Tehran University Medical Journal

---

A random panel of 500 healthy unrelated subjects from Isfahan province were HLA typed for A, B and C locus antigens. The lymphocytes were separated from 5 ml of whole peripheral blood and HLA-A, B, C typing were performed on them, using the standard two stage microlymphocytotoxic NIH technique. The antigens HLA-A1, A2, A3, A9, HLA-B5, B35, HLA-CW4 had the higher frequency than other HLA antigens among the population studied. The distribution of HLA class I antigens in Isfahan is similar with their distribution in Tehran and Mashhad.

---

In order to evaluate the role of idiopathic hypercalciuria (IH) in causing hematuria, nephrolithiasis and recurrent urinary tract infections we studied two groups of children for idiopathic hypercalciuria. 1) Patients group: children with hematuria, nephrolithiasis and recurrent urinary tract infections (n=452). 2) Control group: children with no urinary tract problem (n=100). In control group 3% of children had IH. In patients group 27.5% of patients with hematuria, 37% of patients with nephrolithiasis and 7.9% of patients with recurrent urinary tract infections had IH, P values=0.001, 0.005 and 0.2, respectively. This study confirms that there is a positive association between IH and hematuria or nephrolithiasis, but there is no significant association between recurrent urinary tract infections and IH

---

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).

---

102 patients with ascites were enrolled in a sonographic study of abdomen and pelvis without awaring of history, clinical and paraclinical findings. So with only sonographic finding we suggested the diagnosis and etiology of ascites. All patients were hospitalized. Finally all the patients were diagnosed definitely and were compared with sonographic diagnoses done before. Results: In this survey 42% of patients had cirrhosis, 20.5% had malignancy, 14.7% had renal disease. Overall sensivity of sonography in diagnosing etiology was 91.1%, overall specifity was 97.8%, overall accuracy was 94.4%. Sensivity, specifity and accuracy of each group have also been determined separately.

---

Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.

---

We have compared the effects of fentanyl and pethidine in the treatment of postanaesthetic shivering. Fifty patients who were shivering after routine abdominal surgery were allocated randomly to receive fentanyl 75 µg and pethidine 25 mg. After 10 min, 23 patients in pethidine group and 22 patients in the fentanyl group had stopped shivering which was not significantly different in the two groups. We conclude that fentanyl 75 µg was effective in the treatment of postanaesthetic shivering.

---

With the intention of research about culture and autologus graft of epithelial tissue we used 4 french Albino Rabbits with an average age of 2 months. After reproduction on the support in EMEM (Eagle's Minimum Essential Medium) we used this for graft after 4 weeks. This region which grafted total replaced. After fixation of this sample and passing them through various process, histological sections were prepared. These sections were stained with H & E and masson's trichrome and studied by light microscope. We succeeded in graft. We hope in the near future by using the method of epithelium tissue culture improving to treat burned patients.

---

Indacrinone is a loop diuretic which also has uricosuric, kaliuretic, saliuretic and natriuretic effects. Since it has been reported that this drug has several actions in different organs, we decided to evaluate its mechanism of action on the rat jejunum smooth muscle. After preparation of the tissues, different concentrations of indacrinone were applied. Doses of 8.2×10^-6 M, 2.7×10^-5 M, 8.2×10^-5 M and 2.7×10^-4 M were all effective in a dose dependent manner to relax the muscle. Increase in the drug concentration resulted in much faster reduction in twitch amplitude. The jejunum is innervated by adernergic, cholinergic, serotonergic and histaminergic systems. To find the mechanism of action of indacrinone in rat jejunum, experiments were conducted by appropriate receptor agonists and antagonists of the above systems. There was a marked increase in muscle contraction tone and ampliture by the use of histamine, while indacrinone prevented the increase induced by histamine. It was concluded that indacrinone may be a competitive antagonist for histamin receptors in rat jejunum muscle.

