Tehran University Medical Journal

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SCL-90-R-scale was used to asses 1184 enrolled medical colleges students, Tehran University of Medical Sciences and Health Services. Out of nine orthogonal symptome dimensions of the instrument, paranoid ideation, interpersonal sensitivity and obsessive complusive were the most frequent in the study.
Difference between males and females was significant in depression, anxiety and phobic anxiety dimensions. Mean psychopathological dimensions in students with GPA lower than 14 were detected to be more significant than others

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Post partum haemorrhage (PPH) and retained placenta are the most common serious abnormalities encountered during the third stage of labour. PPH is one of the most common causes of mortality in childbirth, particularly in developing countries. The incidences of PPH and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction (CCT). Weather such treatment is valuable is open to question because of the lack of clinical and physiological studies. Unfortunately, oxytocic drugs are not available to about half the women of developing countries, who do not deliver under the care of a trained midwife. We know that sucking stimulates uterine contractions in lactating women. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast-feeding and again within 3 min of the start of sucking. Traditional birth attendants (TBAs) do not have the skill to administer injectable oxytoxics. It has become the practice in some TBA training programmes to teach that the risk of PPH can be reduced if the mother puts her baby to the breast immediately after delivery. Objective: To determine the effect of sucking immediately after childbirth on the length of 3rh stage and amount of bleeding in the first day. This is a semi-experimental study. It was done in Tehran'e Mirzakochak hospital. 100 women received oxytocin intramuscularly and 120 women were placed in sucking group. Then the lenghth of 3rd stage and amount of bleeding in the first day was compared between two groups. Results: The duration of the third stage and number of pads different between oxytocin group and sucking group (4.42 vs 6.08 min) and (10.58 vs 11.72 number). As for the, parity, gestational age, maternal systolic and diastolic blood pressure, infant weight and hight, the results showed no significant difference between the groups. As for the, maternal age, the results showed differed significantly between the groups. As for the gestational age, the results of the research showed that between the gestational age and the duration of the third stage, there was a reverse correlation in multipare women. So when gestational age decreases the duration of third stage will be longer. As for the maternal age, parity, systolic and diastolic blood pressure, infant weight, infant hight, infant sex, the results showed that there was no correlation between these and the duration of the third stage.

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In a bacteriological study on 230 biopsies of patients suffering gastrointestinal disorders in Imam Khomeyni Hospital, 88 patients were selected as case and another 88 as control groups. Case group was treated by triple (Bismuth subcitrate, Metronidazole and Tetracycline) drugs for a period of 14 days. The latter treated by nonbismuth regiment eg. Amoxicillin and Ranitidine mainly. All of the patients were examined bacteriologically by biopsies in 1, 6 & 12 months after treatment. Obtaind data revealed that the Bismuth composed regiment was more effective than non-bismuth composing ones. In fact, bacterial eradication was approved in 89.8% of case group without recurrence of symptoms among them at least for entire year. Conversely, eradication occulted just in 23.5% of control group, frequent recruidescen Cl of pipriculear observed among them within one year.

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Norplant is one of the most effective contraceptive divices with low failure rate and long effect, which has been used in governmental centers, since 1992. considering high costs of this program, this study was designed to specify norplant continiuation rate, the causes of discontiniuation and also its complications. This descriptive study was done by reviewing women using this method in Hospitals of Tehran Medical Sciences University. The results indicate that since 1992 to 1997, 305 women have used Norplant. The mean age of them has been 27 years and 17% are employed. During the follow-up period (55 months) 43 percent have discontiniued using Norplant. The mean continiuation period in this group has been 14.6 month in 0-55 months limit. According to this study, the most common side effects of Norplant are menstrual irregularities including sporting, and amenorea, and neuropsychiatric disorders. No case of pregnancy has been reported in this period

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The present study demonstrated that comfortable listening and tolerance to loud speech, differs significantly between children with and without ADHD. Children with ADHD judged speech to be comfortable of tolerable at loudness levels significantly below those levels chosen by the children without attentional problems. Results of the present study could be interpreted according to the hypothesis presented as indicating that a central auditory ptocessing deficit exists in ADHD children. Other investigators in related disciplines suppot this assumption by identifiying existing problems in the central nervous system for gating and processing of information in children with ADHD. At present, it is hoped that the results and conclusion of the present study will shed light on improved educational management for children with attention deficit disorders. Although this study is based on our clinical findings and measurements, we do not negate the need to verify this clinical based study with data obtained from other carefully controlled studies.

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This paper represents a retrospective study of 142 patients with skeletal tuberculosis during the years 1350 to 1357 at Shafa Yahiaian Hospital. Confirmation of diagnosis is made by positive culture or pathology. The mean age of the patients was 27.5 years (range from 1.5 to 72 years). Most of the patients were in the second, first and third decade respectively. 45.3% of the patients were female. The spine was the most common site and was affected in 40.88% of the patients. The next sites were knee, hip and elbow, in order of frequency. The commonest site in spine was thoracic. The mean of sedimentation rate in the first visit was 48. Tuberculin skin test was negative in 23% of the patients. Evidence of pulmonary tuberculosis in chest radiography was present in 48.61% of the patients. Five patients had tuberculosis osteomylitis without involvement of the joint.

