Tehran University Medical Journal

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A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

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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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With the intention of research of various methods of epithelial tissue culture we've studied five French Albino rabbits with an average of 8 weeks. In order to evaluate and control growth and proliferation of autologus cultured tissue samples were obtained on 1st, 5th and 8th days. After fixation of these samples and passing them through various processes, histologic sections were prepared. These sections were stained with H-E and studied by light microscope, we succeeded in developing the original donor surface by 18 times.

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Drug therapy and prophylaxy in infectious diseases, from hygienic and economical point of view, are very important. Infections caused by pseudomonas aeroginosa were particularly severe, with high mortality rates. In the recent years pseudomonas aeroginosa continued to cause the most severe, life-thereating infections in burned patients, in spite of the introduction of a wide variety of antibiotics advised specifically for their anti pseudomonal activity. The aim of this study, in which many cases of ps.aeroginosa infections are assessed is to identify the drug resistance of this bacteria to penicillines, cephalosporins and aminoglycosides by antibiotic sensitivity test (disk ager diffusion). Results as percent of resistance to each antibiotic were 89% to carbenicillin, 55% to piperacillin, 89% to mezlocillin, 89.5% to ticarcillin+clavulonic acid, 85% to ceftriaxone, 95% to tobramycin, 5% of all isolates were not sensitive to any antibiotics.

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Primary Hyperparathyroidism is a fairly common disease that is much more predominant in females. Treatment is surgery and includes removing the parathyroid adenoma or the hyperplastic parathyroid glands. Considering the difficulty of this operation procedure, localization test are utilized including ultrasound, MRI, CT scan, Thallium-Technesium subtraction scan, MIBI scan and a series of other tests. According to the studies regarding these tests, MIBI scan is superior to all the others. In this survery we have studied 110 primary hyperparathyroidism patients that were operated on in Dr.Shariati Hospital between 1356 and 1376. In order to localize the adenoma ultrasound was used in ten patients, thallium-technesium subtraction scan in 38 patients. MIBI scan in 30 patients and CT scan in 3 patients. The sensitivity of MIBI scan was 86% and its specificity was 100%. In comparison, the sensitivity of thallium-technesium scan was found to be about 65%. Our results show that MIBI scan has had a high degree of sensitivity and specificity in our patients and has shown to be the best localization test. Therefore we suggest this test for the localization of all parathyroid adenomas.

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Background: Gastric cancer (G.Ca) is significantly more prevalent in north western than central Iran. Growing evidence has related Helicobacter pylori (H.P) to G.Ca worldwide. We assessed the prevalence of H.P infection in high (Ardebil) and low (Yazd) prevalence of G.Ca provinces of Iran. Methods: Cluster sampling of healthy population aged less than 20 years was performed in Ardebil and Yazd provinces over 2 months. Ten cc blood was drawn from each person and H.P IgG was tested using ELISA (Diagnostic Corp., sensitivity 98%, specificity 96%). Results: 711 individuals (358 in Ardebil and 353 in Yazd) were enrolled. 170 individuals (47.5%) in Ardebil and 108 individuals (30.6%) in Yazd were positive for H.P (P<0.0001). Using logistic regression analysis, the predictive probability of H.P infection in different age groups was calculated. Conclusion: H.P infection is significantly more prevalent among individuals less than 20 years in areas with high prevalence of gastric cancer in Iran. Our data suggest a relation between H.P infection and gastric cancer in Iran

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This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents

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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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In this paper we have reported and discussed an unusual histopathologic feature of medullary carcinoma which is one of the pitfalls in the diagnosis of this tumor. The patient was a 14 years old girl who complained of painless, gradually growing cervical mass from one year ago. She had no history of head and neck radiotherapy of familial history of thyroidal or other endocrine disease. In laboratory investigations a cold thyroid nodule was confirmed and FNA of it was reported as follicular lesion. The patient underwent lobectomy isthmectomy with frozen section wich was reported as Hurthle neoplasm and then the other lobe of patient's thyroid resected. In it's pathologic exam another nodule was observed which mostly composed of spindle cells at last histochemically medullary carcinoma confirmed

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Helicobacter pylori (H.pylori) is the most common human infection in the world. This agent has a strong role in pathogenesis of chronic gastritis and peptic ulcers. Therefore introducing of simple and cost effective and non invasive tests are important for diagnosis of H.pylori infections. In this study 215 patient suffering from different gastrointestinal disorders referred to GI endoscopy department of Dr. Ali Shariati Hospital were selected as case and another 50 as control group, which were evaluated for H.pylori infection. Direct smear (staining with Giemsa) and urease tests were used as gold standard tests compared with IFA-IgG and culture. Sensitivity and specificity and accuracy for IFA were 94%, 86% and 90%, respectively. Absorption with campylobacter jejoni did not change the level of IgG against H.pylori. Negativity of urease test dose not show the eradication or absence of bacteria, but shows the low number of bacteria in biopsy materials. This report suggest that IFA is an advantageous, sensitive and reliable test in diagnosis of H.pylori infection.

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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.

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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.

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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.

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Intestinal parasitic infections are found all over the world. With all the progresses made in the last decades which have resulted in reduction of infection and mortality, yet parasitic infections are one of the biggest public health problems in the developing countries. In this research children 2-5 years old of Saveh city were randomly chosen. Intestinal parasitic infections and the effect of medical treatment on the infected cases were assessed. In order to treat the infected cases. Iranian generic drugs were used in which for Giardia infection Metronidazole 87.5% and furazolidone (66.7%) were proved effective. Metronidazole in treatment of Entamoeba histolytica infection (88.2%) and Metronidazole+Paramomycin proved 100% effective. In treatment of children infected with Oxyuris, the two drugs, Metronidazole and Pyrvinium Pamoate were almost 100% effective. Metronidazole in Ascaris infection was about 88.9% effective. Niclosamide in treatment of Hymenolepis nana (100%) and in Tenia saginata were 75% effective. Reinfection after three months in treated children was about 20.9% which was the most prevalent intestinal parasitic infection related to Oxyuris. The successfully treated group had higher average body weight compared to the control group.

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In this study, musculoskeletal disorders incidents have been found through NMQ. Then, with the OWAS method the results have been analysed. In this thesis, we have studied the case in two different workshops of Ballast Production Company. The jobs were classified according to static load caused by poor work posture and recommendations for reducing the hurmful load were made. The study of the questionnaire showe that there is meaningful relation between work experience and Low Back Pain (LBP) (P<3%). Meanwhile BMI (Body Mass Index) is closely related to LBP (P<2%). However a relation was found between low back and back and shoulder pain complaints during recent one year and last one week with that of the existence of the pains, respectively P<2% and P<5%. Jobs related with repair and maintenance rates the first as regards static load on the muscloskeletal system. Cooking, digging operations, driving bullodozer, operation of stone crushing device, loaders and lorries rank respectively in order.

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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.

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In the present survey all together 670 students were chosen randomly. The rate of goiter prevalence was 46.3% and 55.7% among the students of Ilam and Arkavas, respectively. Goiter prevalence rate among females was higher than in males. Prevalence of giother was significantly different between the two cities, also between females and males in Arkavas and females in two cities (P<0.05). In comparison the females had better physical growth than males. Although there was no significant difference between weight and height as well as socio-economic state in comparison with thyroid size, but physical growth and socioeconomic indicators in Arkavas were lower than in Ilam. There was no significant relationship between the size of thyroid and urinary excretion of iodine. The amount of iodine in drinking water was 3.2 and 0.65 Mic.gr/Lit, respectively. Low level iodine drinking water and protein-energy malnutrition are important factors for prevalence of goiter in two cities. According to our results although the value of urinary iodine is normal but prevalence of goiter rate related to the iodine deficiency is due to the past deficiency.

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Over a period of 4 years 325 infertile women were evaluated by diagnostic by laparoscopy, which included 250 cases of primary and 75 cases of secondary infertility. The aim of the present study was to find out the probable causes of infertility by collecting qualitative and quantitative data from laparoscopy results of the secondary infertility group so as to give precautions for decreasing the predisposing factors. The results of this study showed that pelvic adhesion was the most frequent pathologic findings (57 cases), which could be due to complication of PID or surgical trauma. 14 cases had other problems and only 4 cases showed no apparent pathological anomalies.

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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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Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.