Tehran University Medical Journal

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Background and Aim:-thalassemia is the most common inherited disorder of hemoglobin (Hb) synthesis in the world. Alpha thalassemia most frequently results from the loss of one (- ) or both (- -) of the duplicated  genes () on chromosome 16. Carriers of deletional forms of -thalassemia (-/- /-, or --/) are clinically normal but have a mild hypochromic, microcytic anemia. Compound heterozygotes (--/- ) called Hb H disease. Fetuses who inherit no  genes (--/--) (Hb Bart&aposs Hydrops fetalis syndrome) die either inutero or shortly after birth, More than 95% of recognized -thalassemia involves deletion of one or both  globin genes on chromosome 16.

Materials and Methods: The assay was tested on 114 Iranian individuals with low MCV and MCH levels but normal HbA2 who had not responded to Iron treatment. patients was referred to the Department of Biotechnology, Pasteur Institute of Iran by Health Centers. Genomic DNA was isolated from white blood cells by salting out method. We have developed a reliable, single - tube multiplex polymerase chain reaction (PCR) assay for the 7 most frequent - thalassemia deletions (-- SEA , --THAI, --FIL , -α20.5 , --MED, -α4.2 , -α3.7).

Results: DNA fromd thalassemia carriers was tested for the presence of different types of  globin gene deletion (s). The - 3.7 and - 4.2 single gene deletions, and the Mediterranean (-- MED and - 20.5) double gene deletions were found in some samples.

Conclusion: The - 3.7 deletion was found to be the most common cause of  globin gene deletion in our samples. Multiplex PCR for α gene deletion analysis is simple, rapid and sensitive.

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Background and Aim: Anemia is one of the common problems in patients with chronic renal impairment. The most common cause of anemia in this patients is a decreased in erythropoietin hormone excretion, however other common cause include low life of red blood cells, loss of blood during dialysis, frequent blood sampling, uremia, iron, vitamin B12 and folic acid deficiency. Until introduction of erythropoietin in 1982, blood transfusion was an alternative for correction and maintaining hematocrit in normal range in dialyze patients. In current date, any dialyzed patient take rh-erythropoietin .

Materials and Methods: The goal of this study is to evaluate erythropoietin utilization and comparing the effectiveness of the commercial product in the Iranian drugs market. The study was performed at nephrology and dialyze ward of Immam Khomeini hospital in a one year period.

Results and Conclusion: Of the 30 patients&apos subject of study, 13 patients received eprex and 17 received epocim. Average dose of erythropoietin 2000IU was three times per week. The average plasma hemoglobin and hematocrit of patients prior to the treatment were 9.38 g/dl and 28% respectively. Increase in the hemoglobin and hematocrit in the group who received eprex was significantly higher than epocim group (p=0.001 and p=0.026 respectively). The incidents of side effects including hypertension, headache, pain at injection site, and influenza-like in eposim group were considerably higher than eprex.

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Background and Aim: Tuberculous pleural effusion occurs in 30% of patients with tuberculosis (TB). Rapid diagnosis of a tuberculous pleural effusion would greatly facilitate the management of many patients. The purpose of this study was to determine sensitivity, specificity, and predictive values of clinical, laboratory, radiographic findings in patients with tuberculous pleural effusion.

Materials and Methods: The cross sectional study was performed between august 2002 and March 2004 at a referral teaching hospital. Major clinical, laboratory, and radiographic findings were evaluated in 88 cases of pleural effusion, 33 with confirmed TB pleural effusion (TBPE) and 55 with a diagnosis other than TB (NTBPE).

Results: The sensitivity of culture of pleural effusion and tissue were 3% and 9.1% respectively. The mean of adenosine deaminase (ADA) values in TBPE was 36.7 U/L (±18.72), and the mean in the NTBPE was 28.2 U/L (±17.0). Both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were 55%. The sensitivity of PCR was 3% with specificity of 12.7% (positive predictive value, 50% negative predictive value, 70%). Younger age (p<0.024), positive history of exposure to TB patient (p<0.02), and the combination of fever, weight loss and sweating (p<0.01), were associated with tuberculous pleural effusion. There were also significant association between Positive sputum smear (p<0.001), positive sputum culture (p<0.006), positive pleural biopsy (p<0.001), pleural LDH>200 (p<0.005), pleural lymphocytes>50% (p<0.015) and TBPE.

Conclusions: In our region with a high incidence of tuberculosis, the most frequent cause of exudative pleural effusion is tuberculosis. We suggest that the diagnostic planning of pleural effusion should be determined in each region with a view to the adoption of regionally optimized diagnostic and therapeutic facilities.

