Tehran University Medical Journal

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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In this study, chromosome analyses were performed on 70 infertile Azoospermic and Oligospermic (<20 million/ml) men, and also cultures of peripheral blood lymphocytes by high resolution banding method were analysed as well. It is revealed 8 (11.43 percent) men with chromosomal abnormality. There were 31.4 percent patients with azoospermia and 68.6 percent with oligospermia from several thousands to 20×10^6 million/ml and their duration of infertility was at least 2 years. All patients with numerical chromosome anomalies had azoospermia and the most frequent anomaly was 47, XXY chromosomal constitution (klinfelter's syndrome), found in 8.57 percent of patients. We found that chromosomal anomalies found in this study were sex chromosome anomalies and an increased rate of numerical chromosomal abnormalities was among men with azoospermia. As a conclusion, we suggest that all men with azoospermia be considered for cytogenetical evaluation.

 

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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Informations regarding 152 patients of cancer of tongue in cancer institute from 1978 to 1998 was collected and analyzed. From these cases, 53.3 percent were male with a mean age of 54.49 years (SD=16.23) and the mean age of female was 2.5 years more than of male. Positive lymphadenopathy in men was positive and significantly more than that of female (P<0.05). The physical appearance of the tumor was ulcerative (66.7 percent). Most of the referrals were in the range of T1 (62.8 percent) and were operated. Information from 88 patients was evaluated and it was found that 23.9 percent of the patients has died. One year survival was 92.05 percent and 3 years survival 83.3 percent and it was confirmed that advanced stage of the illness decreases the survival rate (P<0.001).

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Typhoid fever is an endemic disease in Iran and other developing countries. This disease has gradually become resistant to the first line of drugs, and because of this resistancy we have studied a new alternative drug (cefixime) on typhoid fever patients and compared it's effectiveness with chloramphenicol. For this purpose, by a randomized clinical trial in Emam Khomeini hospital between 1995-2000, we allocated 44 uncomplicated patient with established typhoid fever (positive blood or bone marrow culture) and by random selection, 24 patient were given cefixime (400 mg PO bid) and 20 patient received chloramphenicol (500 mg po Q6h). The duration of therapy were 10 and 14 days for chloramphenicol and cefixime group respectively. Median fever clearance times were 5±1.9 for cefixime recipients and 3.8±1.2 days for chloramphenicol treated patients, but for improvement in other clinical and laboratory findings, there were not any significant difference. Bacteriologic and clinical cure rate for cefixime was 100 and 92 percents respectively. Though, even cefixime like other betalactam drugs is slow in helping the fever disappearance but our study suggests that oral cefixime is effective and can be used as an alternate treatment of typhoid fever.

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The study was conducted to determine the clinical pattern and etiology of cerebral venous thrombosis in Iran. Records of all adult patients admitted with a clinical diagnosis and MRI of cerebral venous thrombosis from 1993 through 1999 in three major hospitals of Tehran, Iran were reviewed. Fifty patients (39 women, 11 men) aged 14 to 56 years were identified. Headache the most frequent and often the earliest symptom, was encountered in 82 percent and papilledema, the most frequent sign in 56 percent of cases. Infection was the cause of cerebral venous thrombosis in 26 percent of our cases. Other causes included oral contraceptive (32 percent), vasculitis (6 percent), Behcet's disease (4 percent), postpartum state (4 percent), myeloproliferative disease (2 percent), ulcerative colitis (2 percent), antithrombin III deficiency (2 percent) and diabetic ketoacidosis (2 percent). Oral contraceptive was recognized as the most common etiology. Infection is an important cause whereas procoagulation disorders are uncommon.

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There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon) in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.

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Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubation and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, ect. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and Cuffed Pharyngeal Tube (CPT). From the patients, 120 ASA: PS-I cases, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. Their operation were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used for one group and CPT for others. Immediately after operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P<0.001).

