Razi Journal of Medical Sciences
Year:2004 | Volume:11 | Issue:40|Papers Count:25

Tuberculosis of vulva is a rare form of genital tuberculosis. It may be presented as isolated chronic ulcerative lesions in the external genital without the tuberculosis of the upper urogenital system, thus the diagnosis of this type of tuberculosis may be delayed. The present case is tuberculosis of vulva in a 73-year-old woman with chronic external genital ulcers whose treatment with different drugs was failed. In the clinical study and laboratory evaluation tuberculosis of vulva and cervix was detected and after starting anti-tuberculosis therapy the ulcerative lesions were healed.

The objective of the present study was to evaluate the effect of patellar taping on knee joint proprioception in two groups. This research was based on repeated measurement of quasi-experimental design and non-probability sampling. Active and passive angle reproduction and threshold were performed to detect passive movement on isokinetic dynamometer. After taping, evaluation of tests was repeated and it was found that taping could affect passive angle reproduction in 20-degree angle. Further studies are needed to investigate the effect of patellar taping on proprioception status of PFPS subjects.

Branchial cysts are among the common congenital neck masses. Only a few familial cases of this anomaly have been reported. Bilateral cysts comprise 2-3% of the cases. In this article one case of bilateral second type branchial cysts and fistula is presented.

Sebaceous Nevus of Jadassohn is a hamartoma that is a combination of epidermal, follicular, sebaceous and apocrine gland abnormalities. Classically, several types of malignant and benign cutaneous neoplasms have been associated with this hamartoma. Due to the absence of a complete study in Iran for analysis of sebaceous Nevus (SN) incidence, its associated malignancy and developmental defects, we retrospectively studied a series of 42 cases of sebaceous nevus with clinicopathologic correlation over a 10-year period in Hazrat Fatemeh Hospital. The goal of this study was to detect the correlation between sebaceous nevus and cutaneous neoplasms. Several histopathologic changes related to the age of the patients were found. Most of the patients were over 18 years old (63.2%) and the scalp was the most common location of SN (52.4%). Three cases (7.15%) of basal cell carcinoma and three benign cutaneous tumors (leccrine spiroadenoma (2.4%), 1 trichoepithelioma (2.4%) and 1 inverted keratoacanthoma (2.4%)) arising out of previous SN were found. On the basis of these findings, prophylactic treatment which consists of early excision for preventing the development of the malignancy is recommended for this hamartoma.

Asthma is one of the most common diseases and one of the major causes of morbidities which demands high cost. With improvement in research and management methods, electrolyte disorders have been considered in patients with asthma because these disorders may cause exacerbation of asthma and lead to severe complications and even death. However, it does not seem these disorders are side effects of drugs used by these patients and they may be a part of natural history or pathogenesis of the disease. Thus, due to the importance of these disorders in effective management of the patients, creating new treatment methods, decreasing complications and improving outcome of these patients, this study was carried out on 96 patients with chronic asthma to explore the above-mentioned subjects. Patients neither had hospitalization nor received intravenous aminophyline; oral inhaler and intravenous beta-agonist and intravenous corticosteroid. None of the patients used alcohol or diuretics, was smoker and had co-existing disease. Sodium, potassium, calcium, phosphore and magnesium were measured in all of the patients. 45.8% of the patients were males and 54.2% were females. Mean age of males (49.8±3.5) was significantly more than that of females (41.2±3.1; P<0.05). The only electrolyte abnormality in this study was hypomagnesemia (10.4%). Mean plasma potassium level in patients that received inhalational beta-agonists (3.6 meq/dl) was significantly less than those who did not receive them (4.21 meq/dl, P<0.05). Also, mean plasma calcium concentration (10.4 mg/dl) in patients who took oral steroids was significantly more than those who did not receive them (8.8 mg/dl, P<0.05). In conclusion, hypomagnesemia is the most common electrolyte disorder in patients with chronic asthma, which is not related to drugs used in these patients and may be a part of pathogenesis of this disease. Thus, treatment of hypomagnesemia may be effective in better control of asthma and decreasing its complications.

