Tehran University Medical Journal

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S-J syndrome is a rare autosomal recessive disorder of short stature, blepharophimosis, puckerd mouth, myotonia, muscular weakness, pectus carinatum and stiff joints. Case report: first case: n.1. A boy aged 7 years. His main abnormalities included puckered lip, blephharophimosis, muscular hypertrophy and weakness, pectus carinatum, short stature, shoulder joint limitation and myopia. Myotonic discharges in EMG and muscular dystrophy in muscle biopsy observed. Hypoplasia of clavicle, generalized osteopenia, mild platyspondyly and delayed bone age were radiologic findings of this patient. Second case: A boy aged 8 years. His cardinal abnormalities were similar to case 1. Hip joint limitation, low set ear, anterior cortical opacity of lens, small testis and coxa valga were the other manifestations of this patient. Both patients have a normal IQ and parental consanguinity was also present. CBZ was used for both patients

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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.

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In an attempt to investigate the fungous infections of AIDS stricken patients, a study which lasted 1.5 years was conducted, in which 21 patients were examined. The subjects were 20 males and a female. One of the male patients was from Uganda, another was an intravenous drug addict, and one had been abroad for sometimes and had received blood there. All other patients had also blood transfusion instances before 1984. To do the research, 414 laboratory specimens were gathered and examined regarding fungus involvement. The result showed 104 negative and 310 positive cases. Based on these findings and also clinical examination, all patients suffered from one or more fungous infections in the forms of oral candidiasis, perleche, candidal onychomycosis, perianal candidiasis, mucocutaneous candidiasis, tinea versicolor, pityrosporosis and rhodotrulosis. The latter caused skin lesion with scaling and is being reported for the first time. Candida parapsilosis and trichosporon pololans were also isolated specimens. However, concerning the diagnostic value of trichosporon pololans more investigation is needed.

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In a retrospective study, type, origin and relative frequency of pelvic masses during 3 years period in shariati hospital were studied. Ovarian mass was the most common pelvic mass with relative frequency of 88% including neoplastic 58% and non neoplastic 30%. Corpus luteom cyst was the most common cyst in non neoplastic group and serous cystadenoma was the most common in neoplastic group. The most frequent mass in malignant series was serous cystadenocarcinoma. Non ovarian masses was 6% and metastatic masses was 2% of ovarian masses. The average age was 42 years in neoplastic group excluding dermoid cyst which was 33 years and the average age was 32 years in non neoplastic group.

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Hyperthyroidism is often accompanied by diverse types of neuropychiatric complications. To demonstrate these complications we studied 500 hyperthyroid patients, who developed neuropsychiatric complications of hyperthyroidism for which other causes of these neuropsychiatric findings were carefully excluded. The patients were 15 to 65 years old (female to male ratio was 5:1), most of the cases were in third and fourth decades of life. Nervousness, tense dysphoria, insomnia and anxiousness were among the most common psychiatric complications, and tremor, hyperreflexia, thyrotoxic myopathy, thyrotoxic periodic paralysis were the most common neurologic complications. Therefore any physician, wether he or she is a general practitioner or a specialist must be aware of these diverse complications, because these neuropsychiatric complications can lead to the diagnosis of hyperthyroidism and treatment of these potentially serious complications.

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This paper represents a retrospective study of 142 patients with skeletal tuberculosis during the years 1350 to 1357 at Shafa Yahiaian Hospital. Confirmation of diagnosis is made by positive culture or pathology. The mean age of the patients was 27.5 years (range from 1.5 to 72 years). Most of the patients were in the second, first and third decade respectively. 45.3% of the patients were female. The spine was the most common site and was affected in 40.88% of the patients. The next sites were knee, hip and elbow, in order of frequency. The commonest site in spine was thoracic. The mean of sedimentation rate in the first visit was 48. Tuberculin skin test was negative in 23% of the patients. Evidence of pulmonary tuberculosis in chest radiography was present in 48.61% of the patients. Five patients had tuberculosis osteomylitis without involvement of the joint.

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Congenital cyst of the pancreas is an uncommon problem in the pediatric patient. The common symptoms at the time of diagnosis have been abdominal mass and pain or fullness, nausea and vomiting. Despite of various paraclinic methods for diagnosis, ultrasound is now recognized as the most effective and best noninvasive method for diagnosis of pancreatic cyts. Surgical intervention is the best mode of therapy. Upper abdominal cystic mass are seen in the fetus and newborn infants. In Amirkabir Hospital, during 12 years from 1981 to 1993, 8 pancreatic cysts have been operated on and only in this case it was congenital.

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Artifacts in histopathology, could create serios errors and cause misdiagnosis. In some cases, the degree of artifactual damage is so large that may involve the entire specimen, rendering it suboptimal or useless for diagnostic purposes. Usually, cases of oral cavity specimens are of small size and fine texture, and as a result, the astifacts are more effective on them. However, there are very limited reports in this respect. The present study included a relatively vast range of possible causative factors (which could cause artifacts in histiomorphology). 100 specimens went under the influences of 22 factors. We found that in common, causative factors with reports of Mehregan and Margarone our results are, somehow similar in other cases, which were for the first time applied to, the results were interesting and impressive for some kind of mucosal lesions such as pemphigoids are on malignant and premalignant lesions.

