Tehran University Medical Journal

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A case-control study was performed by the Research Center of Isfahan University, to determine the predisposing factors of early atherosclerosis. Children of cases admitted to a university hospital in Isfahan with early myocardial infarction (MI) were considered for the study. The affeckted cases (n=116), had 120 children aged 2-14 years. The control group were selected from children of the neighbors of the cases. The two groups were similar in age of parents, children and socio-economic status. Mean cholesterol and triglyceride levels and the frequency of hypercholesterolemia and hypertriglyceridemia were significantly higher in the children of MI cases. The mean lipid concentration of the controls was significantly higher than standard levels. These results emphasize the importance of evaluating children of high risk cases for risk factors of MI.

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Hypertension is one of the most important modifiable risk factors of vascular heart disease. Control of hypertension in different age groups has a significant effect upon the control and prevention of vascular heart disease. A familial pattern is observed in the distribution of blood pressure in different societies. Family history of hypertension has a profound effect on the future risk of developing hypertension. The blood pressure of approximately 8150 inhabitants of Isfahan aged above 18 years was measured during 1993-94. Blood pressure measurements were performed according to the standards set by WHO i.e., on two separate occasions, in the sitting position, and from both arms. A questionnaire was completed consisting of 26 questions, including questions regarding history of hypertension in first and second-degree relatives. Cases with a blood pressure of 140/90 mmHg or more, were referred to the Cardiovascular Research Center of Isfahan for further evaluation. Mean systolic and diastolic blood pressure was higher in cases with a positive family history of hypertension. In this study, 37.4% of the men with hypertension and 45.4% of hypertensive women had positive history of hypertension in first-degree relatives. The association between positive family history and hypertension was not significant in men (P=0.62), but it was significant in women (P=0.000). This difference was less pronounced in the older age groups, which could be explained by the illiteracy of most of the older cases and their ignorance of the existence of hypertension in family members. After correcting for the effects of confounding factors, it appears that positive family history has a stronger association with the development of hypertension in women. Moreover, positive family history is a strong prognostic factor in the likelihood of hypertension in the children of affected cases. These findings emphasize the importance of routine blood pressure measurement in children and adolescents.

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Port wine stains are benign but cosmetically devasting congenital angiomas. The argon laser is a therapeutic device newly applied to this condition. Our program was begun 6 years ago. From the beginning, the study was conceived as a clinical investigation of both the port wine stain and its argon laser therapy. A total of 218 patients with port wine stains have been studied and many aspects of their clinical condition detailed. Employing the Argon laser, test spots have been carried out in patients and the results have been analyzed with clinical aspects of the lesions. Altogether, 501 treatments were performed in 218 patients. Good to excellent results were obtained in 81 patients. Moderate Result was obtained in 31 weak result in 65 patients. Most common complication were hyperpigmentation and depressed scar.

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Disodium hemiphthalate Glycyrrhetinic acid (DHGA) possesses anti-inflammatory and analgestic activities. In our research, this agent was injected intraperitoneally to mice, according to the following schedule.
1) 25 mg/kg, 50mg/kg & 75mg/kg at 7th day of pregnancy.
2) 50 mg/kg & 75mg/kg at 8th day of pregnancy.
3) 50mg/kg & 75mg/kg at 9th day of pregnancy.
DHGA with doses of 50mg/kg and 75mg/kg at 7th, 8th and 9th day, delays the growth, decreases developing of ossification centers (specially in hand and foot middle phalanxes), decreases the number of caudal vertebrae of sacro-illiac joint and results in slight but important increases in fetus mortality.
Abbreviations
H & E=Haematoxylin & Eosin
CRL=Crown-Rump Length
BPD=Biparietal Diameter
W=Weight
ETS=Embryo Toxicity Score

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We evaluated the power of pregnant women's neutrophils in releasing the oxidant substances (such as H202, superoxide, ...) in the presence of luminol. In the presence of luminol these substances will emit light and we measured this light by a luminometer (chemiluminescence technicque). Baker's yeast was used for neutrophil activation.
This study includes 45 pregnant women (mean age = 30.7 years) and 20 controls (mean age 31.8 years).
Results : 1-the mean of maximum light in p.w (N-CL in p.w) was 209.1 mv (milivolt) and in controls 152.6 mv.
2-the mean of maximum time for N-CL in p.w is 10.3 min and in control 11.1 min.
We observed that N-CL (power of phagocytosis) in p.w increased (P< 0.01) but the time didn't.

