Tehran University Medical Journal

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Background: Gastric cancer (G.Ca) is significantly more prevalent in north western than central Iran. Growing evidence has related Helicobacter pylori (H.P) to G.Ca worldwide. We assessed the prevalence of H.P infection in high (Ardebil) and low (Yazd) prevalence of G.Ca provinces of Iran. Methods: Cluster sampling of healthy population aged less than 20 years was performed in Ardebil and Yazd provinces over 2 months. Ten cc blood was drawn from each person and H.P IgG was tested using ELISA (Diagnostic Corp., sensitivity 98%, specificity 96%). Results: 711 individuals (358 in Ardebil and 353 in Yazd) were enrolled. 170 individuals (47.5%) in Ardebil and 108 individuals (30.6%) in Yazd were positive for H.P (P<0.0001). Using logistic regression analysis, the predictive probability of H.P infection in different age groups was calculated. Conclusion: H.P infection is significantly more prevalent among individuals less than 20 years in areas with high prevalence of gastric cancer in Iran. Our data suggest a relation between H.P infection and gastric cancer in Iran

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It this prospective cross sectional study out-patient endometrial biopsy by PIPELLE was compared with diagnostic curretage (D&C) in patients suffering of Abnormal Uterine bleeding (AUB). Diagnostic accuracy, sufficient tissue sampling, intensity of pain and effective factors in biopsy results were the evaluated parameters in this study. In 70 patients with complaint of AUB (20 of them were post-menoupsal age admitted in hospital for D&C) endometrial biopsy was conducted by PIPELLE before operation and the results were compared. 96% of total patients (67) and 91% of patients with post menopause age had tolerance of undergoing out-patient PIPELLE biopsy of endometrium. 79% of these individuals complained of mild pain and 21% of moderate pain. Endometrium biopsy by PIPELLE in 77% of patients had similar accurate diagnostic results as compared to D&C. PIPELLE in 34% of patients (24) could not be conducted with the same accuracy of D&C patients, although in 14 (20%) of them, notissue samples could be collected by D&C. In none of these methods endometrial hyperplasia or endometrial cancer were detected. This study showed that in 77% of the total patients, the extra cost and general anesthetical risk of D&C could have been eliminated, by utilization of out-patient biopsy with PIPELLE

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Some factors such as: aging, obesity, hypoactivity, stress, urbanization, hyperlipidemia, hypertension, multiple pregnancies, smoking and so forth, are important factors that are always argued whether in disease production or in increasing morbidity and mortality in diabetic patients. In a descriptive, cross-sectional and correlational study, we looked for some important risk factors in 780 diabetic patients in Yazd city. The main objective in this study was to identifying the at risk cases. In this study, 54% of understudied patients were obese, 52.3% hypoactive, 80.7% urbanized, 21.5% smokers and approximately 11% were continiously or occasional alcohol users. 85% of all patients had no habit to sport, and the mean of their last fast blood sugar was significantly upper than those who had continiously physical exercises (P=0.01). Majority of understudied women (65.3%) had experienced 6 or more pregnancies during their life, and the last mean blood sugar in these patients was significantly upper than those with <6 pregnancies (P=0.0004). The age of majority of patients in either males or females was 50-70 years, and duration of disease in majority of them was <10 years. Increasing of the last mean blood sugar was significantly compatible with increasing of disease duration (P=0.00003). Regardless the type of diabetes, the disease in every generation was more frequent in female gender and totally, the mean of last fast blood sugar in the patients was 216 mg/dl which is not a controlled sugar. We have suggested the mean of last fast blood sugar in all of the referal cases as a performance indicator during evaluation of center of diabetic patients control

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In this paper we have reported and discussed an unusual histopathologic feature of medullary carcinoma which is one of the pitfalls in the diagnosis of this tumor. The patient was a 14 years old girl who complained of painless, gradually growing cervical mass from one year ago. She had no history of head and neck radiotherapy of familial history of thyroidal or other endocrine disease. In laboratory investigations a cold thyroid nodule was confirmed and FNA of it was reported as follicular lesion. The patient underwent lobectomy isthmectomy with frozen section wich was reported as Hurthle neoplasm and then the other lobe of patient's thyroid resected. In it's pathologic exam another nodule was observed which mostly composed of spindle cells at last histochemically medullary carcinoma confirmed

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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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Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.

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Epidermolysis bullosa (EB) is the term applied to a group of disorders whose common primary feature is the formation of blisters following trivial trauma. Hereditary EB comprises 3 major classes: simplex, junctional and dystrophic, and includes more than 23 phenotypes. The albopapuloid pasini variant of dominant dystrophic EB is characterized by a distinctive clinical appearance. In this article, we report this disease in three members of a family (father and two sons).

