Tehran University Medical Journal

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This article aim is to introduce a case of PAPVC (partial anomalous pulmonary venous connection). The patient was a 25-year-old women who had dyspnea and palpitation. She expressed no special disease, no past medical history, and no drug usage, but her brother and her aunt had the above-mentioned history. In the physical examination, lungs were clear and the heart had S2 splitting, and there was a systolic murmur in the pulmonary area. Her liver could be palpitated two centimeters below the costal edge, but she didn't have any hepatomegaly. In cardiac catheterism, she had PAPVC, atrial septal defect (ASD), and mitral valve prolapse (MVP). The patient underwent operation had left pulmonary vein was separated from the superior vena cava and anastomosed to the left atrial auricle. By means of the pericardial patch, the left atrium became enlarged and ASD was closed. She was in a good condition after surgery and left the hospital without any complication with a good condition and recovery and had no problem any longer.

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100 patients (93 females and 7 males) in ages ranging between 23 and 65 years were subjected to laparoscopic cholecystectomy for biliary colic (92 pts), acute cholecystitis (7 pts) or asymptomatic gallstones (1 pt). None had a history of icterus and in every case choledocholithiasis was excluded by means of serum alkaline phosphatase assessment and sonography (In addition to ERCP in 3 pts). 3 operations were converted to open cholecystectomy (Because of uncertainty about anatomy in 1 pt, extensive adhesions in 1 pt, and persistent bleeding in 1 pt). Mean operation time was 80 min. 90 patients were discharged on the 2nd post-operative day. Apart from 2 pts who were readmitted (For omental evisceration in 1 pt and sub hepatic hematoma in 1), complications were limited to minor complaints. Laparoscopic cholecystectomy is a safe procedure in the hands of a skilled surgeon who is aware of anatomic variations and is always prepared to liberally convert the operation to an open cholecystectomy

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Sixty pregnant women with the gestational age of 6-14 weeks who met the following criteria were selected: 1) Presence of nausea and vomiting. 2) Absence of other medical conditions that cause nausea and vomiting. 3) Negative history of medical treatment for at last three days prior to admission. 4) Negative for threatened abortion, molar and twin pregnancy. Cases were randomly divided into two groups. Mean age of the cases was 25.16 y (range: 16-37 y) and not significantly different in the two groups. The two groups were also similar in gestational age, severity of nausea and vomiting, number of previous pregnancies and abortions, profession, working inside or outside the house, family income and education of patients and their spouses. In one group, Pe6 point of acupuncture was stimulated by TENS (once every 2 hours, 10 minutes each time, from the time of awakening). The other group received placebo. Both groups were hospitalized for 48 hours, and were evaluated for severity of nausea and vomiting, apetite, frequency of vomiting and VAS at their worst day, 24 hours prior to admission and 24 and 48 hours after admission. The two groups were similar in frequency of vomiting, VAS, appetite, and severity of nausea 24 hours prior to admission, and the worst degree of nausea and vomiting. However, a significant difference was observed in the severity of nausea and vomiting 24 and 48 hours after the adminission between TENS and placebo (P=0.000). In the group who received TENS, 24 cases (86.7%) reported improvement (compared to 23.3% in the control group). Of all the cases, 81.6% had received prior medication, only 18.3% of the latter reported improvement with medication. Level of VAS in the groups with severe and mild to moderate nausea and vomiting was not significantly different in the first and second days of admission. Fifteen percent of the cases reported a transient cutaneous rash. Five cases were hospitalized more than once. Of the cases who reported improvement with TENS, 5% had improved after two stimulations, and 47% reported a relapse of symptoms in less than 24 hours after cessation of TENS. In one of the cases who were re-admitted, TENS did not result in alleviation of nausea and vomiting, and 56.6% of all the cases suggested to use TENS at home, 45% were attracted to TENS by commercial advertisements. Disscusion: Stimulation of Pe6 (Neiguan) point alleviates the nausea and vomiting of pregnancy.

