Tehran University Medical Journal

---

The papillary cystadenoma lymphomatosum (PCL), also called warthin's tumor, is a benign salivary gland tumor which primarily involves the parotid gland. These lesions are composed of a double layer of cuboidal or culmnar eosinophilic cells lining a cystic cavity which lymphoid tissue is present in the supporting stroma. The lesions shows a predilection for males, with peak incidence during the sixth decade of life. Bilateral lesions have been found to occur in 5 to 7.5 percent of the cases. Rarely, these lesions have been reported in the minor salivary glands and oropharynx. Case report: A 47-year-old woman presented with a red lesion on the hard palate between the midline and right maxillary side. The patient had awared of the lesion for one year. The clinical dignosis was a mucocele. An excisional biopsy was performed. Gross examination of the formaline-fixed specimen revealed three pieces of soft tissue measuring 1.0 x 0.3 x 0.3. Histologic examination revealed a nodular mass surfaced by keratinizied stratified squamous epithelium. The connective tissue stroma contained a papillary cystic area lined by a double layer of cuboidal cells with centrally placed nuclei

---

During April, 1991 and September, 1993, eighteen patients with major thalassemia admitted to Shariati BMT center. Seventeen patients were transplanted were from HLA identical siblings and one from. his HLA identical father. Eleven of the donors were the known cases of minor thalassemia. The range of patients' age was within 3-10 years (with the average of 5 years and 11 months). Among them, seven patients were male and eleven were female. As the other international BMT centers, we classified our patients into three classes. Our criteria for this classification were hepatomegaly, ferretin, and liver fibrous 60% of our patients were put in class I and 40% in class II. All of our patients revealed a GVHD (severe graft vs. host disease) three weeks post-BMT as pruritus, diarrhea, and skin erythema especially in hands and feet. Two of the patients showed severe GVHD. One of the patients had chimerism after BMT. Although one year after BMT has passed, the patients is still depended on blood transfusion. One patient, despite graft rejection, died nine months post-BMT another one died after +70 due to GVHD. During 2.5 years, the overall graft survival rate was 88% in our center

---

The treatment of choice for bladder tumors is TUR, but because of high incidence of recurrence in these tumors, various treatments are suggested. In one study, 32 patients involved with superficial T.C.C. of bladder selected and divided in two equal groups. In the first group, after T.U.R, 10 million IU of a alpha-interferon was injected into the bladder through a catheter and in the other group, after TUR, they treated with injection of BCG into bladders. The results of these two drugs in prevention of recurrence and their side effects were studied and compaired

---

Today narcotics and other drugs have become the major cause of poisoning in big cities of Iran. Typical study of 50 drug-related deaths caused by use of narcotics, phenobarbital, tricyclic antiderpressants, meprobamate, aspirin, diazepam, chloropromazine, phenytoin, carbamazepine and propranolole, alone or with other drugs and toxic substances is described. This study covered the following topics: age, sex, pathological examination, autopsy cause of death, medical care prior to death. In toxicological examinations, samples from stomach content, liver, kidney, findings, urine and blood samples were analysed by TLC, GC, Emit d.a.u. assay and colour test methods

---

Histiocytic syndromes have been studied and investigated in these recent years for their cell origin, morphology, pathology, histochemical, immuno-phenotype characteristic, and their nomenclature, but the results of all these studies are confusingly, vague and not acceptable for all scientists and pathologists. Histiocytes very in the morphology, duty and their immunological behaviour. In different lesion these cells are in the form of mononuclear, foamy cell, macrophages like plasma cell and giant cell with many nuclei. When considering malignant Histiocyte cells and benign reactive histiocytes are both present in malignant histiocytic lesion, one can recognize the diagnostic problems of the pathologist. Markers for recognizing histiocytes are numerous and are increasing rapidly, in spite of that monoclonal antibody investigation, and genetic molecular method, the results as yet are not satisfactory. We have to accept that the new method are not at all sufficient and we have to look for a better method which is more sensitive to histiocyte for diagnosis of numerous histiocytic syndromes. In this paper, we discuss the difficulties on encountered in the diagnosis, and problem in defining and nomenclature of these syndromes and, some efforts are made to present the most acceptable classification for them

