Tehran University Medical Journal

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Hyperthyroidism is often accompanied by diverse types of neuropychiatric complications. To demonstrate these complications we studied 500 hyperthyroid patients, who developed neuropsychiatric complications of hyperthyroidism for which other causes of these neuropsychiatric findings were carefully excluded. The patients were 15 to 65 years old (female to male ratio was 5:1), most of the cases were in third and fourth decades of life. Nervousness, tense dysphoria, insomnia and anxiousness were among the most common psychiatric complications, and tremor, hyperreflexia, thyrotoxic myopathy, thyrotoxic periodic paralysis were the most common neurologic complications. Therefore any physician, wether he or she is a general practitioner or a specialist must be aware of these diverse complications, because these neuropsychiatric complications can lead to the diagnosis of hyperthyroidism and treatment of these potentially serious complications.

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This is a retrospective study of the treatment of 68 cases of spine injuries to make an objective assessment of clinical and radiologic results and to introduce the good results of C.D segmental instrumentation. 68 patients, with an average follow up of 36 months, who suffered from thoracolumbar, lumbar and cervical spine fractures and dislocations, underwent surgical and nonsurgical treatment according to the clinical and radiological datas. Patients with more than 50 percent of loss of body height, more than 50 percent of canal compromise and neurologic deficits underwent surgery. With the C.D instrumentation, it was possible to provide solid, short internal fixation with restoration of the sagittal profile without loss of correction. For patients eith heavy works, over-weights and especially, shattered vertebral bodies, to prevent loss of correction, combined posterior and anterior interbody fusion is highly recommended.

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Among the 708 patients who were admitted in the pediatric intensive care unit (PICU) of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L). 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH) (27%), water intoxication (22%) and extrarenal losses (20%)

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The present research evaluated the teaching of treatment hospitals of medical sciences universities in Tehran. The aim of research was a clinical diagnosis on particular nature of medical specialty, sub specialty fields promoting the quality of medical education and offering special services in teaching hospitals in comparison with standard measurements. An effective method in recognizing the strong and weak points of teaching and treatment services in teaching hospitals is choosing the Accreditation Model, that played a great role in this research. The steps to perform the model are as follows: 1) At the beginning, the medical education system criteria was mentioned according to model consisting of five parts: input-process-intermediate output-final input and outcome. The evaluation factors are: 1- Managing, treatment, teaching and research sections. 2- The theoretical, practical and experties of the faculty members. 3- The educational progress of assistants. 4- Resources, facilities, equipment and financial services in teaching of treatment center. 5- The ability to carryout teaching of treatment and clinical projects. 6- Patient satisfaction. 2) To determine if the variables are standard, the national and international documents (teaching standards of Cebec, Canada) were studied to compare the standards to the medical education system in medical hospitals. The viewpoints of board of directors in teaching hospitals were gathered. At last, the final model was devised according to the viewpoints and the final standard confirmed, 96.7% positive votes. 3) To determine the percentage role of evaluation factors, called the basis the investigation forms were filled by the managers of the hospitals according to interview and Delphi technique. The importance of each basis was investigated and confirmed in two stages in teaching hospitals in Tehran and all over Iran, according to the information. 4) According to the standards, many questions were constructed. The board of directors in teaching of treatment sections in every selected hospital determined the rank of each criteria on the hospital where they worked. After gathering the data by the investigator and determining the grades, the following linear-formula will be applied and the criteria to judge a teaching hospital on its credibility will be available. Y=a1x1+a2x2+... akxk. 5) Based on the data collected and the application of the linear formula, the hospitals in the study proved to comply with the accreditation standards. They were rated as satisfactory.

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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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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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Different ossificant materials have been used for induction of bone repair in many studies, and bone matrix gelatin which contains bone morphogenic proteins is one of the best ones. In present study we evaluated the role of this material in acceleration of bone repair in rabbit tibia. A hole of 3.5 mm diameter was made on right tibia of 10 and 12 rabbits as study and control group respectively. In the experiment group, in addition to Bone Wax, we applied bone matrix gelatin in the hole. Radiographic images were taken in days 0, 20, 40 and 53 after operation. In 6 rabbits of each group, photographic pictures were also taken after exposure of entire bone. In 6 controls less degree of restoration were seen on day 53. In 4 experimental animals restoration were completed by this time and in 2 speciments repair processing were better than controls. This results shows that bone matrix gelatin can be used as a accelerator of bone repair.