---

This study was conducted to investigate the prevalence of pulmonary problems, among a group of 1600 selected textile mill workers in the Yazd province. A standard questionnaire on respiratory symptoms was administered and forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined for each worker. The results obtained were as follow: Obstructive ventilatory defect 15 cases (0.9 percent), restrictive ventilatory defect 16 cases (1 percent), combined obstructive and restrictive ventilatory defect (Mix) 53 cases (3.3 percent) and normal 1516 cases (94.8 percent).

---

In order to evaluate accuracy and usefulness of sonography and choose it as preliminary investigation method in pathologic processes of parotid gland, 50 patients were studied in duration of 16 months. The lesions were evaluated with ultrasound and sonographic images were obtained before surgery and then were compared with pathologic results after surgery. All lesions were detected with sonography. This method could differentiate intraglandular from extraglandular lesions with accuracy of 100%. Except one case of lipomatosis which was hyperechoic, all other lesions of parotid gland were hypoechoic. All lesions with sharp and well-defined borders were benign whereas malignant processes had ill-defined borders. The results obtained show that sonography is a reliable diagnostic method to differentiate benign from malignant lesions and it has a high diagnostic value to detect warthin's tumor, plemorphic adenoma, Sjogren's syndrome and lipomatosis. Presence of calcification in a parotid mass of young patient with high probabye is related to cavernous hemangioma.

---

In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1 550: with history of one spontaneous abortion (G2A1), group 2 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000), but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003) and placenta previa (RR=8.5, P=0.03). These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.

---

In this research 600 staff of an educational office (distric seven) were being studied before and after they were educated about breast self-examination. Necessary information was gathered before and after they were educated through questionnaires. The result of the study showed that the average scores of their awareness before and after they were educated was 42.3 and 44.2, respectively. Hence, there was a significant difference because of the education of self-examination women's breasts (P<0.0001). There was no difference between family members nor between those who had different marital status, concerning the awareness of breast self-examination. However, there was a large difference between the educational level of women who were studied and the educational level of their spouses, according to their knowledge concerned about monthly breast self-examination (P=0.04).

---

Cleft palate is a congenital condition that occurs with the incidence rate of one out of 2000 births. This anomaly produces intraoral pressure changes (increase or decrease), can cause speech, sucking and feeding problems of involved patient. On the other hand, if cleft palate is associated with cleft of the lip or alveolar area, growth and alignment of teeth may change the appearance of the patient and affect the psychologic and occupational future of the patient. Eustatian tube malfunction in involved neonates increase. Many procedures are used to repair the cleft palate and correction of palatal muscles which are: 1) Von Langenbeck (18.5%). 2) Veau-Wardil-Kilner (72.5%). 3) Double opposing Z-Plasty (9%). In this research the demographic criteria of patients including age of the patient at operation rime (mean age 30.14 months), city of residence, family history of cleft palate (12.4%), familial relation of parents (15.2%), associated anomalies, complete or incomplete lesion, weight of patients at the time of surgery (mean 11.28 Kg), hemoglobin (11.3 mg/dl), complications, otitis media and the side of cleft palate are studied in 178 admitted patients to Imam General Hospital between 1989 and 1995.

---

The object of this study was to find a suitable staining method for P.carinii. This parasite is not easily stained and clinical signs are not specific for the diagnosis of P.carinii pneumonia and therefore optimal laboratory methods for observing the organism are extremely valuable. In all 17 new conventional and modified staining techniques were used on lung impression smears and tissue section of sprague Dawley Rat treated with cortisone. Of these methods modified methylene blue 1 & 2, modified cresy violet 1, 2, 3, 4 modified Gram, modified Giemsa 2 and modified Griedley techniques have not previously been reported. After comparing readability of the slides, ease of performances, rapidity, availability and sensitivity of these 17 techniques for the diagnosis of P.carinii pneumonia, modified toluidine blue 01 & 2, modified methylene blue 1 & 2 and modified cresyl violet 3, 4 are suggested as the methods of choice for the rapid diagnosis of P.carinii pneumonia.

---

Between 1990-97 two hundered children referred to our department with end-stage renal disease (ESRD) for renal replacement therapy. The ages of these children were 1-14 years (mean 8.14). There was no significant difference in incidence of ESRD between two sexes. We evaluated these children for the causes of ESRD. The most common causes were: Pylonephritis and congenital anomalies of urinary tract (35.5%), glomerular diseases (22.5%) and hereditary kidney diseases (13.5%).

---

This is a study on 62 G6PD patients hospitalized in Bahrami hospital between 1993 to 1995. Favea was the oxidant agent causing acute hemolysis in more than 90 percent of patients. Most of acute hemolysis occurred in spring, the season of high consumption of favea. More than 60 percent of patients had moderate to severe hemolysis with Hb less than 7 gr/dL. According to WHO reports, the incidence of G6PD is 7-12% in Iran and it is favism type. It is suggestive to prevent parents of sugh patients of favea consumption, which in turn decreases the rate of acute hemolysis, its complications, complications of transfusion and hospitalization in endemic area of Iran.

---

Different aspects of the effect of trauma on the health status of populations have been studied annually 35 millions deaths, 3.5 millions disabilities and a sum of 500 billions $ cost. Evaluating different modes of prevention, a comprehensive study was carried out in the US during the 7th and 8th decades, introducing the TRISS method for the purpose of comparing the outcomes of trauma cases among multiple centers. This study has been carried out during 1996-97 in there hospitals of Tehran. After entering the hospital, all trauma cases were traced by trained interviewers until leaving the hospital. Based on the TRISS model, probability of survival was calculated for each patient and compared with the results of the MTOS study. Among 4863 cases evaluated, 300 (6.2%) deaths were observed, which is significantly more than the expected number (222 deaths, 2.7%) calculated under TRISS model. This difference may indicate a difference in the quality of trauma care.

---

Use of tissue expander in the recent decade has revolutionized the plastic surgery. The tissue expansion technique is advantageous in body reconstruction because it makes it possible to resurface the defects resulting from excision of burn scars with neighboring skin similar in color and texture and superior to skin grafts or distant flaps. Treatment of burn alopecia was a major problem in the past, but with the application of tissue expander this deformity is treated. We have learned by experience that tissue expander should not be used in the limbs, because of the high risk of complications. The best locations for tissue expander are in order: Scalp, face, neck and trunk. The incidence of burn induced deformities in Iran is high. In this research, I analyze the use of TE in 130 patients with burn deformities. The variables studied were: Sex of patients (43.1% male, 56.9% female), age groups, level of education, occupation, the anatomical site of burn, extension of burn, volume of tissue expansion, the location of placing the TE and complications.

---

To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y) with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm) and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66%) and good in 3 patients (33%). There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10%) and one case of partial rupture of anastomosis (10%). Complete pathologic response was achieved on one patient (6.6%) and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.

---

It is generally assumed that local muscular fatigue predisposes the individual to injury. Despite the significance of muscular fatigue and endurance, there are not much dynamic endurance studies for trunk muscles in the literature. Most of them have used isokinetic dynamometer which keeps the velocity of movement constant. In this studies with the help of an isoinertial dynamometer we have assessed the effect of repetitive and fatiguing flexion-extension movements patterns and motor output. 38 female subjects with no history of low-back pain for the 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position, velocity impulse, work and power of each axis. Resistance were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a saggital plane resistance equal to 50% of their maximum isometric extension strength in the upright position. The minimum resistance in the coronal and transverse planes were set-up at 5-7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Immediately after dynamic test another isometric test was performed. A paired T-test procedure was performed among the selected parameters of the 1st middle and last 3 repetition cycles. The selected parameters are range of motion, velocity, torque, impulse, work, power, time interval and time of movement. Also, a paired T-test was performed between maximum isometric strength before and after dynamic test. All the selected parameters were significantly reduced in the saggital plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction of the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structures is located in a more injury prone position, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.