---

201 blood samples were collected by cluster sampling from 7-11 years old children and measles antibody titer was measured by hemagglutination inhibition test. Despite testing all the sera, the results were analysed on the 139 samples that had documented vaccination records and no history of measles. Among 139 children 44 had received 2 doses of vaccine one dose before 12 and one after 15 months, 64 had one dose after 15 months, 29 had only one dose before 12 months and 2 had not received vaccine. The antibody titer of the first two groups had no significant difference with those that had received one vaccine dose, before the age 12 months (P<0.001). There were no significant differences in the titer of antibodies with time elapse in none of the vaccination histories. This may be due to efficacy of vaccine and also circulation of wild virus in the community. Regardless of the history of vaccination, 95.5% of children had immunity to measles (titer?3). Considering the results if the current strategy of vaccination implemented completely, the status of immunity would be satisfactory.

---

This article aim is to introduce a case of PAPVC (partial anomalous pulmonary venous connection). The patient was a 25-year-old women who had dyspnea and palpitation. She expressed no special disease, no past medical history, and no drug usage, but her brother and her aunt had the above-mentioned history. In the physical examination, lungs were clear and the heart had S2 splitting, and there was a systolic murmur in the pulmonary area. Her liver could be palpitated two centimeters below the costal edge, but she didn't have any hepatomegaly. In cardiac catheterism, she had PAPVC, atrial septal defect (ASD), and mitral valve prolapse (MVP). The patient underwent operation had left pulmonary vein was separated from the superior vena cava and anastomosed to the left atrial auricle. By means of the pericardial patch, the left atrium became enlarged and ASD was closed. She was in a good condition after surgery and left the hospital without any complication with a good condition and recovery and had no problem any longer.

---

The cyclical changes in the gonadotropins stimulate ovarian follicular development either to the ovulatory stage or to undergo atresia. One such intrafollicular factor may be inter-cellular communication via gap junctions. We have examined the effects of two agents (retinoids and alkanols), known to disrupt or uncouple gap junction, on FSH-stimulated LH receptor induction and progestrone synthesis in granulosa cells. Granulosa cells from diethylstilbestrol-treated immature rats were isolated and cultured in serum-free medium containing either FSH (15 ng/ml) or FSH and estradiol (30 nM), various doses (0.1-1000 nM) of either retinoic acid were added to the cultures at the time of seeding. Additional cultures containing the same concentrations of either FSH, or FSH and estradiol, were treated with 0.01-10 nM heptanol or octanol. The results of this study showed that: 1) Retinol, at all of the concentrations tested, had no effect on either FSH-stimulated LH receptor induction or progesterone accumulation by the granulosa cells. 2) Retinoic acid suppressed both LH receptor induction and progesterone accumulation by the cells. 3) Heptanol and octanol suppressed LH receptor induction but did not have inhibitory effect on the progesterone accumulation.

---

Initial management, incidence and review of hydatidiform mole, chorioadenoma and destruens and chorio carcinoma in Mirza Kochek khan hospital department of ob.gyn and gynecology oncology of women's hospital Tehran-Iran school of medicin from September 1985 to March 1990, 209 patients received primary management for hydatidiform mole at oncology department of Mirza Kochek Khan hospital medical school of Tehran Iran. All of these women HAD complete record available for analysis, of these, 167 women bydatidiform mole, 12 patients chorioadenoma-destruens 30 patients chorio carcinoma a survey was made of factors likely to provide an important clinical perspective patient aye and the status of pregnancy were noted. 41 patient only sharp curettage and 55 patients suction curettage to remove the hydatidiform mole. 97 patient require chemo terapy, suction curettage of the uterus is clearly the best means of management in the most cases their eyperince documents that hydatidiform mole is an high risk pregnancy that requires prompt and in tensive management.