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Tubal ligation is one of the most effective and reliable methods of contraception and of successful program of birth control in Iran. Present study was done to evaluate factors affecting risk of complications during tubal ligation surgery. We studied 1780 women that had tubal ligation in 13 hospitals in Tehran during the years 1993-95. Data on operation were collected by questionnaire and analyzed using logistic regression method. Risk of complications was increased in women had had operation after vaginal therapy, in luteal phase, after cesarean section and in follicular phase, respectively. Modified pomery, pomery and parkland methods of operation were ascendingly related to increased risk of complications. Age, history of pelvic pain, method of anesthesia, incision size and time of operation were not significantly correlated with complications. Frequency of complications was higher in women that had other procedures during surgery. We suggest that tubal ligation be done after vaginal delivery and by modified pomery method.

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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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Difference aspects of multinomial statistical modelings and its classifications has been studied so far. In these type of problems Y is the qualitative random variable with T possible states which are considered as classifications. The goal is prediction of Y based on a random Vector X ? IR^m. Many methods for analyzing these problems were considered. One of the modern and general method of classification is Classification and Regression Trees (CART). Another method is recursive partitioning techniques which has a strange relationship with nonparametric regression. Classical discriminant analysis is a standard method for analyzing these type of data. Flexible discriminant analysis method which is a combination of nonparametric regression and discriminant analysis and classification using spline that includes least square regression and additive cubic splines. Neural network is an advanced statistical method for analyzing these types of data. In this paper properties of multinomial logistics regression were investigated and this method was used for modeling effective factors in selecting contraceptive methods in Ghom province for married women age 15-49. The response variable has a tetranomial distibution. The levels of this variable are: nothing, pills, traditional and a collection of other contraceptive methods. A collection of significant independent variables were: place, age of women, education, history of pregnancy and family size. Menstruation age and age at marriage were not statistically significant.

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In this study we tried to assess the incidence rate of shunt complications and it's association with age, sex, location of shunt, duration of surgery, and so on. For this purpose in a prospective study, 82 cases of hydrocephalus after shunt insertion, during the period of two years (1375-1377) in Shariati hospital were selected and all the complications were evaluated. From the patients, 39 cases were female and 43 were male. The range for age was 15 to 73 years with mean age of 16.67 years (SD=22.77). In 22 cases the complications of shunt surgery were observed. Shunt complications in our patients were infection (8.6 percent) and mechanical failure (17 percent). The mean duration of time for onset of complications was 3.11±4.3 months. The complication rate at the beginning (under two) and the end of life was much higher. In trying to reduce the rate of shunt complications, it is necessary to define and understand the causes of these problems they often arise from multifictorial etiologies.

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Dorsal traumatic dislocation of metatarsophalangeal joint of great toe is a rare injury. Ability to reduce the dislocation by nonoperative measures depends largely on the type of dislocation and involvement of the sesamoid complex. There are three basic types of dislocations. Type I cases are usually irreducible on closed reduction, the metatarsal head being incarcerated by the conjoined tendons with their intact sesamoids. In type II, the sesamoid complex disruption usually pemits closed reduction. We present an irreducible dislocation of the first metatarsophalangeal joint with fibular sesamoid fracture in an 80-year-old man. In addition, he had a concomitant dorsal dislocation of the second MTP of the same foot, to our knowledge only one case with this injury was reported in the literature.

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Job stress results from a mismatch between job requirements and capabilities, resources, or needs of the worker. Physiological, psychological and behavioral outcomes caused by job stress not only hurt the person but also impose expensive costs on organizations. Firefighting is a job that exposes workers to job stress. The purpose of this study is to determine the level of job stress and some related factors in firefighters of Tehran safety services and firefighters organization. This cross sectional study includes 155 male firefighters whom had selected randomly. In this research we used Leiden University Questionnaire. Also Karasek Questionnaire is used for classification of workers according to karasek’s model. Collected data were analyzed by spss9 software. The final grade of firefighter’s job stress shows a significant positive relationship with second job and a significant negative relationship with age. The level of job satisfaction have a significant negative relationship with job insecurity and lack of meaningfulness, and a significant positive relationship with skill discretion, social support supervisor and social support co-workers. According to karasek classification this job is grouped in active not in high strain grup. The highest level of job stress was seen in physical exertion and hazardous exposure factors. Also in work and time pressure factor, job stress level is high. But job stress is in a moderate or low level in other factors. The level of job stress in younger firefighters and in individuals with a second job indicate a significant increase. However, in western country’s studies, this job is classified as high-strain but in this research it is classified as active group.

