Tehran University Medical Journal

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An appropriate approach to surgical patients in emergency situations needs meticulous consideration, especially those with incarcerated inguinal hernias, since delay or inappropriate treatment may lead to severe complications or even death. According to this fact, medical records of patients with incarcerated inguinal hernias referred to emergency department of Sina hospital were surveyed during a 40 year period by a retrospective study. Routine criteria indicating strangulation in incarcerated inguinal hernia were compared between a group of patients with intestinal necrosis and those without this complication. Among 87 patients with relatively complete records which were all operated (immediately or with some delay), 13 patients had intestinal necrosis for whom intestinal resection was performed. The comparison between the gangrenous group and those without grangrene according to the mean interval between the onset of symptoms and hospitalization, body temperature, pulse rate and WBC count, was performed by student t-test, but no significant difference was found. Considering the safety of surgery especially for anterior herniorrhaphy which ia familiar to all surgery residents, the authors suggest immediate operation through ant. approach for incarcerated inguinal hernias

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Aim: It is believed that sampling of the lower airways by BAL in complicated patients with pulmonary infection is often contaminated with upper airways microorganisms. The aim of this study was to assess the value of this procedure and probability of contamination of samples by upper airways flora. Methods: In a prospective study 40 consecutive patients which were candidate for broncholaveolar lavage were choosen for the study, and cultures were obtained from oropharyngeal and peripheral pulmonary airways, respectively. Results: Data showed two different groups of patients, distinctive by wether they have normal flora (group one 55% of total) or they have pathogenic microorganisms (group two, 45% of total). Group one had the normal flora in their upper airway tract, while only half of these group showed the same organisms in their lower airway tract, and the rest had negative cultures of the lower airways. The majority of second group had pathogenic microorganisms in their lower airway tract, while only half of them had negative cultures of the upper airways. Conclusion: We assume that the origin of pulmonary infection in our patients is from the peripheral airways. Thus sampling of the lower airways is representative of the actual pathogen, and we recommend that in order to rule out the suspicion of contamination by the upper airway organisms, simultaneous sampling of the upper airways should be obtained. Thus the application of sophisticated sampling methods and their cost effectiveness must be more investigated in view of the efficacy of our simple and inexpensive and practical method

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To evaluate the effectiveness of conjugated estrogen (Premarin) and progesterone in twenty-one postmenopausal women who had been menopause one year, we tested during a 6-month period the serum lipoprotein levels in subjects who offered by premarin in dosage of 0.625 milligram for days 1 to 25 and oral medroxy progestrone acetste for days 15 to 25 of a 30-day cycle. Twenty-one subjects completed at least 6-month follow-up serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerid (TG) measurements by calorimetric method. The results, six months after treatment, is compared to before treatment. The median change in biochemical studies showed significant decrease in serum total cholesterol (248.85 compared with 229.4, P<0.001) serum LDL-cholesterol (155.7 compared with 130.6, P<0.05), but significant increase in serum HDL-cholesterol (53.46 compared with 61.46, P<0.05) TG and VLDL levels did not occur. We concluded that conjugated estrogen is effective on serum total cholesterol, LDL and HLDL cholesterol in postmenopausal women

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It this prospective cross sectional study out-patient endometrial biopsy by PIPELLE was compared with diagnostic curretage (D&C) in patients suffering of Abnormal Uterine bleeding (AUB). Diagnostic accuracy, sufficient tissue sampling, intensity of pain and effective factors in biopsy results were the evaluated parameters in this study. In 70 patients with complaint of AUB (20 of them were post-menoupsal age admitted in hospital for D&C) endometrial biopsy was conducted by PIPELLE before operation and the results were compared. 96% of total patients (67) and 91% of patients with post menopause age had tolerance of undergoing out-patient PIPELLE biopsy of endometrium. 79% of these individuals complained of mild pain and 21% of moderate pain. Endometrium biopsy by PIPELLE in 77% of patients had similar accurate diagnostic results as compared to D&C. PIPELLE in 34% of patients (24) could not be conducted with the same accuracy of D&C patients, although in 14 (20%) of them, notissue samples could be collected by D&C. In none of these methods endometrial hyperplasia or endometrial cancer were detected. This study showed that in 77% of the total patients, the extra cost and general anesthetical risk of D&C could have been eliminated, by utilization of out-patient biopsy with PIPELLE

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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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This is a report of the first serological survey of influenza C virus in Iran, performed during a one year period (March 1997-May 1998). This study was accomplished in the National Influenza Center-Division of Virology in Tehran University of Medical Scinces. 1080 samples of serum (689 samples from Tehran and 391 samples from other provinces) were assayed for the presence of antibodies against influenza C virus (C/Paris/1/67) by haemagglutination inhibition (HI) test. 43.7% of people tested in Tehran and 40.7% of people tested from other provinces had protective antibodies against influenza C virus. Distribution of seropositives in various age groups had a somewhat similar pattern as what has been reported from other countries. The results of this study indicates that the lowest level of protective antibody titer is found at childhood and the level increases with age. The protective antibody titer level off for 20-30 years old age group and decreases in older age groups. These results indicates a primary contact in childhood, reinfection in adulthood. The influenza C virus is simultaneously circulating in Iran with other types of influenza viruses (types A and B).