Carpal tunnel syndrome (CTS) is the most common compression neuropathy. There are many methods for evaluation of CTS. Nerve conduction study (NCS) and Semmes-Weinstein monofilament (SWMs) test are sensitive tests for CTS evaluation, but the correlation between two methods has not been evaluated. The purpose of this study was to study the relationship between the results of SWMs test and NCS on women with CTS. Samples were 56 hands in 33 women with CTS at age of 20-73 years. SWMs test and measurement of secondary variables was done by an occupational therapist and NCS by a physiatrist. Our research method was analytical nonintervention. Variables were: age, BMI, hand length, hand width, length of distal phalanx of thumb, index and middle fingers, distal sensory latency, distal motor latency, sensory and motor amplitude, nerve conduction velocity (NCV), Semmes-Weinstein monofilament and the results of three fingers severity. Data were analyzed by simple regression test and one-way variance analysis. There was a significant relationship between results of SWMs test and NCV (P=0.0002), distal sensory latency (DSL) (P<0.00001), amplitude of sensory (Amps) NCV (P<0.00001), distal motor latency (DML) (P<0.00001) and amplitude of motor NCV (P=0.0042) which was most obvious in the thumb. There was a negative correlation between SWMs test and NCV, Amps, Ampm and there was a positive correlation between SWMs test and DSL, DML. There was a significant positive correlation between SWMs test and severity; this positive correlation was more significant in the thumb than in the other two fingers. Hand dominance did not have any significant correlation with SWMs test and NCS. There is more significant relationship between SWMs test and NCS in evaluation of the first finger which is most probably because the first finger has large area in brain mapping.

Effective doctor-patient interpersonal communication has been emphasized increasingly in recent years. Communication skills are considered as one of the main components of clinical competence, helping precise diagnosis and patient's compliance for therapeutic measures. Through communication skills the physician is able to demonstrate better performance in: breaking bad news to the patient and his relatives, overcoming patient's anger and discomfort and helping chronic and terminal patient. The objective of this study was to investigate how communication skills are learned at Iran and Kermanshah Universities of Medical Sciences using medical students, interns and faculty members in order to help in planning (compiling) programs. In this descriptive-analytic study a self-administered questionnaire was given to target population in 4 major clinical wards (Internal Medicine, OB & Gyn., Pediatrics, and Surgery). After a pilot study, the questionnaire was distributed among target population. The total number of students/interns/staffs at Iran and Kermanshah Universities were 185/127/14 and 63/61/30 respectively. Based on obtained results 53.6% of students were aware of communication skills while 43.7% of students were not aware of these skills which this difference was significant. The first place of experience in communicating with patients was clinical ward (72.5%), hospital classroom (11.5%), emergency and outpatients ranked next (8%). The impact of teacher/resident presence on learning was assessed as very high and high. Observing teacher's behavior and communication with patients got the highest score in both universities (71.4% & 76.7%) and those of the resident's score got the next score (42.9%-66.7%). Less than 5% of scores was allocated to the other methods of learning including: resources, watching films and observation of a role play. The results of this study revealed that teaching and learning methods at both universities should be revised and formal instructional programs have to be implemented. Meanwhile, medical staffs have to play more active role in teaching the skills.

Chronic exposure to N20 environmental pollution may influence the health of personnel working in operating and recovery rooms. Human studies have indicated that chronic exposure to N20 may decrease mental performance, audiovisual ability, and manual dexterity and may also cause adverse reproductive effects like reduced fertility, spontaneous abortion and neurological, renal, and liver diseases. In this study, concentration of N20 in ambient air was monitored in 45 operating rooms and 12 recovery rooms at 12 hospitals. Ambient air was sampled automatically from three breathing sites in operating room (anesthetists, surgeons, operating room nurse) and one site in recovery room (recovery nurse) using a portable infrared spectrophotometer (N20 monitor 3010) with ppm mode. In addition, the effect of air ventilation system on the outcomes was measured. Statistical analysis of the data demonstrated that mean exposure of operating rooms was significantly lower in ventilated than unventilated rooms (P<0.05). Anesthetists showed higher mean exposure than other staff in all conditions, and operating room nurse showed lowest mean concentration. The breathing zone anesthetic concentration of N20 in 100% of sampling exceeded NIOSH recommended exposure limit (REL) for N20 (25ppm). Our data showed that exposure of recovery nurses to N20 was higher than REL of NIOSH but there was not any significant correlation between room air ventilation and the outcomes (P>0.05). In conclusion, proper use of air ventilation, anesthetic gases and scavenging system are necessary for having limited contamination with N20.

