Tehran University Medical Journal

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The function of Helicobacter pylori (H.pylori) is confirmed as one of the factors which motivates gastric and duodenal ulcer and gastritis. Various methods are used to diagnose the infection. Serological tests are the easiest and most harmless for the patients. Probably, H.pylori strains in Iran are different from the strains in other countries. Hence, it seems neccessary to design a specific serological test to recognize and identify different strains of bacterial antigenic proteins of Iranian patients.
Since the most manifest and specific to these bacterial antigens are the "Outer Membrane Protein" (OMP), therefore, the first necessary step is to separate and purify H.pylori OMP and then to identify antigenic proteins.
In this study, we received bacteria colony that belonged to 15 patients with gastric or duodenal ulcer, which had been growed in blood agar or brucella broth. After processing such as washing, freezing and defreezing, sonicating, centrifugation with high speed (10,000 g) and treatment with sarcosyl, the sarcosyl insoluble fraction was extracted. Sodium Dodecyl Sulfate - Poly Acrylamide Gel Electrophoresis (SDS-PAGE) was preformed. From all 15 OMP specimens, we isolated protein bands.
The first two bands with higher MW, were major bands and the two lighter bands were the minor bands. Approximate MW of these 4 proteins are equal to 67000, 61000, 30000 and 17000 dalton

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The author conducted 1-year study investigating the causation and management of eye trauma at Farabi Eye' center. All patients sustaining eye injuries who were evaluated by ophthalmology service over one year interval were included.
. A formal questionnaire was completed with details of the injuiy being obtained. An ophthalmologic examination was performed on each patient, and examination findings and diagnostic tests obtained, diagnosis and treatment were recorded and analyzed.
Nine hundreds and sixty-one injuries (65%) occured in males and 503 (35%) in females. The average age was 30 years. This study included 1464 eye injuries.
Four handreds and eighty-five (nearly 30%) of patients were in pediatric age group. Seventy percent of all patients were admitted within 24 hours of their injury. Fourty percent of all injuries occurred in the street, 30% at home, 15% at the work place , the rest either in school or sport field.
Among those older than 65 years of age, 70% of injuries were the result of fall. Seventy percent of all eye injuries were caused by blunt trauma. Diagnosis and management were recorded.
Conclusions : Tehran and other metropolitans population is more likely to sustain eye trauma as the result of an assault and is less likely to be involved in a work- or sports-related one.
Given poor compliance without patient management and follow-up, aggressive primary management may be indicated to optimize visual outcome

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Post partum haemorrhage (PPH) and retained placenta are the most common serious abnormalities encountered during the third stage of labour. PPH is one of the most common causes of mortality in childbirth, particularly in developing countries. The incidences of PPH and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction (CCT). Weather such treatment is valuable is open to question because of the lack of clinical and physiological studies. Unfortunately, oxytocic drugs are not available to about half the women of developing countries, who do not deliver under the care of a trained midwife. We know that sucking stimulates uterine contractions in lactating women. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast-feeding and again within 3 min of the start of sucking. Traditional birth attendants (TBAs) do not have the skill to administer injectable oxytoxics. It has become the practice in some TBA training programmes to teach that the risk of PPH can be reduced if the mother puts her baby to the breast immediately after delivery. Objective: To determine the effect of sucking immediately after childbirth on the length of 3rh stage and amount of bleeding in the first day. This is a semi-experimental study. It was done in Tehran'e Mirzakochak hospital. 100 women received oxytocin intramuscularly and 120 women were placed in sucking group. Then the lenghth of 3rd stage and amount of bleeding in the first day was compared between two groups. Results: The duration of the third stage and number of pads different between oxytocin group and sucking group (4.42 vs 6.08 min) and (10.58 vs 11.72 number). As for the, parity, gestational age, maternal systolic and diastolic blood pressure, infant weight and hight, the results showed no significant difference between the groups. As for the, maternal age, the results showed differed significantly between the groups. As for the gestational age, the results of the research showed that between the gestational age and the duration of the third stage, there was a reverse correlation in multipare women. So when gestational age decreases the duration of third stage will be longer. As for the maternal age, parity, systolic and diastolic blood pressure, infant weight, infant hight, infant sex, the results showed that there was no correlation between these and the duration of the third stage.

