Tehran University Medical Journal

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Three hundred and seventy seven patients with different degrees of heat stroke were treated by the haji medical team of the Islamic Republic of Iran in 1371 (1992). Studies were carried out on sex of the patients, time and intensity of occurance and the vital signs after a medical examination. The most important method of treatment employed for intense heat stroke was iced bath. This procedure leads to 64.5% of patients being treated in te specific heat stroke unit and 35% were sent to a general hospital ward for furthur treatment. Morbidity and mortality were seen in less than 0.5% of the patients.

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To evaluate the tolerance and effectiveness of conjugated Estrogen for women with established post-menopausal Osteoporosis and hot flushes, with the use of paired comparison, randomized, we tested during an 10 month period the bone mineral contents and plasma glucose in subjects who afforded by premarin in dosages of 0.625 mg for days 1 to 25 and oral medroxy progesterone acetate for days 15 to 25 of a 29 days cycle. All subjects received supplementation to ensure a minimum of 800 mg calcium per day. 25 subjects completed at least 10 month follow up serum calcium, phosphate, glucose and urinary calcium and phosphatae measurements by colorimetric, method. We compared women with herselves, the median change in biochemical studies showed significant decrease in serum calcium, phosphate an urinary excrition of calcium, but significant increase in urinary excrition of phosphate. Fasting plasma glucose did not change significantly. Decrease serum calcium (9.6 compared with 9.16 P<0.005) decrease, serum phosphate (3.77 compared with 3.39 P<0.005), decrease uri calcium (149.81 compared with 121.46, P<0.005), increase uri phosphate (625.83 compared with 676, P<0.005), FBS (92.03 compared with 91.45, 0.1>P>0.05). Regarding the effects of conjugated Estrogen on plasma and urinary calcium and phosphate levels and amelioration of clinical symptoms, we concluded that conjugated Estrogen treatment in effective in post-menopausal Osteoporosis, but we did not find relation between exogenous Estrogen in post-menopausal women with FBS and hot flush

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Serum copper, zinc and the cu/zn ratio were measured in 55 patients with breast disease (20 with benign breast disease and 35 patients with breast cancer) and 30 healthy subjects. The mean serum copper levels were higher in breast cancer than in benign breast diseases (127.5 µg/dl versus 92.4 µg/dl) (P<0.0005) and controls (127.5 µg/dl versus 75.6 µg/dl) (P<0.0005). Patients with advanced breast cancer had higher serum copper levels than did patients with early breast cancer (163 µg/dl versus 103.9 µg/dl) (P<0.0005). Patients with advanced breast cancer had lower serum zinc levels than did patients with benign breast disease (68.9 µg/dl versus 135.9 µg/dl) (P<0.0005) and controls (68.9 µg/dl versus 129.9 µg/dl) (P<0.0005) but no significant difference have seen between serum zinc levels of early and advanced breast cancer patients (68.9 µg/dl versus 72.9 µg/dl) (P<0.05). Serum zinc levels were not decreased in patients with benign breast disease

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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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To evaluate the effectiveness of conjugated estrogen (Premarin) and progesterone in twenty-one postmenopausal women who had been menopause one year, we tested during a 6-month period the serum lipoprotein levels in subjects who offered by premarin in dosage of 0.625 milligram for days 1 to 25 and oral medroxy progestrone acetste for days 15 to 25 of a 30-day cycle. Twenty-one subjects completed at least 6-month follow-up serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerid (TG) measurements by calorimetric method. The results, six months after treatment, is compared to before treatment. The median change in biochemical studies showed significant decrease in serum total cholesterol (248.85 compared with 229.4, P<0.001) serum LDL-cholesterol (155.7 compared with 130.6, P<0.05), but significant increase in serum HDL-cholesterol (53.46 compared with 61.46, P<0.05) TG and VLDL levels did not occur. We concluded that conjugated estrogen is effective on serum total cholesterol, LDL and HLDL cholesterol in postmenopausal women