---

This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70). Ultimately, these datas have been compared with those in the reputable books and new medical papers And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males And also their most common chief complaints are neurological manifestations, and headache (82%) is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%), excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass) was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

---

AVNRT, (Atrioventricular nodal reentry tachycardia), atrial tachycardia and atrial flutter are 3 kinds of supraventricular tachycardia, which their mechanism are explained based on reentry. A 60-years-old man is presented with all of the above-mentioned arrhythmias, responsive to intravenous injection of adenosine. Radiofrequency ablation of the slow pathway territories cured all of them. Therefore, we suggest that there was a common pathway among all kinds of these arrhythmias, which were ablated with single RF lesion.

---

This is a study of depressive features in 51 Iranian combatants suffering from PTSD. DSM III-R considers depressive symptoms as associated clinical features of this condition. DSM III and DSM III-R both accepted the strong evidence that PTSD is a form of anxiety and included it in the anxiety disorders category. It is true that many PTSD sufferers present with anxiety features similar to these present in generalized anxiety disorder (The same authors reported anxiety features in 94% of Iranian combatants 1991), but this similarity is true: For depressive features, 92% was found in present study. The findings are discussed in relation to previous studies of combat-related PTSD, both done in Iran or elsewhere.

---

Nelson's syndrome is usually characterized by hyperpigmentation, elevated level of ACTH, and pituitary adenoma, which is frequently available as macroadenoma. It is usually occurred in the patients suffering from Cushing's syndrome. Growth of tumor has been revealed in 10-30% of the patients following adrenalectomy. Tumors are often benign in Nelson's syndrome. The selected treatment of Nelson's syndrome are transsphenoidal or transfrontal microsurgery. The role of radiation as prophylactic effect in the patients following adrenalectomy is unknown. In this research Nelson's syndrome have been studied on the patients records who have been hospitalized in Dr.Shariati hospital during the last 10 years. The achieved results show that, among the 49 patients suffering from Cushing syndrome who have referred after operation, 11 patients (22.4%) of them have been affected with Nelson's syndrome. The syndromes have been appeared after 3-9 months and with regard to occurrence of Nelson's syndrome in some patients immediately after bilateral adrenalectomy, it is recommended that selecting of the patients for bilateral adrenalectomy should be studied accurately

---

To evaluate the tolerance and effectiveness of conjugated Estrogen for women with established post-menopausal Osteoporosis and hot flushes, with the use of paired comparison, randomized, we tested during an 10 month period the bone mineral contents and plasma glucose in subjects who afforded by premarin in dosages of 0.625 mg for days 1 to 25 and oral medroxy progesterone acetate for days 15 to 25 of a 29 days cycle. All subjects received supplementation to ensure a minimum of 800 mg calcium per day. 25 subjects completed at least 10 month follow up serum calcium, phosphate, glucose and urinary calcium and phosphatae measurements by colorimetric, method. We compared women with herselves, the median change in biochemical studies showed significant decrease in serum calcium, phosphate an urinary excrition of calcium, but significant increase in urinary excrition of phosphate. Fasting plasma glucose did not change significantly. Decrease serum calcium (9.6 compared with 9.16 P<0.005) decrease, serum phosphate (3.77 compared with 3.39 P<0.005), decrease uri calcium (149.81 compared with 121.46, P<0.005), increase uri phosphate (625.83 compared with 676, P<0.005), FBS (92.03 compared with 91.45, 0.1>P>0.05). Regarding the effects of conjugated Estrogen on plasma and urinary calcium and phosphate levels and amelioration of clinical symptoms, we concluded that conjugated Estrogen treatment in effective in post-menopausal Osteoporosis, but we did not find relation between exogenous Estrogen in post-menopausal women with FBS and hot flush

