ARCHIVES OF IRANIAN MEDICINE
Year:2013 | Volume:16 | Issue:4|Papers Count:12

Background: Northern Iran (Ardabil) is characterized by a high gastric cancer (GC) rate, whereas Southern Iran (Kerman and Yazd) has a low GC rate. The aim of this study is to verify the potential for pepsinogen I and II to detect atrophic gastritis (AG) in both high and low risk populations for GC.Methods: Sera of blood donors and patients with GC from Ardebil, Kerman and Yazd were used to measure levels of pepsinogen I, II and H. pylori IgG antibody. GC rates in these cities were determined according to the Cancer Registry and upper gastrointestinal (GI) endoscopy results.Results: There were 449 subjects with an average age of 45±15 years. The GC rate in the endoscopy units of the hospital in Ardabil was four times higher than Kerman or Yazd. The mean serum pepsinogen I levels did not differ between Ardabil (102±42.6 mg/mL), Kerman (103.3±49.8 mg/mL), and Yazd (111.7±39 mg/mL). Pepsinogen II levels were: 8.1±4.7 mg/mL (Ardabil), 7.5±5.3 mg/mL (Kerman), and 7.6±4.4 mg/mL (Yazd), which were not different. The H. pylori infection rates were: Ardabil (61%), Kerman (55%), and Yazd (73%). A low ratio of pepsinogen I to II (m3) was seen in Ardabil (1.3%), Kerman (1.9%), and Yazd (0.0%), which was not significant. A total of 51.9% of GC patients from Ardabil had normal pepsinogen I ( ³70 mg/mL) levels and pepsinogen I/II ratios that were>5.Conclusion: Serum biomarkers pepsinogen I and II and their ratios are probably not sensitive predictors of AG in areas that have either a high or low GC prevalence. This finding is likely related to the lack of an association between GC and advanced AG.

Background: Cerebral palsy (CP) is one of the main disabilities in term-born infants. This study attempts to investigate the maternal and neonata l factors associated with CP.Methods: This case-control study consisted of singleton term and near-term (36 or more weeks of gestation) newborns in Tehran healthcare centers and was conducted over a 24-month period. Logistic regression analysis analyzed the data with SPSS 16.0.Results: During the study period there were 53 infants in the case group and 106 in the control group. The main factors associated with CP were perinatal asphyxia [odds ratio (OR): 97.72; CI: 21.2-450.07], maternal age>35 years (OR: 20.89; CI: 1.05-412.62), and high risk pregnancy (OR: 0.2; CI: 0.04-0.932).Conclusions: Several maternal, antenatal and intrapartum factors increase the risk for CP. Identifying and avoiding risks for CP may lead to lower infant neurologic morbidity.

Background: Thalassemia, which may be due to point mutations, translocations, and deletions involving the a or b globin gene, is the most prevalent single gene disorder in Iran. This study aims to calculate the a/b ratio in normal cases, a- and b-thalassemia carriers by RT-PCR, real-time PCR, and in vitro globin chain synthesis (GCS) in order to establish the most accurate technique to distinguish between a- and b-thalassemia carriers in suspicious cases.Methods: The a/b ratios were calculated in all samples by RT-PCR, real-time RT-PCR, and in vitro GCS.Results: Using RT-PCR, the ratios were 1.09±0.07 in normal samples, 1.2±0.17 in b-thalassemia, 1.08 ±0.19 in mild a-thalassemia, and 0.96±0.19 in severe a-thalassemia carriers. In real-time RT-PCR, the ratios were 2.21±1.36 in normal samples, 5.12±1.83 in b-thalassemia, 2.88±0.81 in mild a-thalassemia, and 1.18±0.52 in severe a-thalassemia carriers. With GCS, the ratios were 1.03±0.1 in normal samples, 1.9±0.37 in b-thalassemia, 0.8±0.13 in mild a-thalassemia, and 0.59±0.12 in severe a-thalassemia carriers.Conclusion: To determine the most accurate technique, we statistically analyzed the a/b ratios obtained from the three standard methods.The ratio obtained by GCS and real-time PCR were helpful in distinguishing between a and b carriers in suspicious patients in whom the mutation detection was limited and the risk for offspring was not clear. The use of this technique is more obvious when time is restricted (i.e. during the pregnancy period).