Bcl-2, a well-known anti-apoptotic gene, promotes cell viability without cell proliferation. Expression of the bcl-2 oncogene is reported in certain low grade neoplasms including Basal Cell Carcinomas (BCCs). Bcl-2 expression in BCCs is contradictory, with 67-100% immunopositivity being reported. The purpose of this study was to evaluate bcl-2 expression in the indolent variants of BCC, namely superficial and circumscribed subtypes and their aggressive counterparts; infiltrative and morphea-like subtypes. Anti-human bcl-2 monoclonal antibody was used to identify its protein product in formalin-fixed tissue from 33 BCCs. 22 histophathologically non-aggressive and 11 aggressive subtypes were investigated. Quantity of decoration of tumor cells for bcl-2 was graded in the following fashion: 0 to 25%, 26% to 50%, 51% to 75%, 76% to 100%. Intensity of decoration was evaluated as slight, moderate and intense. Bcl-2 expression was observed in all of the BCCs, but high bcl-2 expression was statistically a significant feature of non-aggressive BCCs (P=0.001). Different bcl-2 expression in various non-aggressive and aggressive histopathological subtypes of BCCs suggests that despite the common derivation of these tumors from a primitive basaloid stem cell and a limited potential for metastasis, they form a heterogeneous group of tumors. While the superficial and circumscribed BCCs are indolent slow-growing tumors with high bcl-2 labeling, the aggressive BCCs are infiltrative and morphea-like tumors with low bcl-2 labeling. High expression of bcl-2 may indicate a more favorable prognosis in BCCs.

Persuading physicians to work in underserved areas has been a major concern for health policy makers and there are many programs to fulfill this goal. This research has been done to find the inclination of Iranian physicians to work in underserved areas. This mail survey study was conducted on a random sample including 5482 physicians whose particulars had been registered at Medical Association of Islamic Republic of Iran. A questionnaire including items on employment and unemployment quality and some related factors was filled and the final analysis was done on the 2789 returned questionnaires. Based on the obtained results, there were 1965 physicians (74.1 %, 95% Confidence Interval: 70.8%-77.4%) who declared that they would work in the underserved areas without any special condition or under some special conditions, mainly their income concerns (83.0%) and their employment relationship status (50.3%). Male gender (78.2% vs. 64.2% in females), lower age (36.9 vs. 41.9 mean age in non-inclined ones), and being single (79.8% vs. 72.8 in married ones), having fewer off springs (1.4 vs. 1.7 in non-inclined ones), and matriculation in 1986 and afterwards all were correlated with this inclination. In a logistics model, gender, age, matriculation cohort, and the interaction term between age and gender were the determinants of inclination to work in underserved areas. About three-fourths of Iranian physicians would work in underserved areas if there were some special privileges for them, mainly income and employment relationship. Younger males and those who belonged to the Medical Student Boom Generations had more inclination.

Corynebacterium urealyticum is a normal human skin flora. Mode of transmission is uncertain, but it can probably access to patients' normally sterile sites endogenously. In spite of having low virulence, C. urealyticum has high resistance to antibiotics which allows survival in hospital setting. The incidence of infection caused by C. urealyticum is low. The most common infection is urinary tract infection, but infection in other sites has also been reported. In the present study out of 1338 positive samples, one case (0.074%) with corynebacterium urealyticum was isolated. The bacterium was sensitive only to vancomycine. Although C. urealyticum is not common, it is necessary to identify any diphtheroides micro-organisms from clinical site and to consider their clinical significance.

Entrapment of median nerve can be developed at multiple sites along this nerve. One of the compression sites of median nerve is supracondylar area of humerous. Sometimes struther ligament or spur or both of them are the rare cause of entrapment syndrome of the median nerve. Struther ligament or spur can compress ulnar nerve and/or brachial artery. These cases may have median ulnar nerve or brachial artery symptoms and they are sometimes asymptomatic which can accidentally be detected by radiography. Most commonly, these cases refer with median nerve compression syndrome and they complain about numbness and pain in their upper extremity. Sometimes pain radiates to shoulder and neck in the upper part and to hand in the lower part, that is mistakenly diagnosed as a sign of radiculopathy or other compression neuropathies. The present study is a case report of a 25-year-old man who referred with having pain and numbness in right upper extremity.

The object of the present study was to investigate the effect of membrane stripping at term pregnancy on the duration of pregnancy and labor induction and its complication. Therefore, a randomized trial of membrane stripping at term pregnancy versus vaginal examination alone was performed. In this study 101 patients with 39 completed week's pregnancy were selected. All the patients, 50 patients (membrane stripping) and 51 patients (vaginal examination alone), were similar in age, parity, Bishop score and birth weight. Also, placenta previa was excluded by sonography in all of them. The obtained results showed that the interval between membranes stripping until delivery was not significantly different from that of control group. Therefore, membrane stripping could not decrease the duration of pregnancy in this study and at the same time did not have any effect on membrane rupture, vaginal bleeding, meconium passage, cesarian delivery and puerperal fever. It can be concluded that membrane stripping does not have any significant effect on the duration of pregnancy and probably prevention of post-term pregnancy, but it is safe and without any significant complications.

The aim of the present study was to investigate the correlation between different lower urinary tract symptoms with uroflowmetry parameters in 190 women aged between 15-75 years who referred to our urology clinic during 2000-2002 with lower urinary tract syndroms. A detailed history, physical examination, sonography of the urinary tract with measurement of post void urine residue, frequency/volume bladder chart, urinalysis, urine culture and data of uroflowmetry were obtained for each patient. Uroflowmetry traces were interpreted by two physicians experienced in u'rology and urogynecology. Patients were assigned into 8 groups according to their symptoms. There was statistically significant difference in voiding volume (VV) and average flow rate (QAve) (P=0.025) between the groups. There was no significant difference in maximum flow rate (QMax), voiding time (VT), time to maximum flow, and flow time between groups (P>0.05). The most common pattern of flow was staccato (multi-peak) (43.9%) and then interrupted (21.9%). Only 9.1% of patients had a normal flow curve. On a Liverpool mean flow rate nomogram for females, the mean flow rate of 70.5% of patients lay below the 50th percentile. Voiding volume had a significant relation with age and abnormal emptying (P=0.04, 0.02, respectively). With increasing age there was a decrease in QMax and QAve (P=0.001). Abnormal storage and sensation had a significant correlation with QAve (P=0.051, 0.071 respectively). The correlation between symptoms and uroflowmetry variables was poor. However, most of the patients with lower urinary tract symptoms had abnormalities in uroflowmetry parameters with existence of voiding dysfunction. Voiding dysfunction which is the consequence of pelvic floor disorder can cause urinary tract symptoms. For proper management of urinary tract symptoms, these correlations should be considered.

Desmopressin (intranasal spray or drop, IV injection or tablet) is a drug choice for the treatment of central diabetes insipidus and the intranasal spray is a more common treatment. In the present study, the efficacy and side effect of oral desmopressin was compared with the intranasal spray. This before-after clinical trial study was performed on 14 outpatients (9F, 5M, age 14-50Y) with central diabetes insipidus treated with intranasal spray of desmopressin. Weight, pulse rate (PR), blood pressure (BP) (sitting-standing), biochemical profile, serum electrolytes, 24h urine volume, specific gravity of urine and LFT were measured before and after the study. No clinically significant change was noted with regard to weight, PR, BP, blood chemistry, electrolyte and urinalysis. Reported single adverse effects were headache (43%) in tablet group and dyspnea (7%) in spray group. Both of the drug modes were able to control polyuria and nocturia. The antiduretic dose-equivalence ratio for intranasal to oral desmopressin was 1:18. Spray was reported superior in terms of rapid onset of action and duration of antiduretic action in 100% and 75% of cases, respectively. Tablets were more available and much more easily consumed as reported by patients (86%). In conclusion, treatment with tablets offers a good alternative to the intranasal route, especially in patients with chronic rhinitis or common cold and similar conditions.

Hearing loss is one of the prevalent impairments among older adults and hearing screening is an efficient method to detect hearing impairments. Although the effects of some chronic conditions such as arthritis and heart diseases have been found, there is still limited information regarding effects of hearing impairment on general health and functional capabilities. So far no study has been conducted on hearing screening among older adults especially in nursing home residents in Iran. This random study was conducted from July to October 2003 on 130 elderly residents (50 males, 80 females) over 60 years of age (mean age: 78.90±9.36) living in nursing homes in Tehran province. Pure-tone audiometry screening was conducted based on two ASHA protocols including 25 dB HL at 1000, 2000 and 4000 HZ and 40 dB HL at 2000 and 4000 HZ. Also, a short and simple questionnaire was completed by elderly residents' caregivers which were an indicator for referral for audiologic/otolaryngologic services. (Due to having impacted cerumen, 28 persons were not included in data analysis, and data analysis was finally conducted on 130 ones). Using 25 dB HL, 40 dB HL and completing questionnaire as the pass/fail criteria, 89.24%, 65.39% and 66.93% of individuals failed the screening program respectively. In each of these criteria there was no passing over 90 years of age except one passing in 40 dB HL criterion. Regarding questionnaire, the highest number of failings was related to those questions which assessed communication capabilities of persons. Also, 55.38% partial cerumen in right ear, 60.0% in left ear, 4.61% collapsed ear canal in both ears and 3.07% eardrum perforation were found. With regard to the results of pure-tone screening criteria in this study and also similarity of the results of pure-tone screening at 40 dB HL and questionnaire completion, more than 65.0% of elderly residents had hearing loss further than mild levels and needed otolaryngologic examination and/or conducting more complete audiologic tests and using audiologic rehabilitative services.

Poisoning due to chemical or pharmaceutical products is a relatively common cause of emergency room admissions in our country. These cases constitute between 0.5 to 2% of emergency room mortalities here. Data relating to poisoning in most developing countries is often patchy. Therefore, it was decided to conduct a study on deaths referred to autopsy division of LMO from June 2000 to June 2001 via an analytical descriptive method. The exact cause of death was determined by considering history and physical examination of emergency rooms and/or clinical toxicology division, physical examination and autopsy finding of the corps and laboratory results. The cases were divided to narcotic, drug and chemical groups and the data were analysed with SPSS software. Out of 8800 cases referred to autopsy division of LMO during 12 months, 10.23% died due to poisonings, one-sixth of whom were females (mostly singles), and the most common age was between 21-30 years. The most common routes of poisoning were IV injection and oral consumption in narcotic and oral consumption in non narcotic group. Intentional and accidental poisoning were seen in 60% and 38% of total cases respectively. 10.7% of deaths were due to drug poisonings and 29.9% due to non narcotic non drug materials. Heroin injection was the main cause in narcotic group. In non narcotics with descending frequency the main causes were TCA, Inderal, CO poisoning and TCA in females whereas Methanol, Organophosphates, CO and Cyanide poisonings in males. 30% of non narcotic deaths were due to tattoos found on the corps body surface. 14% of total cases were students and 10% of deaths took place in the bathroom. With respect to other studies, death age due to narcotic usage is becoming lower with time which may be the result of easier access to street narcotics than before. This study as well as some others in our country showed unemployment states as a predisposing factor to narcotic addiction and suicidal death with these materials.

Gastric cancer is the second most common cancer and the second cause of death due to cancer worldwide. Gastric adenocarcinoma is the most common fatal cancer in Iran. Recently, some studies have reported a marked proximal shift in the distribution of gastric cancer. An analytic cross-sectional study was done on 350 patients with gastric cancer in Rasoul-e-Akram, Firoozgar and Hafte-Tir Hospitals during 1992-2001. Mean age was 59.9±0.69 years and there were 230 (66%) males and 120 (34%) females. Histopathologic type of gastric cancer was correlated with its location (P<0.001, r=0.291). Adenocarcinoma was mostly found in proximal and lymphoma in the middle of stomach. Crude number of new cases with gastric cancer is increasing per year. Mean age and sex percentage among our patients are similar to the reports from high risk areas in the world. Proximal shift of gastric cancer observed in this study was similar to new studies. Comparative studies of the pattern of gastric cancer in various populations of our country may help in better understanding of environmental and genetic or racial factors contributing to the evolution of gastric cancer.

We report herein a 41-year-old woman who underwent excisional biopsy of a firm mass beneath the left nipple. Gross examination of the lesions revealed a firm irregularly-bordered cream-gray mass measuring 1.5x1.5x1cm which histologically exhibited an infiltrative tumor constituted by small cord-like and angulated tubules individually set in an abundant fibrous stroma. These tubular structures were lined by one or more layers of epithelial cells and had the teardrop, tadpole or comma-like shapes characteristic. On closer examination, a distinct layer of myoepithelial cells could be identified between the epithelial cells and the fibrous stroma. In most areas epithelial cells exhibited squamous differentiation with occasional keratin-filled cysts formation. Multifocal neural invasion was also evident. Eventually, with respect to mentioned features the diagnosis was a very rare syringomatous adenoma, benign tumor of the nipple which only 27 cases of it have been documented in the English literature. To the best of our knowledge this may be the first reported case in Iran.

Primary sarcomas of the fallopian tube are extremely rare and excluding malignant mixed mullerian tumors, 34 cases have been reported in the literature of the recent 100 years. Out of 34 cases only 15 cases have clearly been described as leiomyosarcomas. The patient of the present report was a 45-year-old woman with leiomyosarcoma confined to the right fallopian tube. She is still alive without any sign of disease 16 months after surgery. The clinical signs and symptoms of fallopian tube sarcomas are usually non-specific and include lower abdominal pain and pelvic pressure. The age of patients during diagnosis varies from 21 to 70 years (with a mean of 47 years) and prognosis is poor. The primary treatment is surgical excision but adjunctive chemotherapy or radiation may be of some benefit.