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AV-node modification by catheter RF energy delivery is treatment of choice in the symptomatic patients with AVNRT. This study included 30 patients with AVNRT (19 women, 11 men). We did slow pathway ablation in 29 cases successfully. Maximum effective energy delivery was 40 watts for 40 msec. 1:1 AV conduction increased from 290±40 msec before ablation to 340±65 msec after ablation. Also AV-node ERP increased from 235±35 msec before ablation to 280±65 msec after that. There was no recurrence of arrhythmia in the group with slow pathway ablation during 28 months follow-up. We did fast pathway ablation in one case. In this patient AH interval increased from 120 to 200 msec, maximum RF energy delivery was 20 watts for 20 msec (2 times). Recurrence of non sustained PSVT occurred in this patients 20 months after RF ablation. There was no case of permanent AV Block. We recommond slow pathway catheter RF ablation in patients with symptomatic AVNRT.

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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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Job stress results from a mismatch between job requirements and capabilities, resources, or needs of the worker. Physiological, psychological and behavioral outcomes caused by job stress not only hurt the person but also impose expensive costs on organizations. Firefighting is a job that exposes workers to job stress. The purpose of this study is to determine the level of job stress and some related factors in firefighters of Tehran safety services and firefighters organization. This cross sectional study includes 155 male firefighters whom had selected randomly. In this research we used Leiden University Questionnaire. Also Karasek Questionnaire is used for classification of workers according to karasek’s model. Collected data were analyzed by spss9 software. The final grade of firefighter’s job stress shows a significant positive relationship with second job and a significant negative relationship with age. The level of job satisfaction have a significant negative relationship with job insecurity and lack of meaningfulness, and a significant positive relationship with skill discretion, social support supervisor and social support co-workers. According to karasek classification this job is grouped in active not in high strain grup. The highest level of job stress was seen in physical exertion and hazardous exposure factors. Also in work and time pressure factor, job stress level is high. But job stress is in a moderate or low level in other factors. The level of job stress in younger firefighters and in individuals with a second job indicate a significant increase. However, in western country’s studies, this job is classified as high-strain but in this research it is classified as active group.

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Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients.
Materials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age>12 years), neutropenic (PMN<1000) patients with fever (Temperature, oral >38.5c) in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A) and Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B). Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever) were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result).
Results: During a twelve months period of study, a total of 57 patients (17female, 40male) were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent), the treatment was effective, compared to 15 of 29 (51.7 percent) in groups B. The duration of fever after initiation of treatment was 37.9 ± 17 hours in arm A and 40. 1 ± 20 h in arm B. Blood and / or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B).
Conclusion: Cefriaxon monotherapy is at least equally effective in low risk neutropenic patients with fever compared to combination of ceftazidim plus amikacin at a decreased cost and probably (expected) less adverse side effects in our patients.

 

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Essential hypertension is one of the risk factors of cardiovascular diseases. Hypertension etiology is not completely known, it seems that rennin-Angiotensin system has an important role in its etiology, Thus better recognition of this system and its activity changes or vascular reaction changes to different parts of this system during progressive hypertension can be more effective in better recognition of the disease progress and treatment.
Materials and Methods: In this study responsiveness of mesenteric vessels of Goldblatt two kidney- one clip (2k-lc) renovascular hypertensive rats to angiotensin / and II with and with out captopril during a time of two , four , six and eight weeks after hypertension induction was investigated and compared with control and surgical sham groups.
Results: This study shows that vascular responsiveness to angiotensin // in animals that passed four weeks of their hypertension , (p< 0.05) and in the sixth and eight week of post induction hypertension (p< 0.01 and p< 0.001) has a significant different with both sham and control groups. Also it has been observed that an increased reaction to angiotensin II with an increased significant rate of arterial hypertension in hypertensive group. In the other hand in spite of inhibition of angiotensin converting enzyme by captopril in animals that have been eight weeks hypertension , on the contrary to other groups reactive to angiotensin /.
Conclusion: Results of this study show that vessels reaction to angiotensin /and II increased due to six to eight weeks post induction renal hypertension. Captopril does not inhibite mesenteric vessels reaction to Angiotensin / in hypertensive Rats after eight weeks. Try to completely inhibit production of angiotensin II maybe a hopful way in controlling essential hypertension.

