Tehran University Medical Journal

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Alpha-interferon therapy has been approved for treatment of chronic hepatitis C and B. Candidates for treatment are patients with well-compensated liver disease and histologic evidences of chronic hepatitis who have demonstrated abnormal aminotransferase levels for more than 6 months. From 30 patients with chronic hepatitis with diseases prolonged more than 6 months, we selected only 16 patients with necessary criteria for interferon therapy (10 patients with chronic HBV and with evidence of viral replication, and 6 patients with chronic HCV). Dose of interferon used for hepatitis B was 5mu TIW for 16 weeks and for hepatitis C was 3mu TIW for 24 weeks. At the end of treatment, HbeAg was eliminated from 3 patients. From 10 patients chosen, from none of them the HBsAg was not eliminated at the end of 4 months treatment. In comparison with 10% elimination of HBsAg in treated groups that have been reported in other countries, our results demonstrated that interferon therapy is less effective in Asian patients in comparison with western patients.

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The routine intake of surfactant as a part of HMD (Hyaline Membrane Disease) treatment had significant effect on the prognosis of premature neonates. But since in our country this drug is not widely and routinely used, and there are not records about its use, we decided to make good on this shortcoming through a retrospective study. During 1 year, 54 neonates with HMD were admitted in Ali-Asghar's NICU, 30 of them had gestational age of less than 34 weeks and for 15 cases, surfactant was used. The results of treating this group were then compared with another group of neonates, who were not given this drug. From a statistical point of view, mortality, the length of the period in which the respirator was used, the use of high pressure in respirator, pneumothorax and pulmonary hemorrhage in neonates under treatment with surfactant was significantly less than those of the other group.

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Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

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Although cellular immunity involving activated macrophage is important in resistance to Brucella infections, serum factors and polymorphonuclears (PMNs) play some role in the initial responses to Brucella infections. In this research, we studied respiratory burst of PMNs against opsonized yeast and opsonized inactivated Brucella melitensis in chronic Brucellosis patients and controls with no previous history of Brucellosis. A group of 41 patients and another group of 20 blood donors as control, were included. The other 2 groups included 10 cases and 6 controls. Mean responses of PMNs of patients and controls to opsonized yeast were 110.3 and 129.3 milivolt respectively and the difference was not statistically significant. No statistically significant difference was observed between respiratory burst of PMNs exposed to inactivated Brucella in 10 patients with chronic Brucellosis (Mean 67.2) and 6 control blood donors (Mean 112.5), so we concluded that inactivated Brucella melitensis can't inhibit activity of myeloproxidase enzyme.

 

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Typhoid fever is an endemic disease in Iran and other developing countries. This disease has gradually become resistant to the first line of drugs, and because of this resistancy we have studied a new alternative drug (cefixime) on typhoid fever patients and compared it's effectiveness with chloramphenicol. For this purpose, by a randomized clinical trial in Emam Khomeini hospital between 1995-2000, we allocated 44 uncomplicated patient with established typhoid fever (positive blood or bone marrow culture) and by random selection, 24 patient were given cefixime (400 mg PO bid) and 20 patient received chloramphenicol (500 mg po Q6h). The duration of therapy were 10 and 14 days for chloramphenicol and cefixime group respectively. Median fever clearance times were 5±1.9 for cefixime recipients and 3.8±1.2 days for chloramphenicol treated patients, but for improvement in other clinical and laboratory findings, there were not any significant difference. Bacteriologic and clinical cure rate for cefixime was 100 and 92 percents respectively. Though, even cefixime like other betalactam drugs is slow in helping the fever disappearance but our study suggests that oral cefixime is effective and can be used as an alternate treatment of typhoid fever.

