Tehran University Medical Journal

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In a cross-sectional epidemiological study of headache disorders in neurology clinic of Fatemieh hospital of Semnan (August 22-November 20.1996), information on types of headaches, quality, severity, location, duration, frequency, precipitating factors, age of onset, influence of menstruation and pregnancy, positive familial history, use of oral contraceptive pills and other epidemiological factors including socioeconomic and age/sex composition was collected. The presence of any types of headaches was ascertained by a clinical interview and examination using the operational diagnostic criteria of the International Headaches Society. The prevalence of migraine and tension type headache was also analysed in relation to variables of life style (physical activity and sleep pattern) and associated signs and symptoms (nausea, vomiting, photophobia and phonophobia). In this study migraine and tension headache were also compared in variable aspects with each other. 1) Headache was more prevalent in women than men (F/M=3/1). 2) The most common types of headache included: tension type headache (41.4%), migraine (31.2%) and unclassified headaches (17.2%). 3) Migraine and T.T.H were more prevalent in early adult life and middle ages. 4) In both migraine and tension type headache the time profiles (duration, frequency, age of onset), quality and location were like that noted in textbook and previous studies. 5) In both migraine and tension type headache the most conspicuous precipitating factor was stress and mental tension and frequent headaches were accompanied with psychiatric problems (e.g depression and or anxiety). 6) Nausea, vomiting, phonophobia and photophobia were the most common associated symptoms in both of them. 7) Positive familial history and aggravation of headache in perimenstual period were more commonly seen in patients with migraine than tension type headache. In conclusion using the operational diagnostic criteria of International Headache Society in clinical practice, treating, teaching, clinical and epidemiological research is very useful and must also be applied for Iranian patients.

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Calcium channel blockers are used worldwide in CAD, hypertension and arrhythemia. As recent international studies show these drugs in addition to cardiovascular effects have immunosuppressive effects and can prolong graft life in transplanted patients. In a single blind prospective trial we studied 30 patients on 120 mg/d Verapamil for at least 3 months compared with 15 patients on placebo. Changes of cell immunity markers were impressive as T suppressor lymphocytes increased and CD4/CD8 ratio decreased significantly compared with placebo (P<0.05). This study confirms that Verapamil reduce cell immunity that may prone human beings to infections and on the other side we can use it in hypertensive patients with organ graft.

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Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm) and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular) and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

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

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This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents

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As the effectively transportation of injured patients is one of the most important concerns in developed countries, we tried to evaluate the patients transportation to Sina hospital trauma center in this regard. During an eighty-day period, 200 injured patients were transported to Sina hospital with intravenous cannula inserted only in 17.5 percent and fracture fixation was accomplished in only 8.5 percent of patients. We coucluded that the transportation quality was rather poor and more attention should be paid to this social problem

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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 ulcers. Therefore introducing of simple and cost effective and non invasive tests are important for diagnosis of H.pylori infections. In this study 215 patient suffering from different gastrointestinal disorders referred to GI endoscopy department of Dr. Ali Shariati Hospital were selected as case and another 50 as control group, which were evaluated for H.pylori infection. Direct smear (staining with Giemsa) and urease tests were used as gold standard tests compared with IFA-IgG and culture. Sensitivity and specificity and accuracy for IFA were 94%, 86% and 90%, respectively. Absorption with campylobacter jejoni did not change the level of IgG against H.pylori. Negativity of urease test dose not show the eradication or absence of bacteria, but shows the low number of bacteria in biopsy materials. This report suggest that IFA is an advantageous, sensitive and reliable test in diagnosis of H.pylori infection.

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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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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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Bone age determination is one of the important radiological methods of diagnosis. However, unfortunately considerable misunderstanding is seen among physicians and even radiologists. This is due to a general lack of knowledge concerning basic concepts, normal variation and the areas choosing for X-Ray. Most of errors are attributable to ignorance of the expected range of normal bone development. A well-known atlas of wrist and hand by "Greulich and Pyle" is widely accepted because of its simplicity and low radiation exposure, but the bones of these areas do not necessarily reflect development of the skeleton generally. This method is more abused by referring physicians when they limit the X-Ray to the wrist region, which considerably reduces accurate assessment. In this paper, different aspects of subject, including assessment and clinical use of neonatal bone maturation, such as hypothyroidism, low birth weight babies, and respiratory distress syndrome are also dicussed.