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Introduction: For the time being we have considered that the myocardial infarction is an increasing event in Islamic Republic of Iran and there are many procedures and methods which can help us to diminish the number of death from this ongoing event. The main aim of this research is to determine the survival rate in those patients who have had acute myocardial infarction and the association of it with different variables.

Methods and Materials: The present research is a descriptive case-series study which evaluates the 100 cases of acute myocardial infarction who had been admitted in Tehran Emam Khomeini Hospital during the year 1999.

Results: The mean age of patients was 57 years. The peak of attack rates was in spring and autumn. Investigating of the past history of these patients reviled that 41 percent had been smokers, 63.5 percent have had the history of previous ischemic heart disease, 41 percent have had hyper cholestrolemia, 34 percent had hypertension, 18 percent had diabetes mellitus, 9 percent had mitral rigurgitation and 9 percent had heart block. The Survival rate in our study has been calculated 68 percent in first 28 days of disease.

Conclusion: In our study we concluded that there is significant correlation between survival rate and past history of hypertension, ischemic heart disease, tobacco smoking and clip classification.

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Introduction: Children with coronary renal failure had problems with their catch-up growth. The aim of this study was the Assessment of catch-up growth of children after renal transplantation by analyzing the 6 months changes in height deficit and height standard deviation scores (SDS) on age, sex, initial height deficit, initial SDS, graft function, renal failure duration and renal transplantation duration.

Methods and Materials: Between 22 September 1998 and 2000, 25 pediatric recipients followed up quarterly for height in the Labafi-Nejad hospital. Data on height submitted at each 6-month follow-up were converted into height and SDS. All the results were analyzed by simple and multiple regression and t-test.

Results: 68 percents were male and 32 percent were female Mean age at transplantation was 10.39±2.95 SD years. The average duration of renal transplantation was 20.7±8.96 SD months. The aerage of height deficit was 20.7 cm (±10.55 SD) and SDS -3.5 (±1.72 SD) at the time of renal transplantation. The height deficit was more significant in the patients with tubulopathy. Catch-up growth observed at month 12. That was more obvious in females, in patients with tubulopathy disorders, in preemptives and in all three age groups. Simple and stepwise regression analysis showed that at month 12 only initial height deficit (P<0.05) and at month 24, only sex (P<0.05) were independent predictor of improved height post transplantation. Catch-up growth were seen in more student patients and girls. This may be the result of puberty spurt that occur two years sooner in girls than in boys.

Conclusion: In this study we concluded that the renal transplantation alone is not sufficient measure for correction of catch-up growth in renal failure children and because of that the other treatments should come under consideration.

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Complications of Coronary artery disease remain the most common cause of morbidity and mortality after vascular surgical procedures. Goldman risk factor analysis has been suggested as peri-operative noninvasive screening method to detect significant coronary artery disease in emergent vascular procedures.
Methods and Materials: In this study, the accuracy of the Goldman scale was assessed with regard to the development of cardiac complications such as asymptomatic ischemic change in ECG, arrhythmia, myocardial infarction and cardiac death. We studied 100 patients that were required emergent vascular procedures from 2000-2001. Data about perioperative complications were extracted and analyzed using SPSS computer program.
Results: Our study indicated there is not statistical correlation between cardiac death, infarction, arrythmia, ECG change, age, sex and cardiac class.
Conclusion: We concluded that Goldman scale could not be regarded as a screening method to predict peri-operative cardiac complications in emergent vascular procedures.