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Typhoid fever is an endemic disease in Iran and other developing countries. This disease has gradually become resistant to the first line of drugs, and because of this resistancy we have studied a new alternative drug (cefixime) on typhoid fever patients and compared it's effectiveness with chloramphenicol. For this purpose, by a randomized clinical trial in Emam Khomeini hospital between 1995-2000, we allocated 44 uncomplicated patient with established typhoid fever (positive blood or bone marrow culture) and by random selection, 24 patient were given cefixime (400 mg PO bid) and 20 patient received chloramphenicol (500 mg po Q6h). The duration of therapy were 10 and 14 days for chloramphenicol and cefixime group respectively. Median fever clearance times were 5±1.9 for cefixime recipients and 3.8±1.2 days for chloramphenicol treated patients, but for improvement in other clinical and laboratory findings, there were not any significant difference. Bacteriologic and clinical cure rate for cefixime was 100 and 92 percents respectively. Though, even cefixime like other betalactam drugs is slow in helping the fever disappearance but our study suggests that oral cefixime is effective and can be used as an alternate treatment of typhoid fever.

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Ambiguous genitalia means difference between gonads morphology and external genitalia. Gender assignment and surgical correction must be done as early as possible to assure unambiguous bonding between the parents and the child. The purpose of this study was to evaluate Ambiguous genitalia in a referral children surgical center.
Materials and Methods: We retrospectively reviewed records of 200 patients admitted to children medical center hospital in a period of 16 years for Ambiguous genitalia surgery. Data about clinical and laboratory examination collected and analyzed.
Results: The prevalence of female pseudohermaphrodism, male pseudohermaphrodism, ture hermaphrodism and Mixed gonadal digenesis was 70.5%, 20.5%, 5% and 4%, respectively. 76.5% and 23.5% of the patients was converted to female and male, respectively. 29% had congenital Adrenal hyperplasia of whom 86.5%, 10.5% and 3% had 21-hydroxylase deficiency, 11-/? hydroxylase deficiency and 3/?HSD deficiency, respectively. 70.5% had 46xx karyotype and 21.5% had 46xy karyotype and the remainder were musaic. 52.5% had relative parents. The malformation were corrected by vaginoplasty (105 patient) and clitoral resection (51 patients). A variety of anomalies was seen.
Conclusion: Age of presentation ranged from 1 day to 13 years. 151 patients were diagnosed in infancy, but only 43 patient was brought for treatment in infancy to this center by parents.

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One of the useful function of melatonin is its protective effect against endogenous oxidants. The object of this investigation was to study the protective effect of melatonin on stress-induced gastric lesions.
Results: Our results show that pretreatment of animals with melatonin decrease the stress-induced gastric lesions dose dependently.
L-NAME, a nitric oxide synthesis inhibitor, potentiat the stress-induce gastric lesions and melatonin produced gastro-protective effect against concurrent stress and L-NAME-induced gastric lesions.
Conclusion: Our results indicate that melatonin may produce its gastro-protective effect Via increasing level of nitric oxide.

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Renal transplantation is ideal treatment of chronic renal failure. Pulmonary infection is a common and serious post transplant infection requiring hospitalization and is associated with high mortality. Increased susceptibility to infection is due to a decrease in the patients' immunological response caused by immunosuppression through drug administration, and by other influences.
Materials and Methods: This study was case series and prospective, from July 2001 to July 2002 in Imam Khomeini hospital of Tehran.
Results: 164 renal transplant recipients were studied, 14 patients (8.5%) had pulmonary infection, 11 of them (78.6%) were female and 3 (21.4%) were male. The mean age of them was 42.6 years. The patients were followed up for 9 to 12 months. All patients were on triple immunosuppressive regimens. The interval between transplantation and the appearance of pneumonia was 2 months to 10 years. The time of beginning infection in 3 cases (21.4%) was between 1 to 6 months post transplantation, 11 cases (78.6%) were occurred beyond 6 months after transplantation. In 7 cases (50%), pulmonary infection was occurred during first year after transplantation. None of the 14 patients developed pulmonary infection in first month after transplantation. BAL were used in 6 cases (42.8%) of pulmonary infection, and organism were detected in 5 of them (83.3%). The most common clinical feature was fever. Six cases were due to mycobacterium tuberculosis (42.9%), this organism was the most common ethiology of pneumonia. In this study tuberculosis was seen in 3.6% of renal transplant recipients. One patient had pulmonary mucormycosis. All patients with pulmonary TB were cured, and other cases with unknown case, were cured with empirical treatment.
Conclusion: Our finding indicate the invasive diagnostic procedures are required in order to earlier and reliable diagnosis and then better outcome of transplantation.

