Researcher Bulletin of Medical Sciences
Year:2000 | Volume:5 | Issue:2 (18)|Papers Count:18

Since little is known about the relations, courses, and connections of the white matter fibers of human cerebral hemispheres, and on the other hand, it is very important to increase our knowledge in this field for anatomical diagnosis of neurological diseases and improvement of neurosurgical techniques, therefore this study was performed. In this respect, one of the mysterious matters regarding white matter of the human cerebral hemispheres is nerve fibers of the external capsule. Most of the reliable neuroanatomical texts present nothing or paradoxical matters about these fibers. For this reason, we decided to trace fibers in the external capsule of human brains. For this purpose, 10 previously frozen, formalin-fixed human brains with no signs of cerebral diseases were dissected using Klingler's technique. It was found out that the main components of external capsule are those fibers from different parts of cortex which pass through the corona radiata and into the dorsal border of the external capsule, and then continue in dorsoventral direction and pass through or from beneath the lentiform nucleus into cerebral peduncle and finally terminate in midbrain tegmentum. These fibers give off branches in their course to the striatum and some fibers from the corpus callosum enter the external capsule. In addition, some fibers from anterior commissure terminate in the external capsule. The superior longitudinal fasciculus lies along the dorsal border of external capsule and the fibers pass through between the two systems. addition, inferior longitudinal fasciculus, uncinate fasciculus, and occipitofrontal fasciculus pass through the ventral portion of external capsule. These findings demonstrate that the external capsule contains all of the three types of fibers (projectional, associational, and commissural). This conclusion denies the previous beliefs on external capsule that suggested its fibers are exclusively of a projectional and/or associational type.

Considering the high incidence of appendicitis and its unreliable complications and the existence of controversies on the symptoms and for epidemiological diagnosis of the appendectomized patients, this study was performed on referrals of Imam Hossein Hospital during the years 1996-1999. The study was carried out on the existing data from medical records on the basis of age, gender, symptoms, and complications, pathologic report and outcome. The incidence of negative appendectomy determined in patients with a probability of 95% in population. Out of 1452 appendectomized cases reviewed, 61% were male and 39% were female with a mean age of 24.7±12.4 years, 37% younger than 20 and 12% older than 70 years. The incidence of negative appendectomy, acute appendicitis, gangrene, and perforation were 15.4%, 64%, 14% and 6% respectively. Negative appendectomy was more common in women than in men (P<0.0005) and the incidence of abdominal pain, tenderness, and tachycardia were alike in both positive and negative groups. In addition, it was found out that leukocytosis and pain shift to RLQ were more common in positive appendicitis in 27% of the cases (P<0.001). It is concluded that incidence of negative appendectomy and perforation is low and because of its significance, it is needed to perform a clinical trial to determine the diagnosing power of clinical symptoms and paraclinical results for appendicitis.

Considering the increasing trend in consumption of meat, especially edible organs of chicken in the nutritional style of our people and an increase in the quantity of antibiotics used in chicken industry, and well-known side effects of consuming antibiotic-contaminated meat of chickens, and meanwhile the existence of controversies in this field, this research was carried out to study the antibiotics residue in the chicken meat consumed in Tehran in 1994. The descriptive strategy of this study was performed on 272 full chicken cadavers, 356 blood specimens and 80 crops selected systemically in a randomized manner. The tissues of chickens raised for this purpose with no antibiotics in their food were considered as control. The strain used was Bacillus subtilus. Swabs were used for sample taking through making a split in the tissues, and directly for that of blood. For oxytetracycline, chlorotetracyline, neomycin, tylosine. erythromcyin and penicillin G, the swab taking was done after complete absorption of antibiotic solution. Then, the swabs were placed in culture plates at green house conditions at a temperature of 29°C for 16-20 hours. Thereafter, a comparison was made between undeveloped corona diameter and undeveloped diameter for different concentrations of antibiotics. Corona with a diameter less than 5.5 mm was considered as non-contaminated, a range of 5.5-7.5 as low-contaminated, and greater than 7.5 was regarded as high contamination. Also, the contamination rate among the chickens as well as its confidence interval was determined in society. It was found out that the antibiotic residues were from 1.5 to 50% in studied specimens. In this respect, the tissues kidney, liver and blood showed the highest rate of contamination at the time of slaughter and breast and legs showed the least contamination. With respect to high incidence of antibiotic contamination and the occurrence of resistance to microorganisms, it is suggested to take necessary measures to decrease the level of consumption and have more control on their usage.