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Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

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Background: Fumes generated during electric welding are one of air pollutants of working place in industrial companies, which can cause some clinical signs and diseases in worker, including mucosal irritation, changing of semen quality and cancer. Chronic exposure of workers with these fumes can cause reduce sperm motility and forward penetration and decrease in normal sperm count. Although a lot of researches were done in this field up to now, there is little information about histopathological effects of these fumes on germinal epithelium. The aim of this study was to identify structural changes of germinal epithelium in Rat as an experimental model after exposure to fumes of electric welding in exposure chamber.
Material and Methods: A total number of 60 Sprague Dawley Rats were chosen and divided into experimental (40) and control (20) groups. Each of groups was subdivided into 2, 4, 6 and 8-week subgroups. The number of Rat in each subgroup of experimental and control group was 10 and 5 respectively. Animals were housed in standard situation. After adaptation experimental group were exposed to fumes of electric welding (AMA 2000 electrode, 100 Ampere, 0.1 cm/s speed of electrode welding) for 2 hour/day and 5 day/week. The rate of air turn over in exposure chamber was fixed to 12-15/hour. The amount of O3, CO, CO2, NO + NO2 and particulate matter were measured by Galtec detectors and Cellulose acetate filter respectively. According to time table animals were killed and specimens from testis were taken and fixed in formaline buffer solution and processed routinely. Sections with 5-7 micrometer in thickness were stained by H-E, PAS, PNA and Alcian blue pH=2.5. The thickness of germinal epithelium was measured and data were analyzed by Kruskall Wallis test.
Results: The results of this study showed a few quantitative and qualitative changes in germinal epithelium. Vasodilatation of vessels in tunica albuginea and interstitial tissue, decreasing of eosinophilia in myoid cells, increase in size of spermatogonia especially dark type, disorganization of association between sertoli and spermatogenic cell lineage and spermatogenic arrests in spermatocyte I period. There were significant difference between experimental and control group for thickness of germinal epithelium (p<0.001).
Conclusion: It seems that although some adaptation response was appeared in experimental group, a lot of structural changes also appeared in germinal epithelium. The amount and severity of these changes were dependent to 3 factors include the amount of fumes, the variety of it and the duration of exposure.

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Background: In the year 2003, an earthquake in Bam led to death and injury of many of the inhabitants. The aim of this study was to the changes in opioid drug use in the survivers eight months after the earthquake in comparison with the month before the quake and its related factors.

Methods: An epidemiologic survey was carried out on 779 survivors, selected by desert sampling from the Bam citizens in the age of 15 and over. Bivariate and multivariate Logestic regression analysis were done for examining the relationship between an increase in opioid use and various factors.

Results: An increase in opioid use was reported in 18.3 percent of men and 2.3 percent of women. Odds Ratio (OR) for increase in opioid use was 9.4 times more in men than in women (95% CI=4.9-18.0). In men, increase in opioid use was related with the history of opioid use during the month before earthquake (OR=5.6, 95% CI=2.4-13.1), age (OR in age group 30 to 44 was 4.7 times more than age below 30, with 95% CI from 1.8 to12.1), and PTSD (OR=3.7, 95% CI=1.5-9.2). In women, it was only related to the history of opioid use during the month before earthquake (OR=43.8, 95% CI=12.5-154.0).

Conclusion: The findings show that following disasters, especially in the areas or groups that drug use is common, an increase in the drug use might occur. In these situations provision of preventive and treatment interventions particularly for at risk population is necessary.

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Background: The Composite International Diagnostic Interview (CIDI) is a comprehensive, standardized diagnostic interview for the assessment of psychiatric disorders. There have been few studies on the validity of the CIDI. The objective of present study was to assess the validity of a Farsi translation of the complete CIDI and its psychosis/mania module in five referral clinical psychiatric settings.
Methods: Two hundred and three as well as 104 consecutive admissions were interviewed using the complete and the psychosis/mania module, respectively. Within two days of the CIDI interview, two last year residents of psychiatry or psychiatrist who were blind to the CIDI diagnosis completed the Clinical diagnostic checklists (based on DSM-IV and ICD-10 criteria) simultaneously and reached the consensus diagnosis. Data analysis was performed using SPSS 11 to determine the validity of CIDI.
Results: The sensitivity and specificity for the diagnosis of schizophrenia was 0.12 and 0.96 using DSM-IV criteria. According to ICD-10 criteria, the results were the same with 0.19% sensitivity and 0.96% specificity. The sensitivity for the diagnosis of bipolar I disorder was low (0.21 using DSM-IV criteria and 0.17% using ICD-10) and specificity, high (0.90 compared to DSM-IV and 0.89 compared to ICD-10 criteria). The results were rather similar for the psychosis/mania module of CIDI.
Conclusion: This study suggests that the Farsi translation of both the complete CIDI and the psychosis/mania module of CIDI have good specificity, but poor sensitivity for the diagnosis of schizophrenia and of bipolar I disorder.