 

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Background: This research was conducted for the purpose of determining the effect of hormonal and non-hormonal contraception on the mother milk and infants growth among lactating women received by south Tehran’s Health Centers. In this regard a broad spectrum study from December 2000 until February 2001 was done by Tehran university.

Materials and Methods: By sampling method, 200 lactating women were chosen randomly. They were divided into two groups according to their preferred method of contraception: 67 women chose hormonal method and 133 women chose non –hormonal method.

Results&Conclusion: During the time of the study on infants growth (increase in head circumstances, increase in height, increase in weight), There was no significant difference between the two groups. If we take the effect of contraceptive methods into consideration, the Triglyceride levels in non-hormonal group were increased considerably compared to the other group. Other ingredients were almost the same.

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Background and Aim: Total laryngectomy following laryngeal cancer has many sequelae , that loss of voice is the most important of them. Tracheoesophageal puncture (TEP) and prosthesis insertion has evolved into the most widely used and accepted technique for vocal rehabilitation.

Materials and Methods: 10 patients that underwent TEP in Amir Alam and Imam Khomeini hospitals from Feb. 2002 through Nov. 2003 were included in this study. Prosthesis insertion in 4 patients is primary and in 6 patients is secondary and all patients are men.

Results: The age of patients was between 50 to 70. 90% of patients had history of cigarette smoking and 10% of them had history of drinking alcohol. Salivary leakage was seen in 30% of patients that was improved with conservative management. Fluency of speech in 30% of patients and intelligibility of speech & voice quality in 40% of patients is good.

Conclusion: We could conclude that TEP has less complication & better speech results of other vocal rehabilitation methods. Carefully selection of patients & size of prosthesis has important role in results of TEP.

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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: Post-transplant erythrocytosis (PTE) is characterized by persistent hematocrit level above 51% that develops in 10-20% of kidney recipients, mostly 2 years after kidney transplantation. PTE is self limited in 25% of the patients but can be persistent in other patients with an increased susceptibility for thrombosis. The purpose of this study was to identify the risk factors for development of PTE in our center

Methods: We selected 45 patients who were transplanted at least 3 months before selection (minimum time required for detection of PTE) and were referred to the kidney transplantation clinic during 5 years (1998-2003) as the case group. At the same time, we considered 2 patients without erythrocytosis as control for each patient in the case group among kidney transplant recipients who were referred to the same clinic during 5 years (1998-2003). In total we had selected 135 patients, 45 patients with erythrocytosis as the case group and 90 patients without erythrocytosis as the control group. Patients who were affected by high hematocrit before transplantation (HC>51%),overt pulmonary disorder, and polycytemia Vera were excluded from this study. We collected basic information by using old charts and complementary information was added through phone conversations and physical examination in the clinic. All the information was entered in the digital questionnaire and was analyzed by the SPSS statistical package.

Results: There was no significant difference between the case and control group for age, history of hypertension, diabetes, pretransplant hematocrit, pretransplant transfusions, function of graft and source of kidney. A significantly higher proportion of PTE patients were male, also the case group had a significantly higher frequency for personal history of polycystic kidney disease , glomerulonephritis and higher frequency of azathioparine, prednisolone and cyclosporine regimen.

Conclusion: PTE is an important complication of kidney transplantation that can be fatal. There are multiple risk factors that should be addressed to prevent this complication.

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Background: addiction and drug abuse have many risk factors in community and individual attitude also causes much diversity in community perception and attitude toward addiction.

Methods: in this study we assessed attitude toward an addict in 42 addict men and asked about problems in their community and recreational behaviors. They were residents of a rural area in Babol city. In the control group we assessed the same parameters in 268 non addicts in the same area. All of the addicts have been using opium more than many times a week at least for recent 6 months. Data collected via a semi structured questionnaire through conversation.