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Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

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Introduction: Hand eczema is one of the most common causes of disabiliting dermatoses. Objective: Our purpose was to determine the frequency of hand eczema in out patients seen in Razi hospital (university medical center). Design: Of 3754 patients with skin problems, 206 were investigated for hand eczema and the study was carried out with regard to age, sex, occupation, exposure to chemical and physical irritants and predispositional factors. Results: The prevalence of hand eczema was 5.48%. The mean age was 30.8 years. The female: male ratio was 1.6. The highest number of patients were in the occupational group with exposure to reegents and water (we couldn't do patch test because it was not available). The most common complaint was itching (85.5%) and the fingers were the predominant affected sites. Conclusion: The major cause of hand eczema in contact dermatitis (Irritant and Allergic) and patch testing in necessary to determine the allergic agent, that can be helpful in allergic contact dermatitis (ACD) but are sometimes discouraged because of high false-positive rate and also in many instances, simultaneous exposure to irritant factors plays an essential role in the development of ACD.

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This is a retrospective study of the treatment of 68 cases of spine injuries to make an objective assessment of clinical and radiologic results and to introduce the good results of C.D segmental instrumentation. 68 patients, with an average follow up of 36 months, who suffered from thoracolumbar, lumbar and cervical spine fractures and dislocations, underwent surgical and nonsurgical treatment according to the clinical and radiological datas. Patients with more than 50 percent of loss of body height, more than 50 percent of canal compromise and neurologic deficits underwent surgery. With the C.D instrumentation, it was possible to provide solid, short internal fixation with restoration of the sagittal profile without loss of correction. For patients eith heavy works, over-weights and especially, shattered vertebral bodies, to prevent loss of correction, combined posterior and anterior interbody fusion is highly recommended.

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57 cases of jaw's SCC who were hospitalized in Imam Khomeini HSP, Amir-Alam HSP & Cancer Institute between the years of 1373 to 1376, were studied. 23 cases of them were female and the rest of them (34 cases) were male. The range of age of patients was between 25 to 85 years. 21 cases (36.8%) have maxillary involvement and 37 cases (64.9%) have mandibular involvement and there was one case (1.7%) of synchronous involvement of both sites. Patients were categorized according to their individual characteristics (sex, age, occupation, birth & living place), etiologic factors (smoking & familial susceptibility), complaints, sites of involvement in each jaw, histopathological characteristics of tumor (stage, grade, lymphatic involvement), rate of bone and soft tissue involvement, type of treatment, and recurrences of previous lesions. According to the results, and apart from late consultation of majority of patients with their physicians, invasive behaviours of tumoral lesions were less than expected rate. And despite of using radical and invasive treatments, considerable percent of patients were facing recurrence of their previous lesions. Besides, patterns of distribution of birth and living places of patients may probably show the role of geographical and environmental factors in making patients susceptible to certain diseases.

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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.

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Introduction: It has been shown that repeated large volume paracenthesis associated with intravenous albumin infusion is a rapid, effective and safe therapy of massive ascites in cirrhosis. Our aim was to investigate wether IV infusion of albumin is necessary in large volume paeacenthesis therapy of cirrhotic ascites. Methods: 37 patients with tense cirrhotic ascites who were intractable to diuretic therapy were randomly assigned in two groups. 16 patients (group A) were treated with paracenthesis of 4 lit/day plus intravenous albumin infusion (7 gr/lit), and 21 (group B) with paracenthesis without albumin infusion. Hemodynamic status, liver and kidney function and serum lectrolytes were assessed before, while and after paracenthesis. Results: Paracenthesis without IV albumin did not induce significant changes in standard renal function tests, serum albumin, serum electrolytes and liver function tests. One patient from each group developed renal impairment. Two patients from group A and 3 from group B developed asymptomatic hyponatermia. One patient from group A died due to hepatic encephalopathy during paracenthesis. Conclusion: Intravenous albumin infusion is not necessary during large volume paracenthesis for treatment of tense ascites in cirrhotic patients.

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A random panel of 500 healthy unrelated subjects from Isfahan province were HLA typed for A, B and C locus antigens. The lymphocytes were separated from 5 ml of whole peripheral blood and HLA-A, B, C typing were performed on them, using the standard two stage microlymphocytotoxic NIH technique. The antigens HLA-A1, A2, A3, A9, HLA-B5, B35, HLA-CW4 had the higher frequency than other HLA antigens among the population studied. The distribution of HLA class I antigens in Isfahan is similar with their distribution in Tehran and Mashhad.