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Background: The purpose of this study was to identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuver (CRM).

Methods: This interventional study was conducted on 58 patients (14 males, 44 females, mean age 48.12+13.22) referred to the Vertigo Rehabilitation Clinic of the Rehabilitation School of Tehran University of Medical Sciences from 2002 to 2004. All patients were treated with CRM. According to the treatment efficacy the patients were allocated in three groups: completely treated, partially treated, and not treated. The effect of factors including age, sex, etiology, duration of BPPV, unilateral or bilateral disease, number of maneuvers, and number of sessions on outcome in patients was evaluated.

Results: Forty-nine patients (84.5%) were completely cured. Age, sex, etiology, and duration did not significantly affect the treatment outcome. Unilateral BPPV can be treated significantly better than bilateral BPPV. Forty-seven patients who were completely treated needed 1 session and thirty-seven of them required 2 maneuvers.

Conclusion: CRM is significantly effective for BPPV treatment. Treating unilateral BPPV is expected to be easier. As most of the patients will be cured by 1 or 2 maneuvers or in 1 session, patients who required more sessions or more maneuvers may not be completely treated.

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Background: Abnormal uterine bleeding (AUB) is a common presenting symptom indicative of abnormal menstrual bleeding patterns that may occur in anovulatory or ovulatory women.There are different ways to diagnose AUB, all requiring much time and energy. The purpose of this study was to evaluate and compare the value of endometrial biopsy, transvaginal ultrasonography with dilation and curettage (D&C) which is the current gold standard procedure.

Methods: A prospective-descriptive study was conducted on fifty patients referred to our center for refractory abnormal uterine bleeding who were candidates for hysterectomy. All patients underwent endometrial biopsy and transvaginal ultrasonography , followed by D&C as a Gold standard procedure in operating room just before surgery.

Results: Mean age of patients was 46.62 years. Transvaginal utrasonography offered a sensitivity of 70% and specificity of 68% demonstrating the lowest numbers compared to D&C. Endometrial biopsy had a sensitivity of 70% and specificity of 75% that was better than sonography alone.

Conclusion: D&C was the most useful and valuable procedure and addition of endometrial biopsy with transvaginal ultrasonography will not be of high value in diagnosis.

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Background: Pruritus is one of the most common problems in patients suffering chronic renal failure. Twenty five - 35% of predialysis patients and 60-80% of patients during dialysis complain pruritus. The exact pathophysiology of pruritus is unknown however, some possible interactive factors include: histamine release from mast cells and basophiles, uremic skin, cutaneous mast cells proliferation, adipose cells atrophy, electrolyte imbalance, and accumulation of bile acids. Since histamine is the main proposed mediator in pruritus, the goal of this study was to evaluate the role of antihistamines in controling of pruritus of patients with chronic renal failure. This study was done as a before - after study during one year period in dialysis department of Imam Khomeini hospital.

Methods: Thirty patients complied with inclusion criteria were entered in the study. Treatment strategy was: 2 weeks treatment with hydroxyzine 25 mg TDS, followed by one week wash-out period, then 2 weeks ketotifen therapy 1mg BID and finally two weeks treatment with chlorpheniramine 4mg BD following one week washout period after ketotifen therapy. Pruritus severity before and after each treatment period was evaluated with Pruritus Severity Score (PSS) chart.

Results: The mean PSS reduction by hydroxyzine, ketotifen and chlorpheniramine, were 33%, 4.5% and 20%, respectively.

Conclusion: PSS improvement with hydroxyzine and chlorpheniramine was statistically significant (p<0.001). However, ketotifen induced pruritus reduction was not considerably significant.

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Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory.

Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40), elective C/S under general anesthesia (n=35) and C/S under spinal anesthesia (n=25). Duration of anesthesia and its effect on blood gas and infants apgar were assessed.

Results: In the first group (vaginal delivery) mean blood gase parameters were pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia) mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia) mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05).

Conclusion: There was no significant difference between type of delivery and umbilical blood gas parameters. Neonatal apgar score in NVD is higher than the other groups. With increasing duration of general anesthesia in C/S, umbilical po2 is reduced.

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Background: Polycystic ovary syndrome(PCOS) is the most common endocrinopathy in women and the most common causes of anovulatory infertility.Inadequate follicule stimulating hormone is hypothesized to be a proximate cause of anovulation.Inhibins are glycoprotein hormone produced by the granulosa and theca cells of the ovary that selectivly inhibits FSH production and or release from the pituitary. The possible role of inhibin in the etiology of polycystic ovary syndrome (PCOS) is controversial. This study was designed to investigate levels of serum inhibin in women with PCOS.       

