurological outcome after a period of three months.

Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS). Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS) and the patients were allocated to "Good" (GOS = 4, 5) and "Poor" (GOS= 1-3) outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.

Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05), whereas low serum magnesium levels during days 4-7 17% of patients) and the second week (22% of patients) after SAH were correlated with poor clinical outcome (p<0.05). No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.

Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

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Background: Acute lung injury (ALI) is a pulmonary pathology occuring in context of infection, trauma, burn, and sepsis. Tissue injury and release of chemical mediators result in tissue damage and organ failure especially respiratory failure. Many therapeutic modalities including vitamin E, allopurinol, and N-acetylcystein (NAC) have been used to decrease levels of inflammatory factors and to control and improve signs and symptoms. The antioxidant feature of NAC induces synthesis of glutathione- the scavenger of free radicals- and increase respiratory drive and PaO₂. In time diagnosis of ALI, prompt institution of treatment will reduce mortality and morbidity in critical illness.
Methods: This open label analytical clinical trial included a total of 50 patients admitted in the ICU ward of Sina University Hospital. They were randomly divided into two groups of 25, the case group received NAC 150mg/kg in 100ml Normal saline within 20 minutes then 50mg/kg in 100ml Normal saline within 4 hr after that 50mg/kg daily for three days. The controls received only normal saline. Oxygenation and ventilation parameters were studied In both groups.
Results: There were no significant difference between the groups in terms of demographic indices, mean SpO₂, ABG values, mortality rates, and clearing of chest x-rays. The best outcome was seen in young traumatic patients.

Conclusion: In this relatively small group of patients presenting with an established ALI/ ARDS subsequent to a variety of underlying disease, intravenous NAC treatment during first four days neither significantly improved systemic oxygenation nor reduced the need for ventilatory support.

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Background: Though many therapeutic modalities have been suggested but still no definite treatment for Cutaneous Leishmaniasis is available. Many compounds including Alkaloid, Quinones, Iridoids, Terpenes, Indole analogue have been documented to have antileishmania activity invitro. On the other hand, the aforementioned compounds can be found in the herbs including Thyme, Yarrow. Propolis is a brown color substance that is collected by honey bee from plants. Regarding the lack of data about the possible efficacy of these herbs against leishmaniasis, we have decided to evaluate and compare the efficacy of herbal extract of Thyme, Yarrow, Propolis and systemic glucantime against cutaneous leishmaniasis in Balb/c, and to formulate drugs without harmful chemical material and without side effect.

Methods: During three weeks of inoculation of parasite in base tail of mice, lesions will appear in the inoculation site. The animals divided into seven groups. We used mix alchoholic extract solution two times a day, checked lesions weekly for six week and measured size of lesion in the base of tail with kulis- vernieh.

Results: We observed significant difference between mean of lesion diameter before and after treatment in control, Yarrow and Thyme groups (p<0.05). Paired t test showed no significant difference between mean of lesion diameter after treatment between treatment and glucantime groups (p>0.05).

Conclusion: Alchoholic extract to Thyme and Yarrow have good effect on lesions treatment, we suggest repeat of this study with Thyme and Yarrow extract in gel or cream base in first stage of lesions appearance.

