Tehran University Medical Journal

---

A retrospective study was conducted to investigate about breast cancer in Tehran from 1985 to 1995. All breast pathological records at five General District and Teaching Hospitals (18 general surgical wards) were reviewed and data were extracted. Overall, 3085 records were found (7291 female and 294 male). The final diagnosis was made for 2436 female records including 903 breast cancer (37.1%), 1430 benign breast disease (58.7%), 45 breast skin disease (1.8%) and 58 normal pathological report (2.4%). The dominant group age for breast cancer in women was age group of 40-49 years. The most frequent pathological stage was stage III. Breast cancer was also seen in 2.3 percent of women of 25 year old or younger. The diagnosis was also made for 278 men showing 32 breast cancer (11.5%), 23 benign breast disease (86%), 3 breast skin disease (1.1%) and 4 normal pathological report (1.4%). The results suggest that 3.5 percent of the overall breast cancer were men's, all having over 40 years of age with 60 years or older as the most frequent age. The most frequent pathological stage was stage III. The findings have some implications for public health professionals in terms of breast cancer screening in Iran.

---

Nowadays, trauma is a major complex of industrial and developed countries. Integrated trauma systems have been used for many years to evaluate and minimize the severity of trauma outcomes (mortality and morbidity). We haven't had any trauma system or any comprehensive study, giving us proper information about our country trauma state. This article is based on comprehensive information of a descriptive prospective cohort study, performed in one year period in 3 major trauma centers in Tehran, evaluating 58005 Traumatic patients, referred to emergency rooms of these hospitals. In this article we have tried to represent a complete report of our patients' epidemiologic and demographic factors and trauma inducing mechanisms including traffic accidents, falls, gunshots, cutting objects ..., and their effect on the severity of injury and patients' outcome. Based on our study, traumatic patients are mainly young (age mode between 20-29) males (80%). The majority of patients were illiterate or had a low level of education. The most common mechanism of trauma was hitting of blunt objects (44.9%), however, it was car accidents in hospitalized and severely injured patients (39.9% and 53.7% respectively). The mechanism of trauma correlates significantly to the severity of injury, the need to hospitalization and the patients' outcome. In our study gunshots, car accidents and falls are the most important trauma inducing factors.

---

As the effectively transportation of injured patients is one of the most important concerns in developed countries, we tried to evaluate the patients transportation to Sina hospital trauma center in this regard. During an eighty-day period, 200 injured patients were transported to Sina hospital with intravenous cannula inserted only in 17.5 percent and fracture fixation was accomplished in only 8.5 percent of patients. We coucluded that the transportation quality was rather poor and more attention should be paid to this social problem

---

This article is to verify mortality rate, cause of death, severity of injury (ISS),GCS, patient fate in hospital, pattern of specific organ injuries and some other characteristics among injured pedestrians and car occupants referred to three trauma centers in Tehran (Sina hospital, Shohada Tajrich hospital, Fayazbakhsh hospital) from May 1996 until May 1997.
Materials and Methods: 57367 patients were admitted to emergency department of these centers among which, 6027 victims of motor-vehicle accidents were included in this study.
Results: 71% of cases were pedestrians and rest was car occupants. M/F ratio was 1.8/5. Mean age was 29y. Motor vehicle accidents occurred most commonly during nights. The patients' GCS at arrival in emergency department had similar distribution in both groups. The most commonly injured organs in both groups were: integument, head and neck, extremities and bony pelvis. Thoracic and spinal injuries were more common among car occupants. Extremities and boney pelvis injuries were more common among pedestrians. The mortality rate was the same between both groups. Mortality rate was affected by GCS at arrival and severity of injury. Mortality rate among the old was 4 times the rate among the children. The accidents most commonly occurred on metropolitan roads and streets. The most common cause of death between both groups was head injury. Surprisingly head injury was a more common cause of death among the car occupants.
Conclusion: Pattern of specific organ injuries was different form the pattern in previous studies as the pattern was virtually the same between both groups except for spinal and thoracic injuries were more common among the car occupants.

---

Background: To identify the risk factors of fourth-degree laceration during vaginal delivery.
Methods: This is a retrospective, case control study. We reviewed 131802 records of vaginal deliveries within 14 years period from 1990 to 2004 in two obstetric center. Cases were 93 vaginal deliveries with fourth-degree laceration and 7 cases were delivered at home, control subjects were 200 vaginal deliveries without third- or fourth-degree lacerations and were identified with the use of random selection. We studied the effects of: maternal age, nationality, parity, gestational age, hour of delivery, birth attendants, episiotomy use and duration of second stage of labor, use of oxytocin, use of forceps or vaccum, Infant birth weight, presentation and postion of fetus, previous severe perineal injury, maternal medical illness and place of delivery.
Results: We found 93 cases (%0.07) of documented fourth-degree laceration in 131802 deliveries
Conclusion: This study identified several factors associated with fourth-degree laceration. Median episiotomy should be avoided. Nulliparity, fetal macrosomia and OP position are significant risk factors that require caution by birth attendants during delivery

---

Background: Hysterectomy is a common surgery as treatment for chronic and benign gynecologic problems. Eeach year more than half million women in USA undergo hysterectomy.
Methods: This analytical cross-sectional study, was done on 100 women who had underwent hysterectomy at least two years before the study and met inclusion criteria of study. During interview, the questionnaire were completed, then examination was done by gynecologist. Most of the information were collected from the patient’s files.
Results: In this study the most indication of hysterectomy was fibroma and the most common type surgery was total abdominal hysterectomy, and mostly were done without oophorectomy. 20% of cases were without or weak prior to operation and 80% with medium (or high) libido, after hysterectomy the figures changed to 41% and 59% respectively. After hysterectomy libido with P=0.001, frequency of coitus with P=0.001, and sexual satisfaction with P=0.013, significantly declined. Libido after hysterectomy declined with aging (P=0.01). There was no significant correlation between oophorectomy and libido.
Conclusion: Sexual function declines significantly after hysterectomy, with no association with oophorectomy and type of surgery.