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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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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.

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

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

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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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Erectile dysfunction is an important problem for men and their families which has an organic cause in about 50 percent of cases. When there is a vasculogenic etiology for this defect, radiologic assessment is unavoidable. Cavernosometry and Cavernosography are ultimate procedures for diagnosis of venous leakage. There is no reliable data about this defects in Iran. The objective of this study was to determine the rate of venous leakage in patients with erectile dysfunction by Pharmarco-Cavernosometry and Cavernosography. In this case series study, 100 patient with erectile dysfunction who referred to radiologic ward in Sina hospital was selected and Pharmarco-Cavernosometry and Cavernosography were conducted for them. In Cavernosometry, after injection of Prostaglandin E1 and salin normal infusion into corpus covernosum, the pressure was determined. In cavernosography, diluted omnipaque was injected and venous leakage and other defects were recognized. Myoclinic's criteria was use for analysis of the results. Mean age of patients was 35.6±11.6. Most of the cases were in 20 to 40 age group. The frequency of venous leakage based on 50 mmHg reduction in pressure (from 150 mmHg), after 30 seconds discountinuance of normal salin infusion was 90 percent. This figure based on the ratio of Maintenance Flow Rate to Induced Flow Rate, was more than 92 percent. The frequency of venous leakage according to Cavernosography was 89 percent. There was no significant side effects in any of cases induced by procedures. The results of study, shows the high prevalence of venous leakage in patients referring for erectile dysfunction.

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Erectile dysfunction is an important problem for men and their families which has an organic cause in about 50 percent of cases. When there is a vasculogenic etiology for this defect, radiologic assessment is unavoidable. Cavernosometry and Cavernosography are ultimate procedures for diagnosis of venous leakage. There is no reliable data about this defects in Iran. The objective of this study was to determine the rate of venous leakage in patients with erectile dysfunction by Pharmarco-Cavernosometry and Cavernosography. In this case series study, 100 patient with erectile dysfunction who referred to radiologic ward in Sina hospital was selected and Pharmarco-Cavernosometry and Cavernosography were conducted for them. In Cavernosometry, after injection of Prostaglandin E1 and salin normal infusion into corpus covernosum, the pressure was determined. In cavernosography, diluted omnipaque was injected and venous leakage and other defects were recognized. Myoclinic's criteria was use for analysis of the results. Mean age of patients was 35.6±11.6. Most of the cases were in 20 to 40 age group. The frequency of venous leakage based on 50 mmHg reduction in pressure (from 150 mmHg), after 30 seconds discountinuance of normal salin infusion was 90 percent. This figure based on the ratio of Maintenance Flow Rate to Induced Flow Rate, was more than 92 percent. The frequency of venous leakage according to Cavernosography was 89 percent. There was no significant side effects in any of cases induced by procedures. The results of study, shows the high prevalence of venous leakage in patients referring for erectile dysfunction.

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The evaluate the diagnostic value of image guided Fine Needle Aspiration (FNA) in breast lesions, the cytologic results of 401 patients were studied. All patients had either unpalpable masses or lesions who were hardly possible to localize by palpation and FNA was performed by single radiologist under ultrasound guide in all cases. The cytologic results were divided into four categories (inconclusive, benign, suspicious and malignant. Pathologic results were also divided into two categories (benign, malignant) and additional statistical analysis was conducted to find te cut-off point between benign and malignant cytologic results. Following cytologic results were obtained: 7.98 percent inconclusive, 67.83 percent benign, 10.97 percent suspicious, 13.22 percent malignant. Of the patients undergone breast operation after image guided FNA, the surgical pathology of 128 cases were found. In this study the sensitivity, specificity and accuracy of image guided FNA were calculated as 94.34 percent, 82.67 percent and 87.5 percent respectively. Person's coefficient analysis revealed significant correlations between FNA diagnosis and surgical pathology (P<0.001, r=0.66). Thus, image guided FNA of breast lesions can be a reliable substitute for the excisional biopsy breast operation in many patients.