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Intestinal obstruction is a significant disease specially in patients with previous surgery. Patients symptoms and signs usually are abdominal pain, vomiting, abdominal distention and obstipation. Adhesion bands secondary to previous abdominal surgery is the most common cause of small bowel obstruction and in USA up to 70% of small bowel obstruction is caused by adhesions. In our study adhesion is also the most common cause but 23% of patients have obstruction secondary to adhesion. In the literature colorectal cancers are the most common cause of colonic obstruction and volvulus is the third common cause of colonic obstruction after obstruction from compressive effect of other primary abdominal or pelvic tumors. In our study vuvulus was the most common cause of colonic obstruction and colorectal cancer was the second most common cause. The most common previous surgery that lead to obstruction in our study was appendectomy. From 112 patients 75% of patients had complete and 25% had partial obstruction. Frequency of mortality was six from 112 patients or 5.3%. Seventy percent of our patients had small bowel obstruction and 30% had colonic obstruction. Patients with hypertension before surgery for obstruction had greater risk of mortality in the postoperative period than other patients. Patients with intestinal gangrene had greater risk of postoperative complication and morbidity than other patients.

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This is a prospective descriptive research which was carried out in surgery ward 1 of Imam Khomeini Hospital during 6 years (1992-1998). In order to study the results of thymectomy in Myasthenia gravis we evaluated 18 thymectomies via median sternotomy which was performed in the course of six years. In this research the thymectomy was associated with 16.6% morbidity but no mortality. Follow up evaluation after a mean period of 38 months (Min.5-max. 72 months) revealed a remission rate in 44.4%, clinical improvement in 38.8% and relapsing rate in about 16.6% after thymectomy 55.5% of patients required medical treatment which 70% of them needed only one drug, with lower dose than before thymectomy.

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With retrospective evaluation of 44 patients suffering from Guilan-Barre Syndrome (GBS), Chronic Idiopathic Demtyelinative Polyradiculoneuropathy (CIDP) and Myasthenia Gravis (MG) treated with intravenous immunoglobulin, we found following results: 1) Initial symptoms of improvement on forth or fifth days. 2) Maximum recovery for CIDP and MG were after 16-24 and 3-11 days, respectively. 3) No major complication, but mild side effects in 32% of patients. 4) In patients with GBS one grade improvement achieved after 8-30 days. 5) Intravenous immunoglobulin (IVIG) plus plasmapheresis had no advantages over IVIG alone. 6) No reasonable conclusion about relapsing rate and duration of response due to follow up restrictions.

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The effects of taking snacks on the learning ability and educational achievement of elementary school children in district 18 of Tehran educational organization were examined in the school year 1997-98. Other factors such as grade, nutritional status, breakfast eating habits and snack eating habits in the school were also studied. For this purpose 236 boys were selected by random sampling in 4 different schools. The children were randomly assigned to a group, with a low calorie snack (119 subjects), and a low-calorie control group (117 subjects), and then given 3 cognitive functions tests. The test were repeated after 4 months. The data were collected by questionnaires and included family socio-economic conditions, nutritional status and dietary habit of the children. Also, the grades of the major courses and scores of cognitive tests were collected, and the effects of treatment on the mean grades and scores differences were determined by T-test and analysis of variance (ANOVA). Our findings are presented as follow: The experimental and control groups were similar in the initial assessment. 7.1% of the students were stunted based on height-for-age classification (NCHS). The intervention led to an increase in tests scores, but the increase was only significant in the case of the short-term memory test (P<0.03). The findings of the study showed that the intervention was effective on short-term memory and since short-term memory function in memorization process and retrieval of subjects form long-term memory and congenitive functions, we can conclude that the food intervention with an energy lower than 10% of recommended dietary needs increases learning ability level of the subjects. Stunting and the habit of eating breakfast were related to educational performance of students. Therefore implementation of such programs in the community, such as food intervention and nutritional education may be effective.