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Superficial mycosis of the skin is one of the most prevalent human infections. Within these infections, tinea pedis and tinea cruris have been studied. Different aetiologic causes play role in these infections which the most important of them are Trichophyton rubrum, Trichophyton Mentagrophyte and Epidermophyton floccosum. Prevalence arrangement of these causes are defferent in societies. This study is a case series study which in the course of this period 42 affected patients 0 tinea pedis and 40 affected patients to tinea cruris have been studied. From patients with doubtfull clinical lesion, whom have reffered to Razi Hospital within the first six months of the year 77, smear and culture were provided and in the meanwhile for consideration of possible association of Dermatophytoses in these two location in cases of clinical doubt to tinea pedis among the affected patients to tinea cruris, smear and culture wase made and it wase observed that 40 of affected patients to tinea cruris, 4 patients simultaneously have tinea pedis (10%). In this study also, risk factors of tinea pedis and tinea cruris have been studied. Etiologic causes in tinea pedis in this study with respect to arrangment are: T.Ment, T.rubrum and then Epid.floccosum and the causes of thinea cruris with respect to arrangment are: Epid.floccosum, T.rubrum and then T.Ment. In this study foot and groin Etiologic factors have been considered, it was observed that the pattern of their etiologic causes in Iran with respect to other countries are different.

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Many studies have shown the clinical importance of CD7 expression in AML patients. To evaluate the clinical importance and response to chemotherapy in CD7 positive AML, this study was conducted. From the patients, 76 cases were studied during 3 years. In 3 years of this study 70.5 percent of CD7 positive and 89.6 percent of CD7 negative patients achieved complete remission with no significant difference between these two groups (P=0.11). We concluded that despite no importance of expression of this antigen in our patients, prevalence of CD7 positive cases in our study in higher than similar studies done abroad (52.6 percent versus 30 percent). It seems in respect of small number of our patients for evaluation of clinical and laboratory properties, larger study is needed.

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This study is carried out to determine effective risk factors for early death and their causes in those who died due to intra cerebral hemorrhage within 30 days.
Materials and Methods: From patients who have been admitted in Neurologic ward of Imam Khomeini hospital in Tabriz, We enrolled 100 patients with intra cerebral hemorrhage and the causes and risk factors effective in early death were evaluated among these patients by age, sex, blood pressure, level of consciousness, location of hematoma, CT findings and other risk factors.
Results: We enrolled 100 patients who died due to intra cerebral Hemorrhage among 358 patients with I.C.H, 62 male and 38 female, with mean age of 60.8. The time course of hospitalization was 4.5 days. The most important risk factor was hypertension on 90 percent of patients, previous C.V.A on 28 percent other risk time of admission in 66 percent of patients with G.C.S under 8.
Conclusion: Hypertension was the most common and important risk factors and male gender and age were the second risk factors for early death with intra cerebral hemorrhage.

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Backgroud: Measles, as one of the most contagious diseases, because of the risks of mortality, mental and physical disabilities which may afflict on the patients, has always been so important to the scientists and researchers. With respect to burden of diseases, numerous measures have been taken to control and eliminate measles. In our country, vaccination is considered as the most important strategy to control the measles, however, the surveillance on the patients is on the second place. Screening (Active & passive), prompt and appropriate control of measles in high risk areas can help to control the disease.

Materials and Methods: There are 1375283 people with a variety of demographic traits who live in southern Tehran. Southern Tehran covering 10th, 11th, 16th, 17th, 19th divisions of Tehran municipality consists of high risk areas. Because of too many immigrants, overcrowded areas, malnutrition and poverty, the south of Tehran is considered as one of high risk areas, predisposed to measles epidemics. So in 1999, a cross-sectional study was done.

Results: On 230 subjects suspected to be measles in south of Tehran, 147 subjects were diagnosed as measles by para clinic evidence, 121 subjects of which were men. Most of these were of the age 20 to 24 years old who lived in the eleventh part of Tehran municipality area. The majority of patients were found among soldiers who lived in dormitories in Horr garrison and military training college located on the above-mentioned area. Unfortunately, most of them did not have reliable history of vaccination. Most of these patients had been in close contact with the colleagues who were measled (61.2 percent). The rate of measles incidence during winter soars at most.

