Tehran University Medical Journal

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Relationships among lipids, hormones and anthropometric indices of patients in a reproductive endocrinology outpatient clinic were investigated. Subjects were divided into 2 groups according to their hirsutism score (Hirsute score>=8, N=102 And non-hirsute score<8, N=83). Weight (Wt), height (Ht), waist (W) and hip (H) circumferences were measured in all women and serum levels of lipids, hormones and glucose were determined in about one half of them. Hirsute women were heavier and had higher waist to hip ratio (WHR) and waist to height ratio, increased LDL and decreased progesterone levels (In all cases, P<0.04). In 26 subjects with a high serum androgen level (Testosterone, and"or androstenedione and/or DHEAS) there was a significant correlation between triglyceride and testosterone levels (P<0.02). Multiple regression analysis showed that WHR was an independent variable for cholesterol and LDL Age for triglyceride Glucose for HDL And androstenedione for the LDL/HDL ratio. It is concluded that altered blood lipid profiles in women with hirsutism and"or hyperandrogenism may be the result of obesity, testosterone or androstenedione blood levels.

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twenty-two patients were reviewed retrospectively to determine the effects of embolization on Glomus Jugulare tumors. 6 patients underwent embolization and 16 did not. All tumors were removed with a type A infratemporal foassa approach. The patients were evaluated for operative blood loss, operative time, length of hospitalization and new post-operative nerve deficits. The embolized group lost less blood and shorter operative times and less hospitalization. Embolization did not reduce the incidence of new post-operative cranial nerve deficits. The experience of the surgeon and operative team also play a significant role in the reduction of blood loss and operating time. Embolization carries a risk of significant morbidity, and its use depends on the experience of the radiologist.

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We studied fertility indices of Iranian and non-Iranian populations which were covered by 23 Rays health houses. This cross-sectional study aimed to prove the effect of increasing number of non-Iranian immigrants on health indices of the area covered by Tehran university of medical sciences and health services, consequently giving attention to specific health programs. The data collection method was census of permanent residents of the villages by means of vital horoscopes. 8494 of 27611 persons were non-Iranian. Dependency ratio and natural growth rate was 75%, 1.14% in Iranians and 98%, 1.74% in non-Iranians, respectively. Mortality in non-Iranians was 1.24 times more than Iranians. General fertility rate in Iranians was 60 and in non-Iranians was 110 live births in 1000 women of child bearing age. Total fertility rate in Iranians was 1.73 and in non-Iranians 3.27 neonates for each woman. Age-specific fertility rates were absolutely higher in non-Iranians. Gross eproductive rate was 0.87 in Iranians and 1.59 in non-Iranians. Mean number of girls born by a non-Iranian mother will be double times of an Iranian mother (P<0.01). Modern contraceptive methods coverage was 70% in Iranian couples and less than 40% in non-Iranian couples. 96.94% of Iranian deliveries and 70.9% of non-Iranian deliveries were safe (P<0.01).

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Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

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Hepatomegaly, decrease in the liver paranchymal echo and increase in the gallbladder wall thickness has been shown in acute viral hepatitis. The present study was done to determine sonographic changes in acute viral hepatitis. We performed liver and bile ducts sonography and specific tests on 42 patients (mean age: 31.5 and 61% male) with acute viral hepatitis. Gallbladder wall thickness was seen in 45.2% and hepatomegaly in 33.3% of patients and liver paranchymal echo was decreased in 19.3%. Age, sex, type of hepatitis, cholecystitis like symptoms, aspartate aminotransfrase, alanine aminotransfrase, alkaline phosphatase and bilirubin did not significantly corralate with these changes. Only raised prothrombin time was strongly correlated to the thickening of the gallbladder and decrease in the liver paranchymal echo and cholesistic like symptoms we can postulate that thickening of the gallbladder and decrease in the liver paranchymal echo is not dependent on the severity and speed of the paranchymal necrosis (as considered with ALT and AST) but they depend on the liver function disturbance (as considered with PT) because the thickening of the gall bladder is present in 45% of the patients and 10% of the normal population have gallbladder stones, one should not perform the diagnosis of acute cholecystitis, only on the basis of sonographic report without attention to the clinical and laboratory data.

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Sex determination is the first step in identification of dead body and hip bone or its components are reliable in sex discrimination. The present study was done to determine the applicability of some osteometric parameters of human hip bone in sex identification. Sixteen different variables for the anterior border of 50 human hip bones from a skeletal collection were studied. Statistically significant difference were detected between means in relation to sex for four variables, including: distance from the anterior superior iliac spine to the pubic tubercle, distance from the anterior inferior iliac spine to the iliopubic eminence, distance from the anterior inferior iliac spine to the pubic tubercle and length of the notch between the anterior inferior iliac spine and the iliopubic eminence. These variables could be used for sex determination of the unknown human hip bones.