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Differentiated carcinoma of the thyroid occruing within the gland is generally not regarded as an aggressive tumor however, when the tumor extends beyond the gland's capsule and onto adjacent structures, its prognosis worsens. During the past three decades such locally invasive thyroid cancer has been studied, specifically concerning invasion into the airway. Progress in tracheal operations in the past 20 years has changed remarkably in terms of the operative methods and indications for thyroid carcinoma invading the trachea. Resection and primary reconstruction of the trachea invaded by carcinoma of the thyroid should be done in the absence of extensive metastases when technically, feasible. It offers prolonged palliation, avoidance of suffocation and an opportunity for cure. In carefully selected patient with massive regional involvement, radical excision laryngopharyngoesophagectomy and mediastinal tracheostomy is also appropriate. In this article, management of one patient with intraluminal involvement of trachea by thyroid carcinoma is presented and management of upper aerodigestive tract invasion by thyroid cancer reviewed.

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Fine-needle aspiration biopsy for the diagnosis of breast lesions has been used for more than six decades and has been established as an effective procedure in Europe for many years. In order to evaluate the accuracy of fine-needle aspiration with histopathologic confirmation, a retrospective study was performed in Iranian Center for Breast Cancer, using a computer database over one year period. All women who had had fine-needle aspiration breast biopsy with histopathologic diagnosis included open excisional biopsy or mastectomy specimen. A total of 49 patients fulfilled the criteria. The test had a 93% sensitivity, 73% specificity, 65% positive predictive value, and 95% negative predictive value. Fine-needle aspiration is a sensitive test that Van be useful as an adjuct in the diagnosis of breast cancer.

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Intestinal parasitic infections are found all over the world. With all the progresses made in the last decades which have resulted in reduction of infection and mortality, yet parasitic infections are one of the biggest public health problems in the developing countries. In this research children 2-5 years old of Saveh city were randomly chosen. Intestinal parasitic infections and the effect of medical treatment on the infected cases were assessed. In order to treat the infected cases. Iranian generic drugs were used in which for Giardia infection Metronidazole 87.5% and furazolidone (66.7%) were proved effective. Metronidazole in treatment of Entamoeba histolytica infection (88.2%) and Metronidazole+Paramomycin proved 100% effective. In treatment of children infected with Oxyuris, the two drugs, Metronidazole and Pyrvinium Pamoate were almost 100% effective. Metronidazole in Ascaris infection was about 88.9% effective. Niclosamide in treatment of Hymenolepis nana (100%) and in Tenia saginata were 75% effective. Reinfection after three months in treated children was about 20.9% which was the most prevalent intestinal parasitic infection related to Oxyuris. The successfully treated group had higher average body weight compared to the control group.

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In this study, musculoskeletal disorders incidents have been found through NMQ. Then, with the OWAS method the results have been analysed. In this thesis, we have studied the case in two different workshops of Ballast Production Company. The jobs were classified according to static load caused by poor work posture and recommendations for reducing the hurmful load were made. The study of the questionnaire showe that there is meaningful relation between work experience and Low Back Pain (LBP) (P<3%). Meanwhile BMI (Body Mass Index) is closely related to LBP (P<2%). However a relation was found between low back and back and shoulder pain complaints during recent one year and last one week with that of the existence of the pains, respectively P<2% and P<5%. Jobs related with repair and maintenance rates the first as regards static load on the muscloskeletal system. Cooking, digging operations, driving bullodozer, operation of stone crushing device, loaders and lorries rank respectively in order.

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Cleft palate is a congenital condition that occurs with the incidence rate of one out of 2000 births. This anomaly produces intraoral pressure changes (increase or decrease), can cause speech, sucking and feeding problems of involved patient. On the other hand, if cleft palate is associated with cleft of the lip or alveolar area, growth and alignment of teeth may change the appearance of the patient and affect the psychologic and occupational future of the patient. Eustatian tube malfunction in involved neonates increase. Many procedures are used to repair the cleft palate and correction of palatal muscles which are: 1) Von Langenbeck (18.5%). 2) Veau-Wardil-Kilner (72.5%). 3) Double opposing Z-Plasty (9%). In this research the demographic criteria of patients including age of the patient at operation rime (mean age 30.14 months), city of residence, family history of cleft palate (12.4%), familial relation of parents (15.2%), associated anomalies, complete or incomplete lesion, weight of patients at the time of surgery (mean 11.28 Kg), hemoglobin (11.3 mg/dl), complications, otitis media and the side of cleft palate are studied in 178 admitted patients to Imam General Hospital between 1989 and 1995.

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A 43-day old infant with myelomeningocele was evaluated for feeding problems and ill appearance. The presence of metabolic acidosis, hyponatermia and hypercalemia suggested renal tubular acidosis type IV. Later examination showed urinary tract infection together with bilateral vesicoureteral reflux. After treatment of the infection, metabolic acidosis and electrolyte imbalances were resolved and the diagnosis of pseudohypoaldosteronism was confirmed.