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Background: For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical examination of arteriovenous fistula by the surgeon at the end of the surgery was evaluated.
Methods: In the general surgery ward of Imam Khomeini Hospital in 326 chronic renal failure patients, 354 arteriovenous fistula operations were accomplished by two surgeons from 1377 to 1381 (ca. 1998 to 2002). The performance of each fistula was divided into the following groups by the surgeon at the end of operation: 1) systolic and diastolic thrill, 2) systolic thrill 3) souffle 4) pulse 5) not functional. Clinical function of the fistula was evaluated by the same surgeon in the following days if no souffle or thrill, early failure was detected on initial inspection.
Results: In the 354 cases of arteriovenous fistula, the total early failure rate was 12.7%. The lowest early-failure rate was 3.5% in the systolic and diastolic thrill group. The highest early-failure rate was in the not functional group (P<0.001). There was no correlation between early failure and age, sex, surgeon and location of fistula.
Conclusion: Optimally, an arteriovenous fistula has a thrill with a soft compressible pulse. At the end of each operation, if the surgeon cannot detect a thrill at the fistula site, can find only pulse, or if the function is otherwise unsatisfactory, considering of a new arteriovenous fistula may be required, however it is better to postpone the surgery.

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Background: Infertility is a worldwide problem. Many different factors may cause infertility. Among them, bacterial infection of the reproductive system is one of the main factors. Recently, some limited investigation has revealed that H. pylori is capable of causing genital inflammation that may lead to infertility. Although known to be a causative agent of gastritis and duodenal ulcers, this species may be transferred orally to the vagina and asymptomatic infection leads to inflammation of the system and finally manifestation of infertility. In addition, infertility may be due to antibodies synthesized against H. pylori cross-reacting with the genital tissue.
Methods: In the present study, 180 women consisting of 90 cases referred to IVF center of Yazd and 90 matched controls were enrolled. Serum was taken from all women for detection of IgG and IgM using the ELISA technique.
Results: A total of 117 (65%) serum samples were positive for Helicobacter, of which 63.3% were from fertile and 66.7% from infertile women. The serum positive population was found to be predominantly in the age range of 25-35, although some 35-42 year olds were also serum positive. When the prevalence of Helicobacter infection status was compared with marriage duration in both groups, it was found that antibody titer in subjects from marriages with durations of greater than five years was significantly higher than those of five-year marriages. In addition, higher antibody titers were found in infertile women with fallopian tube (FT) factor and lower titers in those with polycystic factors.
Conclusion: Although the results were not significant, they nevertheless indicate that the Helicobacter antibody titers in infertile women were higher than those of fertile women (P =0.6). Therefore, further studies are necessary to determine the role that Helicobacter infection plays with regard to infertility among women. Since the antibody titer in infertile cases with FT factor was higher than others, it may indicate that inflammation caused by H. pylori plays an indirect role in the induction of infertility.

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Background: Acupuncture is one of the most effective methods of alleviating pain in different situations including chronic and acute pain management. The aim of this study was to evaluate the effectiveness of acupuncture in the reduction of post-operative pain after hernia repair.

Methods: In this placebo-controlled, double-blinded clinical trial, we enrolled 60 male patients aged 30 to 60 years old with an ASA physical status of I or II undergoing elective inguinal hernia repair under general anesthesia in Imam Khomeini Hospital, Tehran, Iran. All patients experienced standard anesthetic and surgical procedures. After completion of the operation and while the patients were still under general anesthesia, they were randomly assigned to two groups: acupuncture (with stimulation of GV2, GV4 and SP6 points with sterile acupuncture needles), and control (with sham acupuncture stimulation). After termination of anesthesia, during the first six hours, the pain intensity was evaluated hourly. Pethidine (25 mg) was administered for the patients when necessary. Pain intensity and pethidine use were recorded and compared between the two groups.

