Tehran University Medical Journal

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Background: Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. Central lung distance (CLD), the distance from the chest wall to the edge of the field at the central axis, is an indicator of lung volume within the radiotherapy fields. In this study, we aim to detect the relationship between CLD and pulmonary function tests.

Methods: In this study we included 50 patients with breast cancer receiving postoperative adjuvant radiotherapy at Imam Hossein Hospital, Tehran, Iran. The patients received radiotherapy with a total dose of 4800-5000 cGy. For all patients, the central lung distances were measured using simulation of tangential fields, in addition to determination of pulmonary function, including force vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) determined before radiotherapy, one month and three months after radiotherapy.

Results: There is no significant statistical difference between the FEV1 and FVC values before radiotherapy and those measured one month after radiotherapy however there was a significant statistical decrease in the FEV1 and FVC before radiotherapy and those measured three months after radiotherapy (P<0.001 and P<0.006, respectively). There is a positive statistical correlation between the change in the FEV1 three months after therapy and the CLD (r=0.71, p<0.01) and that of the FVC three months after therapy and the CLD (r=0.59, p<0.01). Linear regression for the prediction of FEV1 and FVC three months after radiotherapy was designed according to the CLD, FEV1 and FVC values before radiotherapy.

Conclusions: Three months after breast radiotherapy, the FEV1 and FVC values decrease, and the CLD is a proper predictor of these changes.

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Background: An outlier is an observation that lies an abnormal distance from other values in a random sample from a population. Outliers sometimes deal with to abnormality in obtained results from collected data and information. known outlier data by researchers, physicians and other persons that work in medical fields and sciences is important and they must control data before getting result about outlier data, effect of them in information bias and how to remove & control to obtain minimum bias and exact data .in this paper we had trying by known technique and tests to control them and minimized the errors related to them.
Methods: This paper has been done on 30 student's height in Tarbiat Modares University that measured by meter in smoothing area. We applied some methods such as Z-test, Grub test and graphical methods to determine outliers. In this paper the advantage and disadvantage of methods were evaluated and finally compares with each other.
Results: The above tests showed that the data values 153, 110 among collected data were outliers. All of the methods showed that the above data were outliers. Calculation quartiles and intermediate quartiles showed that the observations under 125 and upper 141 were mind outliers and if the observation under 119 and upper 147 is the sever outliers. According to upper situations the amounts of 110 and 153 is the sever outliers and resulted from all methods.
Conclusion: The results showed that all methods were useful in determine outlier data and between them Quartiles were important to known severe and mild outliers. Also Grub test with p-Value is very useful to report outliers.

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Background: To eradicate a problem such as drug abuse, we need thorough knowledge of the problem and its epidemiological aspects. In response to increasing ecstasy abuse among youth, as noted by the increase in related health issues at emergency clinics, we performed this epidemiologic study on ecstasy use in Tehran.

Methods: In this cross-sectional study, including 1,903 youth aged 15-25 years, at different coffee shops in Tehran, Iran, subjects filled out questionnaires to evaluate the prevalence of ecstasy use with regard to gender, age, family income, level of education, psychological state (Beck test), acute complications of ecstasy use, as well as manner and place of ecstasy use and reason for repeated ecstasy use. Information was gathered from September 2004 to January 2005, using simple nonprobable sampling.

Results: The prevalence of ecstasy abuse among our study population was 18.5%, which meaningfully correlated with gender (male), education level (undergraduate degree), family income (high), drug abuse and Beck test score (high). The mean age of ecstasy abusers was 21.3 years (SD: 2.65), which wasn't statistically different than the study population as a whole and the portion that did not use ecstasy. Tablet was the most common form of ecstasy usage (97.1%). In this study population, 91.4% had heard of the ecstasy name, and 83.7% were familiar with its use. The most common site of usage was in parties (85.7%) and in group forms (84%). Of all the users, 30% stated the reason for repeat ecstasy use was their friends' insistence, 38.8% expressed emotional need, 37.7% had no reason, whereas 6.6% felt a physical need and 1.7% repeatedly used ecstasy to prevent withdrawal symptoms

Conclusion: Some studies have reported that drug abusing friends are the basic cause of drug abuse. In this study, the ecstasy users admitted that the influence of friends and emotional need were the causes of their repeat use. Remarkably, these subjects report withdrawal symptoms with ecstasy use. Most importantly, families have to consider the relationships and emotional needs of their children. The statistical difference between Beck test scores between ecstasy users and the non-users placed them in two clinically different psychological groups. The ecstasy users were in groups that definitely needed psychological consultation and non-users were in the slightly depressed group. These psychological aspect of drug abuse expressed here is an alarm.

