Tehran University Medical Journal

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Some syndromes that are characterized by abnormalities of the skull, facial bones, and mandibule, most of these patients are from the pediatric population. For the anaesthetic management of patients with various craniofacial dysostosis are as follows: 1) The necessary for careful evaluation of the airway by simply observing the patient. 2) Evaluation of the patient for abnormalities of the heart and lungs. 3) Patients may also have increased intracranial pressure. 4) Anaesthetic drugs and techniques: no particular drugs is recommended. Techniques controlled ventilation. 5) All patients should be cared in the intensive care unit after operation between 24-48 hours

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A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

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D.I.P is a rare disease. The etiology is unknown. It is characterized pathologically by massive proliferation and desquamation of alveolar cells and thickening of the alveolar walls. In our studies from 1368-73 we have three patients hospitalized earlier the prognosis would be much better. Corticosteroid and other effective drugs would be helpfull in treatment of these patients.

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Helicobacter pylori, as a causing agent of peptic ulcer in adults, is also encountered in children although in a lower incidence. Endoscopic biopsy studies of gastrointestinal mucosa in 110 children with clinical signs of peptic ulcer (continuous vomiting, chronic abdominal pain, hematemesis and melena) in Amir-Kabir Children's Hospital in Tehran showed positive helicobacter pylori findings in Giemsa or Hematoxylin-Eosin stained specimens. Doudenal ulcer with 81.1% was the most frequent lesions involved, the next more frequent lesions being gastric ulcer (805), dudenitis (75%) and gastritis (51.7%)

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HIE is a primary immunodeficiency characterized by recurrent staphylococcal abscesses and markedly elevated serum IgE concentrations. These abcesses involve the skin, lungs, joints, and other sites, and there is a unique tendency to form pneumatoceles following staphylococcal pneumonias. Although, there is as yet no clearly defined immunologic cause for this rare syndrome, but some form of T-Cell defect may be cause, leading to matkedly elevation of IgE and eosinophillia. In this study clinical and immunopathological aspects of HIE syndrome in 11 patients have been evaluated

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Objective: To compare the obstetric and neonatal outcome in women with and without a history of infertility. Study design: A case-control study at four hospitals of Tehran (Selected Randomly) between October 1st 1993 and February 20th 1994. Subjects: 212 women with a history of infertility who reached 20 weeks gestation with a singleton live fetus and 212 control women matched for age and parity. Main outcome measured: frequency of some antepartum complications. Obstetric and neonatal outcome. Variables: Demographic variables, systemic diseases, history of last and present pregnancy. Type and duration of infertility and kind of infertility treatment. Results: Sixty-one percent of study group were primery infertility patients and fifty-two percent of them had been pregnant after being treated. The incidence of the most complications was similar to that among controls. As compared with controls there was an increased incidence among study group of cesarian births (P<0.005), previous history of abortion (P<0.05), and history of vaginal bleeding in first and second trimesters of present pregnancy (P<0.005), and among primery infertility an increased incidence of preeclampsia (P<0.05)

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The rapid growth of population in the third world countries specially in recent decades has posed an important social problem. There have been some attempts to propose solutions for this problem by scientists from various disciplines. However, it seems that an integrated approach calling for collaboration of various efforts can be more fruitful. In this work, we study the relation of women fertility and socio-economical indices along with government's programmed efforts in the third world countries. Employing a statistical approach, we show that development indices such as gross national product, infant mortality rate, education enrolment, and access to mass media along with government's programmed efforts are effective in reducing the fertility rate, but more important is the interaction between these factors. Thus, an integrated approach emerges as a better solution to population control

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Carpal tunnel syndrome (CTS) is considered by researchers because of its high prevalence, and several studies have been done to find the causes and factors which increase the chance for the syndrome. These studies have shown relationships between this syndrome with some physical parameters like wrist dimensions, weight and systemic conditions. There is no investigation on risk factors in CTS in our country. So the main goal of this research is to find and introduce predisposing factors for carpal tunnel syndrome. Methods: Seventy patients and 33 controls 22 to 70 years old were studied. Standard methods for median and ulnar nerve studies were used and questionnaires included physical measurements, history of diseases and personal information were completed for each person. Results: Patients had higher wrist ratio (mean difference, 0.0267, P<0.001), weight (mean difference: 6.098, P<0.001) and body mass index (mean difference: 3.376, P<0.001). Regression analysis showed strong positive relation between wrist ratio and median latencies. The strongest correlation was found between wrist ratio and median minus ulnar distal sensory latencies (Y2=0.4014, P<0.0001). No relation was found between weight and body mass index with median latencies. Seventy-nine percent of patients and 48.5% of controls had wrist ratio of 0.7 or greater (P<0.05). Seventy-two percent of patients with repetetive hand activities and 78% with associated conditions had wrist ratio of 0.7 or greater. Seventy-six percent had wrist ratio less than 0.7. No relationship was found between obesity, diabetes, thyroid disorders, rheumatoid arthritis, taking oral contraceptive, hysterectomy, oophorectomy, menopause and repetetive hand activities with involvement of carpal tunnel syndrome. Discussion: Wrist dimensions seem to be an important predictor for carpal tunnel syndrome also in patients with associated conditions. If individuals with squarer wrists are involved in special conditions, they may show symptoms of the syndrom. Carpal tunnel syndrome is caused by many factors but wrist dimensions seem to be a predisposing factor and provides an explanation for bilateral involvement or familial occurrence of it.

