Tehran University Medical Journal

---

Infection by M. tuberculosis can be demonstrated by tuberculin testing. On sequential PPD some person show a marked increase in the size of their skin reactions which may not be due to recent or past tuberculous infection. This phenomenon (booster effect) can occur as soon as a week after the initial test and persist for as long as a year.

Methods and Materials: The purpose of this research is studying the size of induration following repeated PPD tests (booster effect) that studied in children who came to our clinic or imbedded in pediatric unit and the group of student in grades 4 and 5 at elementary school (totally 80 cases) for one year.

Results: Increase of induration in 25% of all (20 cases) was 5 mm or more and in 75% of all (60 cases) was less than 5 mm and between these two groups, differences was meaning full (P< 0.05). The increase of induration in 12.5% was 7 mm or more.

Conclusion: Because there is not shown definite increase of induration (more than 5 mm) on sequential PPD in children, we must to consider to new infection.

---

In view of the rapid expansion of contact lens amongst the users, new dimensions have been added to the domain of ophthalmology: Giant papillay conjunctivitis, a disease caused by different kinds of contact lens, appears weeks or months after they are used, although some patients are struck years later. The predominant symptoms are increased awareness of lenses, ocular itching, blurred vision and excessive lens movement. The predominant signs are the formation of papillae, the presence of excessive mucus, and contact lens coatings. The syndrome occurs mostly with the soft lens and is more intense. Other independent studies show that the rate of prevalence of the disease with soft lenses and hard lenses is 10% and 5% respectively. The study comprised 550 soft lenses and 150 hard lenses. The diagnosis of the disease was based on the symptoms and signs of the disease. Eleven percent of the patients using soft lens and 4% of the patients using hard lens had the disease at some stage. Almost all of the patients were using dirty and low grade lenses. The therapy protocol of the disease consisted of changing the polymer type of the lens and administering cromolyn 4% drop. In cases that the therapy was unsuccessful, a temporary suspension of the lens and administration of cromolyn 4% was recommended before using the new lens.

---

Amount of environmental lead pollution is increased with progression of industry. This pollution is able to damage the living beings in many ways. Blood and Immune systems are more sensitive to toxic effects of lead. 30 female and 6 male rats from Sprague dawley race are chosen by simple random sampling. After copulation and vaginal plug observation, expectant rats are calssified in test and control groups. Since the first day of pregnancy, test group is given a drink containing lead acetate 0.13% in distilled water and control group is given distilled water. After delivery, for ultrastrectural studies, spleen specimens of newborn rats are fixed in glutaraldehyde solution 2% and after processing are studied by T.E.M. Sinusoidal endothelial cell show: morphological changes in mitochondria, appearance of primary & secondary lysosomes and multivesicular bodies and swelling in ER. It seems that these changes are caused by interaction of lead with enzymathic functions or lead accumulation in these cellular organels.

---

Sixty pregnant women with the gestational age of 6-14 weeks who met the following criteria were selected: 1) Presence of nausea and vomiting. 2) Absence of other medical conditions that cause nausea and vomiting. 3) Negative history of medical treatment for at last three days prior to admission. 4) Negative for threatened abortion, molar and twin pregnancy. Cases were randomly divided into two groups. Mean age of the cases was 25.16 y (range: 16-37 y) and not significantly different in the two groups. The two groups were also similar in gestational age, severity of nausea and vomiting, number of previous pregnancies and abortions, profession, working inside or outside the house, family income and education of patients and their spouses. In one group, Pe6 point of acupuncture was stimulated by TENS (once every 2 hours, 10 minutes each time, from the time of awakening). The other group received placebo. Both groups were hospitalized for 48 hours, and were evaluated for severity of nausea and vomiting, apetite, frequency of vomiting and VAS at their worst day, 24 hours prior to admission and 24 and 48 hours after admission. The two groups were similar in frequency of vomiting, VAS, appetite, and severity of nausea 24 hours prior to admission, and the worst degree of nausea and vomiting. However, a significant difference was observed in the severity of nausea and vomiting 24 and 48 hours after the adminission between TENS and placebo (P=0.000). In the group who received TENS, 24 cases (86.7%) reported improvement (compared to 23.3% in the control group). Of all the cases, 81.6% had received prior medication, only 18.3% of the latter reported improvement with medication. Level of VAS in the groups with severe and mild to moderate nausea and vomiting was not significantly different in the first and second days of admission. Fifteen percent of the cases reported a transient cutaneous rash. Five cases were hospitalized more than once. Of the cases who reported improvement with TENS, 5% had improved after two stimulations, and 47% reported a relapse of symptoms in less than 24 hours after cessation of TENS. In one of the cases who were re-admitted, TENS did not result in alleviation of nausea and vomiting, and 56.6% of all the cases suggested to use TENS at home, 45% were attracted to TENS by commercial advertisements. Disscusion: Stimulation of Pe6 (Neiguan) point alleviates the nausea and vomiting of pregnancy.

