Tehran University Medical Journal

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Hysteroscopy is a new and precise method for evaluating of uterus, so it is valuable in evaluating infertile women. In 18 months, 363 hysteroscopies were done on patients who were visited in IVF center of Shariati Hospital for treatment of infertility. Incidence of abnormal hysteroscopy was 18%. 32% of these abnormal hysteroscopies was endometrial hyperplasia. In evaluating of laparoscopy and other factors of these patients there was a statistically significant relation between diagnosis of PCOD (polycystic ovary disease) and endometrial hyperplasia (P<0.008), but there is no significant relation between other diagnoses like endometriosis and endometrial hyperplasia (P<0.4).

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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.

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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 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

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Pulmonary artery pressure can be estimated from right ventricular-right atrial pressure gradient in patients with tricuspid regurgitation. The most common approach is to estimate pulmonary artery systolic pressure from right ventricular pressure (assuming no pulmonic stenosis) determined as the sum of the right ventricular-right atrial pressure gradient and either an assumed or clinically determined right atrial pressure. But in this study, that was done on 62 patients in 1996 in Imam Khomeini hospital, we demonstrated that it was not needed to add an assumed right atrial pressure to right ventricular-right atrial pressure gradient. We also demonstrated that pulmonary artery pressure estimated in this study, bears a direct relationship to systolic pulmonary artery pressure derived in right heart catheterization (r=0.98, standard error of estimulation)

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To determine circumcision prevalence and complications in under 5 year old boys. We assessed 181 boys in a cross sectional study at a rutal area in Tehran suburbs, in Jan 1997. Data were collected by an interview about age, circumcision age and method, type of complications, nationality and parent literacy. 126 boys (69%) were circumcised, (mean 12 months). Only 27 of them (21.4%) were circumcised in neonatal period. 62 boys (49.2%) were circumcised with ring methods (plastibell or clamp), 54 boys (42.9%) with surgical methods and the others (7.9%) with nonmendical methods (traditional). Complications were 9.5% (16) and the higher circumcision age was related significantly with higher complications (P<0.04). In our study was no complication in the boys who circumcised under six months. Complications prevalence were high (9.5%). In neonatal period 34% (9) and in postneonatal period 53% (52) of boys were circumcised with inappropriate methods with age. The most common complications were local infection (43%)

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In a period of 5 years (1371-1375), 87 cases of septic abortion were analyzed in Mirza Koochak-Khan Hospital. Most cases were in 21-25 years old group (28.7%) and most of them were in 5 or more gravidity group (48.2%). Fever was the most important symptom in these patients (80.4%). In this 5 years, period patients have paid 45900000 RLS for septic abortion. Treatment for most patients was antimicrobial treatment and curettage

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Febrile seizure is the most frequent type of seizure in childhood occurring in 2-4% of children under the age of 5. Although pathogenesis of seizure following fever is not well understood, multiple risk factors are known to contribute to its precipitation. One of the possible risk factors which had not been mentioned yet in reference texts and still is in the research phase is a serum sodium level below the normal limits which specially plays a role in the recurrence of febrile seizure. In this descriptive retrospective study records of 400 in-patients cases of primary episodes of febrile seizure in Bahrami children hospital in the years of 1996-1997 were reviewed. 214 (53.5%) cases had serum sodium levels of <135 m.mol/L. The mean serum sodium level for all the cases was 135.28±4.65 m.mol/L which is considerly less than the serum sodium level of 140±0.8 m.mol/L seen in healthy children. There was no significant difference in serum sodium levels different sex and age groups in this patient population

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Acute appendicitis is the most common condidition, requiring emergency operation in children. Late appendicitis is still a major sours of morbidity and potential mortality. The charts of all pediatric appendectomy patients (150 cases) treated between 1367-1373 (Iranian calender) in Amir Kabir Medical Center were reviewed. Mean hospital stay was 4.7 days. Mean ages of patients was 8.5 years. Male to female ratio was 1.2/1. Most common symptom was abdominal pain (100%) and deep tenderness in right lower quadrant in 94.6%. Mean temprature was 37.2 and leucocytosis (more than 10000) were in the 76.3%. 14 patients had perforated appendicitis and most common pathology was acut supporative appendicitis. Accuracy of diagnosis was 96.6% and post operative pelvic abccess was 2%. Mortality occurred in one case (0.6%)

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Fever among elderly patients frequently marks the presence of serious illness. All such patients should be strongly considered for hospital admission, particularly when certain clinical features are present. In prospective case series study in Emam Khomeini hospital during 6-month period (March Through October 1991). All patients presenting to infectious wards who were 65 years or older who had fever (oral temperature 37.8°C or more) were studied. There were 101 patients (63 men and 43 women) with 65 to 92 years old (mean 73). The most important predisposing factor were, hypertension and heart disease in 20 patients, diabetes in 15 patients and pulmonary disease in 5 patients. Final diagnosis among 101 patients were: pneumonia 25 (24.8%), UTI 14 (13.9%) sepsis 12 (11.9%), cellulitis 16 (15.8%), IUO 4 (4.9%), malignancy 6 (5.9%) meningitis 8 (7.9%), gastroenteritis 4 (4.4%) brecullosis 7 (6.9%) and others 5 (5%). Outcome of them were complete recovery 41 (40.6%), relative recovery 42 (41.6%) and death 18 (17.8%)

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Macrophage colony stimulating factor (M-CSF) has previously been shown to affect the differentiation of cells of the mono-nuclear phagocytic line. More recent studies indicate that M-CSF may have a role in pregnancy. In the present study, the expression of M-CSF in the human placenta was demonstrated. Placental mRNA was isolated and used as template for synthesis of complementary DNA (cDNA). The presence of M-CSF related sequences in the cDNA was shown by PCR and RT-PCR reactions in which M-CSF specific primers were used. In addition, it was shown that a 2.4 kb cDNA after electrophoresis and transfer to a nylon filter, hybridized with a digoxygenin labeled M-CSF specific probe.