Conclusion: The most important factor to be researched is that, the age of these patients differs much from what is expected, due to unknown reason.

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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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Unstable angina (UA) is situated in a spectrum with myocardial infarction (MI) at one end of it and stable angina at the other end. To determine the clinical and paraclinical characteristics of unstable angina this study was designed.
Materials and Methods: Two hundred patients with definite UA who were hospitalized at cardiac care units (CCU) in Yazd were enrolled in this cross- sectional study. Clinical and para-clinical characteristics including class of severity of angina, clinical circumstances, drugs, risk factors, changes in ECG, and patient's condition at the time of leaving hospital were evaluated.
Results& Conclusions: The average of age of patients was 61.85 years and 57% of them were female and 43% were male. The most prevalent risk factor among men was smoking (48.8%) and among women was hypertension (62.8%). According to Braunwald suggestion, patients were divided into 3 classes based on the severity of their diseases. Frequency distribution of patients in classes I,H and III were 24.5%, 4% and 71.5%, respectively. Normal ECG, was observed in 24.5% of subjects at the time of hospitalization and in 67% of patients when leaving hospitals. Frequency distribution based on the risk stratification was 22.5%, 58.5% and 19% in the low, medium and high risk groups, respectively. During hospitalization, acute myocardial infarction (AMI) was seen in 3.5% of individuals that majority of them belonged to class III of angina.

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The main purpose of this study was to evaluate the prevalence of overweight and obesity among guidance-and high school students and its relation to modifiable environmental factors.
Materials and Methods: The subjects have been 1000 girls and 1000 boys aged between 11-18 years, selected by multi-stage random sampling, their parents (2000 subjects) and their school staffs (500 subjects) in urban and rural areas of two provinces in Iran. Data have been analyzed by SPSSV10/ Win software.
Results: The prevalence of 85th < BMI<95th percentile and BMI>95th percentile in girls was significantly higher than boys (10.67±1.1%, 2.9±0.1% VS. 7.37±0.9%, 1.87±0.1% respectively, p<0.05). The mean BMI value was significantly different between urban and rural area (25.38±5.2 VS. 23.25±7.1, P< 0.05). BMI > 85th percentile was more prevalent in those with lower educated mothers (9.2+2.1 vs. 11.5+2.4 years of mothers education respectively). The mean of the total energy intake was not different between overweight or obese and normal- weight subjects (1825±90Kcal VS. 1815±85Kcal, P>0.05) but the percent of energy derived from carbohydrates was significantly higher in former than the latter (69.4% VS. 63.2%, P<0.05). Regular out-school sport activities were significantly lower and the time spent on television watching was significantly higher in overweight or obese than non-obese subjects (300±20 VS. 240±30 minutes/day, P<0.05). Significant linear association was shown between the consumption frequency of rice, bread, pasta, fast foods and fat/salty snack and BMI (p=0.05-0.06, p<0.05). A significant correlation was shown between BMI percentiles with serum triglyceride, high density lipoprotein-cholesterol and systolic blood pressure (Pearson r=0.38,-0.32 and 0.47 respectively).