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Sepsis is the systemic response to severe infection in critically ill patients. Sepsis, septic syndrome & septic shock represent the increasingly severe stages of the same disease. Despite the remarkable improvements in outcome, sepsis & septic shock remain an important cause of morbidity & mortality in children. This is a retrospective study among the patients who were admitted in the pediatric intensive care unit (PICU) of Children's Hospital Medical Center from Farvardin 1371 till Esfand 1375. During this period 4018 children were admitted in the PICU, 138 of these patients (3.4%) had the initial diagnosis of sepsis or septic shock. The age of these patients were from 3 months to 14 years (mean of 23.5 months). The male to female ratio was 2.1:1. Out of these 138 patients only 16 cases (11.6%) had sepsis and the others (88.4%) had criterias of severe sepsis or septic shock. Multiple Organ Dysfunction (MOD) were found in 96 cases (69.3%). Diarrhea was the most common primary disease that resulted in sepsis or septic shock. Only 20.3% of the cultures were positive, among which E-Coli was the most in 8.7%, Staphylococcus aureus in 5.7%, Klebsiella in 2.9% and pseudomonas in 1.4%. 66.7% of these patients expired, the mortality rates of the patients with severe sepsis or septic shock that concommitantely had MOD were higher than the other (P<0.0005). So it may be better if children with clinical diagnosis of sepsis be hospitalized in an intensive care unit or at minimum in a facility that can closely monitor these patients during the initial stabilization period.

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102 patients with ascites were enrolled in a sonographic study of abdomen and pelvis without awaring of history, clinical and paraclinical findings. So with only sonographic finding we suggested the diagnosis and etiology of ascites. All patients were hospitalized. Finally all the patients were diagnosed definitely and were compared with sonographic diagnoses done before. Results: In this survey 42% of patients had cirrhosis, 20.5% had malignancy, 14.7% had renal disease. Overall sensivity of sonography in diagnosing etiology was 91.1%, overall specifity was 97.8%, overall accuracy was 94.4%. Sensivity, specifity and accuracy of each group have also been determined separately.

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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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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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The routine intake of surfactant as a part of HMD (Hyaline Membrane Disease) treatment had significant effect on the prognosis of premature neonates. But since in our country this drug is not widely and routinely used, and there are not records about its use, we decided to make good on this shortcoming through a retrospective study. During 1 year, 54 neonates with HMD were admitted in Ali-Asghar's NICU, 30 of them had gestational age of less than 34 weeks and for 15 cases, surfactant was used. The results of treating this group were then compared with another group of neonates, who were not given this drug. From a statistical point of view, mortality, the length of the period in which the respirator was used, the use of high pressure in respirator, pneumothorax and pulmonary hemorrhage in neonates under treatment with surfactant was significantly less than those of the other group.

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Fine-needle aspiration biopsy for the diagnosis of breast lesions has been used for more than six decades and has been established as an effective procedure in Europe for many years. In order to evaluate the accuracy of fine-needle aspiration with histopathologic confirmation, a retrospective study was performed in Iranian Center for Breast Cancer, using a computer database over one year period. All women who had had fine-needle aspiration breast biopsy with histopathologic diagnosis included open excisional biopsy or mastectomy specimen. A total of 49 patients fulfilled the criteria. The test had a 93% sensitivity, 73% specificity, 65% positive predictive value, and 95% negative predictive value. Fine-needle aspiration is a sensitive test that Van be useful as an adjuct in the diagnosis of breast cancer.

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This study was conducted to investigate the prevalence of pulmonary problems, among a group of 1600 selected textile mill workers in the Yazd province. A standard questionnaire on respiratory symptoms was administered and forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined for each worker. The results obtained were as follow: Obstructive ventilatory defect 15 cases (0.9 percent), restrictive ventilatory defect 16 cases (1 percent), combined obstructive and restrictive ventilatory defect (Mix) 53 cases (3.3 percent) and normal 1516 cases (94.8 percent).

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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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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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A descriptive, analytical cross-sectional syudy was conducted in 1996 on 350 female students 11-14 years old in the center of Tehran, Iran. The general objective was determining energy and nutrient intakes and weight, height and BMI (Body Mass Index) of the girls, using anthropometric measurements, interviews (24-hour dietary recall and food consumption frequency), and the NCHS standards. The results were as follows: 1) Based on weight for age and the Z-score, 20% of the girls suffered from mild past and present malnutrition. 2) Based on height for age and BMI, 16.6%, 12.5%, and 1.3% suffered from mild past malnutrition, severe present malnutrition and overweight, respectively. 3) The height curves were normal, as compared to the respective standards. 4) The BMI curves were quite different from the respective standards. 5) On the whole, 53.7%, 49.7%, 86.0%, 59.0%, 67.7%, 76.5% and 88.0% of the girls had low intakes of energy, vitamin A, riboflavin, vitamin B12, folic acid, calcium, and iron, respectively. 6) A positive linear correlation was observed between energy intake and height, vitamin A intake and weight, zinc intake and height, and carbohydrate intake and height.

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Different aspects of the effect of trauma on the health status of populations have been studied annually 35 millions deaths, 3.5 millions disabilities and a sum of 500 billions $ cost. Evaluating different modes of prevention, a comprehensive study was carried out in the US during the 7th and 8th decades, introducing the TRISS method for the purpose of comparing the outcomes of trauma cases among multiple centers. This study has been carried out during 1996-97 in there hospitals of Tehran. After entering the hospital, all trauma cases were traced by trained interviewers until leaving the hospital. Based on the TRISS model, probability of survival was calculated for each patient and compared with the results of the MTOS study. Among 4863 cases evaluated, 300 (6.2%) deaths were observed, which is significantly more than the expected number (222 deaths, 2.7%) calculated under TRISS model. This difference may indicate a difference in the quality of trauma care.

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To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y) with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm) and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66%) and good in 3 patients (33%). There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10%) and one case of partial rupture of anastomosis (10%). Complete pathologic response was achieved on one patient (6.6%) and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.

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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.