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Cesarean section (CS) is a relatively safe procedure, performed for different maiernal and fetal indications. Despite complications of general anesthesia, post-operative infections, and thromboembolic events, CS is being performed with increasing frequency. In this study, we have examined the indications and complications of CS's performed in Arash Hospital from December 1993 to November 1994. Of the total 3480 cases of chiidbrilh, 900 (24.45%) were performed by CS, most and last frequently in December/January and November/December respectively. However, Ute ratio of CS cases to all cases was equal throughout the year. The most common indication of CS was failure to progress in labor (38.54%), and the other causes were repeat CS (21.77%), meconium excretion (11.97%), malpresenlation (8.55%) and fetal distress (5.58%). The indication of CS varies with meternal age. Between 41-45 years, the most common indications were prior CS (42.5%), and request for concommitant tubal ligation (12.5%), whereas in the younger age groups, the most common indication was failure to progress in labor. In primiparous cases, 44.55% of the CS's were performed due to failure to progress in labor, while the latter was the indication of CS in only 14.5% of the multiparous women. Complications were observed in only 4.54% of CS cases

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Mullerian anomalies are one of the interesting but uncommon entities that gynecologists confront. The incidence is 1-6%, It is difficult to" anticipate the real incidence, because most of information is obtained from infertile or complicated patients with inadequate work-up. Recently endoscopic pocedures reveal more details about these anomalies. Today, classification of Buttram & Gibbons (modified by AFS [American Fertility Society]) is accepted. In this paper one patient with septate uterus, duplication of cervix and vaginal septum is introduced. According to information obtained, only one similar case is reported (by McBean et al). This entity is not conformed with AFS classification. Only in Toaff et al classification, there is a class similar to these patients. This entity is not explained by classic embryological theory of mullerian development

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One hundred and sixty preterm deliveries were done at our center in (1996-97). Classification according to etiology shows that 30% of these deliveries were due to PROM, and 13.75% had to be induced secondary to underling fetal or maternal indication, in 35.6% there were maternal or fetal pathology, and in 20.6% there were no recognized reason (idiopathic). The various etiologic factors were evaluated in 160 term deliveries as control group. The preterm deliveries had significantly higher rate. There were 40 cases of perinatal mortality that included 77% of total perinatal mortality in (1996-97). Acute lack of neonatal intensive care unit in Iran requires closer attention in the future.

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Diabetes Mellitus is one of the common diseases leading to dialysis. In a cohort study, diabetic dialysis patients were compared with non-diabetic dialysis patients for one year about age, sex, cause and times of admission and rate of mortality. The study was done on 101 patients. At the end of the study, 88 patients remained. Results were interprected by T-test and chi-square statistical analyses and signified with P value less than 5 percent. Results: Diabetes was the cause of 17.8 percent of renal failure in 101 patients. The mean age of diabetics was greater than non-diabetics (P=0.02). Mortality of diabetics in one year was 20 percent, similar to non-diabetics. Infection (chills and fever) was the most common cause of admission in diabetics (33 percent) and non-diabetics (25 percent) with no significant difference. Conclusion: Mortality and morbidity between diabetic and non-diabetic dialysis patients had no significant difference.

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Hysteroscopy is a new and precise method for evaluating of uterus, so it is valuable in evaluating infertile women. In 18 months, 363 hysteroscopies were done on patients who were visited in IVF center of Shariati Hospital for treatment of infertility. Incidence of abnormal hysteroscopy was 18%. 32% of these abnormal hysteroscopies was endometrial hyperplasia. In evaluating of laparoscopy and other factors of these patients there was a statistically significant relation between diagnosis of PCOD (polycystic ovary disease) and endometrial hyperplasia (P<0.008), but there is no significant relation between other diagnoses like endometriosis and endometrial hyperplasia (P<0.4).