Leishmania is a common parasitic protozoan in Iran. This genus includes more than 20 species, each of them having several strains. Cutaneous and visceral leishmaniasis are caused by the microorganisms of this group and are spread in an endemic and sporadic form. Considering the severe and threatening complications of some kinds of leishmaniasis in human population, it is very important to preserve safely these protozoa in labs for a long time for preparation of vaccines, and in addition to study its species and strains. Conventional methods for preservation and maintenance of this protozoan are in-vitro culture or performing passage in sensitive animals. These procedures are rather expensive, time-consuming, and with a high risk of human contamination through culture media. In addition, it is possible that antigenic, biologic, and chemical properties of microorganisms alter in culture media. Therefore, it is preferably recommended to use cryopreservation method. The explorative and descriptive strategy of this study was carried out in parasitologic lab of Health School and Health Research Institute of Tehran Uni. of Med. Sci. In this respect, 4 species and strains of Leishmania (responsible for Kalaazar and cutaneous leishmaniasis) were studied and cryopreserved for one year using DMSO (Dimethyl sulfuxide). It is concluded that cryopreservation is more effective than the other available method and it is appropriate to be used for Leishmania.

Although recent studies have focused on finding the major molecule involved in migraine, but its exact molecular mechanism has not been clarified yet. Based on human headache models (GTN and Histamine), it has been proposed that histamine may play a role through affecting cerebral endothelial H1- receptors followed by NO release. In addition, there are more recent studies showing that migraine is due to histamine release from mast cells, which are often in close vicinity of neurons where they are activated by neuropeptides and in response release nitric oxide. Since there was no report on parallel alteration of histamine and nitric oxide in biological fluids of migraine sufferers, therefore we decided to determine the role of histamine in migraine-associated pain (lonely or via NO). For this purpose, we measured serum histamine level by an improved fluorometric method and serum NO level by Griess method in pain and no-pain phases of migraine attack. These results showed that there is a significant increase in serum histamine level in pain and no-pain stages of patients compared with control group and in contrast, serum NO level in migraine sufferers was significantly reduced. These findings may indicate the involvement of these molecules in migraine pain. In addition, data analysis showed that serum NO level of those patients with a higher serum histamine level is significantly lower. Thus some kind of relationship exists between these two molecules.

This randomized, double blind, placebo-controlled trial was performed on 200 pregnant women at a gestation age less than 17 weeks to evaluate the effectiveness of pyridoxine in pregnancy-associated nausea and vomiting. In this respect, 100 of them received pyridoxine tablets (20 mg) three times a day for 5 consecutive days and the remainder (control group) (n=100) received placebo with the same order. The average values for age, age of pregnancy, and other background variables showed no statistically significant difference between the two groups. For collection of data, the patients were taught to record the severity of their nausea by visual analogue scale and the number of vomiting episodes and the quality of their appetite over 24 hours before treatment and again during 5 consecutive days of treatment in especially-designed forms. After treatment, the mean score of severity of nausea was significantly less in pyridoxine-treated group compared to placebo group (P<0.05). In addition, the mean number of vomiting episodes was also less in pyridoxine group, but did m\not reach to a significant level and there was an improvement in the quality of appetite from the 2nd to 5th day and the difference was significant (P<0.03).