Results: The mean age of two groups did not differ. Pain intensity was significantly lower in the acupuncture group between the second and fifth postoperative hours. Moreover, pethidine use was significantly lower in the acupuncture group versus the control group during the first six hours after surgery (12.07±7.5 mg vs. 12.91±6.5 mg, respectively p=0.0001).

Conclusion: The application of acupuncture in patients is associated with a marked decrease in pain after inguinal hernia repair and does not have any serious complications. Acupuncture is strongly recommended for all post-operative patients.

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Background: The misdiagnosis of urinary tract infection (UTI) may lead to kidney deficiency and even pyelonephritis. Since different species may cause this disease, urine culture (UC) and antibiogram of the isolated species should be performed and results compared to urine analysis (UA) parameters to obtain the best diagnosis.
Methods: The urine specimens from 1509 patients (1195 women and 314 men) were processed for UA, UC and antibiogram. First of all, the sterile urine samples were cultured using differential media, including EMB and blood agar. After 24 hr incubation, the colonies were identified and differentiated by biochemical tests. Antibiograms for all isolated species were determined using Muller Hinton agar. All results obtained from this survey were analyzed using SPSS software.
Results: Of the 1509 samples, 986 (65.3%) were positive for pathogenic bacteria, 170 (17.2%) of which were from men and 816 (82.8%) from women. E. coli was the most prevalent with 591 cases (58.7%), followed by Enterobacter 115 (11.4%) and Klebsiella 88 (8.8%). Data analysis revealed that the correlations between the WBC, RBC, nitrite, crystal, and protein were significantly higher in culture-positive samples. Of the antibiotics tested, isolated species were most sensitive to amikacin and most resistant to ampicillin.
Conclusion: The present study revealed a correlation between pyuria and bacteruria however, it should be noted that the clinical signs and the presence of WBC in urine could not be used to confirm the UTI. In addition, since different bacterial species are able to cause UTI, in order to administer proper treatment while controlling improper use of antibiotics, thorough testing, including UA and UC together with antibiogram, is strongly recommended.

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Background: surgical site infection is one of the most common post operative complications alongside with sepsis, cardiovascular, pulmonary and thromboembolic complications. The development of surgical site infection is related to three factors: the degree of microbial contamination of the wound during surgery, the duration of the procedure, and host factors such as diabetes, malnutrition, obesity, immune suppression, and a number of other underlying disease states. The purpose of this study was to evaluate the effects of topical cephazolin in controlling infection of the site of surgery after non-laparoscopic cholecystecomy.

Methods: One hundred and two of patients referred to the outpatient clinic of Imam Khomeini Hospital from fall 2005 to fall 2006 non- laparoscopic cholecystectomy enrolled in a randomized clinical trial. All patients underwent the same procedure of anesthesia and surgery and they were randomly assigned into two groups of cases with irrigation of the site of surgery with 1g of topical Cephazolin prior to the termination of the operation- and controls. Cephazolin is a first generation cephalosporin which binds penicillin binding protein and is a potent cell wall synthesis inhibitor. The patients were followed up for six weeks for symptoms and signs of infection including discharge of the wound and presence of pain, warmness, swelling and erythema of the wound.

Results: There were no significant differences between two study groups regarding mean age, duration of operation, and sex. There was no significant difference in the incidence of infection of the site of surgery (11.8% in both groups with p=0.99) between two groups.

Conclusion: Analyzing the collected data confirms that prophylactic use of topical cephazolin was unable to decrease the risk of infection of the site of surgery in patients undergoing non- laparascopic cheolecystectomy.