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Background: The most common methods for screening of patients with probable ischemic heart disease are stress test and in special conditions are perfusion scan, so that their positive results was important indication of coronary angiography. Although, predictive value of perfusion scan has been considered, with regard to the impact of technical and specialized factors and according to the spread of this technique that has wrongly replaced the stress test, it is necessary to compare predictive value of this method with stress test in our country.

Methods: In a cross-sectional study, patients referred to Tehran Heart Center from all centers of country between January 2004 and January 2005 for coronary angiography was included. Demographic characteristics of patients were collected by interview and clinical tests and analyzed in two genders. Then, positive predictive value (PPV) of both techniques was calculated and compared.

Results: The total number of positive perfusion scan and stress test were 2178 and 2581, respectively. It was not significant difference between PPV of perfusion scan and stress test in men (86.9% vs 86.6%, P=0.814). PPV of perfusion scan was higher than stress test only in women more than 60 years old (P=0.0002).

Conclusions: According to the results of this study and with regard to high cost of perfusion scan, it seems that in case the possibility of stress test, the use of perfusion scan had no advantages with the condition of our scan centers and especially in women, predictive value of these techniques were similar. However, it is necessary to consider the causes of this unusual finding according to the role of drugs, instruments, and specialists in the future.

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Background: Nasogastric tube (NG tube) usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases.

Methods: This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound (BS) upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5.

Results: After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for placing/replacing the NG tube was the same for both groups. There was no difference in the perioperative death rates between the two groups.

Conclusions: We conclude that the routine use of NG tubes after surgery is not recommended for all patients. NG tube should be used according to the specific needs of each patient. This protocol will protect patients from undesired complications.

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Background: Surgery operations are the fearful events among all other medical procedures. This fear causes anxiety and stress which affects the outcome of treatments, recovery from surgery and some maladaptive behaviors. To cope with surgery worries and minimize the fear, it is important to study these fears and its associated factors. This study attempts to explore the surgery worries and the associated factors among Iranian high school adolescents.
Methods: To measure surgery worries, high school adolescents of age 11-15 completed the Child Worries Questionnaire (CPCI) adolescent form, and also answered the questions about the 14 independent variables (sex, age, parents education and occupation, previous hospitalization experience of child and immediate family and friends, number of hospitalization during Child’s life long, previous surgery experience of child and her or his immediate families, death of close friends in hospital). Multivariate regression method was used for statistical analysis to determine the effective factors.
Results: The results of this study showed that the Iranian Adolescents have most worries about the “Not being able to do the same things as before” and least worries about “What I will feel during the anesthesia”. The factors associated with Surgery worries are parent’s education (P=.021 for father and 0.049 for mother), adolescent previous experience and number of hospitalizations (P=0.025 and P=0.008, respectively), the number of previous hospitalizations (P=.003), previous experience of hospitalization of immediate family and friends (P=0.035). The findings of this study have implications for parents, family, hospitals’ staff and care given.
Conclusions: It seems, according to the findings of this study, there should be a special educational program for children who are going to be operated in a hospital ward to reduce their worriships.

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Background: The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body. In clients with a chronic disease, such as end-stage renal disease, functioning status and hematologic indexes are different than among the general population. Electrolyte and hematologic changes may induce many illnesses for such patients. The purpose of this study is to determine the effects of applying the continuous hemodialysis (HD) the blood test results of HD patients.

Methods: This quasi-experimental, before-after study included 38 HD patients from Hamedan, Iran in 2005. Subjects were selected using simple randomized sampling and were assigned to one group for the purpose of this research and investigated over a period of six months. Data collection tools included demographic questionnaire and control check lists. The first phase of the research involved orientation of the control group, which was limited to completion of the questionnaires and control check lists. Immediately after, the same patients became the case group, upon which continuous HD was applied and hemoglobin, hematocrit, blood urea nitrogen (BUN), potassium, sodium, and albumin tests were performed. Statistical analysis of the data employed SPSS (version 13), descriptive statistics, paired t-test and the Friedman test.