The comparative studies on topical corticosteroids and antihistamins have not always demonstrated a significant difference between them in their therapeutic efficacy. According to the existing evidence, fluticasone propionate that is an aqueous nasal corticosteroid spray, is an effective drug in the treaiment of allergic rhinitis with little side effects. Therefore, this study has been done to compare the therapeutic effect and side effects of the aqueous nasal fluticasone propionate spray with pyrilamin maleate tablet in the treatment of allergic rhinitis. The randomized clinical trial strategy of this study was performed on patients with at least three of the symptoms and signs of allergic rhinitis (rhinorrea, sneezing, nose and throat itching, nasal congestion, snuffle and tearing) who had referred to otolaryngology clinic of Loghman Hakim hospital from October 1999 to April 2000. For this purpose, 60 patients were divided into two groups, the case group was treated with fluticasone propionate, 4 puff (200 μg) daily and the control one with oral pyrilamin maleate 25 mg three times a day for three weeks. Then, they were visited at 2nd, 3rd and 5th weeks (that is, two weeks after drug cessation) and were examined by a resident who was unaware of drug. In each visit, symptoms and signs of allergy and side effects of drugs were assessed. Two groups were matched for age, sex and smoking habit and interfering factors such as septal perforation and obstruction of nose more than 50% were removed from the study. The patients (60) were divided into two groups: case and control. The mean age in case and control groups was 30.6±11.8 and 33.6±11.8 respectively. The case group consisted of 16 male (53.3%) and 14 female (46.7%) and for that of control group, 17 male (56.7%) and 13 female (43.3%). The number of smokers was 2 (7%) in control group and 3 (10%) in case one. Tearing and nasal congestion, were significantly lower in all of the three visits in the case group than the control one (P<0.05). In addition, throat and nasal itching, snuffle and nasal mucosal pallor was lower in the case group only at the time of drug consumption. Rhinorrhea, sneezing, nasal obstruction and clear discharge from nose was significantly lower only at the follow up period (5th week). The only side effect that had significant difference between the 2 groups was sedation in the control group. In the case group, one patient refused to continue therapy because of occurrence of dyspnea and one patient (3.3%) had relatively sever epistaxis and 2 patients (6.6%) had mild epistaxis. These side effects had no significant difference in comparison with control group. It is concluded that aqueous nasal spray off luticasone has better and longer effect in the treatment of tearing and nasal congestion and has longer effect on rhinorrhea, sneezing, nasal obstruction and clear nasal discharge, and better effect on throat and nasal itching, snuffle and mucousal palor only with its consumption. It seems reasonable that aqueous nasal spray of fluticasone has more efficacy than pyrilamin maleate and is with lower side effects in the treatment of allergic rhinitis.

Disk hernia and lumbar canal constriction are among the common disorders of vertebral column and compose a great multitude of referrals to neurosurgical, rheumatological and orthopedic divisions. The complications are from a simple pain up to a complete disability. In this study the risk factors for the occurrence of disk hernia and lumbar canal constriction were studied in referrals of the neurosurgical centers affiliated to Shaheed Beheshti University of Medical Sciences and in one of the private clinics in 1997. The descriptive protocol of this study was performed on 500 patients of the aforementioned centers and 200 patients of the private clinic. For this purpose the Lazek test, tendon reflexes, lower limb muscular power and sensation and some related paraclinical tests including radiography, CT- canning, myelography and! pr MRI were performed. In addition the parameters height, age, weight, sexuality, occupation, cigarette smoking, exercise and family history were evaluated. Overweight is considered as a BMI greater than 25, hard-conditioned occupations such as those of the workers and office work as mild to moderate occupation. Out of the total, 539 cases had disk hernia and 161 had a constricted lumbar canal. For disk hernia, the ratio of male to female was 1.5/1 and the greatest incidence occurs at the 4th and 5th decades. For constricted lumbar canal, the ratio was 1.3/1 and occurs most frequently at 6th and 7th decades. The incidence of lumbar disk hernia is one to two decades earlier than the lumbar canal constriction and its incidence is greater in men and the incidence of lumbar canal constriction is greater in women. Many of the patients had an abnormally high MBI and this is more obvious in lumbar canal constriction. In addition disk hernia frequently occurs at the working period of life, whereas the canal constriction frequently occurs at the end of the working period.