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Association of EBV with the tumor cells of HD has been proven by a variety of the methods, using serologic and immunohistochemical techniques and in the recent years with molecular biologic techniques which can detect EBV genome in tumor biopsies. In this regard we prompted to perform a case control study on 25 childhood HD cases with respected to their antibodies gainst EBNA and EBV-IgM antibodies in Imam Khomeini Hospital in Tehran. In our study the ratio of positive titers was significantly higher among HD patients compared with age and sex-matched healthy controls.

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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.

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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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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.

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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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This is a retrospective study of the treatment of 68 cases of spine injuries to make an objective assessment of clinical and radiologic results and to introduce the good results of C.D segmental instrumentation. 68 patients, with an average follow up of 36 months, who suffered from thoracolumbar, lumbar and cervical spine fractures and dislocations, underwent surgical and nonsurgical treatment according to the clinical and radiological datas. Patients with more than 50 percent of loss of body height, more than 50 percent of canal compromise and neurologic deficits underwent surgery. With the C.D instrumentation, it was possible to provide solid, short internal fixation with restoration of the sagittal profile without loss of correction. For patients eith heavy works, over-weights and especially, shattered vertebral bodies, to prevent loss of correction, combined posterior and anterior interbody fusion is highly recommended.

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In the present research work, a specific 285 bp DNA fragment was used for detection of Mycobacterium Tuberculosis complex. 100 samples were chosen randomly from sputum specimens that were negative with conventional methods (direct smear, culture, and radiometry), and examined by PCR 7 cases of them were positive. Also, 20 sputum specimens were obtained from suspected patients to tuberculosis, and examined by three methods (culture, radiometry and PCR). The sensitivity of PCR compared with culture and radiometry was 100%, the specificity of PCR compared with culture was 91.66%, and compared with radiometry was 68.75%. Therefore, results of PCR revealed, this method is more sensitive, specific and rapid and it can detect ycobacterial infectious agents within one day period.

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Effects of preanaesthetic medication are as follows: 1) Promotion of mental and emotional relaxation. 2) Inhibition of nausea and vomiting after surgery. 3) Stability of haemodynamic response. We performed 105 patients, randomized, single blind clinical trial, preanaesthetic drugs, promethazine and droperidol: A comparison of haemodynamic response for patients in elective surgery at imam hospital. 105 patients were divided in three groups. Promethazine group 35 patients, dropetidol group 35 patients and normal saline group 35 patients. Systolic and diastolic blood pressure and pulse rate were recorded before and after intramuscular injection. Patients of promethazine and droperidol groups responded with decreasing in blood pressure and pulse rat lower than normal saline. But haemodynamic response did not show any difference between two groups (promethazine and droperidol).

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Clostridium difficile toxin was checked in fecal extract of 62 ulcerative colitis patients and 62 normal controls, by Elisa and cell culture methods. Clostridium difficile toxin was found in 48.71 percent of ulcerative colitis patients in their acute exacerbations, and in 26.08 percent of cases in their remissions. This toxin was found in the fecal extract of only 3 percent of normal controls. Chi-2 analysis showed that the differences between normal individuals and patients with ulcerative colitis were significant (P<0.001), but these differences between two groups of ulcerative colitis patients either with exacerbations or in remission were not significant (P>0.05).

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Group B streptococcus (GBS) is the most important pathogen identified in bacterial cultures in neonatal sepsis, sepecially with early-onset in developed countries (approximately 1-5/1000 deliveries). Neonatal colonization with group B streptococcus results primarily from vertical transmission during the birth process. GBS carrier rate in pregnant women varies from 4.6 to 41 percent in different geographic populations. Contamination of neonates during passage through the birth canal is high (more than 50%). Of the 191 pregnant women screened in this study, 28 (14.7%) were found to be colonized with GBS, by the culture method. Direct CIE and SCA tests on SBM (Selective Broth Medium) containing mixed flora showed that only 11.5% and 18.3% had positive reaction. A total of 530 patients were studied. GBS was isolated from the blood of 4 infants (5.5%, 4 vs 73 positive cultures). Of 181 cultures of CSF only one case was positive for GBS (8.3%) and had meningitis. In another part of experiment, two false positive reactions were found using serum specimen for detection of GBS antigen by CIE. Sensitivity of CIE and SCA both were 75%, specificity, 99.3% and 98.7%. Conclusion: Although specimen collection and microbiologic methods are important factors in identification of women colonized with GBS, there is significant variation in the proportion of women colonization with GBS. This study suggests that GBS is a much less important cause of neonatal sepsis, but further studies are needed to explore these important issues.