Razi Journal of Medical Sciences
Year:2001 | Volume:8 | Issue:23|Papers Count:18

"Acoustic Neuronoma" is a benign neoplasm situated in a critical place, so that one can say its behaviour looks like malignant tissues. Three frequent clinical symptoms are associated with tumor with different sensitivity and priority, including vertigo and imbalance, tinnitus and hearing loss. Presence of one or all of these symptoms does not make the definite diagnosis and differential diagnosis possible with clinical and audiologic examinations, rather one should use more sophisticated methods for judgment about the origins of symptoms.In this article a case of 8th cranial nerve lesion is reported that was detected by ABR and MRI confirmed the diagnosis of acoustic tumor. Also, two cases of cochlear hearing loss with clinical and audiological similarity and different ABRs with the presented case will be described.The comparison will show the role of ABR as a low cost and high sensitivity test in differential diagnosis of 8th cranial never, conchlear and other peripheral lesions.

Jaundice is one of the most complications in the Neonatal period. It is observed during the first week of life in approximately 60% of term infants and 80% of preterm infants. Kernicterus is the serious complication of the jaundice in infants, that is constitute of extrapyramidal disturbances, auditory abnormalities and gaze palsies. Serum albumin for bounding to bilirubin is important.Standard serum albumin is 3-3.5 gr/dl. At molar ratio of one, each gram of human albumin binds 8.5mg of bilirubin. Thus standard exchange transfusion in healthy term infants with jaundice is indicated when the bilirubin is 25-30 mg/dl. In this study the mean serum albumin in 400 healthy term infants was 4.006gr/dl in the first three days of life, that was higher than the standard serum albumin.On the basis of this study, exchange transfusion in healthy term infants with jaundice and without hemolytic disease or sepsis is indicated when the bilirubin is 33 mg/dl.

Vitamin D plays an important role in calcium and phosphorus metabolism as well as bone and teeth growth and maintenance. In the present study, the vitamin D status in postmenopausal Iranian women and its relationship with bone mineral density (BMD) and urine hydroxyproline (OHPr) were determined. The serum levels of 25-hydroxyvitamin D3 (25-OHD3), BMD and OHPr assessed in 85 selected, early postmenopausal women (49-67 yr) referred to the Bone Densitometry Center, Loghman-Hakim Hospital, Tehran. The relations among them were also evaluated. Both 25-0HD3 and OHPr levels were measured for the first time in Iran using HPLC (High Performance Liquid Chromatography) and spectrophotometric methods, respectively. BMD measured with dual energy X-ray absorptiometry in lumbar spine and proximal femur regions.25-0HD3 levels ranged between 3.8-64.0 ng/ml (mean±SD, 17.3 ± 11.4 ng/ml). Thirty-two subjects (38%) were vitamin D deficient (<12ng/ml). In lumbar spine (L2-L4) BMD measurments, 34% were normal, 39% were osteopenic and 27% were osteoporotic. In femur (total) BMD measurments, 50.6% were normal, 47% were osteopenic and 2.3% were osteoporotic. Urine OHPr/creatinine ratio used as an index for OHPr and ranged between 3.5-51.0 µmol/mmol (14.8± 8.8 µmol/mmol).There was a significant correlation between 25-OHD3 and spine BMD (r = 0.21, p<0.05), but regarding femur BMD, the correlation was not significant. OHPr had neither a significant correlation with 25-OHD3 nor with spine and femur BMD.We concluded that vitamin D deficiency was evident in early postmenopausal Iranian women and serum 25-OHD3 levels correlated with the spine bone density.

A normal twelve day old newborn with normal gestational period was admitted because of respiratory problems, agitation and vomiting. The patient was diagnosed to have septicemic and was kept under antibiotic therapy. In blood culture, and also culture of umbilical cord and various secretions, staphylococcus epidermidis was isolated. Despite the therapeutic management, the condition of the neonate aggravated, and, expired after 14 days hospitalization due to respiratory failure. Following autopsy and taking a sample from the lung, the pathologic diagnosis was desquamative interstitial pneumonia. This type of pneumonia is relatively rare in childhood and in neonatal period. Only a few cases suspicious for DIP have been reported in literature. Schroeder has reported 5 cases of interstitial pneumonia which resembled none of the classifications made before. As the definite diagnosis is based on the open biopsy, it is possible that the reported rarity of the diseases may be due to failure of its diagnosis. So it is suggested that as soon as the suspicious signs are seen in the neonates, more attention should be paid to proper management.