Methods: In a case-control setting 41 women with PCOS from the endocrine and gynecology and obstetrics clinic of Shariati Hospital and 44 women with normal cycles (control group) aged 15-40 year-old were evaluated. In all patients with PCOS and control women appropriate medical history was taken and physical examination was done.Serum inhibin levels were compared in two groups. Statistical analysis was performed using the Mann -Whitney U test

Results: Mean age of cases and controls was 23.6±5.3 and 23.1 ±3.9 years, respectively. Mean body mass index (BMI) in cases and controls were 25.07±5.45 and 21.33± 2.46 Kg/m2, respectively. There was no statistically significant difference in mean age between the two groups (p > 0.05) but mean BMI was significantly different between the two groups (p < 0.001). Mean serum levels of inhibin in cases and controls were 1.62±1.23 and 2.26±2.26 U/ml, respectively which was not significantly different between the two groups (p: 0.168).

Conclusion: There was no significant difference in serum inhibin levels between patients with PCOS and healthy women. We concluded that basal inhibin levels cannot be used for routine screening in women with PCOS. Further study is needed to determine the role of inhibin in these patients with assay of its two subunits (Inhibin A and B).

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Background: Rheumatoid arthritis (RA) is an autoimmune disorder with unknown etiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis. The aim of this study was to analyze the level of activities of catalase, glutathione peroxidas (GSH-Px), Super oxide dismotase (SOD) in patients with RA compared with the healthy subjects.
Methods: In a case-control study sixty rheumatoid arthritis patients 18-75 years old and 60 healthy sex and age-matched controls were selected, Catalase activity was measured by determining the constant rate (k) of hydrogen peroxide decomposition. GSH-Px activity of plasma was measured with spectrophotometer by Glutathione oxide generation due to GSH-Px. SOD activity is measured by degree of inhibition effect of SOD in generating super oxide radicals by xanthine and xanthine oxidase. C-reactive protein and rheumatoid factor values were determined by agglutination and latex tests.
Results: The plasma activity of catalase (p<0.001), GSH-Px (p<0.01), plasma level of hemoglobin and hematocrit (p<0.05) were significantly lower in patients with RA comparing with controls. The reduction in SOD activity was not significant (p>0.05). There was a negative significant relation between C reactive protein and Rheumatoid factor values with the erythrocyte activity of catalase and GSH-Px (p<0.01).
Conclusion: These results suggested that oxidative stress plays a very important role in the inflammation and pathogenesis of RA.

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Background: A plan for management of infected arterial pseudoaneurysm has evolved from our experience with forty two cases of such aneurysms treated between 1378 and 1382.
Methods: Clinical data of 42 patients with femoral pseudoaneurysm resulting from addictive drug injection who presented in emergency department of Sina Hospital between 1378 and 1383 were retrospectively reviewed.
Results: All patients were men with the mean age of 36.9 years. Twenty eight patients were referred from other medical centers. The mean time of delay in presentation was 17.3 days. The mean duration of drug injection was 14 months. Primary repair and emergent vascular bypass were performed in 3(7.1%) and 2(4.8%) patients, respectively. 5(11.9%) patients undergone delayed revascularization. Thirty two (76.2%) patients returned to their normal lifestyle without any vascular bypass. One patient required amputation and one patient died due to sepsis and acute renal insufficiency.
Conclusion: Management of infected femoral pseudoaneurysms is simple ligation of the external iliac or femoral artery. When Doppler is not available “Operation Room and postoperative Direct Observation” is recommended in such patients to avoid unnecessary revascularization surgery.

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Background: Staphylococcus aureus (SA (is an important cause of nosocomial and community-acquired infections. The emergence of antibiotic resistance, especially in methicillin-resistant SA (MRSA) strains, has caused difficulties in treatment of such infections. The determination of antibiotic resistance patterns, particularly domestic patterns of Iran, is essential for appropriate treatment of MRSA infections and proper infection control measures in our country.
Methods: The antibiotic resistance of 338 SA isolates from various clinical specimens was determined by disk agar diffusion (DAD), minimum inhibitory concentration (MIC) and polymerase chain reaction (PCR) methods.
Results: Using the DAD method, 47% (160/338) of the SA isolates were resistant to oxacillin, and only 6% (20/338) were resistant to vancomycin. By PCR, 48% (162/338) of the isolates had the mecA gene. The MIC of oxacillin in 93% of isolates was higher than 256µg/mL. The MRSA isolates, showed a high resistant to gentamicin (40.5%), erythromycin (40%), and ciprofloxacin (38%). However, only a few of the SA isolates showed a high resistance to vancomycin (5%) or erythromycin (3.5%).
Conclusion: The results of this study can provide guidance for physicians toward a more appropriate treatment of SA infections in Iran, thereby preventing the emergence of further antibiotic resistance among SA. Our results also revealed the need for further investigations using a higher number of specimens representing a wider variety of locations to determine the antibiotic resistance patterns in our state more precisely.