This analytical cohort study was carried out to determine the rate of incidence rate, time of onset, and duration of post-traumatic diabetes insipidus, and their relationship with basal skull fractures. For this purpose, the records of 16 patients with post-traumatic diabetes insipidus (DI) identified at Imam Hossein hospital from 1992 to the mid 2006 were retrospectively reviewed and statistically analyzed. The patients were matched for the kind of head trauma, having a survival time of at least 2 weeks after trauma, having a neurogenic diabetes insipidus, diabetes insipidus being the main complaint, place of examination, diagnosis, and treatment Patients were evaluated for GCS scoring, skull X-rays, and CT-Scan findings. The statistical Chi Square-Fischer test was used. Out of the 16 patients so identified, 13 were male and 3 were female with a mean age of 20±11.4 years, ranging from 5 to 41. The rate of occurrence of post-traumatic DI was 1.45% and association of basal skull fractures with DI was found in 56% of patients. In 75% of patients, DI occurred within the first week (early) following head injury, while delayed occurrence (more than one week) of DI was observed in 25% of patients. A statistically significant relationship was found between the time of onset and the duration of DI (P<0.001). Meanwhile, early and late occurrence of DI was associated with shorter (less than 2 weeks) and longer (more than 2 weeks or permanent) duration of DI respectively. Basal skull fracture was also significantly correlated with early occurrence (P<0.01) and longer persistency (P<0.05) of posttraumatic DJ. In addition, no significant relationship was found between severity and duration of post-traumatic DJ.

Rapid, accurate and punctuate diagnosis of acute abdomen in neonates and infants is very important and any delay in its diagnosis and treatment results in, higher rates of morbidity, mortality, post operative complications and hospitalization costs. So this retrospective study was performed on patients under 2 years of age who referred to Mofid children hospital during the years 1992-1998. In this study the medical records of234 patients, 92 (39%) females and 142 (61%) males were reviewed. In this regard, neonatal age group (1 -28 days) and infants (1-24 months) were characterized and methods were applied according to the kind of abnormality or disease. The main objectives were to reduce the mortality rate and meanwhile minimize the medical costs. In this study the most common cause of acute abdomen in neonates was intestinal atresia and in infants, the most common causes are invagination and strangulated hernia with a higher rate in males. It can be concluded that rapid, accurate and on time diagnosis of acute abdomen in neonates and infants is very critical and for this purpose, close co operation among surgeons, laboratory and radiology departments including sonog raphy and CT -scan is of considerable benefits.

Breast carcinoma is the most common malignant turnor and the major cause of carcinoma death in women. Involvement of axillarv lymph nodes by tumor cells are the most important prognostic factor and it should be considered as key point in the prognosis and treatment of these patients. In this descriptive research study, 40 patients that admitted to Imam Hossein hospital during the years 1997 and 1998 re-examined that previously reported as having negative lymph nodes. According to obtained results, a 7.4% increase in positive lymph nodes was observed that is obvious especially in those patients that initially showed no positive sign in lymph nodes, thus it is strongly recommended to use serial sections in negative lymph nodes.

Thyroid nodules are very common in population (50%), but a few have malignant nodule (5%) and therefore, an operation is needed. Obviously, the best diagnosing method for differentiation of malignant and benign cases is biopsy that is performed by at least one lobectomy. With introduction of FNA method in 1930, cases of thyroidectomy reduced to 1.3%. Currently, FNA is the best-preferred method for diagnosis of thyroid nodule. Unfortunately, in our academic centers thyroidectomy is still a commonly used method that in 70% of cases, it has been unnecessary. For this reason, the present study was performed on 128 cases of thyroid nodule through use of FNA method. The sensitivity, specificity, and accuracy of this method were 94%, 100%, and 97.8% respectively. However, there was no statistically significant difference between FNA and pathology using Mc Nemar test. Thus, FNA can be used instead of biopsy and it can reduce the necessity to perform costly scanning procedures and surgical operations. More studies in this field are suggested.

Steroids are a large group of therapeutic agents that have widespread pharmacological effects including anti-inflammatory, contraceptive, and anabolic effects. Different methods have been employed for their production. In this study, the growth and production ability of Aspergilus nayger selected from the collection of infectious bacteria and fungi in Iran have been investigated in three kinds of culture media, maximum pH and the maximum period to product. Several metabolites were isolated under optimum condition, the main of them was a substance that after isolation and purification by chromatographic methods was studied by mass spectrometry, H - NMR, and IR for determination of structure. It was obtained that the chief products are progestrone and 11-a-hydroxyprogestrone. These compounds have been used as precursor in the synthesis of hydrocortisone.

Proximal dome-shaped tibial osteotomy (H.T.O) is one of the corrective procedures for genu varus deformity. Considering the known complications of these procedures and the incidence of this deformity, and for evaluation of the effectiveness of corrective measures, this study was carried out on 14 patients who referred to the Pars, Khatamolanbia and Taleghani hospitals during the years 1995-1998. The quasi experimental strategy of this study was carried out on 14 patients and 17 knees with a diagnosis of genu varus. The modified procedure is based on the previous experiments of authors with standard proximal dome-shaped tibial osteotomy and its complications. Out of 14 patients, 7 cases were male and 7 cases were female with an average age of 21±10 (from 13 to 59 years old) and the period of follow-up was 18±8 months (from 7 to 24 months).The applied modifications were: fibular osteotomy in appropriate location, tibial osteotomy in its correct manner, 1.5 to 3 cm fibulectomy, pinning from lateral side to medial cortex, pin and plaster method as the fixation procedure, predrilling of pin tract, routine fasciotomy and other procedures. These modifications reduced significantly the complications, so the pin trat infection was 5.9%, superficial and deep proneal nerve palsy was 5.9%, hallucis extension difficulty was 5.9% and temporary pain in fibulectomy site was 11.8%. No other early complications were observed. It is suggested to consider these modifications in proximal dome-shaped tibial osteotomy to reduce its complications.

Considering the high prevalence of sunburn and its known complications and the necessity to prevent them and for comparison between the sun creams Seagul (Iran, SPF 30) and Lutsin (France, SPF 30), this study was carried out on climbers in varamin region in 1999. The matched clinical trial strategy of this study was performed on 50 persons and number of samples was 100. In this regard, one side of face was randomly chosen as case and the other side was considered as control. The creams at a volume of 0.3 ml were applied on each side of the face (case and control ones). Climbers were exposed to sun for 3.5 h. the evaluation was done by a resident of dermatology 6 h after sun exposure and by climbers themselves 24 h after exposure. The criteria were erythema, burning, pruritus, and satisfaction from the product. Then, the data were analyzed by both Mc Nemar and Chi-Square tests. The studied persons included males (64%) and females (36%) at an age of 31.1±0.75. Both creams were able to prevent sunburn after 6 h (in 34% of cases for Seagul cream and in 40% of cases for Lutsin cream). After 24 hours, the Seagul and Lutsin creams were reported to be useful in 32.4% and 24.3% of the cases. In addition, satisfaction was was 86% in case group and 90% in control group, pruritus was 6% in both groups, and burning sensation was 10% in case group and 6% in control group. There were no significant differences between the groups. Although both creams have similar efficacy and complications, but it is needed to perform more studies in this field.

This study was performed to evaluate the rate of reduction of intraocular pressure and the occurrence of long-term complications following trabeculectdmy in patients with narrow- and open-angle glaucoma. The descriptive strategy of this study was performed on 142 eyes, of 119 patients with narrow- and open-angle glaucoma having trabeculectomy and followed up for at least one year. The limbal base trabeculectomy was performed by removing a 33 sclera flap and 2x3 conjunctiva flap, they were stitched by nylon thread 10 and criterion for performing surgery was intraocular pressure greater than 20 mmHg with respect to visual field. Out of 142 eyes, 126 (88.7%) showed a reduction in intraocular pressure. Out of 125 eyes with an early open-angle glaucoma, 109 (87.2%) and out of 17 eyes with an early narrow-angle glaucoma, 16 (91.2%) showed a reduction in intraocular pressure. From a total of 45 patients with an age less than 60 years, 33 cases (73%) and from a total of 74 patients with an age greater than 60 years, 70 cases (94.5%) had a reduction in LOP. The complications including progression of optic nerve damage, cataract occurrence, endophthalmitis, vitreous loss, central visual loss, Dellen and intractable glaucoma were evaluated. Choroid detachment and flat anterior chamber was observed in 12 eyes (8.5%) and none of them did not show an increase in lOP during follow-up, that was greater than previous reports (4.5%). Considering benefits of trabeculectomy and its negligible complications in treatment of narrow- and open-angle glaucoma, this surgical procedure can be suggested as the first option in treatment strategies in clinics. Furthermore, since better results are achieved in persons with an age less than 60 years, it is recommended to use antimetabolites in such cases