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Tumor angiogenesis shown by Microvessel Count (MVC) or Microvessel Density (MVD), is assessed by several studies as prognostic factor in some types of tumors, and also in colorectal carcinoma. This article is payed to correlation between clincopathologic factors and tumor angiogenesis. In this study, immunohistochemical techniques are used for vascular evaluation in specimens from twenty-nine colorectal carcinoma, and stained for Factor VIII-Related Antigen (F8RA) by using monoclonal antibody. Uni and multivariate analysis disclosed that total MVC was higher in tumor [76.3±33 (×100=2.5 mm²/field) and 29.8±11 (×200=0.785 mm²/field)] than in normal tissue [37.7±15.8 (×100) and 17.6±7.8 (×200)], (P=0.022, P=0.000009). Microvessel quantification was significantly higher in stage D (115±36.6, ×100 and 26.7±6.4, ×200, P=0.002 and P=0.04). In this study MVD has correlation with vascular invasion (P=0.024, ×100 and P=0.007, ×200), the mean tumor vessel count although was increased with clinicophatologic findings such as age<60 years, male, right colon involvement, infiltrating type, mucinous carcinoma, transmural penetration, grade III, lymphatic and perineural invasion, but was not statistically significant. Lymph node and hematogenous metastasis and size of tumor also, was not important. As a conclusion, MVD was increased in tumor and has shown correlation with metastasis, and vascular invasion. Resulting angiogenesis increase risk of metastasis.

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This study is carried out to determine effective risk factors for early death and their causes in those who died due to intra cerebral hemorrhage within 30 days.
Materials and Methods: From patients who have been admitted in Neurologic ward of Imam Khomeini hospital in Tabriz, We enrolled 100 patients with intra cerebral hemorrhage and the causes and risk factors effective in early death were evaluated among these patients by age, sex, blood pressure, level of consciousness, location of hematoma, CT findings and other risk factors.
Results: We enrolled 100 patients who died due to intra cerebral Hemorrhage among 358 patients with I.C.H, 62 male and 38 female, with mean age of 60.8. The time course of hospitalization was 4.5 days. The most important risk factor was hypertension on 90 percent of patients, previous C.V.A on 28 percent other risk time of admission in 66 percent of patients with G.C.S under 8.
Conclusion: Hypertension was the most common and important risk factors and male gender and age were the second risk factors for early death with intra cerebral hemorrhage.

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"Arterial Thromboembolism" is the most common cause of "Acute Arterial Ischemia" of extremities. In this study, It is attempted to collect retrospectively some documentary information of all "acute arterial thromboembolic occlusions of the limbs".
Materials and Methods: In descriptive retrograde study in Sina General hospital, all related records in this regard were collected from March 1991 to March 1997. To reveal the statistical outcomes and analysis the associations between them as well, the statistical tests like nonparametric ones were employed.
Results: Total number of the cases was 24 with " Acute Thromboembolic Arterial limb Ischemia" (3 in upper and 21 in lower limbs). The results were as follows: Female to male ratio =1/2, "Range of Age": 34-91, "Mode"=8th decade of life, "Mean"-64.48, "Etiology" Cardiac Origin in majority of cases ("A.F" in 57 percent) and Unknown Origin in 1/4 of cases. "Pain" was find in 95 percent, Grade HI ischemia in only 38 percent of patients on presentation and the others in Grade n. The most common "site of embolic occlusion" was "Femoral Ar." (76 percent). "Simultaneous Embolic Events" were fined in 29 percent. "Embolectomy" was performed in 79 percent (84 percent success rate) and "Primary Amputation" in 12.5 percent. "In hospital Mortality Rate" was fined in 24 percent and "Limb Salvage rate" in 68 percent. In conclusion, there were some logic relationship only between "Limb Salvage rate" and "Ischemic Grading" and also "Delayed diagnosis". There was also some significant direct relationship between "Mortality rate" and "Concomitant Embolic events".
Conclusion: This study was an explorative one that paves the way for further complementary investigations. Although there are many recommendations due to upgrading knowledge, attitude and practice of physicians as well as lay people Besides, the upgrading of educational and curative facilities should not be neglected.