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A retrospective study was conducted to investigate about breast cancer in Tehran from 1985 to 1995. All breast pathological records at five General District and Teaching Hospitals (18 general surgical wards) were reviewed and data were extracted. Overall, 3085 records were found (7291 female and 294 male). The final diagnosis was made for 2436 female records including 903 breast cancer (37.1%), 1430 benign breast disease (58.7%), 45 breast skin disease (1.8%) and 58 normal pathological report (2.4%). The dominant group age for breast cancer in women was age group of 40-49 years. The most frequent pathological stage was stage III. Breast cancer was also seen in 2.3 percent of women of 25 year old or younger. The diagnosis was also made for 278 men showing 32 breast cancer (11.5%), 23 benign breast disease (86%), 3 breast skin disease (1.1%) and 4 normal pathological report (1.4%). The results suggest that 3.5 percent of the overall breast cancer were men's, all having over 40 years of age with 60 years or older as the most frequent age. The most frequent pathological stage was stage III. The findings have some implications for public health professionals in terms of breast cancer screening in Iran.

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Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

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Introduction: Hand eczema is one of the most common causes of disabiliting dermatoses. Objective: Our purpose was to determine the frequency of hand eczema in out patients seen in Razi hospital (university medical center). Design: Of 3754 patients with skin problems, 206 were investigated for hand eczema and the study was carried out with regard to age, sex, occupation, exposure to chemical and physical irritants and predispositional factors. Results: The prevalence of hand eczema was 5.48%. The mean age was 30.8 years. The female: male ratio was 1.6. The highest number of patients were in the occupational group with exposure to reegents and water (we couldn't do patch test because it was not available). The most common complaint was itching (85.5%) and the fingers were the predominant affected sites. Conclusion: The major cause of hand eczema in contact dermatitis (Irritant and Allergic) and patch testing in necessary to determine the allergic agent, that can be helpful in allergic contact dermatitis (ACD) but are sometimes discouraged because of high false-positive rate and also in many instances, simultaneous exposure to irritant factors plays an essential role in the development of ACD.

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The present research is a quasi-experimental prospective study to determine usefulness of stripping the fetal memberanes at term for preventing of postterm pregnancy. 212 pregnant women with firm gestational dates entered the study, 112 underwent stripping of the membranes and 100 controls did not. The difference between the number of patients who advanced beyond term (>290 days) was statistically significant between groups (P<0.01). The mode of delivery and neonatal APGAR score were similar in both groups.

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This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373). In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

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Oxidation of low density lipoproteins (LDLs) is belived to be an important step in the pathogenesis of atherosclerosis. During oxidation, LDL particle undergoes a large number of structural changes that alters its biological properties, so it becomes atherogenic. To study atherogenic proteins, usually two forms of modified LDLs, including Cu2+-oxidized LDL (ox-LDL) and malondialdehyde (MDA) modified LDL (mal-LDL) are used. In this study, LDL was isolated from 72 ml freshly prepared plasma by sequential Floatation Ultracentrifugation (SFU), which resulted in separation of 12.5 mg LDL protein. LDL oxidation was accomplished in Phosphate Buffered Saline (PBS) with 2µM cupric sulfate, and mal-LDL was prepared by incubating LDL in PBS with 0.5 M solution of freshly prepared MDA. These modifications were evaluated by measuring optical density at 234 nm, Thiobarbitoric Acid Reactive Substances (TBARS), and electrophoretic mobility at pH 8.6. The increase of 234 nm absorption reflected initiation of LDL oxidation. TBARS of ox-LDL and mal-LDL was 80 Nm MAD/mg LDL protein and 400 nm MDA/mg LDL protein, respectively. Electrophoretic mobility of ox-LDL and mal-LDL, in respect to native LDL (n-LDL), were increased.

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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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This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents

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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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Iodine availability for the maternal thyroid is reduced during pregnancy as a result of the loss of the nutrient by increased renal clearance, and competition by the fetoplacental unit. So with a marginal iodine intake, pregnancy constitutes a stimulus for both the maternal and fetal thyroids. On the other hand, iodine deficiency in the first trimester of pregnancy results in impaired development of the central nervous system, lack of T4 then results in smaller brain size associated with fewer neurons which are also shorter in length. This cross-sectional study was undertaken to evaluate pregnant women and their newborns, these two susceptible groups to IDD in an endemic area such as Shiraz. Urinary excretion of iodine as iodine (µg/dl)/creatinine (gr) ratios in two groups of pregnant women, one group without goiter (52.88%) and the other with goiter (grade Ib and II 47.2%) and their newborns were compared. There was no significant difference in urinary excretion of iodine in mothers and newborns of the 2 groups. In all newborns even in those of mothers excreting <50 mg iodine/gr creatinine, there was a significantly greater excretion of iodine probably due to increased renal clearance of iodine by the immature kidney, and their excretion of iodine was not parallel to those of mothers. There was no significant difference between weight, height and head circumference of the two groups of newborns. It is concluded that iodine excretion in neonates can not be used as an indicator of iodine deficiency disorder. In iodine deficient areas pregnancy justifies monitoring thyroid function and volume and therapeutic intervention to avoid hypothyroxinemia and goiterogenesis in both mother and newborn. Likewise neonatal thyroid screening constitutes a valuable and sensitive index for detecting the presence of iodine deficiency.