Results: In this group, 47.2% of the subjects were male and 52.8% female. Data analysis shows that, using repeated measurement ANOVA test, a significant relationship between application of the continuous HD and improvement in hemoglobin, hematocrit, BUN, potassium, sodium, and albumin levels (p<0.05).

 conclusion: Application of continuous HD causes a significant improvement in the blood test results of HD patients. We recommend that continuous HD be used, whenever appropriate, to resolve the common causes of complications in HD clients, including abnormal levels of electrolytes, especially potassium and phosphorus, as well as BUN and creatinine.

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Background: The resistance of Pseudomonas aeruginosa strains to broad spectrum cephalosporins may be mediated by extended spectrum b-lactamases (ESBLs). These enzymes are encoded by different genes located either on chromosome or plasmids. In this study, we determined the antimicrobial resistance patterns of P. aeruginosa isolates and screened for ESBL production.

Methods: After isolation from burn patients in Tehran Hospital, identification of P. aeruginosa isolates were assessed using biochemical tests. We then performed disk agar diffusion (DAD) according to CLSI guidelines to determine the pattern of antimicrobial resistance. The frequency of ESBLs and prevalence of the OXA-10 and PER-1 genes were determined with combined disk and polymerase chain reaction (PCR) methods, respectively.

Results: One hundred strains of P. aeruginosa were isolated. The resistance of these strains to cephpodoxime, aztreonam, ciprofloxacin, ofloxacin, ceftazidime, cefepime, imipenem, meropenem, cefotaxime, levofloxacin, piperacilin- tazobactam and ceftriaxon was 100%, 90%, 83%, 92%, 85%, 88%, 63%, 66%, 98%, 89%, 70% and 91%, respectively. Of these, 40 strains (40%) were ESBL positive, 29 strains (29%) were OXA-10 positive and 18 strains (18%) were PER-1 positive.

Conclusion: Our results confirm the need for proper antimicrobial therapy in burn hospitals, considering the resistance pattern and frequency of strains producing ESBLs and the presence of the OXA-10 and PER-1 genes. Since an increase in the prevalence of ESBL in P. aeruginosa strains might lead to the transfer of these ESBL genes to other gram-negative bacteria, we recommend the use of appropriate drugs, especially cephalosporins, in burn hospitals.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stromal tumors of the gastrointestinal tract (GISTs) are uncommon and the cell of origin is actually mesenchymal. Stemming from smooth muscle, 90% of GISTs, or leiomyomas, are found in the lower two thirds of the esophagus. Typically solitary, multiple tumors (leiomyomatosis) are occasionally reported. Remaining intramural during their growth, most of their bulk protrudes toward the esophageal outer wall, with a freely-movable, normal-looking overlying mucosa. In this study, we report a rare case of esophageal leiomyomatosis treated by esophagectomy.
Case Report: A 70-year-old man presented with discomfort upon swallowing, dysphagia, nausea, belching and weight loss. After a barium swallow, only dilatation of the esophagus from the retained food and saliva was seen. CT scan revealed a 10-cm dilatation of the thoracic esophagus. An endoscopy and upper GI series was performed, but no pathology was found. Esophageal manometry and pH monitoring for gastroesophageal reflux were normal. Upon endoscopic ultrasonography, a thickening of the esophageal wall was identified 20-30 cm from the dental arch. The patient was diagnosed with a GIST, referred to surgeon and a transhiatal esophagectomy was performed. The patient was discharged from the hospital in good condition and has had no problem during the one-year period of follow up. 

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Background: Tumor cells need food and oxygen supply for growth and division. Therefore one of the most promising areas of cancer therapy focuses on using agents that inhibit tumor angiogenesis. Inhibition of angiogenesis prevents cell growth, division and metastasis. Previous studies showed that plasminogen related Protein-B has an anti-tumor activity in mice. This protein has a high level of homology with preactivation Peptide (PAP) of human plasminogen. According to this high homology, antiangiogeneic activity of PAP was investigated in an in vitro angiogenesis model.