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Improper drug prescription by physicians due to wrong diagnosis, wrong drug choise or other causes will waste national funds. The annual drug costs in Iran is 900 billions Rials. With approvement of prescription, it can be reduced to 500 billions Rials. Effective factors in costs reduction are: 1) Increasing medical knowledge and persistent education of physicians. 2) Spending more time for each visit. 3) Giving more information to physicians about pharmacological compounds. 4) Teaching symptoms and signs of the common diseases and proper diagnosis of them. 5) Checking the prescriptions of physicians.

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Helicobacter pylori (H.Pylori) is the most common human infection in the world. This agent has a strong role in pathogenesis of chronic gastritis and peptic ulcer. Therefore introducing of simple and cost effective tests are important for diagnosis of H.Pylori infections. ELISA has been considered as an alternative test compare with biopsy, histological staining, culture and urease test in diagnosis of H.Pylori infection. In this investigation, 111 patients referred to GI endoscopy department of Imam Khomeini Hospitals for U.G.I problems which were evaluated for H.Pylori infection. Culture and histological staining (GIMSA and H & E) were used as a gold standard test compare with ELISA-IgG and urease test. Sensitivity and specificity for ELISA were 90%, 93% respectively. This report suggests that ELISA is a cost effect and valid test in diagnosis of H.Pylori infection

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In this study we review 82 infants under two months with bacterial meningitis admitted in Tehran University's hospitals during a 14 year period. Male to female ratio was 1.4 to 1. The patterns of predominance among bacterial pathogens changed during the period of study. During the first six years the most common pathogens were Salmonella-SP., but during the later years E.coli became the predominant pathogen, and also meningitis caused by GBS and Staph. epidermidis was observed. The case fatality rate was 37.8 percent. The antibiogram revealed that E.coli were hundred percent resistant to ampicillin and 50% resistant to gentamicin, 40% of all bacteria isolated were resistant to ampicillin and gentamicin. These findings provide guidelines for the selection of empiric antimicrobial agents in our country

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S-J syndrome is a rare autosomal recessive disorder of short stature, blepharophimosis, puckerd mouth, myotonia, muscular weakness, pectus carinatum and stiff joints. Case report: first case: n.1. A boy aged 7 years. His main abnormalities included puckered lip, blephharophimosis, muscular hypertrophy and weakness, pectus carinatum, short stature, shoulder joint limitation and myopia. Myotonic discharges in EMG and muscular dystrophy in muscle biopsy observed. Hypoplasia of clavicle, generalized osteopenia, mild platyspondyly and delayed bone age were radiologic findings of this patient. Second case: A boy aged 8 years. His cardinal abnormalities were similar to case 1. Hip joint limitation, low set ear, anterior cortical opacity of lens, small testis and coxa valga were the other manifestations of this patient. Both patients have a normal IQ and parental consanguinity was also present. CBZ was used for both patients

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Manifestation of chorea in patients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APA synd.) is not common. Moreover, primary presentation of the disease with chorea is rare and only few such cases are reported in literature in recent years. We report here the case of a 28 year old woman who was first seen at the age of 10 with clinical manifestations of chorea. Later she developed deep vein thrombosis, thrombocytpenia, stroke, cardiac valve involvement and recurrent abortions. Laboratory investigations confirmed the diagnosis of SLE and the presence of antiphospholipid antibodies. We present this patient as a case of SLE and antiphospholipid antibody syndrome with chorea being her primary clinical presentation

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In an attempt to investigate the fungous infections of AIDS stricken patients, a study which lasted 1.5 years was conducted, in which 21 patients were examined. The subjects were 20 males and a female. One of the male patients was from Uganda, another was an intravenous drug addict, and one had been abroad for sometimes and had received blood there. All other patients had also blood transfusion instances before 1984. To do the research, 414 laboratory specimens were gathered and examined regarding fungus involvement. The result showed 104 negative and 310 positive cases. Based on these findings and also clinical examination, all patients suffered from one or more fungous infections in the forms of oral candidiasis, perleche, candidal onychomycosis, perianal candidiasis, mucocutaneous candidiasis, tinea versicolor, pityrosporosis and rhodotrulosis. The latter caused skin lesion with scaling and is being reported for the first time. Candida parapsilosis and trichosporon pololans were also isolated specimens. However, concerning the diagnostic value of trichosporon pololans more investigation is needed.