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Gentamicin was evaluated for developmental toxicity in pregnant Sprague-Dawley rat. Gentamicin was administered subcutaneously on days 6-15 gestation at dose of 100 mg/kg. On gestation day 21, all live fetuses were examined for external and skeletal malformations and variations. Increased resorptions and dead fetuses, and reduced fetal body weight were observed at dose of 100 mg/kg. Gentamicin caused severe skeletal anomalies, such as: wavy ribs, incomplete ossification of sternebrae, tail vertebra, metacarpus, metatarsus and calvaria. These results indicate the nature and extent of embryotoxicity and teratogenicity of gentamicin in Sprague-Dawley rats.

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The object of this study was to find a suitable staining method for P.carinii. This parasite is not easily stained and clinical signs are not specific for the diagnosis of P.carinii pneumonia and therefore optimal laboratory methods for observing the organism are extremely valuable. In all 17 new conventional and modified staining techniques were used on lung impression smears and tissue section of sprague Dawley Rat treated with cortisone. Of these methods modified methylene blue 1 & 2, modified cresy violet 1, 2, 3, 4 modified Gram, modified Giemsa 2 and modified Griedley techniques have not previously been reported. After comparing readability of the slides, ease of performances, rapidity, availability and sensitivity of these 17 techniques for the diagnosis of P.carinii pneumonia, modified toluidine blue 01 & 2, modified methylene blue 1 & 2 and modified cresyl violet 3, 4 are suggested as the methods of choice for the rapid diagnosis of P.carinii pneumonia.

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This is a study on 62 G6PD patients hospitalized in Bahrami hospital between 1993 to 1995. Favea was the oxidant agent causing acute hemolysis in more than 90 percent of patients. Most of acute hemolysis occurred in spring, the season of high consumption of favea. More than 60 percent of patients had moderate to severe hemolysis with Hb less than 7 gr/dL. According to WHO reports, the incidence of G6PD is 7-12% in Iran and it is favism type. It is suggestive to prevent parents of sugh patients of favea consumption, which in turn decreases the rate of acute hemolysis, its complications, complications of transfusion and hospitalization in endemic area of Iran.

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Brucellosis is a multisystem disease with diverse clinical presentations and involvement of the nervous system is considered to 5 to be 10% in adult patients and 1% in children. The presentations of neurobrucellosis includes meningoencephalitis, subarachnoid haemorrhage, myelitis, radiculoneuritis, intracerebral and epidural abscess, psychosis and vascular syndrome. Twenty-two patients with neurobrucellosis are described. Ten patients had meningoencephalitis, seven patients had meningitis, three patients had polyradiculopathy and one patient presented with spinal epidural abscess and one patient had brain abscess. Results of an agglutination test for Brucella in serum were positive for all patients (>1:160) eight of 15 patients had positive agglutination test in CSF. Five patients had positive blood cultures, 3 patients had positive bone marrow cultures and 2 of 15 patients had positive CSF cultures. All of cultures were Brucella Mellitensis. Antimicrobial treatment included concurrent administration of Doxycycline, Rifampin and Trimethoprim-Sulfametoxazole. Four patients received Dexamethason concurrently. In conclusion, nervous system involvement is a serious manifestation of brucellosis. As brucellosis is an endemic disease in Iran we suggest that brucellosis be investigated with neurological symptoms and signs.

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twenty-two patients were reviewed retrospectively to determine the effects of embolization on Glomus Jugulare tumors. 6 patients underwent embolization and 16 did not. All tumors were removed with a type A infratemporal foassa approach. The patients were evaluated for operative blood loss, operative time, length of hospitalization and new post-operative nerve deficits. The embolized group lost less blood and shorter operative times and less hospitalization. Embolization did not reduce the incidence of new post-operative cranial nerve deficits. The experience of the surgeon and operative team also play a significant role in the reduction of blood loss and operating time. Embolization carries a risk of significant morbidity, and its use depends on the experience of the radiologist.

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Kindler syndrome is characterized by acral blister formation in infancy and childhood, poikiloderma and cutaneous atrophy. Undoubtedly, similarities of the clinical features exist between Kindler syndrome and Epidermolysis bullosa simplex with mottled pigmentation. In this article, we report 3 patients with Kindler syndrome. Until the Bullous component of Kindler syndrome is more completely understood, we believe that this disorder should continue to be classified as a separate disease.

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The term histiocytosis refers to a group of idiopathic clinics entities characterized by diffuse proliferation of mature histiocytes associated with tumorlike masses of foamy reticuloendothelial cells containing lipoid droplets with variable number of eosinophiles and connective tissue. This cells causes tumorlike masses in the bones and other vicera in the body thus it may have very different clinical signs and symptoms. Also it may have acute and fulminant form or chronic and slowly progressive. We have an interesting case with multiple organ involvement and chronic otitis media with granulation in the external audiotory canal and perforation of tympanic membrane. The patient was 3 years old with diabetes insipidus and visceral involvement such as hepato-splenomegaly. Histologic diagnosis was Hand Schuller Christian disease.