---

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.

---

Mycosis Fungoides (MF) is a cutaneous T-cell lymphoma (2,5). Alopecia is rarely seen in this disease, and the reported cases are in the form of follicular mucinosis (1,2,4). In this case report a patient is presented whose lesions all showed alopecia without mucinosis. Furthermore there was a patch of alopecia without any epidermal changes, which was clinicaly identical with alopecia areata, and histologically identical with MF. After six months of treatment there is regrowth of almost normal hair on all of the lesions

---

Artifacts in histopathology, could create serios errors and cause misdiagnosis. In some cases, the degree of artifactual damage is so large that may involve the entire specimen, rendering it suboptimal or useless for diagnostic purposes. Usually, cases of oral cavity specimens are of small size and fine texture, and as a result, the astifacts are more effective on them. However, there are very limited reports in this respect. The present study included a relatively vast range of possible causative factors (which could cause artifacts in histiomorphology). 100 specimens went under the influences of 22 factors. We found that in common, causative factors with reports of Mehregan and Margarone our results are, somehow similar in other cases, which were for the first time applied to, the results were interesting and impressive for some kind of mucosal lesions such as pemphigoids are on malignant and premalignant lesions.

---

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.

---

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.

---

In this paper, factors affecting the result of prophylactic lymph node dissection in 125 patients with skin melanoma during the period between 1987-1992 in the cancer institute were evaluated and prognostic parameters ascertained. The result showed prevalence of head and neck melanoma in men were two times more than in women with a preponderance of regional and lymphatic recurrence. Majority of patients presented with advanced clark levels (76.8 Pct). Clinical and histologic evaluation of the regional lymph nodes failed to show any meaningful relation.

---

Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

---

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.

---

This study is on different surgical techniques for repair of Co-arctation of aort and their effect for correction of systemic hypertension and lower extremity hypotension. In addition to these, the clinical and paraclinical data were noticed. 50 pt were operated in "SHARIATI" hospital during 1370-1377 with diagnosis of Co-arctation of aorta (30 men, mean age 19.4 years, 20 women, mean age 16.6 years). In addition to older age of our patients which results in more post-op sequela, there was suprrisingly a long-lag between onset of symptoms, diagnosis and operation (mean 4.36 years). 62% of Co-arctation were juxtaductal and the remainder were non-classical forms. 52% of our patients had co-existing cardiac disease which were very high in comparison with other studies (12%). This is due to older age of our patients and more valvular heart diseases. Among complicated cases of co-arctation, 71.9% were in men and 28.1% in women and this difference is due to high incidence of bicuspid aortic valve in men. The mean angiographic gradient were 57.5 mmHg which increases with age. CXR was abnormal in 91.7% and ECG in 74.2% of patients. The different applied surgical techniques include ee-A=26%, TIG=40%, TBG=18%, DPR=14%, FSCR=2%. There is no significant difference regarding post-op complications, BP in post-op period, and increase in pedal pulses, except in TBG group which HTN was more common. Two early deaths occurred which were in DRP group.

---

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

---

Hyperprolactinemia probably is one of infertility causes. Its incidence is 20% in infertile patients. In this study importance of hyperprolactinema was studied. Importance of hyperprolactinemia as a primary factor of infertility, is uncertain. We studied 500 infertile women in infertility center of Shariati hospital. Prevalence of hyperprolactinemia was 19%. Hyperprolactinemia as a sole cause of infertility was found in only 0.8%. There was a good correlation between galactorrhea and hyperprolactinemia (P=0.00007). Galactorrhea is not a screening test for hyperprolactinemia (sensivity=25%), but its specifity is high (91%). If we omit prolactin assay for patients without galactorrhea, we will miss primary cause of infertility in probably 0.1% of patients, so we find that performing prolactin assay for patients without galactorrhea is under question. Subpopulation of infertile patients with hyperprolactinemia are not different with infertile population in mean age (P=0.09), mean duration of infertility (P=0.28) and type of infertility. We suggest that hyperprolactinemia is not a primary or sole factor of infertility

---

Some factors such as: aging, obesity, hypoactivity, stress, urbanization, hyperlipidemia, hypertension, multiple pregnancies, smoking and so forth, are important factors that are always argued whether in disease production or in increasing morbidity and mortality in diabetic patients. In a descriptive, cross-sectional and correlational study, we looked for some important risk factors in 780 diabetic patients in Yazd city. The main objective in this study was to identifying the at risk cases. In this study, 54% of understudied patients were obese, 52.3% hypoactive, 80.7% urbanized, 21.5% smokers and approximately 11% were continiously or occasional alcohol users. 85% of all patients had no habit to sport, and the mean of their last fast blood sugar was significantly upper than those who had continiously physical exercises (P=0.01). Majority of understudied women (65.3%) had experienced 6 or more pregnancies during their life, and the last mean blood sugar in these patients was significantly upper than those with <6 pregnancies (P=0.0004). The age of majority of patients in either males or females was 50-70 years, and duration of disease in majority of them was <10 years. Increasing of the last mean blood sugar was significantly compatible with increasing of disease duration (P=0.00003). Regardless the type of diabetes, the disease in every generation was more frequent in female gender and totally, the mean of last fast blood sugar in the patients was 216 mg/dl which is not a controlled sugar. We have suggested the mean of last fast blood sugar in all of the referal cases as a performance indicator during evaluation of center of diabetic patients control

---

Sepsis is the systemic response to severe infection in critically ill patients. Sepsis, septic syndrome & septic shock represent the increasingly severe stages of the same disease. Despite the remarkable improvements in outcome, sepsis & septic shock remain an important cause of morbidity & mortality in children. This is a retrospective study among the patients who were admitted in the pediatric intensive care unit (PICU) of Children's Hospital Medical Center from Farvardin 1371 till Esfand 1375. During this period 4018 children were admitted in the PICU, 138 of these patients (3.4%) had the initial diagnosis of sepsis or septic shock. The age of these patients were from 3 months to 14 years (mean of 23.5 months). The male to female ratio was 2.1:1. Out of these 138 patients only 16 cases (11.6%) had sepsis and the others (88.4%) had criterias of severe sepsis or septic shock. Multiple Organ Dysfunction (MOD) were found in 96 cases (69.3%). Diarrhea was the most common primary disease that resulted in sepsis or septic shock. Only 20.3% of the cultures were positive, among which E-Coli was the most in 8.7%, Staphylococcus aureus in 5.7%, Klebsiella in 2.9% and pseudomonas in 1.4%. 66.7% of these patients expired, the mortality rates of the patients with severe sepsis or septic shock that concommitantely had MOD were higher than the other (P<0.0005). So it may be better if children with clinical diagnosis of sepsis be hospitalized in an intensive care unit or at minimum in a facility that can closely monitor these patients during the initial stabilization period.

---

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (offtherapy). Results reveal minimal psychopathology in these children and their parents based on self-and informantreports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

---

Differentiated carcinoma of the thyroid occruing within the gland is generally not regarded as an aggressive tumor however, when the tumor extends beyond the gland's capsule and onto adjacent structures, its prognosis worsens. During the past three decades such locally invasive thyroid cancer has been studied, specifically concerning invasion into the airway. Progress in tracheal operations in the past 20 years has changed remarkably in terms of the operative methods and indications for thyroid carcinoma invading the trachea. Resection and primary reconstruction of the trachea invaded by carcinoma of the thyroid should be done in the absence of extensive metastases when technically, feasible. It offers prolonged palliation, avoidance of suffocation and an opportunity for cure. In carefully selected patient with massive regional involvement, radical excision laryngopharyngoesophagectomy and mediastinal tracheostomy is also appropriate. In this article, management of one patient with intraluminal involvement of trachea by thyroid carcinoma is presented and management of upper aerodigestive tract invasion by thyroid cancer reviewed.

---

The routine intake of surfactant as a part of HMD (Hyaline Membrane Disease) treatment had significant effect on the prognosis of premature neonates. But since in our country this drug is not widely and routinely used, and there are not records about its use, we decided to make good on this shortcoming through a retrospective study. During 1 year, 54 neonates with HMD were admitted in Ali-Asghar's NICU, 30 of them had gestational age of less than 34 weeks and for 15 cases, surfactant was used. The results of treating this group were then compared with another group of neonates, who were not given this drug. From a statistical point of view, mortality, the length of the period in which the respirator was used, the use of high pressure in respirator, pneumothorax and pulmonary hemorrhage in neonates under treatment with surfactant was significantly less than those of the other group.