Tehran University Medical Journal

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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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Congenital cyst of the pancreas is an uncommon problem in the pediatric patient. The common symptoms at the time of diagnosis have been abdominal mass and pain or fullness, nausea and vomiting. Despite of various paraclinic methods for diagnosis, ultrasound is now recognized as the most effective and best noninvasive method for diagnosis of pancreatic cyts. Surgical intervention is the best mode of therapy. Upper abdominal cystic mass are seen in the fetus and newborn infants. In Amirkabir Hospital, during 12 years from 1981 to 1993, 8 pancreatic cysts have been operated on and only in this case it was congenital.

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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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Increase in the rate of elderly population have persuaded the people and governments of the most developed countries to evaluated and confront the complexity of social, economic, and health issues involved. Increase in the number of aging people is commonly called the aging of society. Currently, in the countries of Western Europe (Germany, France, England, Sweden), the figure of the people over 60 years old comprises 12-15 percent of total population, and according to the forecasting estimate will reach to 25% up to the year 2020. In our country, based on censuses that have been carried out during the years of 1355, 1365, 1375 this figure is 5.12%, 5.25% and 7.67%, respectively. The number of 60 years old persons or over under the supervision of Tehran University of Medical Sciences was 135379 persons, in the year 1376. Due to these demographic changes that is arising from the phenomenon of aging of society, a considerable increase in the incidence of chronic diseases and health requirement of the elderly living in the society happens. This can be translated in terms of more demands in the affiliated fields of nursing, health care and treatment. This study has been proposed to clarify and evaluate the afore mentioned requitements. In this study, the following results can be concluded. Contrary to physical and psychological problems of adulthood, only 25% were aware of assisting economic, health and treatment institution that were available to them. These people were usually suffering from a single to multiple ailments that happen concurrently and ladies were complaining more in this respect. The interesting point in this study is the answer to the question of most basic problems of their life. Many elderly mentioned financial problems the most influential factor in their life. The figures concerning the responses to the question of basic problems of elderly for economic and physical problems were 37.7% and 18.3%, respectively.

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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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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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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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Two factors changed the clinical course of infective endocarditis dramatically: 1) The discovery and evolution of techniques for identifying and treating its microbiologic causes and 2) Valvular surgery. We retrospectively evaluated 43 (33.5%) patients (8 female, 35 male) from 4 to 65 years old of 128 patients with infective endocarditis who underwent surgical intervention. Indication for surgery were: Refractory congestive heart failure 14 (32.5%), prosthetic valves 10 (23.2%), large vegetation 6 (13.9%), recurrent endocarditis 4 (9.3%), ring abscess 4 (9.3%), brucella endocarditis 2 (4.6%), staph aureus endocarditis 3 (6.9%) and recurrent emboli 2 (4.6%). 30 to 50% of patients with infective endocarditis are operated during the active phase of the disease, this percentage is higher in case of aortic valve endocarditis, prosthetic valve endocarditis, some microorganisms such as staph aureus, gram negative bacilli, fungus and brucella. We suggest that internists refer patients for surgical intervention with infective endocarditis as early as possible in the active stage of infection.

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It is generally assumed that local muscular fatigue predisposes the individual to injury. Despite the significance of muscular fatigue and endurance, there are not much dynamic endurance studies for trunk muscles in the literature. Most of them have used isokinetic dynamometer which keeps the velocity of movement constant. In this studies with the help of an isoinertial dynamometer we have assessed the effect of repetitive and fatiguing flexion-extension movements patterns and motor output. 38 female subjects with no history of low-back pain for the 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position, velocity impulse, work and power of each axis. Resistance were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a saggital plane resistance equal to 50% of their maximum isometric extension strength in the upright position. The minimum resistance in the coronal and transverse planes were set-up at 5-7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Immediately after dynamic test another isometric test was performed. A paired T-test procedure was performed among the selected parameters of the 1st middle and last 3 repetition cycles. The selected parameters are range of motion, velocity, torque, impulse, work, power, time interval and time of movement. Also, a paired T-test was performed between maximum isometric strength before and after dynamic test. All the selected parameters were significantly reduced in the saggital plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction of the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structures is located in a more injury prone position, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.

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Lithium is a immunomodulator that can increase immunoglobulins to confront infectious desese. It is also able to increase the production of interleukins, interferon gamma and prostaglandins. We conducted this study to evaluate the correlation between lithium consumption and humoral immunity. Blood samples were obtained from 76 patients under lithium treatment. We classified the patients according to their serum lithium level in to five categories. Using single radial immuno diffusion technique, we measured IgG, IgA, IgM, C3 and C4 levels in the blood samples of our patients and a group of 100 controls as well. Analysis of variance method was used for comparison of groups. We found significant differences between groups in level of IgG, IgA, IgM and C3 (P<0.05). This findings show that lithium has many effects on humoral immunity.