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Two hundred charts of infertile patients who admitted from April 1995 until March 1996 at Mirza Koucha Kkhan Hospital, retrospectively were reviewed. In this study, the results of hysterosalpingograms and laparascopy of all patients were evaluated. The goal of this study was: whether polypoid alterations and endometrial hypertrophy were a cornerstone sign for endometriosis. Among 32 patients who showed endometrial hypertrophy or polypoid hypertrophy only 3 has had endometriosis in laparascopy which were proved by histopathology, while 22 out of 168 with normal hysterosalpingograms revealed endometriosis. In conclusions: hypertrophic alternations and polypoid changes of endometrium could not be a good sign for endometriosis, and normal hysterosalpingograms do not rule out the endometriosis.

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Some of ICU patients with Acute Renal Failure (ARF) require dialysis. Conventional or intermittent hemodialysis (HD) may cause hypotension and insufficient loss of fluids and toxins from blood. Peritoneal dialysis also my cause peritonitis and has lower efficiency than HD. We did continuous Venovenous Hemodialysis (CVVHD) for three ICU patients with ARF in Saint-Zahra Medical Center for the first time in our country. Method and Material: With a polysulfone membrane, blood pump, peritoneal dialysis solution, heparin, and a fix nurse, HD was done for 12-24 hours. Results: 1) Urea clearance was 18-50 ml/h. 2) Ultrafiltration was 160-1000 ml/h. 3) With dialysis, hemorrhage, coagulation disorder, and oxygenation recovered. 4) All of patients developed hyperglycemia and hypothermia. 5) All of patients died (two with septicemia and one with hypotension). Conclusion: In the absence of hemodialysis or peritoneal dialysis, CVVHD with present preliminary equipments is suitable and can excrete more toxins and fluids.

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Intrauterine insemination (IUI) has been practiced since the late 1800's primarily for idiopathic infertility, and in men with deficient semen parameters. The procedure is done by placing washed sperm in uterus a few hours before ovulation. The records of 427 couples receiving IUI for treatment of infertility at Shariati hospital in 1370-74 were reviewed retrospectively. These patients had IUI in 574 cycles. Eighty patients became pregnant and delivery rate was 14% per cycle. Pregnancy rate is impressive when ovulation induction is combined with insemination timed just before ovulation. The success rate in Shariati hospital is comparable to other infertility centers in the world and cost of a cycle of IUI with HMG superovulation is approximately one third the cost of IVF-ET or GIFT cycle and avoids invasive oocyte retrieval and extracorporeal fertilization. So we suggest that women with refractory infertility without anatomic distortion of pelvis can have at least 3-6 cycles of IUI before IVF or GIFT.

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Food, it's production and preserving has been one of the most important problems in human life. Limitation of production due to climatic, geographic and papulational situations and conservation due to providance and prosecting for solution of one of the most fundamental human needs, has been discussed much. Difference between the lands, temperature, humidity and rainfall on one hand and texture and accumulation of papulation on the other hand, not only has limited the amount and kind of food production but also has improved the preserving methods as much as possible. Extra production in fertile lands and confirmed need for receiving food in deserts and dry areas, makes the need of exchanging and transfer of food inevitable because of economic and ethical matters and sanitation of food. Avoidance of being contaminated and resistance against decay seems very important and vital. So process of preserving and conserving of eaw or cooked food became a fundamental problem. In previous 200 years, many advanced methods have been designed for preserving food in which the role of conserving and packing in vital often. Because of industrial production, conserved food have a great influence on sanitation of people nutrition, and herefor the rate of diseases from consumption of contaminated food has been reduced in industrial countries and the tensancy of people to use conventional food has been decreased gradually. Because of high cost of industrial conserved food production some people produce conserved foods in the way which is not hygienic. That may have a high risk when ingested. In this article we discuss about unwarranted conserved foods productions.