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Background: The health risk associated with chronic exposure to organic solvents investigated in several epidemiologic studies indicates a significant relationship between solvent exposure and glomerulonephritis. Solvents are the most commonly used chemicals in industry. According to European statistics 43% of all solvent consumption takes place in the painting industry, 10% in metal cleansing, 6.7% in adhesives and 3.9 percent in the laundry (dry cleaning) industries. Although BUN and creatinine indicate massive loss of glomerular function, microalbumin is a sensitive urinary marker for nephrotoxins in the early detection of solvent-induced effects on the glomerulus. The purpose of our study was to use microalbumin, serum BUN and serum creatinine levels to identify occupational solvent-induced effects on the glomerulus.
Methods: Renal dysfunction was monitored by microalbumin, BUN and creatinine serum levels in a cohort study of 92 workers currently exposed to solvents (solvent group). A control group of 92 individuals were selected from parts of the same factory not exposed to solvents. All individuals in the study were men, without diabetes or hypertension. The percentage of smokers was equal between the two groups. The solvent group was selected using environmental monitoring of organic solvents in different parts of the painting room. The individuals were chosen by simple random selection. Exclusion factors included less than one year of work in the painting room, use analgesic or aminoglycoside one month before the study and medically diagnosed renal disease, such as glomerulonephritis or renal failure. Data was gathered using a questionnaire requesting demographic information, history of present and past diseases, present and past occupational history, drug history, history of illness in their colleagues and safety conditions at work (use of safety gloves, masks, clothing, goggles and general and local ventilation). The results analyzed with SPSS 11.5.
Results: Several studies showed that solvents cause renal disorder (tubular and glomerular), although glomerulonephritis is more prevalent. The mean age of the solvent group was 28.6 ±2.7 years and was 33.7 ±7 years in control group (p<0.05). The mean duration of solvent exposure was 4.8 ±1.5 years. Statistically meaningful differences were found between solvent and control groups for microalbuminuria, increased serum BUN and creatinine levels (p<0.05), although there was no significant correlation between these parameters and the duration of exposure (p>0.05).
Conclusion: The results suggest that kidney dysfunction results from chronic occupational exposure to solvents at levels found in automobile painting rooms in Iran. We recommend increased monitoring of workers using solvents and increased review and enforcement of safety regulations regarding such use of solvents.

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Background: In the treatment of bronchial asthma, the identification, isolation, and elimination of causative allergens is the most effective part of treatment. With the recent diversification within the pet industry, pet owner exposure to many unknown antigens is on the rise. The results of population studies have been contradictory and some epidemiological studies have failed to confirm this, some indicating that keeping pets might actually reduce the risk of sensitization and asthma. The purpose of this study was to determine the association between pet ownership and asthma.

Methods: This case-control study included 300 asthmatic participants referred to the Children's Medical Center over a two-year period. Participants were asked to fill out a questionnaire regarding pet ownership, pet gender and puberty, the place it was kept, how long the pet was kept and the reason for keeping the pet. The same questions were asked from 300 age- and gender-matched nonasthmatic individuals as the control group. Statistical analysis was performed to calculate odds ratios (OR) of asthma morbidity in individuals who kept pets.

Results: The OR for asthma morbidity in patients who kept pets was 2.59 (CI=1.60-4.21 and p>0.001). Financial aim was the most common reason for keeping a pet and most pets were mature and kept outdoors. No significant correlations for pet genders were observed.

Conclusion: This survey provides evidence that pet ownership is an important risk factor for asthma, therefore we suggest that individuals at risk for asthma (atopic individuals) must avoid contact with pets. However, more research in this field in Iran is necessary.

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Background: Myasthenia Gravis (MG) is a neuromuscular disorder with weakness of skeletal muscles. Thymectomy is now recognized as a treatment modality in MG. The aim of this study was to evaluate the clinical effect of thymectomy on MG.

Methods: MG patients with history of thymectomy at a tertiary referral center during twelve year period were included. The medical records were reviewed and telephone survey was conducted to evaluate the effects of thymectomy.

Results: Sixty MG patients, 46 females and 14 males, aged 30.4±11.1 years, underwent open (n=48) or video-assisted thoracoscopic thymectomy (n=12) during study period. The mean dosage of preoperative pyridostigmine was 235.4±86.2mg/day. This figure reached to 129±18mg/day after thymectomy (p<0.0001). 17 patients (28.3%) had complete remission (complete freedom of symptoms without medications). Improve-ment (improved symptoms or less medication requirement) was seen in 34 patients (56.6%). There was no response to surgical therapy in six patients (10%). Three patients (5%) had experienced progression of disease postoperatively. Overall, benefit of thymectomy was observed in 85% of patients. Age, sex, duration and severity of disease, quantity of preoperative drugs, surgical approach, and presence of thymoma did not affect the outcome. Satisfaction was stated as excellent in 17%, good in 43%, moderate in 35% and poor in 5% of patients after operation.

Conclusion: Thymectomy is an effective treatment for MG which leads to less severity of disease and less drug requirement. It would be considered in all myasthenic patients regardless of age, sex, duration and severity of disease and presence of thymoma.