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Rhinocerebral mucormycosis is a rapidly progressive fungal infection that spreads from nose and sinuses to brain in short time. Cunent hypothesis about brain involvement explains that infection initiates in nose and progresses into orbit through ethmoidat sinuses via erosion of lamina papyranea. Then infection spreads from orbit apex to cavernous sinus and brain. Therefore, in addition to medical therapy surgical debridement of the sinuses plays a major role in treatment of these patients. The aim of this study is introduction of a new point of view about extension of mucor from the nose to orbit and brain. Also we discuss clinical implication of this perspective on surgery.
Materials and Methods: Since 1997-2002 nine patients with mucormycosis involving nose. Sinuses and orbit were admitted in ENT ward of Imam Khomeini general hospital. 8 patients with positive pathology entered the study. Variable such as age, underlying diseases, symptoms, site of involvement, extent of debridement and its times, and outcome were studied.
Results: After review of the history, surgical reports and pathological results, we found these findings in almost all patients: 1) facial pain, facial anesthesia, paralysis of buccal branch of facial nerve, paralysis of extrocular muscles, chemosis, periorbital edema 2) involvement of cheek subcutaneous tissue, buccal fat pad, IOF, SOF, orbital apex, infraorbital and maxillary nerves 3) involvement of pterygoid fossa with or without infratemporal fossa extension. Three patients have survived. Causes of death in other five patients were pneumonia, hypokalemia, and arrythmis during anesthesia. Mucormycosis was under control in most of these patients.
Conclusion: Pterygopalatine fossa is the main source for replication and extension of mucor. After entrance to the nose, mucor reaches this site and after involvement of IOF and SOF rapidly extends to retrobulbar portion of the orbit. Paranasal sinuses, buccal space, cheek, palate and infratemporal fossa may be secondarily involved. Exploration and debridment of this area has beneficial effect on surviving of these patients.

 

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Kimura's disease (K.D) is an uncommon, benign, chronic inflammatory condition of unknown etiology and pathogenesis involving subcutaneous tissue presenting as a tumor like lesion with a predilection for the head and neck region. If parotid gland is affected clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnosis before tissue biopsy and fine middle aspiration (FNA) has only limited value. There is no evidence of malignant transformation and occasional spontaneous resolution occurs. Various treatment modalities have been suggested in the management of this condition but none is proved best and recurrence is common. we describe a 33 - year- old man with KD who presented with left parotid mass.

 

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Background: All the patients with Angina pectoris have not stenotic coronary artery. Syndrome x consists of patients with Angina pectoris and positive Exercise test along with normal coronary angiography. Syndrome x includes 25-30 percent of those who undergo diagnostic coronary arteriography at the different centers. In our study it was attempted to know the prevalence and characteristics of this special group in Afshar cath-lab.

Materials and Methods: In a prospective cross sectional descriptive study 200 patients who were admitted for coronary angiography evaluated in terms of Risk factors: HTN, Family history Hyperlipidemia, DM, Cigarette smoking , clinical symptoms , response to TNG, different symptoms, ECG and Exercise test. data in two subgroups with normal and abnormal Coronary angioghraphy were compared. Six patients were excluded because of ambiguous Coronary angiography.

Results: Among 194 patients 51 patients (26.3% )had normal coronary artery. 38.9% of female and 21.4% of males showed normal coronary angioghraphy (P = 0.013). The prevalence of risk factors among those with syndrome x and abnormal coronary Artery were as follow. HTN 37% vs 42% , Hyperlipidemia 50% vs 51% , smoking 25% vs 37% , DM 12% vs 28% , obesity 45% vs 47% Positive family history for CAD = 21.5% vs 47% respectively. Angina relieved suitably with TNG in 24% of those with syndrome x compared to 76% suitable response in those with abnormal coronary arteries.(P Value = 0.49 ). Regarding to functional class , 87% of patients with normal coronary artery belonged to class I and II. also 26% had atypical pain 50% had normal rest ECG and 51% achieved stage III or IV of Bruce protocol during Exercise test.

Conclusion: Syndrome x was more prevalent among women ,also angina was less typical and less responsive to TNG. Most patients had not positive familial history for CAD. normal ECG was more prevalent among those with syndrome x .

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Sphenochoanal poyp is rare nasal mass that originates from sphenoid sinus. In anterior rhinoscopy it may be mistaken with antrochoanal polyp. CT of paranasal sinuses and nasal endoscopy has increased diagnostic accuracy. Simple polypectomy without removal of intra sinus mass is associated with increased risk of recurrence. ‏Treatment of sphenochoanal polyp must include removal of intrasphenoid part via enlargement of the sphenoid sinus ostium. At present time the choice of the surgical approach for sphenochoanal polyp is endoscopic sinus surgery. We introduce a case of sphenochoanal polyp and review its clinical, radiologic and pathologic findings and insist on endoscopic sinus surgery as a safe, effective treatment for it.