Methods: PAP encoding region of human plasminogen gene was isolated by Polymerase Chain Reaction and ‎cloned in pGEX-2T vector. This plasmid was expressed in Escherichia coli as a fusion protein (GST-PAP). ‎GST-PAP was expressed as inclusion body and purified by affinity chromatography on GSH-sepharose ‎resin after refolding. antiangiogenic effects of purified protein were surveyed with Matrigel assay‏.‏‎ ‎

Results: The GST-PAP was expressed and purified and its accuracy was confirmed by SDS-PAGE analysis ‎and immunoblotting. Microscopic studies showed that GST-PAP inhibited angiogenesis in Matrigel system ‎which is shown by shrinking the length of capillary like structures and a decrease in the number of tubule. ‎While applying concentarations of 25μg/ml of GST-PAP and concentrations above that, antiangiogenic ‎activity of GST-PAP was significant comparing to the controls. ‎

Conclusion: Finding shows that GST-PAP can inhibit network formation in Matrigel system. This findings ‎support the theory that PAP is a potent angiogenesis inhibitor.‎

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Background: Obstructive gastrointestinal (GI) malformations are one of the most important congenital problems and have different clinical manifestations, which depend on the severity and location. Although, complete obstructive lesions cause classic intestinal obstructive symptoms in infants, incomplete obstruction might be asymptomatic until adulthood and sometimes cause unusual symptoms, which need extensive work up. Moreover, this delay could produce significant complications. Near all of these lesions are surgically correctable therefore awareness of this possibility is important in order to prompt appropriate management and referral plan.

Case report: In this report, we introduce five infants who had congenital GI malformations with different presentations such as vomiting, hematemesis, growth failure and steatorrhea. Appropriate time of diagnosis caused surgical correction of lesions except in one patient with very unusual presentation who was diagnosed late. As a result, in this case, severe growth and developmental delay appeared.

Conclusion: Congenital gastrointestinal obstruction has different manifestations. Awareness can help to survive patients.

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Background: Streptococcus pneumoniae is a common cause of respiratory infection. Pneumococcal upper respiratory tract infection (URTI) in children is seldom bacteremic. Determination the prevalence of S.pneumoniae infections in children with URTI using rapid urinary antigen test (BINAX now) and titration of serum pneumolysin antibody (added to conventional culture) was the object of this study.
Methods: A cross sectional, case-control study done in ENT & pediatric departments of Rasoul Hospital in Tehran, Iran, (2008 -2010) upon 133 cases with upper respiratory tract infection (otitis media, sinusitis and tracheitis). The nosocomial infection omitted in first step. 60 remaining cases followed for S.pneumoniae infection by culture and rapid urinary antigen test (Binax Now). Serum pneumolysin antibody titers compared between 45 cases and 66 controls.
Results: Positive culture (S.pneumoniae, H.influenza) obtained in 4/60 URTI cases. Positive urinary S.pneumoniae antigen detected in 50% (30/60) of cases and 6% (4/66) of controls (p=0.01). The pneumolysin antibody level with cut-off level 525pg/ml was higher in URTI cases than controls (982±441 Vs. 525±42, p<0.0001). Area under the ROC curve for pneumolysin antibody was 0.923 (95%CI 0.86-0.97, p<0.0001) and had 87% sensitivity and 82% specificity for differentiation between cases and controls.
Conclusions: The high pneumolysin antibody level in cases with URTI strongly indicates the pneumococcal infection. Pneumolysin antibody level even in little amounts (525pg/ml) with 87% sensitivity and 82% specificity is a suitable test for diagnosis of pneumococcal infection in children with URTI, but this test should be added to conventional culture (gold standard) and rapid urinary antigen test.