Results: There was a significant difference between addicts’ attitude toward toward addiction compare to non-addicts’. Both addicts and non-addicts indicated that the first three community problems in their area were unemployment, lack of recreational facilities and addiction, in respective order. Answering questions about recreational activities, both groups indicated that there were no recreational facilities in the community.

Conclusion: In planning a preventive approach, there is a major role for attitude toward addiction in any community. The conflict seen in this study between addicts’ attitudes toward an addicted person and addiction as a community problem has it’s interesting feature. Recreation and physical and cultural facilities need to pay more attention as indicated by our study participants. This seems to have an important impact in prevention of many community problems as well as addiction.

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Background: Multiple sclerosis (MS) is a chronic disease that begins most commonly in young adults and is characterized pathologically by multiple areas of central nervous system (CNS) white matter inflammation, demyelination, and glial scarring. The most valuable aid for diagnosis is magnetic resonance imaging (MRI). New type of MRI has been developed on the basis of molecular diffusion which capable of detecting acute and active lesions. Early diagnosis and treatment is possible to stop or slow down progression of disease. The aim of this study is to compare the findings of conventional and diffusion- weighted (DW) MRI in detection cerebral lesions of MS.

Methods: Thirty patients with clinically definite MS and 30 healthy volunteers were studied in a descriptive-prospective survey over a twelve-month period of time. Conventional and DW MRI were used in both groups. Total number, morphology, location and the mean size of the intra-cerebral plaques of MS were compared between group. The sensitivity and the specificity of both imaging methods in detecting these plaques were determined.

Results: Thirty patients with MS with the mean age of 32.76±8.79 years and 30 healthy individuals with the mean age of 32.75± 9.23 years were enrolled. Plaque within the brain was significantly higher by the conventional method (P< 0.05). Ovoid lesions were greater in number in the conventional method group. More lesions were detected by the conventional method in the areas of periventricle, centrum semiovale and corpus callosum. Regarding the size of plaque, the minimum measurement was significantly lower in the conventional method group. The sensitivity of both methods was 100%. The specificity of conventional and DW MRI was 86.6% and 96.6%, respectively.

Conclusion: In our study the sensitivity of both methods was the same but the specificity of DW MRI was higher. DW MRI may detect lesions which are not detectable by the routine methods.

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Background: Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder. We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.
Methods: In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy group CBT plus art and sport interventions art and sport interventions without group CBT and control group.
Results: Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.
Conclusion: Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we couldn't find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.

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Background: Radiofrequency has recently been used in treating tonsilar hypertrophy in adults. We evaluated the results of partial resection (volume reduction) of tonsil using this method.
Methods: Twenty patients with tonsilar hypertrophy were enrolled in a quasi-experimental before-after clinical trial. Local anesthesia was achieved by utilizing lidocain spray and then injection of lidocain and epinephrine, then radiofrequency was performed at power=7-8w. Bleeding, pain and need for analgesics were assessed during, immediately, 4, 6, and 8 weeks after operation.
Results: The mean pain scale was 2.68±2.11 according to (VAS) and the mean bleeding amount was 1.16±0.24ml during operation. The mean operation time was 7.81±2.56min. Ten percent of our patients did not have pain immediately after surgery while 55% complained of pains that did not warrant using analgesics and the remaining 35% experienced pains that were alleviated by analgesics. During and immediately after operation 95% of the patients experienced mild bleeding and only one patient (5%) had moderate bleeding (2-5ml). Mild bleeding was only reported in 10% of patients during the first 4 weeks after operation and was not seen in patients in following weeks. The grade of tonsilar hypertrophy decreased in all patients and the mean time of symptom disappearance was 7.81±0.36 in 8 weeks. Finally the mean satisfaction rate of the patients was 66.92±12.5% (ranging from 50% to 80%). Mild complications were reported in 15% of patients.
Conclusion: Radiofrequency is a safe procedure with minimum possible complication rate for tonsilotomy.