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This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373). In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

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Natural Killer (NK) cells are the main lymphocyte population expressing P75 B chain of the IL-2 receptor (IL-2R). Consequently, incubation of peripheral blood lymphocytes with IL-2 induce selective activation of NK cells and results in NK activity and generation of Lymphokine activated killer (LAK) cells activity and proliferation. One of the early events during IL-2 activation of peripheral blood lymphocyte in both rodents and humans is adherence of some NK cells to plastic surface. The cells adherence to plastic after 24 hr of culture with IL-2 are almost exclusively CD56+, have the morphology large granular cells to yield a highly entiched population of activated NK cells that have been used for systemic adoptive immunotherapy. To test these hypothesis, we used highly purified population of human peripheral NK cells through the biological and nonimmunclogical phenotyping technique. Blood mononuclear cells were separated by centrifugation of ficol-hypaque gradient from normal blood donor (20-30 years age). We depleted after purification of nonadherent cells with nylonwool. We collected with rosette technique to remove cells with high affinity SRBC receptors. These cells separate in two parts A-NK and NA-NK by mononuclear celss activated supernatant media. The main objective results of this study show that the subpopulation of human NK cell which develope early adherent to plastic surface in the presence of supernatant mononuclear celss activation media was functionally more cytotoxic and killed K562 targets in single cell sytotoxicity manner and LDH activity assay than nonadherent NK cells and resting NK cells

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Aim: It is believed that sampling of the lower airways by BAL in complicated patients with pulmonary infection is often contaminated with upper airways microorganisms. The aim of this study was to assess the value of this procedure and probability of contamination of samples by upper airways flora. Methods: In a prospective study 40 consecutive patients which were candidate for broncholaveolar lavage were choosen for the study, and cultures were obtained from oropharyngeal and peripheral pulmonary airways, respectively. Results: Data showed two different groups of patients, distinctive by wether they have normal flora (group one 55% of total) or they have pathogenic microorganisms (group two, 45% of total). Group one had the normal flora in their upper airway tract, while only half of these group showed the same organisms in their lower airway tract, and the rest had negative cultures of the lower airways. The majority of second group had pathogenic microorganisms in their lower airway tract, while only half of them had negative cultures of the upper airways. Conclusion: We assume that the origin of pulmonary infection in our patients is from the peripheral airways. Thus sampling of the lower airways is representative of the actual pathogen, and we recommend that in order to rule out the suspicion of contamination by the upper airway organisms, simultaneous sampling of the upper airways should be obtained. Thus the application of sophisticated sampling methods and their cost effectiveness must be more investigated in view of the efficacy of our simple and inexpensive and practical method

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102 patients with ascites were enrolled in a sonographic study of abdomen and pelvis without awaring of history, clinical and paraclinical findings. So with only sonographic finding we suggested the diagnosis and etiology of ascites. All patients were hospitalized. Finally all the patients were diagnosed definitely and were compared with sonographic diagnoses done before. Results: In this survey 42% of patients had cirrhosis, 20.5% had malignancy, 14.7% had renal disease. Overall sensivity of sonography in diagnosing etiology was 91.1%, overall specifity was 97.8%, overall accuracy was 94.4%. Sensivity, specifity and accuracy of each group have also been determined separately.

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Results of a twelve-year (1987-1998) prospective study of Visceral Leishmaniasis in 103 patients admitted to the Ahari Children's Hospital Medical Center indicate that IFA (Indirect immunofluorescence antibody test) is highly specific and cheap. Finally we found that 86 patients (84%) were IFA positive and bone marrow aspiration of 34 (79%) of these patients were negative. 59 cases had positive bone marrow aspiration (57%) of which 52 cases had positive IFA (P<0.001). Visceral Leishmaniasis usually responds to fifteen days treatment with Glucantime (Megalumine antimonate). The pediatric dose is 20 mg/kg daily, administered intramuscularly. The treatment can be repeated.

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In order to evaluate accuracy and usefulness of sonography and choose it as preliminary investigation method in pathologic processes of parotid gland, 50 patients were studied in duration of 16 months. The lesions were evaluated with ultrasound and sonographic images were obtained before surgery and then were compared with pathologic results after surgery. All lesions were detected with sonography. This method could differentiate intraglandular from extraglandular lesions with accuracy of 100%. Except one case of lipomatosis which was hyperechoic, all other lesions of parotid gland were hypoechoic. All lesions with sharp and well-defined borders were benign whereas malignant processes had ill-defined borders. The results obtained show that sonography is a reliable diagnostic method to differentiate benign from malignant lesions and it has a high diagnostic value to detect warthin's tumor, plemorphic adenoma, Sjogren's syndrome and lipomatosis. Presence of calcification in a parotid mass of young patient with high probabye is related to cavernous hemangioma.

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In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1 550: with history of one spontaneous abortion (G2A1), group 2 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000), but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003) and placenta previa (RR=8.5, P=0.03). These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.