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Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium+E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D.) 1 disorder (manic episode) 24 were given E.C.T.+lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001). These findings show that combination of E.C.T. and Lithium may not be so harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

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Many studies have shown the clinical importance of CD7 expression in AML patients. To evaluate the clinical importance and response to chemotherapy in CD7 positive AML, this study was conducted. From the patients, 76 cases were studied during 3 years. In 3 years of this study 70.5 percent of CD7 positive and 89.6 percent of CD7 negative patients achieved complete remission with no significant difference between these two groups (P=0.11). We concluded that despite no importance of expression of this antigen in our patients, prevalence of CD7 positive cases in our study in higher than similar studies done abroad (52.6 percent versus 30 percent). It seems in respect of small number of our patients for evaluation of clinical and laboratory properties, larger study is needed.

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Helicobacter pylori (H.pylori) is the most prominent causative agent of gastroduodenal diseases all over the world. Other manifestations such as urticaria and coronary heart diseases, also are suspected to be induced by H.pylori. Non invasive methods are preferred for diagnosis and ELISA, because of its reliability, speed, sensitivity and specificity is widely preferred as diagnostic tool. Previously we have used IFA, and here, we report an indirect ELISA technique for H.pylori diagnosis. First, 9 strains, of H.pylori isolated from biopsies, were cultured, and the soluble crude antigen was used to coat ELISA plates. Antigen concentration and conjugated antiserum dilution were optimised using checker board method. In this study the gold standard was: rapid urease test, culture and direct smear. Patient serum dillution and the cut-off value was determind, using 22 negative and 30 positive confirmed samples according to ROC curve and the results were compared with a commercial kit. The sensitivity and specificity of this method were 93.2 percent and 95.4 percent respectively. A commercial ELISA Kit, was used and compared simultaneously. The sensitivity and specificity were 87.8 percent and 73 percent respectively. Therefore, regarding the acceptable sensitivity and specificity, ease of work of ELISA, being economical and non-invasive, it can be employed in diagnosis of H.pylori infection and also in epidemiological studies.

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Testicular germ-cell tumors are the most common malignancy among men aged 20-40 years, and 60 percent of them are seminomas. These tumors are now an important socio-economic problem, considering their growing incidence. Thus we undertook to evaluate the results of curative irradiation in our testicular seminoma patients and compare them to literature results considering the use of cobalt-60 systems in our department (in contrast to the use of linear accelerators). All testicular seminoma cases referred after orchiectomy to Radiation-Oncology Department of Tehran Cancer Institute and treated curatively during the 12-years period of 1987-1998 were reviewed. These included 147 patients. The results showed a mean age of 34.5 years. Eighty-six patients (58.5 percent) were in stage I, 57 (38.8 percent) in stage II and 4 (2.7 percent) in stage III. With a mean follow-up time of 53.5 months (range 2-158 months) after radiotherapy, there were 12 (9 percent) local relapses and 8 (6.5 percent) distant metastases among the 122 patients who came back for follow-up. The 10-years overall survival was 97.9 percent and disease-free survival 79.7 percent (life-tables). Mean overall and disease-free survival time was 155 and 133 months respectively, with a median survival time of more than 158 months (Kaplan-Meier). The only significant prognostic factor was stage of the disease (P=0.01), though lactate dehydrogenase (LDH) was significant only in multi-factorial analysis (P=0.02). In conclusion, our survival figures were all favorably comparable to literature results, considering the higher ratio of stage II in our patients. We recommend training of young men for testicular self-examination and a greater attention to LDH measurement, and hope for installation of linear accelerators in our department to further improve the treatment results with less side effects.