---

Background: Trauma is a common problem in the world, predominately affecting young adults. Considering the high mortality rate in patients suffering from thoracic trauma, the condition is considered to be extremely important. The purpose of this study was to evaluate the prevalence and the epidemiology of chest trauma as well as the severity of the resulted injury in Tehran, Iran.

Methods: This prospective, descriptive study was conducted on patients admitted to three medical centers in Tehran during June 1997 and 1998 due to chest trauma. The data on the demographic information of the patients, the mechanism of the trauma and the severity of the injury were collected and analyzed.

Results: Three hundred forty two patients were admitted to hospital due to thoracic trauma the majority of which were male adults. Blunt trauma especially secondary to motor vehicle accidents were the most frequent cause of chest injury in the studied patients. In 280(82%) of the cases, another form of trauma was also reported. Chest wall injury was the most common type of thoracic trauma in these patients. The trauma was reported to be mild in 181(53%) of the patients (ISS<7). Only 42(12%) patients required surgical intervention. The overall mortality rate was 14% which was reported to be ISS- related.

Conclusion: Chest injury is quite prevalent among trauma patients and is associated with other injuries in a considerable number of the patients. This type of trauma is associated with a high mortality rate among elderly and therefore needs special attention and care.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Vulvovaginal candidiasis is a fungal disease with itching, and vaginal thick white discharge. Most of non-albicans species have less sensitivity to azoles. So, definition of candida species which lead to vulvovaginal candidiasis is very important to perfect usage of drugs. In the present study 191 Candida isolates from 175 patients who admitted in Gynecology department of Mahdieh Hospital during the period 1385-1387 were identified by multiplex PCR.
Methods: One hundred seventy five vaginal swab specimens from patients were cultured on Sabouraud Dextrose Agar (SDA). The internal transcribed spacer 1 (ITS1) region between the 18S and 5.8S rRNA genes and a specific DNA fragment within the ITS2 region of Candida albicans were amplified and the multiplex PCR products were separated by electrophoresis in 2% agarose gel (200 mA, 140V), visualized by staining with ethidium bromide, and photographed.
Results: One hundred ninety one Candida isolates were identified in vaginal swab specimens from 175 patients. In 89.7% of cases, single candida species and in 10.3% cases, multiple candida species were isolated. C. albicans (65.1%), C. glabrata (13.1%), C. tropicalis (6.2%), C. krusei (4%), C. guilliermondii (0.6%), C. parapsilosis (0.6%), C. glabrata and C. albicans (5.7%), C. albicans and C. parapsilosis (1.1%), C. glabrata and C. tropicalis (0.6%), C. krusei and C. tropicalis (0.6%), C. albicans and C. tropicalis (0.6%), C. krusei and C. albicans (0.6%), C. glabrata and C. krusei (0.6%), and C. glabrata and C. krusei and C. albicans (0.6%) were the cause of disease.
Conclusion: Our findings suggest that, the common cause of both recurrent and non-recurrent vulvovaginal candidiasis was C. albicans, and then C. glabrata. Also the most common mixtures of Candida species were combination of them

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Vulvovaginal candidiasis is a common mucosal infection among immunocompetent, healthy women, and is caused by opportunistic yeasts that belong to genus Candida. In this study, we isolated and identified the Candida species in the vagina of patients who admitted in Gynecology Department of Mahdieh Hospital in Tehran, Iran to evaluate the in vitro activities of fluconazole, miconazole, itraconazole and flucytosine against 191 clinical Candida isolates by the NCCLS microdilution method.
Methods: 191 Candida were isolated from vaginal secretions and identified with conventional mycological methods in the diagnosis of Candida species. The identity of all strains was confirmed genotypically by multiplex PCR. In vitro susceptibility testing of vaginal Candida isolates was performed by the NCCLS broth microdilution method. The results were read at 48 h.
Results: Most C. albicans isolates (>90%) were sensitive in vitro to the antifungal agents tested. Most C. glabrata isolates showed sensitivity to miconazole and then flucytosine while they were more resistant to Itraconazole and fluconazole. Many isolates of C. tropicalis were susceptible to miconazole and then fluconazole. They showed a little resistance to all antifungals tested and flucytosine-resistance was the most frequent in the C. tropicalis isolates. High susceptibility to miconazole was observed in isolates of C. krusei and their susceptibility to the rest of the antifungals tested was dose-dependent. fluconazole -resistance was the most frequent in the C. krusei isolates.
Conclusion: Most isolates tested were susceptible to miconazole. A trend toward increased resistance among C. glabrata and C. krusei strains to antifungals tested was noted. Our findings suggest that, miconazole should be the agent of choice for the treatment of resistant vaginal candidiasis.