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Background: The first step in assessment of children with precocious puberty is to determine whether the cases are of benign nature or have more serious causes. It seems that two criteria of "height age" and "bone age" are helpful for this decision.

Materials and Methods: To evaluate the usefulness of those criteria, a retrospective study of 74 children (50 girls and 24 boys) with precocious puberty whom be visited between years 1993-2000 was performed. According to the medical history, clinical signs, and certain laboratory tests (in some cases) the patients were classified in different groups of precocious puberty.

Results: Height age and bone age were determined for all the patients. Those patients for whom treatment of any kind was required were also identified. The results of the statistical analysis of the findings were as follows: - No clear relation between "height age", "Bone age", type of precocious puberty, and the need for treatment was found in the male patients. All (100 percent) of the boys needed treatment. - Among the female patients, those with progressive complete precocious puberty (16 patients) had a significantly advanced height age and bone age comparing to the other groups. There was also a direct relation between the need for treatment and the advanced height age (11 patients), and between the need for treatment and the advanced bone age (10 patients).

Conclusion: All the boys with precocious puberty should be evaluated thoroughly because they usually have a serious disorder which needs treatment. However among the girls with precocious puberty, those with benign causes can be detected using the criteria of height age, bone age, and clinical signs. Therefore, unnecessary laboratory tests and treatments can be avoided in a percentage of these patients.

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Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving.

Materials and Methods: In our study CPT was compared with endotracheal tube (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, Iaryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia.

Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (P<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (P<0.05).

Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 CmH2O.

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Background: Using the systemic opioids in pain relief has been known during the history. Several evidences indicate that exogenous opioids such as morphine can produce anti-nociceptive effects by interacting with local opioid receptors in peripheral inflamed tissues in addition to analgesic effects of morphine, less clear is potential anti-inflammatory effects of it.

Materials and Methods: In the present study we examined effects of intra-peritoneal (i.p.) injection of morphine (7 mg/kg) on carrageenan (0.05 ml, 3% W/V in saline) induced paw edema in mice.

Results: Carrageenan induced paw edema were measured by mercury plethysmometer and was maximal at hour 3 and pretreatment with morphine could reduce the edema significantly. At the same time the serum levels of interleukin-1 alpha (IL-1α) were increased. Pretreatment with naloxone (2&10 mg/kg, i.p.) at 45 min before and 165 min after carrageenan, respectively, blocked the effects of morphine sulfate on edema in each groups. Pretreatment with naloxone abolished morphine anti-inflammatory while decreased IL-1α serum levels, significantly. Although, administration of anti mouse IL-1α (7, 14 & 28 µg/mice, i.p.) abolished morphine anti-inflammatory effects.

Conclusion: These findings showed that increase in serum levels of IL-1α play important roles in anti-inflammatory effect of morphine. The results indicated that morphine exert significant anti-inflammatory activity. Presumably, the anti-inflammatory action of morphine may be due to change on the cytokine production and/or release by host immune system.

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Introduction: Succinylcholine is a depolarizing muscle relaxant, which has been used extensively in anesthesia to produce muscle relaxation. The present study was done with the aim of comparing Fasciculation and postoperative myalgia after injection of two different doses of Succinylcholine (1.5 mg/kg and 3 mg/kg).

Materials and Methods: In this study which has been conducted in the form of Randomized double blind study in Tehran Shariati Hospital in the year 2000, 50 male patients in two groups (25 in each) with ASA I&II, age between 18 to 65, were candidate for an elective surgical repair of inguinal hernia received a standard anesthetic technique, including one of the two doses of Succinylcholine.

Results: After collecting data it has been considered that the average difference of two respective groups is meaningful in terms of fasciculation (P<0.05), but not in terms of myalgia (P>0.05).

Conclusion: we came to the conclusion that, firstly, the percentage of myalgia after the injection of succinylcholine is totally low and with the increase of the dose of medication from 1.5 mg/kg to 3 mg/kg the very percentage does not change considerably. Secondly, regarding fasciculation the increase of the dose of medication from 1.5 mg/kg to 3 mg/kg causes the decrease of the average limit of fasciculation. This decrease is very obvious in server fasciculation. As a matter of fact no relationship was found between decrease in fasciculation and change in myalgia.