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Organochlorine pesticides are a group of persistant compounds which have been used for a long time. Due to their stability, some of them such as DDT, BHC and their derivatives are still used in the areas with malaria epidemic condition, hence the chance of food contamination always exists. The present survey demonstrated that human milk is one of the best indicator substances in monitoring the environment and human body contamination by organochlorine compounds. We studied the level of residues in the milk of nursing mothers who could be exposed to these compounds through food chain in their contaminated environment. In this investigation, we collected 40 samples from the nursing mothers of two hospitals located in the north and south of Tehran. Detection was carried out by Gas chromatography (GC) with 3% OV17 column and Ni63 ECD (Electron Capture Detector). Reference substances were obtained from WHO. Results are discussed in the text.

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In an evaluation of nine cases (5 females, 4 males, 2.5 to 22 years old) with congenital torticollis who had been treated by bipolar release of sterno-cleido-mastoid muscle at Emam Khomeini Hospital, department of orthopedic surgery between 1981-1994, all of the patients were satisfied with cosmetic and functional results. In spite of palpable soft tissue remaining in some patients, limitation of bending to the opposite side was below ten degrees. Facial asymertery improved in older and resolved in younger children with no recurrence and occurrence of diplopia. Recommendations: 1) Operative treatment of congenital torticollis should be considered beyond the age of 12 months and even over 19 years old. 2) Bipolar tenatomy, cephalad and caudal release of the sterno-cleido-mastoid has better results than limited procedures in older children, especially beyond 3 years old. 3) Postoperatively, early range of motion exercises in extension, and not in flexion is highly recommended.

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Port wine stains are benign but cosmetically devasting congenital angiomas. The argon laser is a therapeutic device newly applied to this condition. Our program was begun 6 years ago. From the beginning, the study was conceived as a clinical investigation of both the port wine stain and its argon laser therapy. A total of 218 patients with port wine stains have been studied and many aspects of their clinical condition detailed. Employing the Argon laser, test spots have been carried out in patients and the results have been analyzed with clinical aspects of the lesions. Altogether, 501 treatments were performed in 218 patients. Good to excellent results were obtained in 81 patients. Moderate Result was obtained in 31 weak result in 65 patients. Most common complication were hyperpigmentation and depressed scar.

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Disodium hemiphthalate Glycyrrhetinic acid (DHGA) possesses anti-inflammatory and analgestic activities. In our research, this agent was injected intraperitoneally to mice, according to the following schedule.
1) 25 mg/kg, 50mg/kg & 75mg/kg at 7th day of pregnancy.
2) 50 mg/kg & 75mg/kg at 8th day of pregnancy.
3) 50mg/kg & 75mg/kg at 9th day of pregnancy.
DHGA with doses of 50mg/kg and 75mg/kg at 7th, 8th and 9th day, delays the growth, decreases developing of ossification centers (specially in hand and foot middle phalanxes), decreases the number of caudal vertebrae of sacro-illiac joint and results in slight but important increases in fetus mortality.
Abbreviations
H & E=Haematoxylin & Eosin
CRL=Crown-Rump Length
BPD=Biparietal Diameter
W=Weight
ETS=Embryo Toxicity Score

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Intrathecal injection of sufentanil with adrenalin was performed in 45 cases (20 female, 25 male age range: 18-40 years). All injections were performed in the sitting position, with a number 20 intrathecal needle immersed in adrenalin. The cases were observed for 72 hours. Maximum duration of analgesia was 12 hours (60%) and the minimum was 3 hours (13.3%). This method reduces the need for repeated administration of intravenous or intramuscular narcotics, and unlike intrathecal morphine, dose not cause delayed respiratory depression

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Sixty-nine children with phenylketonuria (PKU) under coverage of Tehran Genetic Research and
Consultation Center, fed Lofenalac and Phenylfree were studied. The 24-hour dietary recall method was used
to determine food intake and blood samples were analyzed for iron parameters. The results showed that over
7% of the children had a low intake of energy, protein and iron. In addition, hemoglobin and hematocrit were
lower than normal in 3.1% of the children, while in 24.2% of them there was decreased serum transferrin
saturation percent. There was a statistically significant relationship between lenght of diet therapy and iron
parameters. The findings show that inadequate nutrient intakes may, over time, cause appearance of anemia signs in the children with PKU dependent on special formulations

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Cesarean section (CS) is a relatively safe procedure, performed for different maiernal and fetal indications. Despite complications of general anesthesia, post-operative infections, and thromboembolic events, CS is being performed with increasing frequency. In this study, we have examined the indications and complications of CS's performed in Arash Hospital from December 1993 to November 1994. Of the total 3480 cases of chiidbrilh, 900 (24.45%) were performed by CS, most and last frequently in December/January and November/December respectively. However, Ute ratio of CS cases to all cases was equal throughout the year. The most common indication of CS was failure to progress in labor (38.54%), and the other causes were repeat CS (21.77%), meconium excretion (11.97%), malpresenlation (8.55%) and fetal distress (5.58%). The indication of CS varies with meternal age. Between 41-45 years, the most common indications were prior CS (42.5%), and request for concommitant tubal ligation (12.5%), whereas in the younger age groups, the most common indication was failure to progress in labor. In primiparous cases, 44.55% of the CS's were performed due to failure to progress in labor, while the latter was the indication of CS in only 14.5% of the multiparous women. Complications were observed in only 4.54% of CS cases

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Between 270 patients complaining of symptoms of vaginitis, bacterial vaginosis was diagnosed in 68 women (%25) based on at least three of four criteria: 1. Homogenous vaginal discharge 2. Positive amine test 3. pH more than 4.5 4. Clue cell in wet smear. The results were compared to 55 normal controls.
Clue cell with more than %20 of epithelial cells was seen in %87 of cases and %5.5 of controls. A pH more than 4.5 showed the greatest sensitivity (%100) and the smallest specificity (%47). The most frequent complaints included increased discharge, bad odor, and sensing bad odor after coitus.

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Perinatal mortality rate is an import health index. In this study, we have attempted to determine the causes and rate of perinatal mortality, in 18885 randomly selected newborns, in all the obstetrics and delivery centers of Tehran, during one year (1994-1995). The mortality rate was approximately 21/1.000. Cesarean section was performed in 42.2%, and vaginal delivery in 57.8% of cases. Prematurity was observed in 11.3% and 8.4% weighted less than 2500 gr (low birth weight : LBW). Perinatal mortality was significantly more frequent in the presence of prematurity (p = 0,000), LBW (p = 0.000), mothers who were older than 35 y (as compared to the 20-29 y age group p = 0.01), high parity (> 5 p = 0.00001), and high gravida (> 5 p = 0.04), low educational level (less than high school diploma p = 004), twin or multiple pregnancies (p = 0.000), congenital malformations (p = 0.000), low Apgar score (< 4 in 1 and 5 p = 0.000), and in the absence of perinatal care (p - 0.000 002)

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This survey, evaluated the level of awareness and knowledge among the medical staff about conditions and methods of performing cardiopulmonary ressucitation. The study sampling comprised 497 subjects including 208 residents and 262 interns of ten university hospitals in Tehran. In regard to the basic principles, this has been 43.54% (SD = 13.36%), in drug and fluid therapy 31.22% (GD = 13.22%), in electroshock 43.6% (SD=21.12%), in appropriate approach to the problem 34.73% (SD=13.42%) and in complications of CPR 17.7% (SD = 15.25%). Considering the results of the project, the medical staff have insufficient knowledge of CPR md it does not improve significantly during internship and residency period. Therefore, there is a great necessity for the medical students to attend basic and advanced CPR courses during their study

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Migraine as one of the most common types of headaches with high intensity and prevalence, affects life significantly. This study was devised to determine the effects of migraine on economic status and life quality of Iranian surffcres.
"Pain database questionnaire", prepared by the International Association for the Study of Pain (IASP) in the year 1995, was translated to Farsi. Then we modified it regaiding cultural, geographical and social characteristics of Iran. 65 patients (55 women and 10 men) were recruited form neurology clinic consultants. Those patients who met the International Headache Society. (IHS) criteria for migraine, were interviewed using IASP questionnaire. Pain effects on sleep, marital life, social, recreational and sexual activities, quality and quantity of drug consumption as well as using paraclinic procedures were considered.
Significant decrease in sleep duration was seen during pain (7.4 ± 1.9 h) compared to pain-free conditions (6 ± 3.7 h) (P < 0.001). The effects of pain on marital life, social, recrealtional and sexual activities during pain were compared with pain-free conditions based on a zero to ten ranking schedule,. Wilcoxone test showed statistically significant (P < 0.02) differences.
We concluded that the economic effect of migraine and its impact on patients' quality of life are significant and should be considered in health planning and disease management

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The History of closed mitral valve comissurotomy (CMVC) and its indication is discussed in this article. However many of the patients undergo (PTMC) these days as a new procedure and of course more effective and easier way whenever is indicated, yet, (CMCV) should be considered as a simple, and effective surgery when indicated, especialy in third world countries in which economical, social and personal point of views are important.
My main point in this article is to encourage younger surgeons and colleagues to pay more attention to this kind of cardiac surgery, which at the first glimpse seems difficult and perhaps dangerous to untrained and unskillful hands!