Rheumatoid Arthritis (RA) is a systemic autoimmune disease. Production of Rheumatoid Factor(RF) is a characteristic feature of the majority RA patients. Previous studies showed there are differences between seropositive-RA(SP-RA) and seronegative-RA(SN-RA), regarding clinical manifestations.In this study the level of CRP was measured in serum and synovial fluid of 45 RA patients by latex agglutination test. The concentration of IgM RF and IgA RF was also quantitated by ELISA. The patients were divided in two groups (SP-RA, n=35 and SN-RA, n=10) based on the Latex agglutination test.The results show that the level of CRP in SP-RA was significantly higher than that of SN-RA (p<0.0001). This correlation was more evident for the IgA RF (r=0.59, p<0.0001) as compared to the levels IgM RF (r=0.47, p<0.004).These results indicated that there is correlation between CRP and RF levels. However IgA RF may be considered as a marker for disease severity.

Infectious arthritis is one of the most common causes of joint destruction. Our case study was taken from 140 patients of which 60 cases were selected, all of them were diagnosed with infectious arthritis by use of synovial fluid cultures. The male to female ratio was 3/2 (40% female, 6% male). Patients ages varied from 18 day infant to 78 years of age.In 12% of patients, more than one joint was affected, 67.7% the knee joint, 22% hip joint, 10% concomitant osteomyelitis and in 5% underlying disease. The most frequently found microorganism was staphylococcus aureus (72%), and the most frequent underlying joint disease was rheumatoid arthritis. It has been determined that the knee joint is the most frequent joint involved in most cases of infectious arthritis. We recommend empirical therapy against staphylococcus aureus in patients with infectious arthritis.

For evaluating the safety of pediatric anesthesia in an outpatient setting, 100 cases were selected by convenient sampling method in Mofid children hospital. Information about postoperative complications (during 24h) were gathered by telephone interview.Most of patients were in the 1-4years age group (55%), 4-8years, 1 month to 1 year, above 8years and below 1 month were situated respectively. Four surgical procedures of inguinal hernia, hydrocele, circumcision and ectopy of testis consist 73% of all the surgeries. Ninety eight Percent of the surgeries were performed under general anesthesia. In these patients, 25% received narcotics, and in 42% regional block were combined with general anesthesia. Fifteen Percent of the patients were intubated. Complications that occurred at home were pain and restlessness (29%. most common), Nausea and vomiting (17%), sleep disturbances (11%), fever (7%), Anorexia (6%), Urinary retension (5.3%), hoarseness 4% and cough 3%.

Lymphangiomas are rare benign tumors which involve the small bowel and produce multiple intraluminal and intramural filling defects. The patient is a 38 year old female which presented with abdominal discomfort and loss of appetite for 18 months in small bowel transient exam multiple small sharply demarcated intraluminal and intramural filling defects observed. After surgical resection of the involved bowel and pathologic exam, lymphangioma was diagnosed. It is impossible to differentiate these lesions from many of the other causes of filling defects by radiological examinations alone.

Jaundice as a clinical symptom of hyperbillirubinemia will appear generally when the billirubin level is more than 7mg/dl. This temporary elevation of billirubin is caused by hemolysis of erythrocytes. Among several causes of pathologic hyperbillirubinemia in newborns; X-linked G6PD deficiency may be the most important. Iran in one of the high risk countries. Due to the risk of death and severe neurological damage, prompt determination of G6PD deficiency in newborns suffering from jaundice is of importance. Therefore we investigated the deficiency of the enzyme in newborns.The population under study comprised 1500 newborns afflicted with hyperbillirubinemia who were born in the teaching hospitals of Iran University of Medical Sciences and Health Services. The G6PD test was done with blood containing EDTA by using two methods o fluoroscent "spot test" and reduction of NADP to NADPH with dichlorophenol. Of 1500 newborns afflicted with hyperbillirubinemia, 240 newborns had G6PD deficiency and of the 240 newborns, 200 were boys and 40 were girls. This indicated that in the population under study, 16% of them suffering from G6PD deficiency, and deficiency of the enzyme in boys was more frequent than in girls (P<0.001). G6PD deficiency was more frequent in the newborns whose parents had familial marriage (P = 0.001).Total billirubin level in 43.4% of patients was 15±1.04 mg/dl, direct billirubin level in 36% of patients was 1.25 ± 0.25 mg/dl and hemoglubin level in 36.4% of them was 17 ± 1.09 g/dl. Onset of hyperbillirubinemia in G6PD deficient newborns was mostly at first day after birth (68.8%). We propose the screening of G6PD deficiency in newborns is important.

