Tehran University Medical Journal

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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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This prospective study evaluated the long-term results of intraoperative 5-FU in glaucoma patients undergoing trabeculectomy. 14 patients categorized as high risk (10 patients) or medium risk (4 patients) underwent trabeculectomy with 5-FU and were followed for a mean period of 32 months. Patients were evaluated for visual acuity, cup-disc ratio and IOP. The number of medications was also taken into consideration 78% (n=11) of patients achieved controlled IOP, (mean IOP of less than 21 mmHg) with or without medication. There was statistically significant reduction of IOP and number of medication after the operation. There was no significant complication observed during the follow up period.

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Clostridium difficile toxin was checked in fecal extract of 62 ulcerative colitis patients and 62 normal controls, by Elisa and cell culture methods. Clostridium difficile toxin was found in 48.71 percent of ulcerative colitis patients in their acute exacerbations, and in 26.08 percent of cases in their remissions. This toxin was found in the fecal extract of only 3 percent of normal controls. Chi-2 analysis showed that the differences between normal individuals and patients with ulcerative colitis were significant (P<0.001), but these differences between two groups of ulcerative colitis patients either with exacerbations or in remission were not significant (P>0.05).

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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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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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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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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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With the intention of research about culture and autologus graft of epithelial tissue we used 4 french Albino Rabbits with an average age of 2 months. After reproduction on the support in EMEM (Eagle's Minimum Essential Medium) we used this for graft after 4 weeks. This region which grafted total replaced. After fixation of this sample and passing them through various process, histological sections were prepared. These sections were stained with H & E and masson's trichrome and studied by light microscope. We succeeded in graft. We hope in the near future by using the method of epithelium tissue culture improving to treat burned patients.

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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 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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Interest in umbilical cord blood as an alternative source of hematopietic stem cells is growing rapidly. Umbilical cord blood offers the clinician a source of hematopoietic stem cells that are readily available and rarely contaminated by latent viruses. Moreover, the collection of umbilical cord blood poses no risk to the donor. There is no need for general anesthesia or blood replacement and the procedure causes no discomfort. Current clinical experience suggests that the incidence of GVHD in umbilical cord blood transplantation is low. These results and associated laboratory findings pose intriguing possibilities for the future of umbilical cord blood stem cells in the setting of unrelated donor transplantation. There are other intriguing possibilities for example cord blood may be an optimal source of pluripotential stem cells for use in genetherapy.

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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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Nowadays immunochemical techniques have played a very important and valuable role in quantitative and qualitative assays of liquid compounds of the body. Producing antibody against immunogenes is the first step to make immunochemical kits. In this study production and purification of polyclonal antibody against melatonin has been considered. This hormone which has several important functions in physiological conditions such as migraine, cirrhosis, mammary gland cancer and other diseases, is the most important pineal gland secretion. This gland is a circumventricular organ of brain and according to histological and anatomical studies, it is a high secretory organ, that secretes active biological substances like melatonin, oxytocin, serotonin and ect. In this study, melatonin has been considered as hapten and has become an immunogen by being linked to the bovine serum Albumin. Then, by the immunization of three white New Zeland rabbits that had the booster injections in regular intervals, the antibody titer was detected to be 1/2000, by using checkboard curves, and with the use of melatonin linked to penicillinase as a labeled antigen, the titer was detected 1/200. Finally an antibody with high purification rate has been obtained, which can be used in immunochemical assays like RIA, ELISA, and EIA.

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Between 1990-97 two hundered children referred to our department with end-stage renal disease (ESRD) for renal replacement therapy. The ages of these children were 1-14 years (mean 8.14). There was no significant difference in incidence of ESRD between two sexes. We evaluated these children for the causes of ESRD. The most common causes were: Pylonephritis and congenital anomalies of urinary tract (35.5%), glomerular diseases (22.5%) and hereditary kidney diseases (13.5%).

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Acute amniotic fluid infection has emerged as a possible cause of many heretofore unexplained preterm births. Our purpose was to determine the effect of ampicillin in the prolongation of pregnancies receiving tocolysis for preterm labor. A blinded, placebo-controlled, randomized trial was conducted to study ampicillin in women hospitalized for preterm labor between 24 and 37 weeks' gestation. A total of 60 patients with intact membranes and without chorioamnionitis who were receiving magnesium sulfate were screened. Thirty women with preterm labor received ampicillin, and 30 received placebos. The primary end point was prolongation of gestation. There was no difference in age of delivery (37.6±9.7 days vs 36.08±3.9 days, P=0.085) and no difference in retardation of delivery (4.7±3.1 vs 4.1±2.1, P=0.39). The mean degree of preterm delivery were 0.62±1.93 and 1.8±3.3 weeks in ampicillin and placebo groups, respectively (not significant, P>0.1). Conclusions: Ampicillin had no effect on interval to delivery or duration of pregnancy in women treated for preterm labor. So rotine clinical use of ampicillin during tocolysis should not be recommended.

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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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In order to understand the function of mammalians serotonin system, we have to know the anatomical structure, because physiological changes are influenced through the anatomical changes. A number of thalamic nuclei are associated with functions known to be influenced by serotonergic input in brainstem, among them mediodorsal thalamic nucleus has relationship with limbic system and prefrontal cortex. The precise topographical projections of mesencephalic raphe nuclei to the MD nucleus of thalamus were identified in the rat using horseradish peroxidase (HRP) retrograde tracing substance. Injection of HRP in MD labeled a large number of neurons in rostral to caudal part of dorsal raphe nucleus. It exhibited a strong number of neurons in ipsilateral part of DR and a few cells in its contralateral part. Numerously labeled cells were also observed ipsilateral in rostral and medial part of MnR (86%) and a few cells in it's contralateral part. The present study has provided that the MD innervation by DR is more greater in density than that observed at the MnR. Upon these results and previous study, mesencephalic raphe nuclei are involved in several specific functions of thalamus as limbic system behavioral mechanism. A much more detailed knowledge is needed to show topographic relationships between mesencephalic raphe nuclei and forebrain.

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In a cross-sectional survey depression prevalence of 130 nurses in Tehran Imam Khomeini hospital has been investigated by using long from test items (21 questions) of Beck depression questionnaire. Also necessary data for independent variables was collected by interview. The findings of this study indicated that depression rate of mild, moderate and severe type were 73.1%, 21.5% and 5.4%, respectively. In this study statistically significant association has been found between depression and marital status (P<0.0001), level of education (P<0.005), over time's hours at work (P<0.02) and parent's death at childhood (Before 11th age) (P<0.001).

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Use of tissue expander in the recent decade has revolutionized the plastic surgery. The tissue expansion technique is advantageous in body reconstruction because it makes it possible to resurface the defects resulting from excision of burn scars with neighboring skin similar in color and texture and superior to skin grafts or distant flaps. Treatment of burn alopecia was a major problem in the past, but with the application of tissue expander this deformity is treated. We have learned by experience that tissue expander should not be used in the limbs, because of the high risk of complications. The best locations for tissue expander are in order: Scalp, face, neck and trunk. The incidence of burn induced deformities in Iran is high. In this research, I analyze the use of TE in 130 patients with burn deformities. The variables studied were: Sex of patients (43.1% male, 56.9% female), age groups, level of education, occupation, the anatomical site of burn, extension of burn, volume of tissue expansion, the location of placing the TE and complications.