Background: Exposure to electromagnetic fields (EMFs) and its effects at different frequencies on living beings has been investigated for decades. However, there are fewer studies that have been conducted on humans, thus this study aims to determine the effect of extremely low frequency (ELF) -EMFs on pregnancy, fetal growth and development in humans.Material: In this epidemiologic analytical cohort study, cases included pregnant women and their newborns. There were 222 women exposed to ELF-EMFs from high voltage electricity towers and cables during pregnancy and 158 women who had no exposure during pregnancy. Data that included pregnancy duration, neonatal birth weight, length, head circumference, gender and congenital malformations were collected through direct questions, measurements and referral to the registered data of related hospital or health center documents.Collected data was analyzed by SPSS-16. P<0.05 was considered significant.Results: No significant difference was found in pregnancy duration and preterm labor, neonatal birth weight, length, head circumference and congenital malformations in the two studied groups.Conclusion: Although the results of this study have shown no significant effects of ELF-EMFs on human pregnancy, fetal growth and development, taking precautionary measures to reduce exposure to EMFs by pregnant women seems logical. Conducting similar studies is strongly recommended.

Background: One of the most common facial anomalies is the presence of a prominent ear. Numerous surgical techniques have been introduced in the literature for correction of this anomaly, which include suturing and sculpturing the ear cartilage. However, each has different complications. The modified Chongchet technique is one of the less invasive methods and can correct the above abnormality with satisfying results.Methods: From July 2001 to March 2011, 19 cases of prominent ear were corrected using the modified Chongchet technique. The mean follow-up period was approximately 4.5 years. We employed an anterior approach and partial-thickness scaphal cartilage scoring in these cases.Results: We observed no recurrences and no sharp cartilage protrusions following the surgeries. Additionally, all patients expressed satisfaction with the results.Conclusion: We propose that the modified Chongchet approach is less aggressive and has improved surgical outcomes. One of the adverse effects of this procedure is unpredictable warping of the cartilage, which may result in asymmetry.

Background: Magnetic resonance imaging (MRI) of the knee joint has often been regarded as a noninvasive alternative to diagnostic arthroscopy. In day-to-day clinical practice, the MRI scan is routinely used to support the diagnosis for meniscus or ligamentous injuries prior to recommending arthroscopic examination and surgery. On the other hand, rapidly progressing medical technology sometimes obscures the importance of history and physical examination. This study aims to evaluate the accuracy of physical examination and MRI scanning in the diagnosis of knee injury, including meniscus tears and cruciate ligament ruptures.Methods: In a cross-sectional, descriptive analytical study, 120 patients with knee injury who were candidates for arthroscopy were referred to Tabriz Shohada Hospital during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. Before ordering an MRI and arthroscopy, a thorough physical examination of the affected knee was performed and a preliminary diagnosis made. The results of arthroscopy were considered as the definitive diagnosis, therefore the results of the physical examination and MRI were judged accordingly.Results: Of the 120 evaluated patients with knee injuries, there were 108 males and 12 females with a mean age of 29.13 ± 7.37 (16–54) years. For medial meniscus injuries, clinical examination had an accuracy of 85%, sensitivity of 94.8%, and specificity of 75.8%. Lateral meniscus injuries had the following results: accuracy (85%), sensitivity (70.8%) and specificity (88.5%). Clinical examination of anterior cruciate injuries had an accuracy of 95.8%, sensitivity of 98.6% and specificity of 91.7%. According to MRI results, for medial meniscus injuries there was an accuracy of 77.5%, sensitivity of 84.2%, and specificity of 71.4%. In lateral meniscus injuries, MRI had an accuracy of 85.8%, sensitivity of 56.5% and 92.8% specificity. MRI evaluation of anterior cruciate injuries was 92.5% for accuracy, 98.6% for sensitivity, and 83.3% for specificity. Both clinical examination and MRI were 100% for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than with complicated cases. The opposite results were seen for MRI findings in this regard.Conclusion: According to our results, both physical examination and MRI scans are very sensitive and accurate in the diagnosis of knee injuries, with a mild preference for physical examination. MRI should be reserved for doubtful cases or complicated injuries.