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Unstable angina (UA) is situated in a spectrum with myocardial infarction (MI) at one end of it and stable angina at the other end. To determine the clinical and paraclinical characteristics of unstable angina this study was designed.
Materials and Methods: Two hundred patients with definite UA who were hospitalized at cardiac care units (CCU) in Yazd were enrolled in this cross- sectional study. Clinical and para-clinical characteristics including class of severity of angina, clinical circumstances, drugs, risk factors, changes in ECG, and patient's condition at the time of leaving hospital were evaluated.
Results& Conclusions: The average of age of patients was 61.85 years and 57% of them were female and 43% were male. The most prevalent risk factor among men was smoking (48.8%) and among women was hypertension (62.8%). According to Braunwald suggestion, patients were divided into 3 classes based on the severity of their diseases. Frequency distribution of patients in classes I,H and III were 24.5%, 4% and 71.5%, respectively. Normal ECG, was observed in 24.5% of subjects at the time of hospitalization and in 67% of patients when leaving hospitals. Frequency distribution based on the risk stratification was 22.5%, 58.5% and 19% in the low, medium and high risk groups, respectively. During hospitalization, acute myocardial infarction (AMI) was seen in 3.5% of individuals that majority of them belonged to class III of angina.

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Background: Role of cytokines in regulation of immune system has been the subject of studies and clinical investigations. One of these cytokines, IL-2 has been well initially introduced as T cell Growth factor (TCGF), but subsequently it appeared that IL-2 is one of the important mediators affecting growth, development and activity of T, B, NK and LAK cells. Nowadays this cytokines has extensive use in clinical and research fields of immunotherapy of cancer and infectious disease.

Materials and Methods: In this study, we used Jurcat cell line for production and partial purification of IL-2 106 cell/ml were stimulated by PHA (1 µg/ml) and PMA (10 µg/ml) at the third day of the culture and then supernatant were collected after 22 hrs.

 Results & Conclusion: In order to obtain sufficient amount of IL-2 and eliminate interfacing materials, supernatants were concentrated using Amicon 10 and 30 PM filters. After concentrating, bioassay and Elisa were performed to detect the biological activity and amount of produced IL-2. Reversed phase-HPLC was used to confirm the IL-2 identity and purification.

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Background: Epidural injection of the drugs such as opioids has rather been a successful method in controlling post operative pain.

Materials and Methods: In a clinical trial study, 50 Female patients, in a range of 20-40 years old and ASA class I, who were scheduled for gynecologic operation were investigated. They were randomly divided in two groups. Before induction of general anesthesia, an epidural catheter was placed for each patient. Sixty minutes after the end of operation, a 15-ml solution containing 50-microgram clonidine was injected through the epidural catheter in the first group. In the second group, a similar volume solution containing 50- microgram fentanyl was injected. The catheter was removed after all the patients were followed for 4 hours and their pain was assessed by VAS (Visual Analogue Scale) method.

Results: Our findings revealed that the clonidine group had more intense pain however they had fewer complications than the opioid group.

Conclusion: We concluded that although clonidine might act as an analgesic drug, but epidural injection of a single dose of 50 microgram of the drug could not be effective enough for postoperative analgesia.

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Background: Adolescence (10-19 years) is one of the most challenging periods in human development. A second period of rapid growth occurs during the teen years. Not much information is available on the effect of the socio-economic status on the outcome of nutrition education in teenage girls. Objective : The purpose of this study was to determine the effect of socio- economic status on the efficacy of nutrition education in promoting the nutritional knowledge, attitude and practice in first-grade guidance school girls in Tehran.

Material & Methods: A total of 300 students were selected from 11 guidance schools by simple sampling and divided into three groups: 1- guide-book, 2- group discussion, 3- control. The knowledge and attitude data were collected using pre-test and post-test questionnaires and the personal-socioeconomic data were collected using general questionnaires. The students in group 1 were given the guide-book and required to study it at home, while group 2 students were told to discuss among themselves the contents of the guide-book. The control group was given nothing to study or to do.

Results: Nutrition education did not have a significant effect on the increase in the attitude score in the students whose grade-point average and their mother’s education level were high. (p= 0.13, p=0.29). Only mother’s education level independently from the type of education was associated with the difference of knowledge score means (p =0.07).There was interaction between nutritional education and monthly pocket- money with regard to the increase in the knowledge score (p =0.03).

Conclusion: Overall, exception of monthly pocket money, the effect of education on the nutritional knowledge and attitude was independent from other variables. Only mother’s education associate with the difference of knowledge score means.