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Background: Because bronchial hyper responsiveness (BHR) has been shown to be a risk factor for asthma and lung function decline, interest has focused on diagnosing BHR. The aim of our study was to measure the association between airway caliber relative to lung size expressed as the ratio between forced expiratory flow, mid expiratory phase, divided by forced vital capacity (FEF25-75/FVC) and BHR measured by methacholine challenge test (MCT) to obtain a cutoff for this ratio and positive MCT.
Methods: We carried out a cross- sectional study on general Iranian population in 376 subjects aged 7-73 years who were referred to Shariati hospital in Tehran, Iran in an outpatient setting. There were 190 male (50.5%) and 186 female (49.5%) subjects. They had chronic respiratory symptoms such as cough and dyspnea. The physical examination was normal. Baseline spirometry was normal or equivocal. MCT was done for all subjects over a two year period (2009- 2010). Positive MCT was defined by PC 20≤4mg/ml.
Results: The methacholine challenge test was positive in 191 (50.8%) and negative in 185 (49.2%) patients. The mean of FEF25-75/FVC in positive MCT was 0.86±0.27 Vs. 0.91±0.28 in the negative ones (p=0.070). The sensitivity and specificity of FEF25-75/FVC for prediction of MCT results were 57.1% and 60.2% based on cutoff point of 0.85 in all patients, and 87.5% and 70.7% based on cut off point of 1 in allergic patients, respectively.
Conclusion: The FEF25-75/FVC appears to be a useful predictive ratio in allergic patients but not in general population.

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Background: Asthma is a life-threatening disease that can cause death due to bronchospasm. In addition to clinical symptoms such as wheezing, acute paroxysmal dyspnea, chronic cough after exposure to cold air or cough after exercise, spirometry is also necessary for the diagnosis of asthma. The association between respiratory symptoms and a positive methacholine challenge test (MCT) is still controversial. The aim of this study was to determine the association between methacholine test results and respiratory symptoms and allergy.

Methods: One hundred and forty-six patients with respiratory symptoms and normal baseline pulmonary function tests were enrolled in this cross-sectional study. The participants were divided into two groups according to their positive or negative response to MCT. The association between MCT and the clinical symptoms and allergy was later evaluated statistically.

Results: Out of 146 participants of the study 59 (40.4%) were female and 87 (59.6%) were male. The mean age of the participants was 33.8±13.8 years. Sixty-one patients (41.8%) had positive results for the test. There was an association between a history of allergy, wheezing and age with positive MCT results. The other clinical signs had no association with the test.

Conclusion: Methacholine challenge test is the best diagnostic test for ruling out asthma in patients with normal pulmonary function tests in whom we cannot definitely rule out asthma based solely on clinical symptoms. Nevertheless, in adults with a history of allergy, wheezing and also in patients below 30, the probability for a positive MCT is high.

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Background: Infection with Taenia saginata or taeniasis is an uncommon parasitic infection in Iran with a prevalence rate of 2-3% and it is more seen in the northern parts of the country. Epigastric pain, nervousness, dizziness, nausea and loss of appetite may be the only presenting symptoms but secondary appendicitis, acute intestinal obstruction and necrosis of the pancreas are its serious and rare complications. Case presentation: A 62-year old woman was admitted to Imam Khomeini Hospital with signs of acute abdomen. She had a past history of infection with hydatid cyst and its subsequent surgery, eight years ago. At the time of admission, she suffered from persistent abdominal pain and loss of appetite for two years. Despite having the epidemiological evidence of working along the banks of rivers contaminated with human sewage and working on farms fertilized with human waste and presence of signs hinting at the disease, parasitic infection had not been considered in its diagnosis. Conclusion: Although signs and symptoms of taeniasis are non-specific but a complete history, physical examination and detailed patient notes, especially by considering epidemiological factors, are very important to the early diagnosis of taeniasis

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Background: Thymidine phosphorylase (TP) catalyses the conversion of thymidine into thymine. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease which is caused by mutations in the nuclear gene encoding TP, bringing about severe impairment of TP-enzyme specific activity and accumulation of thymidine in plasma. The clinical manifestations of MNGIE are recognizable and homogenous, but not in the early stages of the disease. In patients who are suspected of having MNGIE, determination of TP-specific activity in leukocytes and thymidine levels in plasma are diagnostic. The methods that are usually used for the measurement of TP activity and plasma thymidine are not rapid or accurate enough and lack sensitivity.

Methods: The specific activity of TP was measured by RP-HPLC in leukocytes of both the controls and the patients exhibiting clinical features suggestive of MNGIE. Moreover, plasma thymidine was assessed by the same method.

Results: The patients had detectable plasma thymidine (>3 µmol/L) but it was undetectable in the healthy controls. The patients' TP-specific activity decreased to less than 5% relative to the controls (14±4 nmol/h/mg vs. 525±165 nmol/h/mg, P<0.05). A diagnostic algorithm for the definitive diagnosis of MNGIE is suggestible based on the results of this study which relies on the measurement of plasma thymidine, TP-specific activity in leukocytes, or both.