---

The autopsies, which have been performed within the last 50 years, have revealed that real prevalence of prostatic carcinoma is more frequent than clinical one. The real prevalence of prostatic carcinoma, is prevalence combination of carcinomas which have been revealed clinically (They have been confirmed by autopsy or by operation) and the prostatic latent carcinomas are those, which are found in autopsy or randomly in the biopsies taken for hyperplasia. But they have no clinical syndromes. In order to review prevalence of prostatic latent carcinoma in Iran, all prostatic lesions (Including hyperplasia or carcinoma) were studied in Imam Khomeini medical complex during 10 years (1981-91), in university Jihad center and medical center of Iran within 2 years and in Yazd faculty of medicine within 3 years (1981-84). The total cases were 1110 among which 1085 cases were selected upon reviewing for statistical analysis. At first all lamellas were studied, then the ratio of adenocarcinoma to total prostatic lesions were analyzed and types of carcinoma and their percentage in total cases were identified. Finally the prostatic latent carcinoma and its percentage in total malignancy cases were presented

---

Survey of anatomic variations of coronary arteries is the most fundamental of researches in the field of these vessels. For performing this survey, coronary arteries (CA'S) of 463 human heart cases (gathered from three different surces: 1) Legal medicine center corpses, 2) Cadavers of dissection rooms in medical schools, and 3) CA'S angiographic films from hospital centers) were studied. After comparison between the statistical results in this research and the foreign ones, similarities and differentes from this subjects were ascertained as below, that, there were relatively considerable differences between: the number of CA'S (presence of 2 or 3 branches), origin of S.A. node artery, and type of main left coronary artery divisions (2 or 3 branches producing), but, in the other instances no considerable differences were observed

---

Children undergoing general anesthesia for strabismus surgery have a higher incidence of postoperative vomiting than those receiving the same anaesthesia for other types of ambulatory surgical procedures. Droperidol (0/0 75 mg/kg IV) and promethazine (0.05-1.0 mg/kg) were used in 100 children between 2-15 years old. Promethazine which has sedative property, anticholinergic antihistaminic, antiemetic and anti-motion sickness effects is recommended for children 0.05 mg-1.0 mg/kg of body weight IV. After induction of anesthesia and before operation and manipulation of the eye and combined with 0.5 mg/kg IM promethazine after operation. The incidence of vomiting following strabismus surgery might be reduced more than with intravenous droperidol

---

Proximal weakness specially in extremitas is a common neurologic symptom of patients, for which the physician should consider toxic, metabolic, infectious and paraneoblastic diseases affecting muscular system as well as primary myopathies. Osteomalacia is one of the most common considerations which is treatable but disabling as its natural course. Osteomalacia is the most often due to VITD or calcium deficiency but work up is necessary to find other primary defects that cause this disease. Renal tubular acidosis is one of these primary defects and osteomalacia secondary to it dose not respond to classic treatment of osteomalacia, so specific management is necessary. In this article we report six patients who have been referred to the clinic of neurology of Imam Khomeini Hospital since 1370 to 1374 with proximal weakness for whom RTA has been diagnosed

---

A seventeen-years old woman was presented with infertility and primary amenorrhea. She had normal stature, femate phenotype and normal development of breasts, external genitalia, vagina and cervix. Pelvic examination showed a large lobulated mass. On sonography there was a mass with probable origin of ovary. Paraclinic tests were carried out. Gonadotropins were in postmeno pausal limits. Alpha Fetoprotein, Beta Subunit (B-HCG) assay were normal Laparotomy revealed a gonadat mass on right side, normal uterus and left streak gonad. Pathologic report of tumor was dysgerminoma and teratoma. Due to pathology of tumor and Y chromosome, we advised the patient to remove the other streak gonad and have irradiatio

---

Psoriasis is an common, chronic, recurrent, inflammatory disease of the skin, characterized by red scaling plaques on the skin surface. The morphology of psoriatic lesions allows classification of the different types of psoriasis that included plaque type, pustular type and Erythrodermic type. I have studied the relationship between distribution of RH and ABO blood groups in 110 psoriatic patients and compared with control normal blood groups. The result of this study was as follow: The rate of blood group type AB was significantly lower than that of the control normal blood group ABO