 

 

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Breast cancer is a major cause of mortality in women due to malignant diseases and is the most prevalent type of cancer in western countries. According to investigations which has been done in Iran so far, the prevalence of disease in our country is also very high, therefore complete attention to clinical and pathological findings of this disease would be extremely essential. In this study, the direct relationship between axillary lymph node involvement and the aggressiveness of invasive ductal carcinoma has been brought into consideration. This study is a case series of 90 patients which all of them have had radical mastectomy because of breast cancer and all their samples has been referred to the center of pathology of Imam hospital. Based on modified Bloom-Richardson grading, all the samples have been graded. The study of all lymph node samples related to above cases has also been conducted along with the main study. The most frequent ages of disease was 31 to 40 and left breast had most involvement. From all cases, 12.2% were in grade I with 27.2% lymph node involvement, 66.7% grade II with 73.4% lymph node involvement and 21.1% in grade III with 100% lymph node involvement (P=0.00008). Based on statistical analysis we concluded that the axillary lymph node involvement in breast cancer is strongly associated with the aggressiveness of invasive ductal carcinoma. This important point should not be neglected in planning for treatment of this kind of disease.

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Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

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This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001). Other important causes were, age of patient at surgery (P value=0.04), pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04). Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

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Background: This study was performed in order to detect the frequency of different types of precocious puberty, predisposing factors and to show which group of patients need to treatment.

Materials and Methods: In this study, 74 patients who referred to pediatric endocrine clinic of Imam Khomeini Hospital and private office from 1993-2000 were assessed. A complete history was taken and physical examination was done in all patients by pediatrics endocrinologist. Bone age was done in all patients and specific hormonal tests were measured in some of them.

Results: Among 74 patients, 50 cases (67.6 percent) were female and 24 cases (32.4 percent) were male. The age of the patients was between 0.8-10 years old with mean 5.37 year. 75 percent of male patients had central (complete) precocious puberty and 25 percent had peripheral (incomplete) precocious puberty. 40 percent of female patients had central precocious puberty, 46 percent had premature telarche, 8 percent had premature pubarche, 2 percent had premature menarche and 4 percent had other kinds of precocious puberty (one case with hypothyroidism and one case with Mccune-Albright syndrome). 10 percent of female patients with central precocious puberty had predisposing factor and 90 percent of them were idiopathic. 38.8 percent of male patients with central precocious puberty had predisposing factor and 61.2 percent of them were idiopathic. 100 percent of male patients with peripheral precocious puberty had congenital Adrenal Hyperplasia. 38 percent of female patients and 100 percent of male patients needed to treatment.

Conclusion: According to this study and references, precocious puberty in female usually benign but in male patients it should be evaluated thoroughly because they usually have a serious disorder which needs treatment.

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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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Introduction: Thyroid diseases are one of the most common endocrine diseases. Incidence of thyroid diseases in women is ten times more than men. Menstrual irregularities and fertility is occasionally the first sign of thyroid diseases.

Materials and methods: In a prospective study, 325 thyroid patients were evaluated in Emam hospital. Incidence and type of menstrual irregularities were evaluated in these patients.

Results: 55.8 percent of hypothyroid patients had normal pattern ob bleeding. 44.2 hyper thyroid patients had menstrual irregularities which were in the form of oligomenorrhea and 41.7 percents of hypo-thyroid patients were irregular in the form of polymenorrhea, oligomenorrhea and menorrhagia.

Conclusion: In these patients, menstrual irregularities cured by treatment of thyroid diseases and reduced surgical interventions.

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Spontaneous pneumothorax is a medical condition that potentially may be dangerous. Although several methods for management of this problem have been propounded, there is a great disagreement among the specialists about how to treat it and when more invasive treatments are indicated.
Materials and Methods: This study carried out in two phases. In first phase, 26 patients who had admitted to Imam Khomeini hospital from March 20, 1996 to March 19, 2000 and 50 patients admitted to Baqiatallah hospital between March 20, 1992 and March 19, 2002 with the diagnosis of spontaneous pneumothorax were studied retrospectively. In second phase, these patients were followed up.
Results: 39 patients (51.3%) had primary spontaneous pneumothorax, 35 patients (46.1%) secondary spontaneous pneumothorax and 2 (2.6%) neonatal spontaneous pneumothorax. 67 patients were male and 9 patients were female (male to female ratio: 7.5/1). Mean age of the patients was 35±20 years. Age peaks were the age group between 20 to 25 years old and age group more than 60 years old. Conducted treatments were observation in 3.9%, simple aspiration in 2.6%, thoracostomy alone in 81.6%, thoracostomy and chemical pleurodesis in 2.6%, thoracotomy and mechanical pleurodesis in 3.9%, thoracotomy and pleurectomy in 5.3% of cases. Mean duration of hospitalization was 8.9±7.3 days. Relapse of pnemothorax was seen in 36.9% of the followed patients. Mortality was 17.4% and all died patients had secondary spontaneous pneumothorax.
Conclusion: It seems that the management of spontaneous pneumothorax should be re-evaluated and the exact indications for conservative or more invasive methods of treatment should be defined.