Lung abscess is a purulent and necrotizing infection of lung tissue which leads to cavitation(s). Despite appropriate treatment, it has yet a high mortality rate (20%). Impaired consciousness, oral cavity infections, diabetes, perebro-vascular accidents and alcoholism are some predisposing factors. This research identified different factors affecting on medical treatment response and designed a regression model to predict the outcome.This retrospective study reviewed patients with lung abscess, admitted in Iran Medical College Hospitals, during 1991-2000. Out of 91 patients, 60 were cured by medical treatment but the others failed to response to it. We have compared risk factors in these two groups.The average age was 47.9 years and male to female ratio was 2.7. There was significant statistical relation between failure in medical therapy and diabetes (OR: 0.27, p: 0.04), empyema (OR: 7.25, P:0.0001), pleural effusion (OR: 4.25, P: 0.002), fever (OR: 0.43, P: 0.05) and antibiotic change (OR: 5. 96, P: 0.0001). The best therapeutic regimen was penicillin G ( 100% recovery) and penicillin G accompanied with metronidazol or clindamycin (79% recovery). Mortality and complication are related to antimicrobial regimen and hospital nursing. Patients with empyema; pleural effusion or antibiotic change have a poor prognosis whereas diabetes or fever at admittance means a better prognosis.Since lung abscess also contains anaerobes, the recommended regimen is penicillin G with metronidazol or clindamycin.

The goal of this study was detection of common predisposing factors for diabetic ketoacidosis, which can be a guide for prevention. Also to know, complications and rate of mortality which can be a guide to know difficulties in treatment. This study was descriptive and sampling was in convenience method. About 50 patients were studied in Firooz Abadi Hospital during 1993-1998. Analysis of informations was with Chi-Square (X2 -test) method. Common etiology was related to using drugs 52%, infection 26%, unknown 12% and unawareness of disease 10%. Complication were hyperkalemia 24%, hyperkalemia 11 %, resistance to insulin 4%, cardiac complications 20%, GI bleeding 8%, hypoglycemia 8%, renal failure 6%, adult respiratory distress syndrome (ARDS) 2% and disseminated intravascular coagulations (DIC) 6%. Other complications were rare. Mortality was 18% and was significant in older age (P = 0.01), in septicemia and pneumonia as the etiologies of the condition (P = 0.002, P = 0.003 respectively) and in some types of complications (like cardiac complications, DIC, ARDS, renal failure) and also in multiple complications. Therefore most common predisposing factor for diabetic ketoacidosis is incorrect use of drug, specially discontinuing insulin. Most common complications is hypokalemia and hyperkalemia and cardiac complications. In some complications like cardiac, DIC, ARDS and renal failure, mortality were significant.

Non-union is a complication in the management of patients who have a fracture of the tibia. The records of twenty patients who were treated by intramedullary nailing with reaming for non union of the tibia were reviewed.The fractures had been treated initially by closed reduction and immobilization in a cast, external fixation, fixation by pins in a plaster cast and dynamic compression plating. After the initial treatment had failed, intramedullary nailing with reaming was done to gain union. By usinse the standard operation table, the knee was flexed 90 to 100 degrees. Make an incision Middle to the patellar tendon using the awl opening the medullary canal proximal to the tibial tuberosity, the site of the non union was opened. Bone graft used in all patients and a fibular osteotomy was done. Union occurred in the average time of 7.9 months.The average time from the diagnosis of non union was 10.1 months in %95 of cases. Tibial union occurred in all cases. Complication included fracture of the Nail in one case, which necessitated an additional casting and union occurred finally.

The side effects of toxic trace elements such as lead in the exposed subjects have been investigated in past years. Lead disturbs microvascular system, and changes the plasma level of lipids and lipoproteins. In this research the role of lead in plasma lipids and endothelial permeability of aorta were studied.Two groups of white male rabbits were under investigation for forty days. Group І were used lead water drinking contained 54.7 ppm lead during the experiment. The other group had drinking water with no lead. The plasma lipids, lipoproteins, lead, iron, total iron bounding capacity and calcium were measured before and after the experiments. Both groups also were subjected to determination of endothelial permeability of aorta, direct blood pressure, and other pathological findings.The results indicated no weight gain in group І animals, while other group animals weight were increased significantly during the experiment (P<0.05). No hypertension was resulted in lead receiving animals, but a decrease of endothelial permeability of aorta was seen in group І. Partial decreasing of endothelial permeability in aorta in lead drinking group may confirm the different effect of lead in peripheral vascular system from blood brain barrier.

Prevention of rhegmatogenous retinal detachment (RD) in susceptible eyes is necessary. In order to evaluate the role of signs and symptoms of the treated eyes in preventing RD, this study performed in prophylactically laser treated (PLT) eyes in Rasul-e Akraram Hospital from 1991 to 1999.This is an existing data study from the records of the patients who underwent  PLT around the retinal lesion and had at least 1 year follow up. Collected data were age, sex, refractive error, kind of retinal lesion patients symptoms, previous history of trauma or surgery on the eye, aphakia, noticed decreased visual acuity(VA), floaters and flashing, trauma to the eye. According to VA, the eyes divided in 3 groups of less than 1/10, 1/10-6/10 and more than 6/10. According to the refractive errors they are divided in 3 groups of non-myopic, myopia of less than 5.75 diopters and more than 6, and according to the type of retinal lesions that were treated divided in horse shoe tear (HST), Hole, lattice and dialysis. Collected data were classified and analysed by X2 test to evaluated the role of each factor for chance of post treatment RD.One hundred and twenty-one eyes from 114 patients that had 13 to 92 months (mean 23 months) follow up were considered for this study. Age distribution was 19-74 years(mean 50 years). From 121 treated eye 13.2%(16) developed RD. The rate of RD was 7.3% (2/41)in eyes with history of RD in the other eye, 20.7% (6/24) eyes with decreased VA due to vitreous hemorrhage, 15%(3/20) in aphakics, 11.8%(2/17) in eyes with floaters, 28.5%(217) with flashing, 4.2%(217) with history of trauma to the eye, with a significant statistical relation between these symptoms and chance of RD (X2,P =0.002). Rate of RD was 21.6%(8/37), 9.6%(3/31), 6%(2/33) in eyes with VA of less than 1/10, 1/10-6/10 and more than 6/10 respectively, with no significant statistical differences. RD chance was 17% (9/52) in eyes with more than 6 diopter myopia, 11.4%(4/35) of myopia less than 5.75 diopters, and no RD in non myopic eyes, 16.2%(7/43) for HST, 7.4% (2/27) for retinal hole, 12%(3/25) of lattice and 16.6%(116) eyes with dialysis, but no significant statistical differences was observed.Although PLT could prevent RD in susceptible eyes but its prophylactic effect is not 100%.Chance of RD is higher in eyes with photopsia, history of trauma, HST, high myopia and VA of lees than 1/10. Further clinical trial to prevent RD in recommended.

Hydroxyurea (HU) enhances the production of fetal hemoglobin (HbF) and on the other hand this event can decreases the frequency of painful crises in sickle cell anemia (SCA). We studied the efficiency of HU in reducing painful crises and it's effect on HbF production rate and on other hematologic values in 40 SCA patients. Median age of patients was 20 years. Eighteen were male and 22 were female.Duration of study was 2 years. In the first year, patients were under observation without HU but were on folic acid 1mg/d and necessary data collected, then HU started at a dosage of 20-25 mg/kg/day in addition to folic acid and continued for one year.Among treated patients with HU, HbF level increased significantly in 70% of patients (mean 4% vs 10.8%, p<0.001). Changes in the hemoglobin level and platelers numbers were not significant as HbF but leukocytes and reticulocytes number decreased significantly. Patients treated with HU had lower annual rates of painful crises in comparison to first year of study without HU therapy (mean 3 vs 5.7 crises per year, p<0.001) and crises interval increased significantly(p<0.001).Treatment with above doses of HU had not any important adverse effect. We concluded that treatment with HU can increase HbF production rate and subsequently improves the clinical course of SCA.