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Nodules in the thyroid have always commanded a great deal of attention because of the fear of their being cancerous. The estimated incidence of thyroid nodules in children and young adults is about 0.22 to 1.8 percent. According to different epidemiological data, about 10 to 35 percent of thyroid cancers occur in the first two decades. The present study based on microscopic review of tissue slides obtained from thyroid nodules in cancer institute during 24 years focusing on malignant lesions in the mentioned age group revealed the following results: The average age of patients was 16.5. The female to male ratio is about 3.3/1 (76.7 percent female and 23.3 percent male). About 84 percent of thyroid nodules were benign with the following incidence of different morphologic features: nodular goiter 78.6 percent, follicular adenoma 1.96 percent, 16 percent of thyroid nodules were malignant with the following incidence of different morphologic variants: papillary CA 91.3 percent, follicular CA 3.5 percent and medullary CA 5.2 percent. Papillary carcinoma as the predominant from of thyroid cancer was accompanied by unilateral cervical lymph node metastasis in 53.8 percent of cases and distant metastasis (to lung) just in one case. According to major variation of papillary carcinoma, we found the classic type in 33 cases, the follicular variant in 18 cases and micro carcinoma in one case. Based on the above results once again we reach this belief that every thyroid nodule especially in children and young adults demands careful appraisal.

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Esophageal cancer is one of the most common malignancies in our country. Patients often seek medical advice in advanced and inoperable stages or with cervical esophageal cancer, in which operation is accompanied by sever morbidity. In this conditions many of them cannot tolerate chemo-radiation, or refuse it. Therefore radiotherapy is applied as a single modality in palliation of many patients with esophageal cancer. One of the palliative radio therapeutic methods is application of 5000 CGY in 20 fractions (Long Course) but considering the great number of our patients and limited capacity of radiotherapy centers, as well as emphasis of literature on palliation with 4000 CGY in 13 fractions (short course), we decided to compare these two methods (which are both used in our departments). In this retrospective analytic study, the files of 283 patients with esophageal cancer referred to cancer institute of Imam Khomeini Hospital from 1989-1999 were studied. Patients were between 27-97 years old (mean age=58.3) and most of them were male (53.7 percent). The mean length of lesion was 8.5 cm. The most common site of lesion was middle third at esophagus (48.1 percent) and the most common pathology was squamous cell carcinoma (99.6 percent). Fifty-four percent of patients were hot tea drinkers habitually. From the mentioned variables, only length of lesion had significant relationship with overall survival (P=0.04). Thirty-eight of 283 patients were excluded from analytic study because of incomplete follow-up. The number of patients had been treated by long course (5000 CGY in 20 fractions) was 137 and the remainder (108 patients) by short course (4000 CGY in 13 fractions). No significant difference was seen statistically between these two groups in overall and dysphagia-free survival (Kaplan-Meyer test). Also total dosage of spinal cord is lower in the short course. Thus regarding to less required time in short course and comparable palliation and survival between two methods, the short course policy is more preferable in esophageal cancer patients.

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Postoperative nausea and vomiting is a common complication that all anesthesiologist are familiar with the problems of its consequences. Although continued research on the recognition of factors affecting the incidence of PONV is being done but they are not sufficient and the need for research along with advances in anesthesiology and newer drugs are considered. In this prospective cohort study 400 children of 3 to 12 age who has been operated for general surgery (other than eye, thorax and upper abdomen) and orthopedic surgery in the Imam Khomeini and Children Medical Center Hospital has been evaluated. Of these, 200 children who had smoking parent and according to definition were passive smokers and the other 200 children had no smoking parents. Both the groups were matched for sex, age, and type of operation. With the analysis of data we noted that the incidence of PONV in both groups was 19.5 and there was no significant difference between the two groups. (Passive smoker 19 percent and non-passive smoker 20 percent). We also noted a relation between the duration and the incidence of PONV. So operation with more than 2 hours had higher incidence of PONV. There was also positive relation between PONV and controlled ventilation. However, there was no significant difference as the sex and type of operation was concerned. In conclusion, children of smoker parents suffer more PONV than children of non-smoker parents if operation takes longer than two hours or the patient is mechanically ventilated during operation.

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The newborn's weight at birth is an important measure for newborn's health in all communities. Among developed countries, 70 percent of low birth weight (LBW) newborns are preterm. The corresponding figure for undeveloped countries is only 30 percent, there are also evidence of intra-uterine growth retardation among these countries. Among effective factors on LBW, maternal related factors have important role in promotion and improvement of infants and mother's health. This study is a descriptive-analytic one and was conducted cross-sectionally through a questionnair. The study population determined by simple random sampling from newborns under coverage of urban health centers in Kohgiloye and Boyerahmad province. Necessary data collected from existing medical and health records filed in the health centers. Among 285 newborns, 88.4 percent considered with normal weight, 4 percent with IBW and 11.6 percent with more than normal weight. 7.4 percent of cases were immature. 85.3 percent of the mothers in study population were in immune range of age for pregnancy and 7.6 percent of them were illiterate. Except the sex of newborn (P=0.0008) and gestational age at birth (P<0.001) none of the variables demonstrated a significant statistical relation with the birth weight. The results of this study confirm other research's findings and reveal that with improving material factors such as mother's age, employment and literacy, the factors which are effective on birth weight, will be dependent on physiological factors such as sex of newborn and gestational age at birth.

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The healthy city is one that is designed to achieve optimal echological, social, and physical specifications for residents of the community that are developing constantly, and that a comprehensive different intrasector cooperation, resources and existing utilities are developed so that an environment of mutual cooperation and assistance for every individual civilian are provided. An environment to maximize their potential ability. One of the specific goals of healthy city, is the development of public knowledge, and cooperative involvement in social health and hygienic programs. The project of healthy city is carried in the Koyee Sizdah Aban, Rey city for the first time. This article has compared the studies carried in the Koyee Sizdah Aban and the other one that in carried in the district of Dowlat Abad, in regard to above-mentioned points. In this study the rate of knowledge, attitude, and the practice of four hundred of 15-49 years old women within the limits of healthy city, was compared with other four hundred women residing in the district of Dowlat Abad in regard to hygienic programs. According to the result of this study the mean percent of knowledge in the healthy cities women were significant in relation to other group. The rate of attitude toward the hygienic problems in the health city and the district of Dowlat Abad did not show a significant differences. The rate of practice of the women of healthy city with 95% of confidence was more than the women of Dowlat Abad. This study clarified that literacy of women and their spouse have positive effect on their knowledge and practice in regard to hygienic problems, but there is not meaningful relation between profession and age of women in regard to the knowledge and practice.

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Cut out or extrusion of the lag screw from the superior aspect of head and neck of the femur is one of the most common and devastating complications of the surgery of the intertrochanteric fractures with DHS. The exact cause of this complications is unknown, but it seems to be related to osteopenia, inappropriate position of lag screw inside head of the femur and inability of DHS to slide inside the barrel, which is the most ignored risk factor. We used short barrel Dynamic Hip Screw (DHS) for fixation of the intertrochanteric fractures in Dimon and Hughston procedure in 16 patients with unstable fracture, from may to August 2000. The only patient suffered from cut out is the one with static position of DHS in the center of the head. The other complications were delayed ::::union:::: in one, disingagement of the lag screw and side plate despite using compression screw, and one case of significant limb length discrepancy 6 months after surgery, mild limbing was the rule and the average of harris scores was 76. We think that, it is possible to reduce the rate of cut out with choosing short barrel DHS instead of the standard one, while using short length lag screw.

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The main goal of this study is to determine the auditory feedback effects in improvement of speech production process in prelingual totally deaf children who used cochlear implant prosthesis. For this reason, we recorded speech of four prelingual cochlear implant children pre and post of operation. Then we extract some static features of vowels-such as fundamental frequency, formant frequencies, vowel duration and vowel energy-from their stable mid-section and analyze them using a longitudinal prosthesis-on/off analysis. These patients-where are in the range of 7-13 years old-were operated in the cochlear implant clinic of Amiralam hospital. At each session, patients read the sentences once in device-on condition and then after 30 minutes stay in device-off condition. Quantitative results show that at least for the features under study, the patient's reliance on the auditory feedback decreased consistently by time (about 65%-averaged on all three vowels under study and all patients). So we concluded that after a sufficient time of operation, the speech motor patterns of patients will be trained for the correct production of static features of vowels and the relation of patients to auditory feedback for the production of such features considerably decreased by time.

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This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001). Other important causes were, age of patient at surgery (P value=0.04), pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04). Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.