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Background: The most frequently used test for evaluation of fetal health is the Non Stress Test (NST). Unfortunately it has a high incidence of false positive results. The combination of vibroacoustic stimulation with the NTS has been shown to reduce non reactive results.
Methods: A tests assessment method was chosen with a simple randomized sampling. 40 pregnant women with non reactive NST in the first 20 minutes who received VAS in one of Tehran University's Hospitals were compared with BPP scores. A vibroacoustic stimulation was applied for a 3 seconds on the maternal abdomen and fallowed within 10 minutes.Data collection tools were NST, sonography instruments ,NST result paper, tooth brusher, watch, demographic questioner and check list. Data analysis was made by descriptive static and by using the Fisher's Exact Test (with level of significant at p<0/05). All statistical analysis were performed using an spss/win.
Results: After VAS, 70% of non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). False positivity of VAS was lower than NST.
Conclusion: VAS offers benefits, by decreasing the incidence of non reactive test and reducing test time. VAS lowers the rate of false positive NST. VAS is safe and allows more efficient of prenatal services. This test could be used as a rapid antepartum test to predict fetal well-being.

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Background: Multiple drug use is frequently considered to be hazardous for the elderly because of their greater vulnerability to the complications. The purpose of this study was to determine the prevalence of polypharmacy in Tehran and to assess the relative demographic characteristics of patients.
Methods: In a cross-sectional study 400 persons aging 55 years and older were interviewed in order to determine the presence of polypharmacy (daily intake of three or more drugs). The cases were randomly selected and asked to answer a questionnaire through interview at home. The questionnaire contained questions about all taking drugs, pattern of using each drug and also patients' personal, social and medical history. Chi-square and fisher exact tests and determination of odds ratios were used in order to data analysis.
Results: Medium number of drugs used was 3.4 ± 1.9 in studied cases and %39.6 of cases were exposed to polypharmacy. The prevalence of physician prescribed drug usage was observed to be increased by increasing number of total used drugs in each case (P<0.002). The most commonly used drugs were A.S.A, Atenolol and propranolol and these drugs were prescribed by physician in over than %90 of cases. There was a positive correlations between polypharmacy with referring to multiple physicians (OR=1.96, CI 95%, 1.28-2.98) (P<0.002) and adverse drug reactions (OR=2.44, CI 95%, 1.47-4.05) (P<0.001). Polypharmacy was more prevalent in the age group of 65-75 years (P<0.04) and lower levels of education (P<0.004) and less prevalent in the group with moderate income (P<0.001).
Conclusion: Polypharmacy is common among adults aging 55 years and more in Tehran and is affected by age, education level and economic status.

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Background: Radiofrequency has recently been used in treating tonsilar hypertrophy in adults. We evaluated the results of partial resection (volume reduction) of tonsil using this method.
Methods: Twenty patients with tonsilar hypertrophy were enrolled in a quasi-experimental before-after clinical trial. Local anesthesia was achieved by utilizing lidocain spray and then injection of lidocain and epinephrine, then radiofrequency was performed at power=7-8w. Bleeding, pain and need for analgesics were assessed during, immediately, 4, 6, and 8 weeks after operation.
Results: The mean pain scale was 2.68±2.11 according to (VAS) and the mean bleeding amount was 1.16±0.24ml during operation. The mean operation time was 7.81±2.56min. Ten percent of our patients did not have pain immediately after surgery while 55% complained of pains that did not warrant using analgesics and the remaining 35% experienced pains that were alleviated by analgesics. During and immediately after operation 95% of the patients experienced mild bleeding and only one patient (5%) had moderate bleeding (2-5ml). Mild bleeding was only reported in 10% of patients during the first 4 weeks after operation and was not seen in patients in following weeks. The grade of tonsilar hypertrophy decreased in all patients and the mean time of symptom disappearance was 7.81±0.36 in 8 weeks. Finally the mean satisfaction rate of the patients was 66.92±12.5% (ranging from 50% to 80%). Mild complications were reported in 15% of patients.
Conclusion: Radiofrequency is a safe procedure with minimum possible complication rate for tonsilotomy.