Conclusion: In this study, we set up a sensitive and rapid assay for the evaluation of TP-specific activity by using RP-HPLC in Iran. In addition, we established reference values for TP-specific activity and plasma thymidine in the Iranian patients.

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Background: Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction.

Methods: Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated.

Results: There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years.

Conclusion: There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

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Background: Nowadays, cancer is one of the main causes of mortality in the world and many mutagens are the cause of death in millions of patients. Due to the side effects of anticancer drugs, scientists are in search of natural drugs with fewer side effects and more therapeutic efficacy. This study aims to, firstly, investigate the antimutgenic effects of different Aloe vera gel and latex extracts on mutated Salmonella typhimurium bacterium by using Ames test and to, secondly, study the probable effects of the habitat conditions on the antimutagenic effects of the plant.

Methods: After preparing different Aloe vera gel and latex extracts, the antimutagenic effects of the extracts were evaluated by Ames test. In this test, a mutated strain of S. typhimurium was grown on culture media containing a minimum of salt and glucose in the presence of a mutagen substance (NaN3). Subsequently, only those bacteria that had turned HIS+ by reverse mutation formed colonies. As different alcoholic and aqueous extracts of Aloe vera reduced reversed mutations, the difference between the means of revertant mutants per plate was calculated by one-way ANOVA using SPSS software (version 18).

Results: The ethanol extracts of latex from Karaj had a maximum (91%) and aqueous extract from Dezfoul had a minimum (42%) percentage of inhibition.

Conclusion: Maximum percentage of inhibition was observed in the extracts of the plant cultivated in Karaj reflecting the impact of environmental conditions on the construction of antioxidant compounds in plants.

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Background: Brucellosis is one of the most common infectious diseases in Iran with very different clinical manifestations.

Methods: In this retrospective descriptive study, all patients with brucellosis, who were admitted in Farshchian Hospital in Hamadan, Iran in 2005 to 2010, were enrolled in the study. The data were collected from the patients' medical records and were entered in forms for analysis.

Results: A total of 230 patients with brucellosis, including 130 (56.5%) male and 100 (43.5%) female patients with a mean age of 40.84±20.29 years, who mostly (72.2%) lived in rural areas were enrolled in the study. Outbreaks were most common in spring and summer and the main route of transmission was consumption of contaminated dairy products (60.3%). The most common symptoms were fever (77.4%), arthralgia (70%), sweating (47%), malaise and fatigue (46.5%). Arthritis and epididymo- orchitis were seen in 121 (52.9%) and 48 (8.20%) patients, respectively. CBC analysis showed leukocytosis in 20.8% of the participants. ESR rise was noted in 59.5% of the patients and 52.9% had positive CRP.

Conclusion: Given to various clinical presentations, brucellosis should be considered in the differential diagnosis of individuals with chronic fever with or without other organ abnormalities.

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Background: Regarding the limited number of studies on the feasibility of resection and repair of the small intestine by ligasure, we performed this study to compare ligasure with linear stapler for the previously mentioned operation.
Methods: This phase 1 clinical trial study was performed in Ghaem Hospital, an educational hospital affiliated to Mashhad University of Medical Sciences, from 2010 to 2011. After obtaining permission from the University's ethics committee and a written informed consent from each patient, we recruited 18 patients. The participants who had morbid obesity and were candidates for laparoscopic gastric bypass surgery were randomly allocated to two stapler and ligasure groups. The data were collected and analyzed by three statistical tests, including Mann-Whitney U test, by SPSS 16.
Results: All patients were female with the age range of 20-65 years. Cost in the stapler group ranged between 29,500,000 to 40,000,000 Rial (mean 31,830,000± 3,500,000 Rials) and in ligasure group it was between 24,000,000 to 35,000,000 Rials (mean 26,720,000± 3,290,000 Rials). There was a significant difference between the two groups in cost (P=0.004(. Duration of the operations were 200±3.4 and 240±10 minutes in the stapler and ligasure groups, respectively. The difference in duration was significant between the two groups (P=0.043). No significant differences were observed in complications.
Conclusion: Application of ligasure in resection and reconstruction of small intestine is more cost-effective than stapler, although duration of surgery is longer.