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Parasitic infections, especially opportunistic ones are important problems of immune deficient patients. These groups of patients can encompass a broad spectrum of cancer patients. Patients receiving immune suppressive chemotherapeutic agents and those who receive radiotherapy. This group of patients has much more susceptibility to infections and suffers more complications. The objective of this study is to determine the incidence of intestinal parasitic infestations in patients receiving immune suppressive anti-cancer agents. Stool sample of 261 patients under treatment with chemotherapeutic agents were collected and sent to parasitologic laboratory of Shahid Beheshti medical school. Every sample was evaluated with direct smears formalin and ether concentration technique, shitter dilution, zeil-nelson strip stain, culture on strip of filtration paper according to Hadamvory method and on agar plates. Thus, the incidence of intestinal parasitic infestations was evaluated. In this study 34% (89 samples) of patients, who had receive immunosuppressive medicine, had intestinal parasitic infestation. 31.4% of patients with intestinal parasitic infestation were under 20 years of age, 31.6% were between 21-50 years and 36.5% were above 51 years old. Statistical method did not show significant difference between the incidence of intestinal parasitic infestation and the 2 variables of age and sex. The rate of intestinal parasitic infestations in cancer patients with 1-4 courses of treatment was 34.5% and after more than 5 courses was 33.6%. Statistical analysis with X² test did reveal significant differences. Considering the above studies, we recommend: 1) Stool exam of all chemotherapy patients for intestinal parasites before chemotherapy treatment. 2) Five to seven stool exam is necessary for high-risk group. In other patients one stool examination is enough. 3) Repeated stool examination is recommended during chemotherapy. 4) More specific method is needed for detection of high-risk patients and suspected cases.

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This cross-sectional descriptive study was undertaken to know the rate of intestinal parasites infestations in our school children population. A sum of 1155 fecal samples were analyzed from an equal number of children whose age were between 6-11 years old. The percentage of infestations were: Giardia lamblia (14.11%), hymenolepis nana (1.21%), ascaris lumbricoides (0.08%) and enterobius vermicularis (0.08%). We found no differences with regard to sex, age, father and mother levels of education, family size, body mass index (BMI) and the erythrocyte sedimentation rate (ER) between the stools positive and the stools negative cases. Nearly all cases of giardiasis (99.4%) were symptomatic. Eosinophilia was seen in (5.5%) of the infested children with giardiasis and in (0.5%) of the non-infested children, the difference was statistically non-significant (P=0.056). All cases of giardiasis (N=163) were treated with metronidazole 15 mg/kg/day in 3 divided doses for 7 days. Metronidazole was effective in (92.2%) of the treated children.

 

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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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To evaluate breath-holding spell (BHS) and its triggering factors, 47 children with BHS admitted to the out patients clinic of Children's hospital medical center, between Sept 1998-June 1999, were included in this prospective study. Diagnosis of BHS was made for cases by medical history, pediatric physical examination, EEG, ECG and lab findings. 4 cases were excluded from study because of paroxysmal epileptic discharges at their EEGs. Of 43 cases having BHS (M:F: 1.15:1), 74.4% were less there 24 months of age (Mean age 18.4 mo). 77% of patients had onset of BHS within 12 months of age. Family history of BHS in first degree relatives were found in 51% of patients. Parent consanguinity were found in 30% of cases. The commonest type of BHS were cyanotic (79.1%). Pallid (11.6%) and mixed (9.3%) were other types. Pain and anger were the commonest triggering factors. 78% of cases were iron deficient and 53% of cases had iron deficiency anemia.

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Systemic sclerosis is a generalized disorder of connective tissue, in which the pattern of disease extent, progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scleroderma, disease progression has occurred mostly in the early phase of disease, but in patients with limited cutaneous scleroderma, disease progression was slow and incidious, so disease progression has occurred mostly in the late phase of the disease, thus raynaud's phenomenon, telangiectasia, hyperpigmentation and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, early and extensive organ involvement was observed in patients with diffuse cutaneous sclerodema.

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Squamous cell carcinoma, a cancer of keratinocytes origin, mostly involves sun-exposed areas of the skin. To study the pathologic and demographic features of this disease, records of 395 patients of squamous cell carcinoma of skin and lip were reviewed. Most of the patients (83%) aged 40 years or more at the time of diagnosis. Respectively, 74.4% and 75.8% of cases with skin and lower lip carcinoma were men, but in upper lip cases frequencies of both sexes were equal. The number of patients referred from western and north-western provinces were much more than those of other provinces of the country. The most frequent histologic stage was grade I (53% and 58.8% in skin and lip carcinoma, respectively), showing that most patients visit physicians early enough, and are diagnosed in early stages of the disease.