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Background: Both hypoxia and hypocapnia can cause broncho-constriction in humans, and this could have a bearing on performance at high altitude. The objective of this study was to examine how pulmonary ventilatory function during high-altitude trekking.
Methods: This study was a before and after study on spirometric parameters at Base line (1150 m above sea level), and after ascending at 4150 m above sea level. This study was performed in summer 2004 at Cialan Mountain in Iran. Fifty six healthy male University student volunteers were enrolled in the study. Respiratory function was assessed in participants before ascending at baseline (1150 meter) and after ascending at 4150 meter in Cialan Mount with a Spirolab II. Spirometric parameters changes were compared using paired t-test statistical analysis computations were performed by spss 11.5 and p≤0.05 was considered significant.
Results: The mean age and body mass lindex of our subjects were 22.9±5.3 years and 21.5±2.5, respectively. Forced vital capacity (FVC) was significantly decreased with increasing altitude from baseline level (P<0.01). Forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) and maximal midexpiratory flow rate (FEF 25-75%) were significantly increased with increasing altitude (P=0.001). There was no significant change in forced expiratory volume in 1 second and peak flow (P>0.05). FVC fell by the average of 7.1% at 4150m (2.4% per 1000m increased altitude) in comparison to 1150m.
Conclusion: The changes in some pulmonary ventilatory parameters were proportional to the magnitude of change in altitude during a high-altitude trek.

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Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.
Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.
Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.
Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.

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Background: TPS is one of the tumor markers which has specially been considered due to its exclusive physiological characteristics like its easy measurement in serum of cancer patients. This study has been due to evaluate the efficiency of this tumor marker in the prognosis, treatment control and follow up of patients with gastrointestinal cancers including esophagus, stomach and colorectal.
Methods: TPS has been measured in 109 persons including 28 healthy people and 81 patients with different gastrointestinal malignancies which were composed of 38 patients with esophageal cancer, 20 ones with stomach cancer and 23 ones with colorectal cancer. Sampling has been done in three times depending on treatment methods. TPS has been measured with ELISA in samples which contend of 2 to 3 ml of serum from patients and the health.
Results: The obtained results, demonstrate the obvious changes in TPS serum level in patients underwent various treatment procedures.
 Conclusion: The results have revealed that the serum TPS is not only as a measure of prognosis but also would be helpful in follow up and treatment control of the disease. Moreover the results has shown that serological analysis can be settled in the diagnosis and follow up with production of polyclonal antibody against TPS gene family and planning appropriate pattern.

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Background: Influenza epidemies which occur mosthly in cold seasons could be a risk factor for developing exacerbations and acute attacks of asthma. Although influenza vaccination is recommended for the asthmatic patients, there is a lack of sufficient clinical evidence that this annual vaccination prevents asthma exacerbation in children.
Methods: Prospective clinical trial study of 201 children with asthma, where 79 did, and 122 did not receive the influenza vaccine, was done. The two groups were compared with respect to use of bronchodilators, systemic corticosteroids, emergency department (ED) visits and hospitalizations for asthma. In multi variable analysis, adjustment was made for baseline asthma severity and demographic variables.
Results: After adjusting for other variables, the vaccinated group had a significant decreased in exacerbations frequency and duration. Also the frequency of used bronchodilators and the absence days of daycare center or school were lower in the vaccinated group (P<0.05). There was no significant difference between the two groups in relation to used systemic corticosteroids and ED or hospital admissions (P>005).
Conclusion: This study showed that influenza vaccination may be effective in prevention of some asthma exacerbation aspects.

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

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Background: Germ cell aplasia (G.C.A) is one of the most important testicular causes of infertility and azospermia.In this condition the seminiferous tubules are only lined by a single layer of sertoli cell. In some cases, there is focal area with spermatogenic activity.
Methods: We studied infertile men with G.C.A referred to Jahade Daneshgahi of Iran during 1381-82, retrospectively. All the cases had more than one biopsy of one testis.
Results: In 11.6٪ of 320 cases, comparison of multiple biopsy sites of a testis revealed: when one site showed G.C.A, another site revealed areas with spermatogenic activity. Considering the cases who showed germ cells in both sites, 15.3٪ of cases multiple biopsy sites appeared to have focal spermatogenesis, better maturation of germ cells or higher scoring area for urologic operation.
Conclusion: According to new techniques in treatment of infertility with ICSI (intra cytoplasmic sperm injection) in which fertility is possible with one spermatozoa or even spermatid (after recovery), biopsy of multiple sites instead of only one site is highly recommended in azospermic patient.