Tehran University Medical Journal

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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.

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Hemiballismus is the most rarest type of unintentional movements. Two cases are reported in this article, discussing etiology, pathology and therapy (surgical and drugs).

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Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm) and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular) and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

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Non-Hodgkin's lymphoma is the 3rd most common cancers in children. In the present study, to determine pathological and clinical features of this cancer, we reviewed records of 84 cases of non-Hodgkin's lymphoma who were admitted to Ali Asghar and Bahrami children hospitals from 1989 to 1996. 59% of cases had small non-cleaved cell (SNCC) subtype of disease. 15% were lymphoblastic and 5% diffuse large cell subtype. The most prevalent primary sites were abdomen and lymph nodes. The most prevalent symptoms were abdominal mass (34%), abdominal pain (37%) and cervcal lymphadenopathy (26%). Over half of our patients were small non-cleaved cell subtype, and further studies should be done to find out reasons for this unusual finding.

 

 

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World health organization has introduced concentration of vitamin A in breast milk as a proper indicator for characterization of vitamin A deficiency in lactating mothers and their infants (<6 mo). A normal phase high performance liquid chromatography with spectrofluorometric detection as a specific and sensitive detector was used for characterization of all-trans retional from 13-Cis retinal. The method was sensitive (0.009 ppm) and accurate (1±0.054 µ mol/l) and had a good recovery percentage (99.36%). This method was more better than before methods and was compatible with the other useful methods. Effect of freezing and defreezing on all-trans retinol content of milk sample was investigated. The result was interesting, whatever all-trans retinol content was bigger, it’s destroying was bigger too. Because of that reseon, day today reproducibility wasn’t good. Standard of retinol was 95% all-trans and pure so we should use this method because two retinol isomers wasn’t separated from each other by reversed phase chromatography and UV detection.

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Background: Food allergy is one of the most important among other allergic diseases. Although it is less prevalent in adult but in infants it’s prevalence was reported as much as 8 percent. In part, wheat is one of the six main food allergens in infant and in other part there is extensive cross reactivity between the cereals. Therefore the aim of this study is selection of the best food substitute for wheat among other cereals. Materials and Methods: 24 patients with definitive diagnosis of type one hypersensitivity reaction to wheat were entered in this study. Skin prick test and serum specific IgE (Eliza) with 6 members of cereals family (wheat, barley, oat, Rye-Rice & Corn) were performed for them and open food challenge test was also done with three more available of the cereals (corn, Rice, barley) in our food culture and so comparison between allergenicity of wheat flour and wheat bran with skin prick test were done.

Results: The Skin prick tests (SPTs) were positive in 66.7 percent for Barley, 100 percent for wheat bran and 80-100 percent for other cereals. The results of specific IgE for wheat, Barley were positive in 94.5 percent, 68 percent, 39 percent of patients respectively and the results for other cereals were positive in less than 11 percent of cases. The results of food challenge test, for barley were positive in 60 percent of cases and for Rice and Corn were negative in all cases.

Conclusion: In the base of food challenge test as the gold standard test, the best food substitute for wheat sensitive patient between other cereals, were Corn and Rice respectively. It is important to emphasis that will be needed to perform oral food challenge in hospital with complete emergency equipment before introducing any other cereals as food substitute for wheat, specially Barley.

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Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

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Background: We conducted this study To find relationship between maternal glucose challenge test (GCT) levels and fetal body weight (BW).
Materials and Methods: We analyzed five hundred women with singleton pregnancy, who had GCT at 24-28 week during pregnancy. All of them had no history of hypertension and diabetes mellitus or other medical disease before pregnancy or during previous pregnancy, and all of them had weight gain appropriate with their pre pregnancy body mass index (BMI). Also nobody had history of drug abuse or smoking. In this descriptive–analytic survey, maternal age, gravidity, BMI,GCT level ,gestational age (GA) , sex of neonate, rout of delivery , newborn weight and apgar score were evaluated .The student’s T-test and logistic regression were used for statistical analysis. We used Pearson coefficient and receiver operating characteristic (ROC) curve and chi-square test for determination GCT threshold.
Results: We found rate of small for gestational age (SGA) in newborns statistically was significant, who their maternal GCT level was ≤ 80mg/dl, P value: 0/018, specificity 89%, sensitivity 58% and confidence interval: 95% (0/162-0/545).
Conclusion: Low GCT level has association with SGA and can be used as a predictive test and may be an indication for dietary intervention.