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Background: Rheumatoid arthritis (RA) is a chronic inflammatory condition. The condition can affected many tissues throught out the body, but the joints are usually most severely affected. The high incidence of RA, the conventional treatments and the experimental observation have shown by combination therapy, the disease symptoms of the patients reduce. To compare the efficacy and tolerability of single-agent Hydroxychloroquin (HCQ) with combination therapies composed of (HCQ) and Methotrexate (MTX) and (HCQ), (MTX) and Sulfasalazin (SSZ) in active rheumatoid arthritis patients with additive arthritis.
Methods: One hundred and twenty RA patients with active arthritis (male/female: 30/90) who were treated in rheumatology clinic between 2003 and 2005 were enrolled in this trial. Patients treated with (HCQ) alone(200 mg/day)were include in group (I), patients treated with combination of (HCQ) (200 mg/day)and (MTX) (7.5mg/week)in group (II),and patents treated with combination of (HCQ) (200mg/day),(MTX) (7.5mg/week)and (SSZ)(1 gr/day)in group (III), Forty patients (male/female:10/30) in group (I),(II) and (III)were eligible for statistical analysis at the end of study. Changes in variable were compared by the T-test.
Results: The combination of (MTX), (HCQ)and (SSZ) and the combination of (MTX) and (HCQ) were more effective regarding the clinical and laboratory parameters than (HCQ) alone (P<0.05). Moreover the combination of (MTX), (HCQ) and (SSZ) was more effective than the combination of (MTX) and (HCQ) (P<0.05). Combination therapies seem to be more effective and no more toxic than monotherapy in RA patients with additive arthritis.
Conclusion: Combination therapy with methotrexate, hydroxychloroquin and sulfasalazin is more effective than hydroxychloroquin alone or a combination of methotrexate and hydroxychloroquin in RA. We suggest starting combination therapy for the patients with early RA, when the diagnosis has been established.

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Background: Acute radiation dermatitis is a very common side effect of radiation therapy for many cancers, including breast cancer. Despite the high prevalence of acute radiation dermatitis as well as wet desquamation, only a few trials studying the prophylaxis of this complication using topical treatment have been conducted. In spite of these studies, some controversy still exists about regarding treatments for acute radiation dermatitis, as does some concern about their long-term complications. For this reason, we conducted a clinical trial for a new treatment with the same effectiveness as corticosteroids, but fewer complications.
Methods: This trial included 60 patients with pathologic diagnoses of breast cancer for whom radiotherapy had been planned. Patients were 30-73 years old. Patients with radical mastectomy received 5000 cGy over five weeks, and those with conservative surgery received 6000 cGy over six weeks divided in 200 cGy fractions. Patients were divided randomly into two groups: one group received a moderately-potent glucocorticoid steroid, 0.1% betamethasone ointment (30), and the other received the new treatment, 0.1% calendula ointment (30). All patients applied their respective drugs twice daily within the tangential field from the first day of radiation treatment until one month after treatment was completed. Starting one week after radiation therapy commenced, patients were monitored weekly for symptoms of dermatitis and the degree of severity as well as possible adverse drug effects, in addition to such monitoring on the days of their appointments. Four weeks after termination of therapy, patients were again examined, at which time they completed a questionnaire about dermatologic complications.
Results: The mean time to develop dermatitis was 3.7 weeks for the betamethasone group and 3.87 weeks for the calendula group. Maximal dermatitis intensity during treatment in the betamethasone group was: 0, 6.7% I, 73.3% II, 16.7% III, 0% IV, 3.3%. Dermatitis intensity in the calendula group was: 0, 13.3% I, 67% II, 16.7% III, 0% IV, 3.3%. No significant differences were observed in the incidence of symptoms such as burning, pruritus and pain between the two groups (p=0.762).
Conclusion: Calendula ointment is as effective as betamethasone in reducing acute radiation dermatitis.

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Background: The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single –ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure (off-pump technique) and that of traditional technique (lateral tunnel technique) in which cardiopulmonary bypass is routinely used.
Methods: Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any.
Results: Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years (SD=7.8).In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients (14.6%) we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I.
Conclusion: Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique.