Tehran University Medical Journal

---

SCL-90-R-scale was used to asses 1184 enrolled medical colleges students, Tehran University of Medical Sciences and Health Services. Out of nine orthogonal symptome dimensions of the instrument, paranoid ideation, interpersonal sensitivity and obsessive complusive were the most frequent in the study.
Difference between males and females was significant in depression, anxiety and phobic anxiety dimensions. Mean psychopathological dimensions in students with GPA lower than 14 were detected to be more significant than others

---

Mycosis Fungoides (MF) is a cutaneous T-cell lymphoma (2,5). Alopecia is rarely seen in this disease, and the reported cases are in the form of follicular mucinosis (1,2,4). In this case report a patient is presented whose lesions all showed alopecia without mucinosis. Furthermore there was a patch of alopecia without any epidermal changes, which was clinicaly identical with alopecia areata, and histologically identical with MF. After six months of treatment there is regrowth of almost normal hair on all of the lesions

---

Regarding the importance of cardiovascular disease in the health of societies, Hyperlipidemia is considered as an important risk factor. One of the case recently put forward in the fat profile, is high TG (triglycerides) and low HDL-C (High Density Lipoprotein). Nowadays, we believe that TG without the presence of low HDL-C is not considered as a risk factor for cardiovascular disease. So it was decided to perform a descriptive study to define the prevalence of this syndrom, like other risk factors, in urban population of Isfahan. Samples were selected by random sampling method and the sample size, to have reliability of 95%, was about 1200 from the people over 20 year old in 6 age groups and 2 sexes. After inviting the people while going fast (about 14 hours), a questionnaire including perfect identifications was filled and blood factors include total cholesterol, TG, LDL-C (LOW Density Lipoprotein), HDL-C and F.B.S (Fasting Blood Sugar) were measured. Then the statistical analyzing of data was done to define the relation between TG and HDL-C. Regarding the coefficient of correlation and P.value <0.05 in different age and sex groups (except over 70 years old group which was not significant) was defined that TG has an inverse relation to HDL-C and the prevalence in the urban population of Isfahan is 19.7%. Results got from studying the relation between TG serum level and high LDL/HDL fraction (equal or more than five) showed that the more TG gets, the more the fraction is and regarding to its prevalence (11.6%) in Isfahan. It can be a risk factor for cardiovascular disease. So regarding the high prevalence of High TG and low HDL-C syndrome, treating this syndrome can be considered as one of the primary prevention methods. To fufil the latter goal firstly the syndrome must be identified and the related patients must be treated. So the patients with high TG must be tested for HDL-C and LDL-C too. And secondly therapeutic actions to increase HDL-C and to decrease TG level must be done.

---

Diabetes Mellitus is one of the common diseases leading to dialysis. In a cohort study, diabetic dialysis patients were compared with non-diabetic dialysis patients for one year about age, sex, cause and times of admission and rate of mortality. The study was done on 101 patients. At the end of the study, 88 patients remained. Results were interprected by T-test and chi-square statistical analyses and signified with P value less than 5 percent. Results: Diabetes was the cause of 17.8 percent of renal failure in 101 patients. The mean age of diabetics was greater than non-diabetics (P=0.02). Mortality of diabetics in one year was 20 percent, similar to non-diabetics. Infection (chills and fever) was the most common cause of admission in diabetics (33 percent) and non-diabetics (25 percent) with no significant difference. Conclusion: Mortality and morbidity between diabetic and non-diabetic dialysis patients had no significant difference.

---

Post partum haemorrhage (PPH) and retained placenta are the most common serious abnormalities encountered during the third stage of labour. PPH is one of the most common causes of mortality in childbirth, particularly in developing countries. The incidences of PPH and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction (CCT). Weather such treatment is valuable is open to question because of the lack of clinical and physiological studies. Unfortunately, oxytocic drugs are not available to about half the women of developing countries, who do not deliver under the care of a trained midwife. We know that sucking stimulates uterine contractions in lactating women. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast-feeding and again within 3 min of the start of sucking. Traditional birth attendants (TBAs) do not have the skill to administer injectable oxytoxics. It has become the practice in some TBA training programmes to teach that the risk of PPH can be reduced if the mother puts her baby to the breast immediately after delivery. Objective: To determine the effect of sucking immediately after childbirth on the length of 3rh stage and amount of bleeding in the first day. This is a semi-experimental study. It was done in Tehran'e Mirzakochak hospital. 100 women received oxytocin intramuscularly and 120 women were placed in sucking group. Then the lenghth of 3rd stage and amount of bleeding in the first day was compared between two groups. Results: The duration of the third stage and number of pads different between oxytocin group and sucking group (4.42 vs 6.08 min) and (10.58 vs 11.72 number). As for the, parity, gestational age, maternal systolic and diastolic blood pressure, infant weight and hight, the results showed no significant difference between the groups. As for the, maternal age, the results showed differed significantly between the groups. As for the gestational age, the results of the research showed that between the gestational age and the duration of the third stage, there was a reverse correlation in multipare women. So when gestational age decreases the duration of third stage will be longer. As for the maternal age, parity, systolic and diastolic blood pressure, infant weight, infant hight, infant sex, the results showed that there was no correlation between these and the duration of the third stage.

---

In a bacteriological study on 230 biopsies of patients suffering gastrointestinal disorders in Imam Khomeyni Hospital, 88 patients were selected as case and another 88 as control groups. Case group was treated by triple (Bismuth subcitrate, Metronidazole and Tetracycline) drugs for a period of 14 days. The latter treated by nonbismuth regiment eg. Amoxicillin and Ranitidine mainly. All of the patients were examined bacteriologically by biopsies in 1, 6 & 12 months after treatment. Obtaind data revealed that the Bismuth composed regiment was more effective than non-bismuth composing ones. In fact, bacterial eradication was approved in 89.8% of case group without recurrence of symptoms among them at least for entire year. Conversely, eradication occulted just in 23.5% of control group, frequent recruidescen Cl of pipriculear observed among them within one year.

---

259 consecutive colposcopic examinations were done at colposcopic unit in Shariati Hospital during 1995-97. 58 cases were omitted due to lack of biopsy report. There were 167 cases of concordance and 34 cases of discordance between results of pap test colposcopic directed biopsy in these cases. We evaluated the value of pap test as a screening test versus colposcopic directed biopsy and found sensitivity of 42.4%, specificity of 94%, PPV (Positive predictive value) of 60.8%, and NPV (Negative predictive value) of 89.3%, false nagative and false positive rates were 57.8% and 5.3%, respectively. If pap test and HPV DNA screening were done simultaneously, almost all invasive cancer and HiSIL would be detected

---

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 ulcer. Therefore introducing of simple and cost effective tests are important for diagnosis of H.Pylori infections. ELISA has been considered as an alternative test compare with biopsy, histological staining, culture and urease test in diagnosis of H.Pylori infection. In this investigation, 111 patients referred to GI endoscopy department of Imam Khomeini Hospitals for U.G.I problems which were evaluated for H.Pylori infection. Culture and histological staining (GIMSA and H & E) were used as a gold standard test compare with ELISA-IgG and urease test. Sensitivity and specificity for ELISA were 90%, 93% respectively. This report suggests that ELISA is a cost effect and valid test in diagnosis of H.Pylori infection

---

In a quasi experimental study, the effect of health education program in the students' knowledge about personal hygiene and its related factors were investigated. The subjects were 150 students that selected by stratified sampling from the Moslemebna Aghil guidance school in the rural area of Ghooch Hesar, a district of shahre Rat. It was found that: before the health education program respectively 13.3%, 68% and 18.7% and after that respectively 46.7%, 51.3% and 2% of students had high, medium and poor knowledge about personal hygiene. Knowledge about personal hygiene rose from a mean score of 12.19 to 14.15. Appropriate statistical tests showed a significant relationship between students' knowledge difference and their grade (P<0.006). The results indicated that the students' knowledge about personal hygiene significantly improved after health education program

---

Variation of recurred branch of median nerve in relation to the median and flexor retinaculum are significant for both hand surgeons and specialists always. In this study, 64 cadaver hands (32 men) have been dissected. The median nerve was identified at the proximal edge of the flexor retinaculum, and in order to expose carpal tunnel the ligament was divided, and the above subjects were studied. The results are: 1) The relation of recurrent nerve to the flexor retinaculum was classified into 4 types: A) In (53.1%) of subjects, this branch arises from the median after the flexor retinaculum. B) In (31.3%) of subjects, it arises from the median in the carpal tunnel and the moves around the lower edge of flexor retinaculum and enters the thenar region. C) In (14.1%) of subjects, it arises from the median in the carpal tunnel and pierces the flexor retinaculum. D) In (1.56%) of subjects it arises, in the carpal tunnel and it divides into two subbranches here. One follows pattern A and the other pattern C. 2) In this step, the relation of the recurrent branch to the median nerve was studied. The results show that inspite of this image even though most often the recurrent branch arises from the lateral side of median, in (68.75%) of subjects it arises from it's anterior surface. The MC Nemar test reveals that there is no relation between manifestation of mentioned patterns with right or left hands.

---

Drug therapy and prophylaxy in infectious diseases, from hygienic and economical point of view, are very important. Infections caused by pseudomonas aeroginosa were particularly severe, with high mortality rates. In the recent years pseudomonas aeroginosa continued to cause the most severe, life-thereating infections in burned patients, in spite of the introduction of a wide variety of antibiotics advised specifically for their anti pseudomonal activity. The aim of this study, in which many cases of ps.aeroginosa infections are assessed is to identify the drug resistance of this bacteria to penicillines, cephalosporins and aminoglycosides by antibiotic sensitivity test (disk ager diffusion). Results as percent of resistance to each antibiotic were 89% to carbenicillin, 55% to piperacillin, 89% to mezlocillin, 89.5% to ticarcillin+clavulonic acid, 85% to ceftriaxone, 95% to tobramycin, 5% of all isolates were not sensitive to any antibiotics.

---

Due to the important role of the trace elements (i.e. zinc and copper) in the biochemical processes of body and the effects of exogenous and endogenous hormones in distribution, absorption and excretion of these elements, we decided to determine the rate of the zinc and copper content of serum in women taking (LD) OCPs. Our finding indicates that the rate of the zinc content decreased significantly (P<0.001), whereas the copper content of women serum during this period showed a significant increase (P<0.001). In regard to previous months, the process of increasing were lasting for six months. Therefore, we would like to suggest that the serum content of these two elements should be monitored during the period of medication with OCPs, to avoid the deleterious effect of flactuation rates of these elements in serum.

---

The poll was designed to let the management system of the university know about the opinions, criticisms and suggestions of the faculty members and create a sense of cooperation and promote the level of relationships. In November and December 1997, short after the new Chancellor of the University was selected, the poll was conducted by the new board to reach the above goals. In this survey, all the faculty members of the University were questioned about the problems they faced in the University. A questionnaire of 23 questions in two pages was given to them and was returned by mail. About 47.5% of the questionnaire were returned. Analysis of the results showed that a significant majority (93%) of the respondents believed that Tehran University should be the best University of Medical Sciences in Iran, and that it dose have the capability to be so, however, a majority (66%) of them claimed that it is not so at the present. A significant majority of the respondents believed that education and research are the two most important duties of the University, and the health, treatment, and cultural duties rank next. Except for the Medicine and Health Faculties others were not satisfied with their status at the University. The satisfaction of the faculty members with educational and research performance of the faculties was questioned the results varied in different faculties. Dissatisfaction with research status was most obvious. Forty-six and 25 percent of the staff in the faculty of medicine were satisfied with educational and research performance of their faculty, respectively. The teaching staff were also questioned about their problems the most important of which was shown to be that of convenience. More than 90% of respondents stated that opinion poll is an appropriate way to relate the management of the University to the faculty members and emphasized on holding periodic sessions with the Chancellor of the University and personal visits to him.

---

Intrauterine insemination (IUI) has been practiced since the late 1800's primarily for idiopathic infertility, and in men with deficient semen parameters. The procedure is done by placing washed sperm in uterus a few hours before ovulation. The records of 427 couples receiving IUI for treatment of infertility at Shariati hospital in 1370-74 were reviewed retrospectively. These patients had IUI in 574 cycles. Eighty patients became pregnant and delivery rate was 14% per cycle. Pregnancy rate is impressive when ovulation induction is combined with insemination timed just before ovulation. The success rate in Shariati hospital is comparable to other infertility centers in the world and cost of a cycle of IUI with HMG superovulation is approximately one third the cost of IVF-ET or GIFT cycle and avoids invasive oocyte retrieval and extracorporeal fertilization. So we suggest that women with refractory infertility without anatomic distortion of pelvis can have at least 3-6 cycles of IUI before IVF or GIFT.

---

Our purpose was demographic clinical and pathological aspect of BCE in patients seen in Razi Hospital, during a six-month period (75.8.12 to 76.2.12). Results: From the total 20000 patients, 103 cases of BCE were detected. (0.5%). The male female ratio was 1.71 BCE was more frequent in sixth decade. 40.8% of patients were fair skin (Type II), 54.4% tawny (Type III) and 4.9% brown (Type IV, V). 15.5% of patients had a past history of freckles and history of radiotherapy in childhood was present in 41.7% 89.3% had no history of acne and seborrhea. The scalp was the most common site of BCE. The most common clinical type was nodular BCE and solid BCE was the dominant histological feature. Conclusion: BCE was more common in male and fair skin patients with dry skin. In those having history of radiotherapy of the scalp, lesions were seen mostly on the scalp, forehead and neck: pigmented BCE was predominant in this group.

---

Introduction: It has been shown that repeated large volume paracenthesis associated with intravenous albumin infusion is a rapid, effective and safe therapy of massive ascites in cirrhosis. Our aim was to investigate wether IV infusion of albumin is necessary in large volume paeacenthesis therapy of cirrhotic ascites. Methods: 37 patients with tense cirrhotic ascites who were intractable to diuretic therapy were randomly assigned in two groups. 16 patients (group A) were treated with paracenthesis of 4 lit/day plus intravenous albumin infusion (7 gr/lit), and 21 (group B) with paracenthesis without albumin infusion. Hemodynamic status, liver and kidney function and serum lectrolytes were assessed before, while and after paracenthesis. Results: Paracenthesis without IV albumin did not induce significant changes in standard renal function tests, serum albumin, serum electrolytes and liver function tests. One patient from each group developed renal impairment. Two patients from group A and 3 from group B developed asymptomatic hyponatermia. One patient from group A died due to hepatic encephalopathy during paracenthesis. Conclusion: Intravenous albumin infusion is not necessary during large volume paracenthesis for treatment of tense ascites in cirrhotic patients.

---

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.

---

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.

---

Increase in the rate of elderly population have persuaded the people and governments of the most developed countries to evaluated and confront the complexity of social, economic, and health issues involved. Increase in the number of aging people is commonly called the aging of society. Currently, in the countries of Western Europe (Germany, France, England, Sweden), the figure of the people over 60 years old comprises 12-15 percent of total population, and according to the forecasting estimate will reach to 25% up to the year 2020. In our country, based on censuses that have been carried out during the years of 1355, 1365, 1375 this figure is 5.12%, 5.25% and 7.67%, respectively. The number of 60 years old persons or over under the supervision of Tehran University of Medical Sciences was 135379 persons, in the year 1376. Due to these demographic changes that is arising from the phenomenon of aging of society, a considerable increase in the incidence of chronic diseases and health requirement of the elderly living in the society happens. This can be translated in terms of more demands in the affiliated fields of nursing, health care and treatment. This study has been proposed to clarify and evaluate the afore mentioned requitements. In this study, the following results can be concluded. Contrary to physical and psychological problems of adulthood, only 25% were aware of assisting economic, health and treatment institution that were available to them. These people were usually suffering from a single to multiple ailments that happen concurrently and ladies were complaining more in this respect. The interesting point in this study is the answer to the question of most basic problems of their life. Many elderly mentioned financial problems the most influential factor in their life. The figures concerning the responses to the question of basic problems of elderly for economic and physical problems were 37.7% and 18.3%, respectively.

---

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