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Background: The purpose of this study was to measure isokinetic maximum and average peak torque of internal and external rotators of glenohumeral joint in volley ball and tennis players
Methods: This study was performed on 17 professional female athletes (7 tennis players &10 volleyball players) with age ranged 18-28 years. The subjects had played in a skilled team for more than 3 years. They were free from injury to their dominant shoulder in the past year. Subjects performed a five minute warm up by shoulder wheel and Maximum average Peak Torque (APT) were obtained unilaterally by a Biodex System 3 with the arm of players in 90 degree abduction at 120,180 & 210 o/s. Players performed five trails of concentric movements with 30 second rest between them.
Results: Maximum and average of maximum torques of shoulder rotator, in both groups, expect for internal rotators of tennis players, reduced by increase of movement speed (P<0.05). There are not significant difference between two groups in maximum, average of maximum torques and normalized data (ratio of maximum torque to weight). There is significant difference between two groups in percentage of APT of External rotator / Internal rotator ratio at 210 o/s (P<0.05).
Conclusion: Volleyball and tennis have no effect on isokinetic strength of shoulder rotators. In high speed, ratio of External rotator / Internal rotator is reduced. This indicates that increase in movement speed increase internal rotator in comparison to external rotator in these professional female athletes.

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Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma
Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1) Cisplatin and continuous infusion of 5FU and Epirubicin (ECF), and 2) Cisplatin and continuous infusion of 5FU with Docetaxel (TCF). Reduction in tumor mass, overall survival (OS), time to progression (TTP), and safety were measured outcome.
Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass) was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002) and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0) resection had done in two of ECF and six of TCF tumors (p=0.015). Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups.
Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

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Background: Sudden sensorinueural hearing loss (SSNHL) is a baffling condition for patients, and its etiology, audiologic characteristics, prognostic factors, and treatment are still controversial.
Methods: In this prospective study, we performed pure tone audiometry (PTA), impedance acoustics (IA), auditory brainstem responses (ABR), otoacoustic emissions (OAE), and transiently evoked otoacoustic emissions (TEOAE) before beginning treatment for 53 patients with SSNHL. We then entered each patient, randomly and alternately, in one of two treatment groups: oral steroids + acyclovir vs. intravenous urographin.
Results: In 22 (41.5%) of the 53 patients (22 female, 31 male), we found negative or no signal to noise ratio and overall correlation in TEOAE. Furthermore, 26 cases (49%) had positive overall correlations less than 50%, and five cases (4.4%) had overall correlations >50%. Although 15 cases (28.3%) responded well, 20 cases (37.7%) showed only a partial response, and 18 cases (33.9%) had poor or no response to our treatment. The mean value for overall correlation in the three subgroups of patients (no response, partial response, and complete response) was -3.5% (±1/16%), + 11% (±1.99%), and +36.6% (±3.07%) respectively (P = 0.01). From 52 cases, 20 had no reproducible wave in ABR (38.5%), three cases had abnormal ABR with normal OAE, all of which responded completely to treatments. Thirteen cases had abnormal ABR and OAE, none of which responded to treatment, and six cases had normal ABR with abnormal OAE, which often responded to treatment.
Conclusions: ABR and OAE may be useful in the diagnosis of SSNHL and determining the site of such lesions as ischemia or neuropathy. The overall correlation (and S/N ratio) in TEOAE is a valuable prognostic factor in SSNHL.