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Tubal ligation is one of the most effective and reliable methods of contraception and of successful program of birth control in Iran. Present study was done to evaluate factors affecting risk of complications during tubal ligation surgery. We studied 1780 women that had tubal ligation in 13 hospitals in Tehran during the years 1993-95. Data on operation were collected by questionnaire and analyzed using logistic regression method. Risk of complications was increased in women had had operation after vaginal therapy, in luteal phase, after cesarean section and in follicular phase, respectively. Modified pomery, pomery and parkland methods of operation were ascendingly related to increased risk of complications. Age, history of pelvic pain, method of anesthesia, incision size and time of operation were not significantly correlated with complications. Frequency of complications was higher in women that had other procedures during surgery. We suggest that tubal ligation be done after vaginal delivery and by modified pomery method.

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A role of adenosine in pathogenesis of syndrome X has recently been postulated. Previous studies suggest that aminophylline (An adenosine receptor blocker) improves exercise tolerance in this disorder. Present study was performed to examine the efficacy of Theophylline in syndrome X and to determine the incidence of cardiovascular risk factors and clinical, ECG and angiographic findings in these patients. 31 patients were studied. The first 16 patients received Theophylline. Other 15 cases received placebo. Exercise tolerance test was repeated after 1-2 weeks. Patients who received Theophylline had increase in rate-pressure product at peak exercise and decrease in symptoms during exercise, but stage of st depression, global and peak st depression, exercise tolerance and persistence of st depression more than 3 minutes in recovery and symptoms of patients in general were not significant different. Theophylline has a favorable effect on exercise, reduces chest pain and rate-pressure product at peak exercise in patients with syndrome X, but not on other variables of exercise test.

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DNA typing is a new method with important applications in forensic medicine. In the present study, we evaluated application of DNA typing in Iran. Loci Hum LPL, Hum Tpox, Hum F13, Hum vw 31A, Hum TH01 and Hum FES/FPS of DNA short tandem repeats were studied. To determine sensitivity of the test, 85 mother-child couples (1020 chromosomes) that were referred to DNA section of legal medicine organization of Iran were included and for determination of it's specificity 42 brother-sister couples (1200 chromosomes) and 58 non-relative couples were examined. The results show lack of mutations in the studied loci and acceptable sensitivity of the test. Of 12 alleles of siblings, there were 2-6 differences, in contrast with 3-9 differences in non-relatives, so the test has 100% specificity in these loci. Considering polymorphism, power of exclusion of these 6 sites was 99%.

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Despite many advances in the field of cancer treatment, intra-cranial tumor cases still have a poor prognosis. This research has been carried out in order to describe age and sex distributions and histopathological characteristics and site of intra-cranial tumors. We studied 425 patients with intra-cranial tumor whose samples were examined in pathology center of Imam Khomeini hospital from 1991 to 1996. The commonest types of tumors in our study were glial (28%) tumors and meningioma (27.76%). The commonest sites of tumors were cortex (30.6%), hypophysis (21.89%), and cerebellum (15.3%). Among metastatic tumors of the brain, thyroid carcinoma was the most prevalent one (55.5%). The results of this study did not significantly contrast findings of other studies.

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Apium graveolence has an small brown olyptical seed with pharmacological activity. To evaluate it's application in treatment of hypertension, 37 hypertensive patients (20 female, 17 male) with the age range of 45-65 were given 6 grams of powder of Apium graveolence seed and then the blood pressures before and after the remedy were compared. Before treatment, the mean systolic blood pressure was 171.35 mlHg and the mean diastolic blood pressure was 94 mlHg. After they became 154.3 mlHg and 89.6 mlHg respectively. The difference of blood pressure before and after treatment was statistically significant (P<0.05), so we concluded that Apium graveolence seed can be used as is a safe and effective treatment for high blood pressure. Further controlled studies should be done to compare it with available anti-hypertensive drugs.

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Non-Hodgkin's lymphoma is the 3rd most common cancers in children. In the present study, to determine pathological and clinical features of this cancer, we reviewed records of 84 cases of non-Hodgkin's lymphoma who were admitted to Ali Asghar and Bahrami children hospitals from 1989 to 1996. 59% of cases had small non-cleaved cell (SNCC) subtype of disease. 15% were lymphoblastic and 5% diffuse large cell subtype. The most prevalent primary sites were abdomen and lymph nodes. The most prevalent symptoms were abdominal mass (34%), abdominal pain (37%) and cervcal lymphadenopathy (26%). Over half of our patients were small non-cleaved cell subtype, and further studies should be done to find out reasons for this unusual finding.

