Tehran University Medical Journal

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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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As the effectively transportation of injured patients is one of the most important concerns in developed countries, we tried to evaluate the patients transportation to Sina hospital trauma center in this regard. During an eighty-day period, 200 injured patients were transported to Sina hospital with intravenous cannula inserted only in 17.5 percent and fracture fixation was accomplished in only 8.5 percent of patients. We coucluded that the transportation quality was rather poor and more attention should be paid to this social problem

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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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Kindler syndrome is characterized by acral blister formation in infancy and childhood, poikiloderma and cutaneous atrophy. Undoubtedly, similarities of the clinical features exist between Kindler syndrome and Epidermolysis bullosa simplex with mottled pigmentation. In this article, we report 3 patients with Kindler syndrome. Until the Bullous component of Kindler syndrome is more completely understood, we believe that this disorder should continue to be classified as a separate disease.

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Systemic sclerosis is a generalized disorder of connective tissue, in which the pattern of disease extent, progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scleroderma, disease progression has occurred mostly in the early phase of disease, but in patients with limited cutaneous scleroderma, disease progression was slow and incidious, so disease progression has occurred mostly in the late phase of the disease, thus raynaud's phenomenon, telangiectasia, hyperpigmentation and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, early and extensive organ involvement was observed in patients with diffuse cutaneous sclerodema.

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Squamous cell carcinoma, a cancer of keratinocytes origin, mostly involves sun-exposed areas of the skin. To study the pathologic and demographic features of this disease, records of 395 patients of squamous cell carcinoma of skin and lip were reviewed. Most of the patients (83%) aged 40 years or more at the time of diagnosis. Respectively, 74.4% and 75.8% of cases with skin and lower lip carcinoma were men, but in upper lip cases frequencies of both sexes were equal. The number of patients referred from western and north-western provinces were much more than those of other provinces of the country. The most frequent histologic stage was grade I (53% and 58.8% in skin and lip carcinoma, respectively), showing that most patients visit physicians early enough, and are diagnosed in early stages of the disease.

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Recently, small incision cataract extraction by phaco and implantation of a foldable intraocular lense with topical anesthesia has used in an attempt to decrease the complication of general anesthesia and peribulbar injection. To compare effects and complications of topical, local and general anesthesia, 92 patients admitted to Imam Hosein hospital for cataract surgery, were randomly assigned to three groups and surgery was done under different methods of anesthesia. During routine ECCE, lid and globe movements, miosis and viterous bulg were observed more in topical anesthesia than the other techniques, but serious complications such as posterior capsular rupture and viterous loss were not seen. Because of less systemic and local complications and rapid return of vision and possibility of outpatient surgery, topical anesthesia should be considered as an alternative to local and general methods.

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Rheumatic heart disease is a serious health problem in developing countries. The present study was conducted to evaluate clinical and echocardiographic findings of Mitral stenosis and their relationship with patients functional classes. We studied records of 400 patients with symptomatic mitral stenosis (71% female, mostly in 20s or 30s and 54% function class II) treated in two hospitals in Tehran, Imam Khomeini and Amir-Alam Hospital, from 1994 to 1998. Clinical and echocardiographic data were extracted and analyzed. The most prevalent symptoms were dyspnea (96%), palpitation (41%) and chest pain (26%). Orthopnea, paroxysmal nocturnal dyspnea, hemoptysis and right heart failure were significantly correlated with functional class and severity of mitral valve stenosis (P<0.05). 41% of patients presented with atrial fibrillation at admission or during hospitalization. This arrhythmia had no relationship with age mitral valve area, although it was significantly correlated with left atrial diameter (P<0.05). Diagnosis and management of rheumatic heart disease need accurate physical examination and history taking and careful application of noninvasive and invasive procedures.

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Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptomatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan Hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were obtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%). Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection, preterm delivery and pyuria pvalue <0.05. We suggest routine urine culture in first visit of high risk and 16th week of low risk pregnancies.

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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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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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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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In spite the emergence of potent and broad spectrum antibiotics and recent advances in bronchoscopy and pulmonary physiotherapy, still there is a high rate of morbidity and mortality because of lung abscess. The objective of this study is the indication of risk factors, which have undesirable effects on the prognosis of lung abscess. In a retrospective study, all cases of lung abscess who was confined to bed during 1994 to 1999 in Rasht were collected and analyzed. From 52 cases, 40 (77%) were male and 12 (23%) were female. The mean duration of stay was 20 day (15 to 35). The secondary cause for lung abscess was as follows: 10 cases (19%) COPD, 10 cases (19%) preumonia, 15 cases (29%) bronchiectasia 2 cases lung cancer, 2 cases lung hydatid cyst and 3 cases atelectasia. Extrapulmonary causes of lung abscess were consist of: 10 case (10%) aspiration, 10 case (19%) esophageal diseases tending to reflux, 5 case (9%) periodontal disease. The factors, which had underiable effects on prognosis of disease were lung cancer, anemia, hypoalbuminemia, age over 60, abscess with pseudomonas, abscess cavity greater thus 8 cm, lower lobe in right lung and TB. Because of high mortality and morbidity of lung abscess, due attention for internal drainage, bronchoscopy, physiotherapy and timed surgery are seriously indicated.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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The pre-eclampsia/eclampsia is one of the commonest conditions peculiar to pregnancy, to describe the occurrence of hypertension, proteinuria and edema in pregnancy. It is about seven times more frequent in first gestation and uncommon before 20 week's gestation. Serum BhCG levels were prospectively determined in 260 midtrimester singleton pregnancies where admitted from October 1999 until September 2000 at Mirza Kouchak Khan hospital, prenatal clinic. Obstetric chart review was undertaken after delivery to identify cases in which pre eclampsia developed. The median maternal age was 26.0 years, and the median gestational age at the time of blood collection was 19.0 weeks. Of these, 17 cases (6.5 percent) had pre eclampsia. The median level of the BhCG was 35060.5 mlu/ml in those with pre eclampsia, whereas that in those without pre eclampsia was 33755.1 mlu/ml. The difference was not significant (P=0.28). Although elevated midtrimester serum BhCG levels in clinically normal patients was reported in severaly pre eclampsia women, this is not a good test for early detection of mild pre eclampsia.

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Ovarian cancer is second prevalent cancer among gynecologic malignancies and the most common type of ovarian cancer is epithelial form (85-90 percent). To detect the risk factors for the epithelial ovarian cancer, a case-control study was conducted in Valieasr hospital in 1988. In this study, 118 cases with epithelial ovarian cancer (according histological records) and 240 controls without any gynecological cancer in gynecologic clinic had been interviewed. For data analysis, T-test, Chi2 test and logistic regression have been used at a =0.05 as level of significance. The mean age in cases was 50±13 and in controls was 49.9±12 years, without significant different. The mean number of pregnancies and parity in cases was less than controls, significantly (P<0.03). The mean months of breast feeding in cases was less than controls (54.9±71.2 versus 82.4±62.7) (P<0.001). The cases had a lower mean age of menarch than controls (P=0.03). 58 percent of cases and 21.3 percent of controls hadn't used any contraception methods (P=0.00001). The mean years of contraception was significantly less in cases versus controls (P<0.001). The odds ratio for epithelial ovarian cancer was 0.24 (95 percent CI: 0.13-0.48) in OCP users, 0.47 (95 percent CI: 0.005-0.43) in TL method, and was 0.41 (95 percent CI: 0.22-0.76) in other contraception methods, relative to women who hadn't used any contraception methods. This study reveals that epithelial ovarian cancer risk increases significantly with earlier menarch, decreasing number of pregnancy, deliveries duration of breast feeding and use of contraception methods. Use of contraception pill and tubal ligation method decreases risk of epithelial ovarian cancer.

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Postoperative nausea and vomiting is a common complication that all anesthesiologist are familiar with the problems of its consequences. Although continued research on the recognition of factors affecting the incidence of PONV is being done but they are not sufficient and the need for research along with advances in anesthesiology and newer drugs are considered. In this prospective cohort study 400 children of 3 to 12 age who has been operated for general surgery (other than eye, thorax and upper abdomen) and orthopedic surgery in the Imam Khomeini and Children Medical Center Hospital has been evaluated. Of these, 200 children who had smoking parent and according to definition were passive smokers and the other 200 children had no smoking parents. Both the groups were matched for sex, age, and type of operation. With the analysis of data we noted that the incidence of PONV in both groups was 19.5 and there was no significant difference between the two groups. (Passive smoker 19 percent and non-passive smoker 20 percent). We also noted a relation between the duration and the incidence of PONV. So operation with more than 2 hours had higher incidence of PONV. There was also positive relation between PONV and controlled ventilation. However, there was no significant difference as the sex and type of operation was concerned. In conclusion, children of smoker parents suffer more PONV than children of non-smoker parents if operation takes longer than two hours or the patient is mechanically ventilated during operation.

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One method of drug smuggling is body packing or body stuffing, placement of narcotics (opium, heroin, hashish, …) inside intestinal tract for transfer from city to city or country to country. Estimating of the methods for transferring, content of packets, packaging, cause of death and results of diagnostic and therapeutic methods can effectively decrease the number of body packer and law execution. This study is case series by randomized sampling. Several parameters such as sex, age, marital status, addiction, job, level of education, type of opioids and their weight and number of packets, result of abdominal X-ray, surgery needs, were collected from April 1999 to December 2000. Through this period of time, 32 male smuggler who had swallowed drug packets were detained. The average age was 41 years (max=62, min=20). The minimum weight of the opium carried by this smugglers was below 20 gram and maximum weight was 1000 grams (median=360 grams). The minimum number of packets were one packet and maximum number of packets were 54 (median=10 packets). In 84 percent of body smugglers the content of packets was opium, 13 percent was heroin and 3 percent was hashish. From the cases, 81 percent of smugglers were addicts themselves. Death occurred in 7 cases from which 3 were after surgery.