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Background: Tetralogy of Fallot is the most common cyanotic congenital heart disease. The systolic and diastolic function in both ventricles is altered even after successful corrective surgery for this defect with a transannular patch. Pulmonary regurgitation, a common complication after this treatment, is usually well tolerated in childhood. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (Tei index) in patients who underwent surgical repair of tetralogy of Fallot using a transannular patch. In this article we discuss the impact of pulmonary regurgitation on right ventricular function and clinical outcome, the role of echocardiographic imaging, and current management strategies for patients with pulmonary regurgitation after this treatment.
Methods: Sixty eight patients with tetralogy Fallot were studied in Shahid Rajaie referral Cardiovascular Center during 2003-2005. The studied population, 36 male and 32 female with a mean age of 7.5±4 years and a history of corrective surgery for tetralogy of Fallot using a transannular patch. These patients were randomly selected and assessed by Doppler echocardiography.
Results: Fifty-seven patients (84%) had mild to moderate pulmonary regurgitation, whereas 11 patients (16%) had severe pulmonary regurgitation. Right ventricular Tei index was significantly increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.54±0.18 vs 0.24±0.11, P<0.01). Left ventricular Tei index was increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.46±0.22 vs 0.32±0.14, P<0.05).
Conclusions: The findings of this study suggest that pulmonary regurgitation is a serious complication after repair of tetralogy of Fallot with a transannular patch. Delaying surgery in such patients risks irreversible ventricular function.

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Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.

Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.

Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.

Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.

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Background: Cow's milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow's milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow's milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow's milk.

Methods: All the patients referred to the Allergology Department of the Children's Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio's protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.

Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow's milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow's milk. The levels of specific IgE for cow's milk in the intervention group decreased significantly, which was not observed in the control group.

Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow's milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow's milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.

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Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.

Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut). Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.

Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%). Only five patients (2%) had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00). The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008).

Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

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Background: Leukemia inhibitory factor (LIF) is a group of secreted glycoproteins with molecular weights ranging from 38-67 kD, resulting from differential protein glycosylation. LIF is constitutively expressed at high levels in the human fallopian tube epithelium and has an important role in the motility and vitality of sperm. In the present study, the effect of human recombinant LIF on human sperm motility and survival in vitro was investigated.

Methods: Normal spermatozoa of 30 fertile men were collected and after preparation were incubated in Ham's F10+FCS 10% medium, containing various concentrations (0, 3, 5, 10, and 50 ng/ml) of LIF at 37 ºC under 5% CO2 for 6, 24 and 48 hours. Sperm motion characteristics were measured using a Makler chamber. Sperm survival was determined using the hypoosmotic swelling test. Collected data were analyzed by one-way ANOVA and LSD test using SPSS version 11. The difference in values were considered significant when p<0.05.

Results: Sperm motility was significantly higher after 24 h exposure to 5-10 ng/ml LIF (p<0.05). The survival rate of sperm was significantly prolonged when exposed to 50 ng/ml LIF (p<0.05). Nonprogressive motility and survival rate of sperm were significantly higher after 48 h exposure to 50 ng/ml and 10-50 ng/ml LIF, respectively. (p<0.05). There was no significant difference in progressive sperm motility during the 48 h exposure of sperm to the various concentrations of LIF.

Conclusion: According to our results, the effect of LIF on sperm motility and survival were dependent on the dose of LIF supplementation and the length of incubation.

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Background: Stomatitis, the inflammation of the mucous lining of any of the oral structures, is a frequent side-effect of anticancer drugs due to excess uric acid production. Strict oral hygiene and the application of an appropriate mouthwash has been reported to relieve pain and improve patient quality of life. Allopurinol is a drug used to treat conditions caused by excess uric acid. The aim of this study to evaluate the effectiveness of prophylactic use of allopurinol mouthwash for stomatitis in patients undergoing chemotherapy.
Methods: In this quasi-experimental study, 42 patients were randomly assigned to either a study group or a control group. In the study group (28 patients), patients used 5 mg/ml allopurinol mouthwash in hydroxyl propyl methyl cellulose. The control group (14 patients) used water instead of the mouthwash. Treatment was administered for 16 days.
Results: Data collected during the daily follow-up of the patients' oral mucosa showed that allopurinol mouthwash decreased the severity, pain and duration of stomatitis.
Conclusion: Preventing stomatitis in patients receiving chemotherapy improves the health of the patient and compliance with treatment. Based on our findings, allopurinol mouthwash should be used for all chemotherapy patients for the prevention of stomatitis. This nursing intervention can also improve the patient's nutritional state and level of satisfaction.

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 Background: Approximately 5-10% of epileptic patients do not respond to antiepileptic drugs. Adenosine has an inhibitory effect on the nervous system and its metabolism is prevented as a side effect of allopurinol, a xanthine oxidase inhibitor. The current study evaluates the efficacy of allopurinol in intractable epilepsy.

Methods: In this double-blind case-control clinical trial, of the 38 epileptics with intractable seizures, 18 received 300 mg allopurinol daily and 20 received a placebo as adjuvant treatment to their previous antiepileptic drugs. The patients were first examined two weeks after initiation of the treatment and then monthly for a total of six months, during which they were evaluated for seizure control and possible side effects.

Result: Of the 38 participants, 32 patients completed the study. There were significant differences between the two groups in terms of reduction in the total number of seizures over the entire six-month trial. A seizure reduction of 30% observed in 66% of the patients, 50% in 55%, and 60% in 44% of the cases in the allopurinol group was achieved after two months and persisted throughout the study. Furthermore, a significant difference in seizure duration was found between the two groups in month four of the trial. In the allopurinol group, two patients had transient rashes, two patients had mild nausea, and two experienced dizziness however, only one patient discontinued the drug due to dizziness. In the placebo group, one patient had rash and one had nausea. In addition, no significant hematological or hepatic changes were found during the trial in either group.

Conclusions: The results suggest that allopurinol is a safe and effective adjuvant agent in refractory epilepsy. Based on this study, we suggest that purine metabolic pathways and the specific use of allopurinol should be further investigated for the treatment of refractory epilepsy.

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Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in the pediatric population. With modern treatments, the chance of the complete recovery is nearly 100%. The most important prognostic factors are appropriate treatment protocol and determination of patient risk factors based on clinical, morphological, immunological and cytological characteristics. In this study we reviewed frequency of these factors, like as age, gender, the primary white blood cell number, sub- group on the base of FAB classification, immunophenotype and the clinical progress.

Methods: In this retrospective study, we reviewed 877 pediatric patients with the diagnosis of ALL between the years of 1994 and 2004. In these patients the age, gender, primary WBC count, sub-group based on the FAB classification, immunophenotype and the clinical progress in 177 patient with acute lymphoblastic leukemia at Imam Khomeini Hospital between the years of 1994 to 2004 were determined.

Results: Of these patients, 1.6% was younger than one year, 24.8% more than ten years old and 73.6% were between the ages of one and ten years 63.8% were male. WBC counts were above 50,000/ul in 28.8% of the patients. FAB classifications included L1 in 80.2%, L2 in 17.5% and L3 in 2.3% of the patients. Immunophenotypes included pre-B cell in 63.8%, early pre-B cell in 23.1%, T cell in 12.3% and mature B cell in 0.8% of the patients. Marker CD10+ was detected in 88.1% of the B cell cases. In this study group, 74% of the patients recovered, 16.3% died and 16.5% relapsed.

Conclusions: The prevalence of FAB-L1 and pre-B cell cases in this study is greater than a previous study, while the prevalence of FAB-L2 and early pre-B cell cases is less than that of the previous study.

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Background: Dermal- respiratory reactions to latex glove is a common problem and sometimes life threatening. Among health care workers, dental working personnel have extensive use of latex gloves. A few numbers of researches have been done in Iran about prevalence of these reactions but there is no comprehensive study for dental workers. The purpose of this study was to evaluate reactions to latex gloves amongst dental workers in military dental health centers.
Methods: In this cross-sectional descriptive survey, dental workers with a minimum of three months length of employment and most often use of latex gloves were asked to fill standard questionnaire (derived from South Carolina Medical University) regarding latex related clinical manifestation and personal medical history and predisposing factors Data analysis was done by χ2 and Student's t test.
Results: In our study 330 personnel were assessed. The mean age and length of employment was 31.6 and 8 years respectively. The most occupation was dentistry. A total of 232 subjects (70.3%) reported latex gloves-allergic symptoms. 72 (21.8%) of persons have history of atopy and food allergy was seen in 114 (34.5%). 63 (19.1%) of subjects reported history of hand dermatitis. All of these predisposing factors had positive regression with dermal and respiratory reactions.
Conclusion: In this survey the prevalence of allergic reactions was higher than similar studies which may be due to type of gloves, lack of preemployment assessments and other factors. Use of diagnostic methods such as serologic measures, SPT and pulmonary function testing (such as spirogram) could be considered as tools for confirmatory and differential diagnosis and important complementary for these studies. Because of relationship between allergic reactions to latex gloves and some medical histories, it seems to be necessary for preemployment evaluation and periodic health surveillance of dental workers.