 

 

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Although cellular immunity involving activated macrophage is important in resistance to Brucella infections, serum factors and polymorphonuclears (PMNs) play some role in the initial responses to Brucella infections. In this research, we studied respiratory burst of PMNs against opsonized yeast and opsonized inactivated Brucella melitensis in chronic Brucellosis patients and controls with no previous history of Brucellosis. A group of 41 patients and another group of 20 blood donors as control, were included. The other 2 groups included 10 cases and 6 controls. Mean responses of PMNs of patients and controls to opsonized yeast were 110.3 and 129.3 milivolt respectively and the difference was not statistically significant. No statistically significant difference was observed between respiratory burst of PMNs exposed to inactivated Brucella in 10 patients with chronic Brucellosis (Mean 67.2) and 6 control blood donors (Mean 112.5), so we concluded that inactivated Brucella melitensis can't inhibit activity of myeloproxidase enzyme.

 

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The term histiocytosis refers to a group of idiopathic clinics entities characterized by diffuse proliferation of mature histiocytes associated with tumorlike masses of foamy reticuloendothelial cells containing lipoid droplets with variable number of eosinophiles and connective tissue. This cells causes tumorlike masses in the bones and other vicera in the body thus it may have very different clinical signs and symptoms. Also it may have acute and fulminant form or chronic and slowly progressive. We have an interesting case with multiple organ involvement and chronic otitis media with granulation in the external audiotory canal and perforation of tympanic membrane. The patient was 3 years old with diabetes insipidus and visceral involvement such as hepato-splenomegaly. Histologic diagnosis was Hand Schuller Christian disease.

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Sarcoidosis is a chronic multisystem disorder of unknown etiology. All parts of the body can be affected but the organ most frequently affected is the lung. Otolaryngologic manifestations occur in 20% to 40% of cases of Sarcoidosis and the spectrum of lesions that may come under the purview of Otolaryngologist is broad. In this case report a patient is presented with large cervical lymphadenopathy and without other manifestation of disorder.

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Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.

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This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) and right internal carotid arteries (38.4%). We measured peak systolic and end-diastolic velocities (PSA and EDV) and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio). Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%), accuracy (89.5%) Severe stenosis: Sensitivity (82.1%), accuracy (92.8%) Total occlusion: Sensitivity (93.8%), accuracy (96.5%). There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5%) but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%). EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86%) have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

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This study was designed to determine if body mass index was predictive of mortality in a sample of seriously ill hospitalized patients in intensive care unit (ICU) of Children's Hospital Medical Center. There were 160 children from 1 month to 14 years in this prospective study for a period of 3 months in 1377. For all of the patients after calculation of BMI, the relation between age, sex, duration of illness, underlying diseases, positive family history of serious diseases, duration of admission in ICU, history of previous hospitalization, mechanical ventilation, albumin and PRISM score with mortality risk and outcome were determined. The percentile rank of BMI between 15 to 85 accepted as normal according to previous studies. In this survey the relation between BMI and outcome of the children in ICU were significant (P=0.0001). Also this relation was significant with the children in ages of 1 to 6 months, duration of hospitalization less than one or more than seven days, no surgery, mechanically ventilated patients. BMI, a simple anthropometric measurement of nutrition employed in community epidemiologic studies, has now been demonstrated to be a predictor of mortality in acutely ill children in ICU. Future studies examining variables predictive of mortality should include BMI.

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Superficial mycosis of the skin is one of the most prevalent human infections. Within these infections, tinea pedis and tinea cruris have been studied. Different aetiologic causes play role in these infections which the most important of them are Trichophyton rubrum, Trichophyton Mentagrophyte and Epidermophyton floccosum. Prevalence arrangement of these causes are defferent in societies. This study is a case series study which in the course of this period 42 affected patients 0 tinea pedis and 40 affected patients to tinea cruris have been studied. From patients with doubtfull clinical lesion, whom have reffered to Razi Hospital within the first six months of the year 77, smear and culture were provided and in the meanwhile for consideration of possible association of Dermatophytoses in these two location in cases of clinical doubt to tinea pedis among the affected patients to tinea cruris, smear and culture wase made and it wase observed that 40 of affected patients to tinea cruris, 4 patients simultaneously have tinea pedis (10%). In this study also, risk factors of tinea pedis and tinea cruris have been studied. Etiologic causes in tinea pedis in this study with respect to arrangment are: T.Ment, T.rubrum and then Epid.floccosum and the causes of thinea cruris with respect to arrangment are: Epid.floccosum, T.rubrum and then T.Ment. In this study foot and groin Etiologic factors have been considered, it was observed that the pattern of their etiologic causes in Iran with respect to other countries are different.

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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.