Tehran University Medical Journal

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

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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

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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.

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Natural Killer (NK) cells are the main lymphocyte population expressing P75 B chain of the IL-2 receptor (IL-2R). Consequently, incubation of peripheral blood lymphocytes with IL-2 induce selective activation of NK cells and results in NK activity and generation of Lymphokine activated killer (LAK) cells activity and proliferation. One of the early events during IL-2 activation of peripheral blood lymphocyte in both rodents and humans is adherence of some NK cells to plastic surface. The cells adherence to plastic after 24 hr of culture with IL-2 are almost exclusively CD56+, have the morphology large granular cells to yield a highly entiched population of activated NK cells that have been used for systemic adoptive immunotherapy. To test these hypothesis, we used highly purified population of human peripheral NK cells through the biological and nonimmunclogical phenotyping technique. Blood mononuclear cells were separated by centrifugation of ficol-hypaque gradient from normal blood donor (20-30 years age). We depleted after purification of nonadherent cells with nylonwool. We collected with rosette technique to remove cells with high affinity SRBC receptors. These cells separate in two parts A-NK and NA-NK by mononuclear celss activated supernatant media. The main objective results of this study show that the subpopulation of human NK cell which develope early adherent to plastic surface in the presence of supernatant mononuclear celss activation media was functionally more cytotoxic and killed K562 targets in single cell sytotoxicity manner and LDH activity assay than nonadherent NK cells and resting NK cells

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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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Epidermolysis bullosa (EB) is the term applied to a group of disorders whose common primary feature is the formation of blisters following trivial trauma. Hereditary EB comprises 3 major classes: simplex, junctional and dystrophic, and includes more than 23 phenotypes. The albopapuloid pasini variant of dominant dystrophic EB is characterized by a distinctive clinical appearance. In this article, we report this disease in three members of a family (father and two sons).

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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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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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In the present study, we investigated total cell protein patterns of ten isolates of Epidermophyton Floccosum Var.pigmented by SDS-PAGE on 10% polyacrylamide resolving gels. Densitometric analysis of the gels allowed to detect more than 31 clearly detectable mycelial protein bands with molecular weights in the range of 12 to 98 KD proteins of 12.5, 13.5, 14.4, 16, 18.4, 19.7, 20.1, 23.5, 26, 27, 29, 30, 32.5, 34, 35.5, 37, 39.5, 40.5, 43, 47.5, 50, 63, 68, 75, 79, 82.5, 74.5, 90, 94, 96, 97-5 KD were present but their frequencies varied among the isolates. Protein bands of 18.4, 19.7, 20.1, 27, 29, 34, 37, 43, 47.5, 50, 63, 79, 94, KD were stronger and common among the isolates and could be specific to recognize genus differences. Protein analysis by SDS-PAGE could be considered an useful technique in identifying differences among the dermatophyte isolates.

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Brucellosis is a multisystem disease with diverse clinical presentations and involvement of the nervous system is considered to 5 to be 10% in adult patients and 1% in children. The presentations of neurobrucellosis includes meningoencephalitis, subarachnoid haemorrhage, myelitis, radiculoneuritis, intracerebral and epidural abscess, psychosis and vascular syndrome. Twenty-two patients with neurobrucellosis are described. Ten patients had meningoencephalitis, seven patients had meningitis, three patients had polyradiculopathy and one patient presented with spinal epidural abscess and one patient had brain abscess. Results of an agglutination test for Brucella in serum were positive for all patients (>1:160) eight of 15 patients had positive agglutination test in CSF. Five patients had positive blood cultures, 3 patients had positive bone marrow cultures and 2 of 15 patients had positive CSF cultures. All of cultures were Brucella Mellitensis. Antimicrobial treatment included concurrent administration of Doxycycline, Rifampin and Trimethoprim-Sulfametoxazole. Four patients received Dexamethason concurrently. In conclusion, nervous system involvement is a serious manifestation of brucellosis. As brucellosis is an endemic disease in Iran we suggest that brucellosis be investigated with neurological symptoms and signs.