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Background: Topically applied tranexamic acid has been shown to decrease the amount of blood loss associated with major spinal surgical procedures. The aim of this study was to evaluate the effects of locally applied tranexamic acid in epidural space on post-laminectomy blood loss. Methods: One hundred patients who were scheduled to undergo laminectomy in Imam Khomeini Hospital in Tehran, Iran were enrolled in a clinical trial. Patients were divided into two groups of unilateral one level (n=50) and bilateral two level (n=50) laminectomy according to the extent of surgery. Each group was randomly allocated into two groups of tranexamic acid (n=25) and control (n=25). At the end of the operation, 250mg tranexamic acid, with volume of 5ml or 5ml of normal saline were poured on the site of surgery. The blood volume drained during first and second 24hr, and overall hemorrhage, plus the duration of post operative hospitalization were compared between the two groups. Results: The bleeding volume in the 1st 24hr was significantly less in tranexamic acid than control group (p=0.001). The bleeding volume in the 2nd 24hr was significantly less in tranexamic acid than control group (p=0.001). The hospital stay was less in tranexamic acid compared to control group (2.16±0.37 Vs. 2.96±0.89 days, p=0.001) respectively. Conclusion: Locally applied tranexamic acid in epidural space significantly reduces the amount of the 1st day, 2nd day and overall post-laminectomy blood loss, and duration of hospital stay. MicrosoftInternetExplorer4 Vs. 2.96±0.89 days, p=0.001) respectively.
Conclusion: Locally applied tranexamic acid in epidural space significantly reduces the amount of the 1^st day, 2^nd day and overall post-laminectomy blood loss, and duration of hospital stay.

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Background: Acute gastroenteritis is a major cause of morbidity and mortality among children in developing countries. Rotaviruses are recognized as the most common etiologic factors of gastroenteritis. In this study, we determined the epidemiologic features, clinical symptoms and molecular structure of rotavirus VP4(P) genotypes in children with acute diarrhea in Bahrami Hospital in Tehran Iran, during 2009 for justifying the routine use of rotavirus vaccines in children.

Methods: One hundred fifty fecal samples from 150 children with acute diarrhea in Bahrami Pediatric Hospital in Tehran, Iran were collected from January to December 2009. The patients’ mean age was 20.90+18.19 years (ranging from 1 month to 14 years). Fecal samples were transported on ice to the laboratory of virology department of Pasture Institute of Iran. The demographic and clinical data for each case were entered in an author-devised questionnaire. Group A rotavirus was detected by dsRNA-PAGE. Subsequently, rotavirus genotyping (VP4) was performed by semi-nested multiple RT-PCR and the phylogenetic tree of the Rotavirus nucleotides was constructed. The data were analyzed by statistical tests including Wilcoxon signed and Mann-Whitney U.

Results: Rotavirus was isolated in 19.3% of the samples, more than 90% of which had long RNA patterns. The predominant genotype (VP4) was P[8] (86%) and other genotypes respectively were P[6] (6.9%) and P[4] (6.9%).

Conclusion: A high prevalence of the P[8] genotype was found to be the cause of acute diarrhea. The analysis of P[8] genotype sequence showed a high level of similarity of the virus in this study with those of other Asian countries.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. The objective of this study was to develop and evaluate a rapid and new method to clinically identify relevant Nocardia species. Rapid and accurate diagnosis of Nocardia species is essential for the treatment of severe infections and prevention of cerebral abscess.
Methods:  One hundred and eighty patients, 103 (57.22%) male and 77 (42.78%) female, with severe symptomatic pulmonary infection were studied in the course of a 12-month period in Dr. Shariati Teaching Hospital affiliated to Tehran University of Medical Sciences in 2010. The specimens were cultured and identified using microbiological and biochemical tests. Polymerase chain reaction (PCR) was used to directly identify the organism in the broncoalveolar lavage samples collected from the patients. NG1 and NG2 primers were used to amplify a Nocardia genus-specific 598-bp fragment of 16S rRNA.
Results:  Nineteen samples (10.56%) were positive with PCR and 5 samples (2.78%) with conventional methods. All samples with positive cultures were also positive by PCR.
Conclusion: The results of this study showed that PCR has a high sensitivity and accuracy for the detection of Nocardia compared with culture and biochemical tests. Considering the rapidity, precision, high sensitivity and specificity of molecular techniques, use of these techniques is suggested in conjunction with conventional methods for the detection of Nocardia phenotypes in clinical laboratories and research centers.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain.
Methods : This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery.
Results : The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m². The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001).
Conclusion: It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment.