ARCHIVES OF IRANIAN MEDICINE
Year:2006 | Volume:9 | Issue:4|Papers Count:30

Background: Helicobacter pylori isolates from 84 adults and 51 children were assessed during the period of 2001 through 2004 to find out whether their susceptibilities to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone differ between the two groups or have changed compared with the results from our previous study done between 1997 – 2000. Methods: Biopsies from 135 dyspeptic patients were cultured on Brucella blood agar. Pure cultures of H.pylori isolates were used for antibiotic susceptibility tests. Disk diffusion method was recruited to assess the susceptibility of H.pylori isolates to different dilutions of the above mentioned antimicrobials. Results obtained from the two groups were compared and minimum inhibitory concentrations determined. Results: Thirty-five percent of H.pylori isolates from adults and 37% from children were resistant to metronidazole. Clarithromycin resistance rate was 2.4% and 5.9% in H.pylori isolates from adults and children, respectively. Amoxicillin resistance was 2.4% in isolates from adults and 5.9% in isolates from children. Tetracycline resistance rate was 0% in H.pylori isolates from adults and 2.0% in isolates from children. Resistance to furazolidone was not observed. Conclusion: Resistance rates of H.pylori isolates from adults and children to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone are similar and not significantly affected by age and time.   Background: Helicobacter pylori isolates from 84 adults and 51 children were assessed during the period of 2001 through 2004 to find out whether their susceptibilities to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone differ between the two groups or have changed compared with the results from our previous study done between 1997 – 2000. Methods: Biopsies from 135 dyspeptic patients were cultured on Brucella blood agar. Pure cultures of H.pylori isolates were used for antibiotic susceptibility tests. Disk diffusion method was recruited to assess the susceptibility of H.pylori isolates to different dilutions of the above mentioned antimicrobials. Results obtained from the two groups were compared and minimum inhibitory concentrations determined. Results: Thirty-five percent of H.pylori isolates from adults and 37% from children were resistant to metronidazole. Clarithromycin resistance rate was 2.4% and 5.9% in H.pylori isolates from adults and children, respectively. Amoxicillin resistance was 2.4% in isolates from adults and 5.9% in isolates from children. Tetracycline resistance rate was 0% in H.pylori isolates from adults and 2.0% in isolates from children. Resistance to furazolidone was not observed. Conclusion: Resistance rates of H.pylori isolates from adults and children to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone are similar and not significantly affected by age and time.    

Background: Injection drug use has been the major route of HIV transmission over the past several years in some countries. The aim of this study was to describe epidemiologic and demographic factors, as well as the risk behavior data in HIV-positive patients referred to a private clinic in Tehran. Methods: A retrospective study was conducted in 2005 based on documents of 150 HIV infected patients referred to a private clinic from 1992 through 2004 in Tehran. Results: Documents of 150 HIV-positive patients (124 males and 26 females) were analyzed. Injection drug use with one other risk factor, namely shared needle (n = 46), injection drug use without any other known risk factor (n = 37), and sexual activity (n = 25) were the major possible routes of transmission of HIV infection. The major possible route of transmission in female patients was sexual activity (n = 17), mostly from infected husbands (13/17). There was no patient with a history of drug abuse from 1992 to 1997. The frequency of HIV positive injection drug users was 1 in 1997 – 1998, 6 in 1999, 3 in 2000, 24 in 2001, 32 in 2002, 37 in 2003, and 11 in 2004. Eighty-three (55%) of 150 and 64 (74%) of 86 patients had a history of drug abuse and incarceration, respectively. Conclusion: We observed high rates of hepatitis C and B virus coinfection in our HIV-positive patients. Injection drug use is the main risk factor associated with HIV infection in Iran.      

Background: Though regular blood transfusion improves the overall survival of patients with β-thalassemia, it carries a definite risk of infection with blood-borne viruses. We carried out this multicenter study to provide epidemiologic data on hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection among Iranian β-thalassemic patients. Moreover, HCV infection-associated risk factors were investigated in this population. Methods: Seven hundred and thirty-two patients with β-thalassemia major or β-thalassemia intermedia, selected from five provinces of Iran including Tehran (n = 410), Kerman (n = 100), Qazvin (n = 95), Semnan (n = 81), and Zanjan (n = 46), were enrolled in this study. Using ELISA, their sera were tested for HBsAg, HBcAb, HBsAb, HCVAb, and HIVAb. The positive HCVAb results were confirmed by RIBA-2nd generation. Results: The study sample consisted of 413 males and 319 females, with a mean ± SD age of 17.9 ± 9.0 years. One hundred forty-one (19.3%) patients were HCVAb positive; 11 (1.5%) were HBsAg positive. No one was HIVAb positive. Univariate analysis showed that β-thalassemia major (P = 0.01), older age (P = 0.001), longer transfusion duration (P = 0.000), HBsAg seropositivity (P = 0.03), and higher serum ferritin level (P = 0.002) were significantly associated with a higher prevalence of HCV. Furthermore, the prevalence of HCV infection dropped significantly after the implementation of blood donors screening (22.8% vs. 2.6%; P = 0.000). Using multivariate analysis, β-thalassemia major (P = 0.002), age (P < 0.001), serum ferritin level (P < 0.001), as well as consumption of unscreened blood (P = 0.003), were independent factors associated with HCV infection. Conclusion: The prevalence of HCV infection is much higher among Iranian β-thalassemic patients as compared with HBV and HIV infections. Routine screening of donated blood for HCV is highly recommended.      

Background: Histology is the unique method for diagnosis of silent liver diseases; so, we aimed to determine the prevalence of fatty liver and other silent liver diseases among those who passed away for causes other than liver diseases in Tehran. Methods: Over a two-year period (2002 – 2004) we enrolled autopsies performed at the Forensic Medicine Center in Tehran. Demographic information, history of known acute and chronic liver diseases, and causes of death were determined. Samples from the right and left lobe and one sample from deeper areas of the liver as well as specimens from any grossly visible lesions were obtained in each case. Tissue sections stained by hematoxylin and eosin were evaluated. Reticulin and Masson’s trichrome stains were also performed for evaluation of liver architecture and degree of fibrosis when necessary. Results: Satisfactory tissue samples for histologic evaluation were available in 896 cases (777 males) with a mean age of 43.8 years. Normal histology was found in 467 cases (52.1%). Important findings included: steatosis in 283 (31.6%), steatohepatitis in 19 (2.1%), chronic hepatitis in 23 (2.6%), and cirrhosis in 7 (0.8%) cases. Causes of death were: trauma (35%), acute myocardial infarction (30%), opiate overdose (13%), cerebrovascular accidents (4%), infectious diseases (3%), and others (15%). Conclusion: Silent diseases of the liver are not uncommon. Steatosis is the most common finding but inflammatory disorders comprise a significant minority.      

Background: Present transfusion protocols have increased the life expectancy of patients with β-thalassemia major, but siderosis is a major clinical complication of the treatment. Short stature and hypogonadism are extremely frequent in patients with thalassemia. To investigate the influence of age at the onset of blood transfusion, iron chelation therapy, and serum ferritin levels on growth and pubertal development in thalassemic patients, and the prevalence of these endocrine complications with respect to pituitary somatotropic and gonadotropic functions, this study was designed. Methods: Clinical data of 158 patients (82 females and 76 males) with thalassemia major, aged 10 ─ 20 years (mean age: 15.1 ± 4.8 years) were collected from a pediatric hematology clinic in Tehran. Height was measured and stages of puberty were determined by a pediatric endocrinologist. Serum ferritin concentration, liver function tests, serum calcium and phosphorus, blood sugar, free thyroxine (FT4), TSH, FSH, LH, dehydroepiandrosterone sulfate, testosterone (in boys), estradiol (in girls), and insulin-like growth factor I were measured after overnight fasting. In patients with a height more than 2 standard deviation below the mean, the growth hormone stimulation test was considered. Bone age was determined in all patients. Results: Thalassemic patients in this study showed a high prevalence of short stature (62%) and hypogonadism (69%). We found a low serum level of gonadotropins (FSH and LH) in over 14- year-old patients with impaired puberty, which indicated that hypogonadotropic hypogonadism is responsible for this complication. Results of growth hormone provocative tests and serum insulinlike growth factor I levels in short stature patients showed a reduced growth hormone response in 38% and low insulin-like growth factor I levels in 42% of thalassemic patients. Short stature and hypogonadism were more common in patients with serum ferritin levels above 2000 μg/L and these complications were significantly more frequent in patients who started treatment later than that of the patients who started treatment in the first years of life (P < 0.001). Conclusion: Short stature and hypogonadism are extremely frequent in our patients with thalassemia, but correct blood transfusion and appropriate iron chelation therapy can prevent or limit these complications. These data support the need for vigilant follow-up of patients with thalassemia in order to treat endocrine dysfunction at an appropriate age.    

Background: Analysis of the functional activity of neutrophils is of great importance in the differential diagnosis of patients with recurrent bacterial infections. It has long been established that stimulated polymorphonuclear leukocytes reduce nitroblue tetrazolium. Application of a simple and reliable nitroblue tetrazolium method that clearly differentiates the chronic granulomatous disease patients and heterozygote carriers in some groups suspected to have chronic granulomatous disease was investigated. Methods: This study consisted of 197 samples taken from 100 children (2 – 24-month-old) and 81 neonates (aged <2 months) referred to our center either due to a suspected bacterial infection or suspected immunodeficiency. The sample also included 16 cord blood samples. Fifty healthy adult individuals were enrolled in this study and were diagnosed as normal control. Neutrophil reduction of nitroblue tetrazolium can be stimulated in vitro by protein kinase agonists such as phorbol myristate acetate, resulting in release of superoxide anion. Results: Phorbol myristate acetate is an exceptionally powerful stimulant and when used in conjunction with glass adherence, caused nearly all normal neutrophils to become transformed and reduced nitroblue tetrazolium to formazan deposits. Of 197 blood samples, 9 were diagnosed as having unrelated chronic granulomatous disease and 7 were carriers of X-linked or autosomal recessive chronic granulomatous disease. The carriers had a range of 15 – 75% stimulated neutrophils. Conclusion: We have established a phorbol myristate acetate-stimulated nitroblue tetrazolium test for detection of chronic granulomatous disease patients, which clearly differentiates the chronic granulomatous disease patients from heterozygote carriers. The results in cord fetal blood indicate that this test may be used for antenatal diagnosis of affected boys, carrier females, and autosomal recessive variants of chronic granulomatous disease. The technique is simple, fast, inexpensive, and requires only a few microliters of blood.      

Background: The conventional method of bridging anatomic defects of the upper digestive tract in the neck is by tissue transfer—either gastric or colon pull-through, free jejunal graft, or fullthickness skin flaps. An alternative way of closing such defects is to flex the neck. This moves the remnant proximal esophagus or pharynx a considerable distance downwards—a standard tensionreleasing maneuver in tracheal resection and reconstruction. Methods: Neck flexion was used in 7 patients grouped into three separate surgical conditions: A) in two patients after esophagectomy, where the pulled-up stomach would not reach the remnant proximal esophagus or the pharynx; B) in three patients where the defect after removal of the diseased portion of the cervical esophagus measured 4.5, 5.0, and 8.0 cm, respectively; and C) in 2 patients with 4.5- and 1.5-cm long circumferential postoperative esophageal strictures managed by Heineke-Miculicz repair. Results: No postoperative cervical fistulas were seen. One patient, whose 8-cm long cervical esophageal defect had been closed by end-to-end anastomosis, developed a stricture. Conclusion: In special situations, flexing the neck allows for safe anastomosis or closure of esophageal defects in the neck, obviating the need for tissue transfer.      

Background: Most deaf and severe to profound sensorineural hearing loss patients are incapable to communicate well because of a lack of receiving sound signals. Cochlear implant is one of the effective measures, which has been of great help to the deaf. Up to now, more than 1000 cochlear implants have been accomplished successfully in Iran. Since cochlear implantation is faced with numerous problems and difficulties, we should establish other methods for sound communication. Tactile aids can be a very effective help regarding this issue. Methods: We designed and accomplished a study on the use of tactile aid, along with rehabilitation and training of these patients in our department. We designed four educational stages to check the improvement of subjects who used one-, two-, and seven-channel tactile aids. Results: Hundred percent of the cases passed the first stage (detection) successfully. In the second stage (beginning pattern perception) all the cases with two and seven channel tactile aids were able to distinguish all kinds of sounds. They could differentiate between speech and nonspeech sounds. In the third stage (recognition of speech), all the cases were able to recognize environmental and “sound maker” sounds, but only 43% of the individuals were able to recognize speech sounds and repeat correctly with two-channel tactile aids. In the fourth stage (comprehension of words), identification and repetition of the words were only possible with seven-channel tactile aids. Conclusion: The results of our study show that tactile aids are well accepted by the patients with severe to profound sensorineural hearing loss who do not benefit from usual hearing aids.  

Background: Balloon angioplasty for treatment of coarctation of the aorta in adults, though promising, is sometimes limited by significant residual gradient (>20 mmHg). Few studies have been reported on use of balloon-expandable stents in such a situation. We evaluated the use of self-expandable stents in patients with coarctation of the aorta. Methods: Eight hypertensive patients (age 15 to 27 years) with coarctation of the aorta (n = 6) or recoarctation (n = 2) and peak systolic gradient of >40 mmHg underwent stent implantation. Balloon predilatation was done and self-expandable nitinol aortic stents (Optimed) were implanted in all patients. Results: The mean ± SD peak systolic gradient decreased from a baseline of 55 ± 15 (range: 40 – 75) to 5 ± 2 (range: 3 – 7) mm Hg after angioplasty. Nitinol stents were easier to deploy and conformed better to aortic anatomy as compared with balloon-expandable stents. The mean ± SD diameter of the coarcted segment increased from 3 ± 1 mm to 16 ± 2 mm. There were no complications in our series. On 6- to 9-month follow-up, all the implanted stents remained in their original positions and none showed evidence of fracture. Significant improvement in hypertension was seen in 7 out of 8 patients. Conclusion: Stent implantation is safe and effective in treating coarctation of the aorta. Selfexpandable stents were easy to implant, had good adaptation to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation of the aorta as surgical repair.    

Background: Ebstein anomaly is the downward displacement and adherence of dysplastic septal and posterior tricuspid leaflets into the right ventricle, thereby dividing the ventricle into a so-called atrialized chamber and a functionally reduced right ventricle. We evaluated the early and mid-term results of primary repair of Ebstein anomaly in adult patients. Methods: Eight consecutive patients undergoing repair of Ebstein anomaly with Danielson technique at Imam Khomeini Medical Center, Tehran, Iran from January 1997 through July 2004 were evaluated. Functional and echocardiographic parameters were studied both preoperatively and postoperatively, as well as demographic status and adverse events. Results: Hospital mortality occurred in one patient because of right ventricular failure. The average follow-up period was 5.3 ± 3.4 years (median: 3.8 years). The actuarial survival rate was 85.7 ± 4.8% at 7 years. During the follow-up, six patients were in New York Heart Association functional class I, and one patient was in class II. None of the patients required reoperation related to their Ebstein repair. One patient demonstrated atrioventricular dissociation perioperatively; however, only one patient required permanent pacemaker insertion later. One patient had minimal (1+) regurgitation, with the jet localized along the anterior part of the ventricular septum. Two patients had residual tricuspid valve insufficiency (2+) on echocardiography. Conclusion: Ebstein repair has a good functional and hemodynamic outcome in adult patients.    

Background: It is well known that inhalation of chemical warfare, mostly sulfur mustard, causes injury of the respiratory system. Chronic obstructive pulmonary disease is a common disease among these patients. Health-related quality of life is a common feature of studies in chronic obstructive pulmonary disease. The objective of our study was to assess the quality of life in these patients. Methods: A total of 43 male patients with stable chronic obstructive pulmonary disease due to chemical gas injury were enrolled into this study. Severity of disease was defined by the global initiative for chronic obstructive lung disease (GOLD) guideline. Health-related quality of life was assessed using the St George Respiratory Questionnaire. Symptoms, activity, impact, and total score were calculated for each patient. Results: The mean ± SD age of patients was 42.5 ± 7.4 years. According to the GOLD guideline, most (72%) of the patients were in stage 2 (mean: FEV1 1.9 ± 0.75 L, 53.1% ± 18.5% predicted). The mean ± SD scores for each section of the St George Respiratory Questionnaire were 77.9 ± 16.3 for “symptoms;” 70.2 ± 19.6 for “activity;” 57.8 ± 22.5 for “impact”, and 64.9 ± 19.5 as the “total score.” There was a reverse correlation between FEV1 (% predicted) with symptoms (r = -0.47), activity (r = -0.61), impact (r = -0.44), and total score (r = -0.51) of the St George Respiratory Questionnaire. Conclusion: This study showed that lower lung functions as assessed by the St George Respiratory Questionnaire worsen the quality of life in patients with chemical warfare-induced chronic obstructive pulmonary disease.      

Background: This study was performed in an attempt to assess serum calcium, phosphorus, and alkaline phosphatase in adolescent girls and calcium supplementation in subjects with abnormal serum findings. Methods: A randomized, cross-sectional, cluster sampling, prospective, and descriptive trial was conducted from January through March 2003 for measurement of serum calcium,  phosphorus, and alkaline phosphatase. The study group consisted of healthy girl students aged 11 – 15 years, from various areas of Tehran, Iran. Supplementary calcium tablets (2000 mg per day) were prescribed for 20 days for girls with low or normal serum calcium and raised alkaline phosphatase concentration. Results: Of 414 girls who were evaluated, 29 (7%) had low or normal serum calcium and raised alkaline phosphatase concentration, with other normal findings. The mean serum calcium and alkaline phosphatase in these girls were 9.4 ± 0.4 mg% and 1168 ± 156 IU/L, respectively. The mean serum calcium in 8 (27.58%) of these 29 girls were 8.02 ± 0.3 mg%. The serum calcium and alkaline phosphatase after calcium supplementation were 9.6 ± 0.9 mg% and 666 ± 310 IU/L, respectively, with a significant (P < 0.05) difference existing in serum alkaline phosphatase concentration among girls before and after supplementation. The serum phosphorus concentration in all girls was normal. Conclusion: Hypocalcemia is common in adolescent girls, which is among the subtle biochemical findings of rickets during the rapid growth period and may progress into symptomatic rickets.      

Background: Chronic persistent pain is a common problem in the elderly. However, there are no systematic studies on the prevalence of pain among these old people in Iran. The objectives of the present study were to determine the prevalence of pain among nursing home residents and to assess the impact of persisting pain on mood and quality of life among this population. Methods: One hundred and fourteen residents of 2 private nursing homes in Tehran completed the Beck Depression Inventory as well as the 36-item Short Form health survey, to report their mood and quality of life, respectively. All subjects also gave their demographic details and pain status. Results: The mean ± SD age of the persons studied was 69 ± 8.5 years. While 72.8% of the total sample reported some kind of pain at the time of the study, 66.7% reported persistent pain (i.e., the existence of pain every day or almost every day). Subjects with persistent pain (n = 76) were more depressed than those not reporting persistent pain (n = 38). Also, persistent pain negatively influenced the quality of life. Conclusion: Pain is prevalent in residents of long-term care facilities in Iran. Suffering from persistent pain is significantly associated with higher levels of depression and lower quality of life.  

Attention-deficit/hyperactivity disorder is a common neurobehavioral disorder of childhood and adolescence. The etiology of attention-deficit/hyperactivity disorder is not well understood. Neurochemical studies suggest, alterations in catecholaminergic, mainly dopaminergic and noradrenergic, transmitter functions markedly contribute to the symptoms of this disorder. The symptoms of attention-deficit/hyperactivity disorder are significantly ameliorated by the agents that specifically influence these neurotransmitters. Animal studies implicate areas of the brain in which these neurotransmitters are most dominant. Psychostimulant medications are generally the first choice in the treatment of attention-deficit/hyperactivity disorder. Approximately 70% of the children treated show improvement in the primary attention-deficit/hyperactivity disorder symptoms and in comorbidity such as conduct disorder, although the benefits may not hold beyond two years. Despite the well-established efficacy and safety of stimulants for attentiondeficit/ hyperactivity disorder, alternative medicines are still needed for several reasons. About 30% of children and adolescents with this disorder may not respond to stimulants or may be unable to tolerate potential adverse events such as decreased appetite, mood lability and sleep disturbances. Although stimulants do not increase the risk for later substance abuse in attentiondeficit/ hyperactivity disorder, concerns have been raised about special prescription rules and a potential for abuse by persons other than the attention-deficit/hyperactivity disorder subjects. This review focuses on etiology, assessment, and treatment of attention-deficit/hyperactivity disorder.        

Colorectal cancer is a major cause of morbidity and mortality. About 15 – 20% of all colorectal cancers are familial. Hereditary nonpolyposis colorectal cancer is an inherited cancer predisposition syndrome. It is caused by mutations in mismatch repair genes, predominantly MSH2 and MLH1. Although hereditary nonpolyposis colorectal cancer accounts for a minority of colorectal cancers, the mutations identified in these cases are important in our understanding of colorectal cancer pathogenesis. An increasing number of deletions in different exons of MSH2 and MLH1 genes is reported to result in hereditary nonpolyposis colorectal cancer. This paper reviews the genetics behind these genes and molecular study of the hereditary nonpolyposis colorectal cancer. This may help the medical professionals especially internists, gastroenterologists, and oncologists to update their knowledge in this field.      

Background: Hepatic hydatid cyst is an important public health problem in parts of the world where dogs are used for cattle breeding. Management of uncomplicated hepatic hydatid cysts is currently surgical. However, the puncture, aspiration, injection, and reaspiration (PAIR) method with or without benzimidazole coverage has appeared as an alternative to surgery over the past decade. Objectives: To assess the benefits and harms of PAIR with or without benzimidazole coverage for patients with uncomplicated hepatic hydatid cysts in comparison with sham/no intervention, surgery, or medical treatment. Methods: The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Controlled Trials Register in The Cochrane Library, MEDLINE, EMBASE, DARE, and ACP Journal Club and full-text searches were combined (all searched October 2004). Reference lists of pertinent studies and other identified literature were scanned. Researchers in the field were contacted. Only randomized clinical trials using the PAIR method with or without benzimidazole coverage as the experimental treatment of uncomplicated hepatic hydatid cysts (i.e., hepatic hydatid cysts which are not infected and do not have any communication with the biliary tree or other viscera) versus no intervention, sham puncture (i.e., performing all steps for puncture, pretending that PAIR is being performed, but actually not performing the procedure proper), surgery, or medical treatment were included. Data were independently extracted and methodologic quality of each trial was assessed by the authors. The principal authors of the trials were contacted to retrieve missing data. Results: We found no randomized clinical trials comparing PAIR versus no or sham intervention. We identified only two randomized clinical trials, one comparing PAIR versus surgical treatment (n = 50) and the other comparing PAIR (with or without albendazole) versus albendazole alone (n = 30). Both trials were graded as 'adequate' for allocation concealment; however, generation of allocation sequence and blinding methods were 'unclear' in both of them. Compared with surgery, PAIR plus albendazole obtain similar cyst disappearance and mean cyst diameter with fewer adverse events (32% versus 84%, P = 0.001) and fewer days in hospital (mean + SD: 4.2 + 1.5 versus 12.7 + 6.5 days, P = 0.001). Compared with albendazole, PAIR with or without albendazole obtain significantly more often (P = 0.01) cyst reduction and symptomatic relief. Conclusion: PAIR seems promising, but there is insufficient evidence to support or refute PAIR with or without benzimidazole coverage for treating patients with uncomplicated hepatic hydatid cysts. Further well-designed randomized clinical trials are necessary to address the topic.      

Borderline personality disorder is one of the most problematic psychiatric disorders with aggressiveness and impulsivity as its two main characteristics. Our objective was to determine the efficacy of olanzapine on 20 patients with borderline personality disorder. Results were found to be affirmative in this respect.      

The aim of this study was to evaluate mixed red cells population and red blood cell chimerism after hematopoietic stem cell transplantation. Red blood cell chimerism after hematopoietic stem cell transplantation was analyzed using a series of fluorescein isothiocyanate-conjugated monoclonal antibodies (BioAtlantic, France) directed against ABH, Rh (D, C, E, c, e), Kell, Duffy, Kidd, and Ss antigens on blood samples of 14 patients with hematologic disorders undergoing hematopoietic stem cell transplantation, by flow cytometric method on days 15, 30, and 60 after transplantation. All patients showed expression of donor red cell antigens within days 15 – 30 after hematopoietic stem cell transplantation. Graft versus host disease and ABO incompatibility did not affect the expression of chimerism. Flow cytometric analysis is a simple, accurate, and valuable test which is of significant help in monitoring chimerism in allogeneic hematopoietic stem cell transplantation.      

Deiverting ileostomy was initially introduced and used by Turnbull and Weakley to provide fecal diversion in patients with toxic megacolon. Traditionally, transverse colostomy has been the preferred method for temporary proximal diversion in patients with colonic obstruction. However, recently, diverting ileostomy has been popularized for proximal diversion, mainly for lack of an offensive odor of the ileostomy effluent compared with fecal material from a colostomy. We have used diverting ileostomy routinely for protection of ileorectal anastomoses, especially when tension exists at the site of anastomoses or for those patients who have been on steroids.

A 32-year-old female was diagnosed by loop electrosurgical excision procedure with adenocarcinoma in situ and a focus suspicious for positive lympho-vascular invasion. An abdominal radical trachelectomy was performed to preserve her uterus and fertility. The patient recovered without complications. The patient has had one year of follow-up without any  avidences of recurrence. At present, the patient is not actively trying to become pregnant. We concluded that abdominal radical trachelectomy may be a surgical option for early stage cervical cancer treatment in young women who wish to preserve fertility.    

Shared psychotic disorder develops in an individual in the context of a close relationship with another one who has an established delusion that he/she also believes. It is classified within paranoid disorder. Herein, we present a case of two sisters with their mother. The elder sister was the origin of paranoid delusion. Her delusion was with a dentist who tries his best to prevent her for marrying. They separated completely from all their relatives for two years.    

Heterotopic neuroglial tissue, composed of differentiated neuroectodermal tissue, represents developmental heterotopia of neuroglial tissue rather than true neoplasm. Herein, we present a patient with nasopharyngeal heterotopic neuroglial tissue who presented with respiratory distress and feeding difficulty in early days after birth. Magnetic resonance imaging showed a cystic lesion measuring about 3 × 1.5 cm in the nasopharynx near the uvula. The lesion was resected and confirmed histologically as a heterotopic neuroglial tissue.      

Fracture-dislocation of lumbosacral junction is rare. It usually affects the patients with multiple trauma. In all reported cases, anterior or posterior displacement of L5 on S1 have been reported, but anterolateral displacement has not been reported yet. Herein, we report delayed diagnosis of fracture-dislocation of L5-S1 with anterolateral displacement of L5 on S1, which was treated successfully with surgery (open reduction, posterior fusion, and instrumentation).      

Nephrotic patients are at risk of developing venous and arterial thromboses. Various organ manifestations have been reported. Intracardiac thrombi associated with multiorgan thrombosis have been reported in autopsy in the earlier literature, but there is only one case report in living patients with nephrotic syndrome. Here we report a 9-year-old boy with steroid-resistant nephritic syndrome who developed an asymptomatic but potentially hazardous large intracardiac thrombus.    

Aortic false aneurysm is a rare complication of surgery of the aorta that can occur several months to years after the initial operation. We reviewed our results with false aneurysm repair using deep hypothermia and circulatory arrest. Three patients were reoperated for false aneurysm of the ascending aorta. Femorofemoral cardiopulmonary bypass with a heparinized system was used in all patients. Hypothermic circulatory arrest at an average temperature of 20°C was instituted in all patients for repair. Two patients had a patch repair with pericardium, and the other one had primary repair of the defect. All patients had false aneurysms in the ascending aorta at the site of a previous aortotomy. Two patients had proven infection as the cause. The mean cardiopulmonary bypass time was 183 ± 20 minutes, and the mean circulatory arrest time was 35 minutes. Operative mortality was not seen. The mean time for extubation in survivors was 10 – 12 hours, and the average time to discharge was 26 days. Aortic false aneurysms can be safely approached using femorofemoral cardiopulmonary bypass, hypothermic circulatory arrest, and patch repair with acceptable operative mortality and long-term survival.      

Physicians brain drain was a hot topic a few decades ago. It was reopened about a year ago in the New England Journal of Medicine.1 This paper was what it said it was— quantification of the problem. Additionally, host countries, or the four major recipients of the “medical brains,” were identified in that article as being the United States, the United Kingdom, Canada, and Australia. The term “international medical graduates” (IMGs) has also replaced the former “foreign medical graduate” (FMGs), because this newer term also covers the large number of the United States citizens who obtain their medical education outside the United States.

A 54-year-old man was referred to our hospital because of severe excruciating acute colicky central abdominal pain. The pain was associated with nausea, postprandial vomiting, and constipation. He had history of 15 kg weight loss during the last two months. He was opium addict, and cigarettes smoker (20 packsyear) with a negative history of diabetes mellitus and hypertension. He underwent a surgical operation two months before, when he had a similar attack of abdominal pain. The surgery was then revealed small bowel necrosis for which resection of 30 cm of small bowel was performed. General physical examination was unremarkable. There was mild tenderness in deep palpation of periumbilical area. Laboratory data including serum amylase were reported to be normal. The initial abdominal ultrasonography was normal. Upper gastrointestinal endoscopy and colonoscopy were also normal. On account of his severe abdominal pain, a multislice helical abdominal computerized tomography with contrast was requested (Figure1).    

In the first decade of the twentieth century, a child was born who subsequently became an influential figure in the Iranian contemporary medicine. He was the late Dr. Mostafa Habibi-Golpayegani (1904 – 1948), pioneering professor of the modern pathology in Iran. Herein, a brief account of his life and career is presented.  

Cancers of the esophagus (squamous cell carcinoma and adenocarcinoma) are among the most deadly cancers with a five-year survival of less than 10%. Esophageal squamous cell carcinoma (ESCC) is decreasing rapidly in western countries and adenocarcinoma rising significantly. Gastric cancer (GC) epidemiology is changing as well, with distal GCs decreasing and proximal GCs, especially at the cardia region on the rise. ESCC claims about 335,000 lives worldwide each year with over 90% occurring in developing countries. It is the 6th most common fatal cancer in men and 9th in women with a male/female ratio of 1-3:1. There is a great variation in incidence between and within countries. Most of the hotspots are located along a presumptive belt starting from northern China, extending along the southern parts of the former Soviet Union, and ending in the Caspian littoral in northern Iran. Genetic and familial factors play their role in addition to environmental, nutritional, and habitual factors.  

Nowadays, up-to-date sources are produced by researchers worldwide and published in various biomedical journals. Sharing the results of a study in a reputable journal is both a demanding and an exciting process. It is a form of mental exercise and has to be written in a well-organized manner to present logical flow and should respect the accepted international principles; otherwise the paper's rejection rate will be increased either by the editors or peer reviewers.1 Up to 2002, more than 4500 medical journals, mostly in English (88%) have been indexed in MEDLINE.2 currently, in Iran more than 80 medical journals are published.3