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The purpose of this study was to find a more efficacious treatment for patients with primary central nervous system Lymphoma using chemotherapy. The objective was to determine the optimal time for radiotherapy treatment in relation to chemotherapy. Retrospective evaluation in patients with brain lymphoma was conducted from 1992 to 1998. Twenty-three patients were evaluated. Patients were divided into two groups based on the timing of radiotherapy in relation to the chemotherapy. The first group of patients (n=13) initially received radiotherapy followed by chemotherapy. Five of these patients receied classic CHOP (cyclophosphamide), Doxorubicine, Vincistine and Prednisone), six patients received Cis-platin (60 Megs/M2) and Etoposide (120 Megs/M2) and two patients received Cis-platin (60 Megs/M2), Etoposide (120 Megs/M2) and Cytarabine (600 Megs/M2) every 2 to 3 weeks. The second group of patients (Group II, n=10) received the followeing treatment regimen: a course of BCNU 120 Megs/M2 with Ifosfamide 1200 Megs/M2, Mesna and Etoposide 120 Megs/M2 on the first day of treatment (course A). Two weeks later, treatment was continued with a course of Cis-platin 35 Megs/M2 and Cytarabine 600 Megs/M2 (course B). The treatment was continued 14 days later with a course of Mitoxantron 12 Megs/M2, Ifosfamide 1200 Megs/M2 puls Mesna (course C). After the fourth week of chemotherapy, these patients received radiotherapy to the brain (5000 RADS in 4 weeks). During radiotherapy and at the beginning of course chemotherapy, intrathecal therapy with Methorexate 12 Megs/M2 and Cytarabine 60 Megs/M2 was given. Immediately after radiotherapy, the same chemothotrexate 12 Megs/M2 and Cytarabine 60 Megs/M2 was given. Immediately after radiotherapy, the same chemotherapy treatment was repeated to a total of 3 times. After complete clearance of the tumor determined by MRI and absence of tumor cells in the spinal fluid, the chemotherapeutic regimen was repeated one last time. The patients were evaluated for disease free survival and relaps based on the different treatment groups. Results: Median follow-up time was 19 months. Ten patients relapsed. These patients initially received radiotherapy (Group I). In this time period there were no relapses in Group II patients. The median DFS was 24 months with a chance of survival in 3 years of 45.95+11.95% for both groups. Chemotherapy followed by radiotherapy was more efficacious than radiotherapy prior to chemotherapy. Two years survival was 9% in contrast to 100% in favor of chemotherapy followed by radiotherapy. Conclusion: The above model demonstrated that treatment using a protocol consisting of chemotherapy prior to radiation provides improved disease free survival over a treatment regimen consisting of radiotherapy followed by chemotherapy.

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In order to understand the function of mammalians serotonin system, we have to know the anatomical structure, because physiological changes are influenced through the anatomical changes. A number of thalamic nuclei are associated with functions known to be influenced by serotonergic input in brainstem, among them mediodorsal thalamic nucleus has relationship with limbic system and prefrontal cortex. The precise topographical projections of mesencephalic raphe nuclei to the MD nucleus of thalamus were identified in the rat using horseradish peroxidase (HRP) retrograde tracing substance. Injection of HRP in MD labeled a large number of neurons in rostral to caudal part of dorsal raphe nucleus. It exhibited a strong number of neurons in ipsilateral part of DR and a few cells in its contralateral part. Numerously labeled cells were also observed ipsilateral in rostral and medial part of MnR (86%) and a few cells in it's contralateral part. The present study has provided that the MD innervation by DR is more greater in density than that observed at the MnR. Upon these results and previous study, mesencephalic raphe nuclei are involved in several specific functions of thalamus as limbic system behavioral mechanism. A much more detailed knowledge is needed to show topographic relationships between mesencephalic raphe nuclei and forebrain.

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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.

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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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Recently, small incision cataract extraction by phaco and implantation of a foldable intraocular lense with topical anesthesia has used in an attempt to decrease the complication of general anesthesia and peribulbar injection. To compare effects and complications of topical, local and general anesthesia, 92 patients admitted to Imam Hosein hospital for cataract surgery, were randomly assigned to three groups and surgery was done under different methods of anesthesia. During routine ECCE, lid and globe movements, miosis and viterous bulg were observed more in topical anesthesia than the other techniques, but serious complications such as posterior capsular rupture and viterous loss were not seen. Because of less systemic and local complications and rapid return of vision and possibility of outpatient surgery, topical anesthesia should be considered as an alternative to local and general methods.

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Many studies have shown the effectiveness of photorefractive keratectomy (PRK) in correction of vision in low and moderate Myopia. To evaluate the results of 193-nm exeimer laser photorefractive keratectomy for highly Myopic eyes, we reviewed refractive outcome of 43 eyes of 30 patients. Most eyes were treated with 1-step operation, using a 6 mm optical zone. 43 eyes were treated for Myopia, which were between -6.40 and -16.90 diopters. The mean pre-operative refraction was -9.50 D. All eyes were followed for at least 12 months. At 12tht month visit, 30.2% and 60.5% of eyes achieved correction within 1 and 2 D of attempted correction, respectively. At this time, 62.7% of eyes obtained 20/40 visual acuity or better uncorrected. At 1 year, 13% and 8% of eyes lost 3 and 4 lines of best-corrected visual acuity, respectively. Also 13% of eyes lost 2 lines. 12 months after PRK, 5 eyes developed corneal haze grade 2 and 2 eyes, grade 3 (0-5 scale). There was much undercorrection seen in this group compared with patients undergoing PRK for low and moderate Myopia. Photorefractive keratectomy for high Myopia, though effective, is not a safe and accurate procedure and is less predictable and stable than performing it for low and moderate Myopia.

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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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Although cellular immunity involving activated macrophage is important in resistance to Brucella infections, serum factors and polymorphonuclears (PMNs) play some role in the initial responses to Brucella infections. In this research, we studied respiratory burst of PMNs against opsonized yeast and opsonized inactivated Brucella melitensis in chronic Brucellosis patients and controls with no previous history of Brucellosis. A group of 41 patients and another group of 20 blood donors as control, were included. The other 2 groups included 10 cases and 6 controls. Mean responses of PMNs of patients and controls to opsonized yeast were 110.3 and 129.3 milivolt respectively and the difference was not statistically significant. No statistically significant difference was observed between respiratory burst of PMNs exposed to inactivated Brucella in 10 patients with chronic Brucellosis (Mean 67.2) and 6 control blood donors (Mean 112.5), so we concluded that inactivated Brucella melitensis can't inhibit activity of myeloproxidase enzyme.

 

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Breakthrough bleeding (BTB) is the cause of 50% of discontinuations of use by long-acting progestogen-only contraceptive users. BTB appears to be associated with capillaries of abnormal morphology and fragility. Disturbances in vessels integrity, intercellular junctions or alteration of the basement membrane (BM) composition has been proposed to contribute toward the fragility of these capillaries. In a clinical trial study, 34 healthy fertile volunteers were studied before and during use of levonorgestrel releasing subdermal contraceptive implant Norplant. Three endometrial biopsies were taken from each volunteer, one before insertion and 2 at different time intervals after exposure to Norplant. Then 3 major components of BM of endometrial vessels Collagen IV (CIV), laminin and heparan sulphate proteglycan (HSPG) were immunostained and studied. The density of immunostained vessels by each antibody were measured and compared with density of vessels stained by CD34. Double immunostain of CD34 and laminin was also used for demonstration of vessels without BM. Significant decrease in vascular density showing BM components were shown in the study. The density of laminin, CIV, and HSPG-positive vessels were decreased from 176±8, 166±6.6 and 61±6 vessels/mm² (Mean±SEM) in the endometrium of Norplant acceptors before use control samples to 156±6, 144±6.2 and 33±2.9 in the endometrium of Norplant acceptors after 2 to 13 weeks Norplant exposure, respectively (P<0.05). This was occurring at the same time as the overall density of small vessels in Norplant exposed endometrium was showing increase. Significant decrease was also demonstrated over 13 to 42 weeks of use in the densities of laminin and HSPG-positive vessels compared with control (P<0.05), although decrease in the density of CIV positive vessels was not significant. Percentages of vessels showing BM was also calculated in the study. Significant decrease in the percentage of vessels showing BM were demonstrated after 2 to 13 weeks of Norplant use. The percentages of CD34 positive vessels showing laminin, CIV and HSPG-positive BM in control samples were 97±3%, 88±32% and 31±2% (Mean±SEM) which significantly decreased to 79±3%, 75±4% and 20±2% in Norplant users, respectively (P<0.05). Decrease in the percentage of vessels showing BM was thought to be due to disturbances in the integrity of BM in endometrial vessels of women using Norplant, which could be a cause for the fragility of the vessels. The decrease could also be due to decrease in the density of arteriols and increase in the density of venules and appearance of solid cords of endothelial cells. Double immunostaining of the endometrial vessels with anti-CD34 and anti-laminin clearly demonstrated loss of BM or weak staining of BM in the endometrial vessels of Norplant users. Clarification of the local mechanisms which leads to capillary fragility and abnormal endometrial bleeding may lead to the development of better treatments or prevention and ultimately improve the acceptability of these contraceptives.

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Sarcoidosis is a chronic multisystem disorder of unknown etiology. All parts of the body can be affected but the organ most frequently affected is the lung. Otolaryngologic manifestations occur in 20% to 40% of cases of Sarcoidosis and the spectrum of lesions that may come under the purview of Otolaryngologist is broad. In this case report a patient is presented with large cervical lymphadenopathy and without other manifestation of disorder.