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Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.

Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4(group III) as case groups and, 105 patients with 1.1 60 years (P = 0.02). 238 patients were in group I (25.1 %), 625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P  0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P  0.00). Both hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.

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Background: Adolescence (10-19 years) is one of the most challenging periods in human development. A second period of rapid growth occurs during the teen years. Not much information is available on the effect of the socio-economic status on the outcome of nutrition education in teenage girls. Objective : The purpose of this study was to determine the effect of socio- economic status on the efficacy of nutrition education in promoting the nutritional knowledge, attitude and practice in first-grade guidance school girls in Tehran.

Material & Methods: A total of 300 students were selected from 11 guidance schools by simple sampling and divided into three groups: 1- guide-book, 2- group discussion, 3- control. The knowledge and attitude data were collected using pre-test and post-test questionnaires and the personal-socioeconomic data were collected using general questionnaires. The students in group 1 were given the guide-book and required to study it at home, while group 2 students were told to discuss among themselves the contents of the guide-book. The control group was given nothing to study or to do.

Results: Nutrition education did not have a significant effect on the increase in the attitude score in the students whose grade-point average and their mother’s education level were high. (p= 0.13, p=0.29). Only mother’s education level independently from the type of education was associated with the difference of knowledge score means (p =0.07).There was interaction between nutritional education and monthly pocket- money with regard to the increase in the knowledge score (p =0.03).

Conclusion: Overall, exception of monthly pocket money, the effect of education on the nutritional knowledge and attitude was independent from other variables. Only mother’s education associate with the difference of knowledge score means.

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Background and Aim: Prevalence of malnutrition is high in under-5 years old children and mother’s nutritional knowledge, attitude, practice(KAP) is associated to nutritional status of children and lack of nutritional knowledge and their poor practices can be considered of prominent causes of children malnutrition. This study carried out to assess the nutritional knowledge, attitude and practice of mothers.

Materials and Methods: In this study a group of 632 mothers who had at least one child aged 6-36 month old referred to Kerman health centers were selected to evaluate their nutritional KAP. The data were collected using questionnaires and face-to-face interviews with the mothers and from children health care records. The KAP questionnaires were completed and scores were rated as: optimum, relatively optimum and poor for subjects that achieved 80% – 100%, 60% – 80% and < 60% of high scores respectively.

Results: The findings of this study indicated that 40/2%, 73/6% and 26/9% of mothers had respectively optimum knowledge, attitude and practice. A statistically significant association was found between mother education and maternal nutritional knowledge, attitude and practice. And family income had a statistically significant association with knowledge and not with practice and attitude. There was no association between mother age and knowledge, attitude, practice. And was found a significant positive association between knowledge, attitude, practice.

Conclusion: Education of mothers concerning nutritional requirements of children make them possible to benefit a proper nutritional program.

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Background: The aim of this study was to determine the effect of two different regimes, containing different carbohydrate to protein ratios on performance, serum glucose and insulin after exercise in soccer players in Tehran Iran.

Methods: Nineteen male soccer players under training [age = 17/5 +/- 1.5 (SE) yr] were selected and completed two sequential trials separated by 1 week, in a paired cross-over study design. In each trial, subjects after running to fatigue received one of three regimes, using a random- order design as follows: HPRO ( CHO 56%, PRO 19% & fat 25% of total energy) HCHO ( CHO 64%, PRO 11% & fat 25% of total energy) or control ( CHO 60%, PRO 15% & fat 25% of total energy). The calorie of 3 regimes were equal. After consumption of meal up to120 min, blood was obtained before and at intervals. After 3 hours athlete performance was measured.

Results: The study indicates no significant difference in the serum insulin and glucose response among three regimes (P > 0.05). There was no difference in performance between three regimes after 3 h (p > 0.05).

Conclusion: The results suggest that post exercise regimes have no influence on performance, serum glucose and serum insulin. Thus total energy content and carbohydrate content may be important in recovery after exercise.