Pancreatic cysts (PCs) are being increasingly detected due to the widespread use of high-resolution abdominal imaging. The main imaging modalities to diagnose PCs include high-resolution spiral CT scan, MRI, and endoscopic ultrasound (EUS). EUS has the added benefit of enabling cyst fluid sampling through FNA and significantly improves clinical diagnosis of PCs. Some PCs like pseudocysts, serous cystadenomas, and lymphoepethelial cysts are entirely benign lesions and can be managed non-operatively. However, other lesions like mucinous cystic neoplasms, or cystic neuroendocrine tumors are pre-malignant or malignant lesions and require surgical intervention. In this review, we describe diagnosis and management of common pancreatic cystic lesions.

Human factor is one of the most important causes for traffic accidents. This study has been designed to determine the presence of alcohol and drug abuse among drivers killed in car accidents in Hamadan, Iran during a one year period. This study was conducted as a postmortem series design. Forensic autopsies were performed on all drivers killed in car accidents who were referred to the Hamadan Medicolegal Center. Alcohol and drug abuse was evaluated in these drivers. Of the 106 drivers killed in car accidents, 98.1% were male. Most were 20–30 years of age. In the majority of cases (83%) the toxicologic tests were negative. Higher level of education (diploma and higher) was related to higher alcohol or drug abuse compared with those whose educational status was less than a diploma (46.7%) or those who were illiterate (16.5%; Chi-square: 7.13; P=0.008). There was a remarkable difference between drug or alcohol abuse and season. The majority of substance abusers were in the summer (n=13, 59.1%); the least were in the spring (n=2; 9.1%). This study shows that alcohol and drug abuse, in particular opiates, could be important factors in traffic accidents in Hamadan, Iran.

Between September 2010 and January 2012, four patients in our hospital were observed to have permanent dialysis catheters that adhered to either the SVC or right atrium. The first patient underwent intraoperative fluoroscopy and was scheduled for cardiac surgery.Unfortunately due to metabolic disturbances, the patient’s condition deteriorated and she died before surgery. The second patient underwent cardio-thoracic surgery with mid-sternotomy and cardio-pulmonary bypass. The catheter was removed and another access route for hemodialysis was established. The third case was scheduled for interventional venocavagraphic exploration of the adhered Permcath. An endovascular snare was passed through the guide wire, which separated the catheter from the SVC. Finally, the fourth patient was a known case of Von Willebrand disease who was scheduled for interventional angiographic Permcath removal. Unfortunately, a few hours following the attempt at surgical removal of the Permcath, her condition deteriorated and she died.Several methods have been used to manage an adherent Permcath. It is assumed that the longer the catheter is in place, the probability of adhesion to the central veins increases. Histological changes have been demonstrated in the venous wall adjunct to the catheter.Interventional venacavagraphic exploration of the catheter and snaring the adherent site of the catheter seems to be a valuable option.

This case was an extremely rare form of cervical dysgenesis that presented with cyclic pain. Diagnostic laparoscopy and vaginoscopy showed the presence of a blind uterus at the level of the internal cervical os with a normal vagina and exocervix. Mullerian ducts are the embryologic origin for the uterus, cervix and upper part of the vagina. Mullerian duct migration initiates from the upper part of the Mullerian system. Therefore an obstructed uterus is usually associated with cervical and upper vaginal anomalies. This case was unusual because of the presence of an isolated segmental atresia at the level of the internal cervical os. However the vaginal portion of the cervix, vagina and urinary system were normal. We theorized that the absence of an appropriate fusion between the Mullerian duct and its underlying mesoderm, loss of cell-to-cell communication and special gene expression during a critical time period or a vascular accident between 12–22 weeks of gestation might have caused this anomaly. The patient underwent a laparotomy to create a utero-cervical canal using a peritoneal graft.

A 72-year-old male presented to our outpatient clinic with a history of long term dyspnea. During a high resolution thoracal computed tomography (CT) scan, the left diaphragmatic crura showed a smooth, rounded small hypodense mass and an enormous pericardial mass.

Note: In April 2012, a paper entitled “Impact of Quality Mentorship on Achievements of Shiraz Medical School in the 1970s and the Role of Professor Faramarz Ismail-Beigi” was published in Archives of Iranian Medicine. (Azizi MH, Nasseri-Moghaddam S.Impact of Quality Mentorship on Achievements of Shiraz Medical School in the 1970s and the Role of Professor Faramarz Ismail- Beigi. Arch Iran Med.2012; 15 (4): 259-262.) The following papers describe the profound impact of two great medical mentors, Professors Khosrow Nasr and Asghar Rastegar on achievements of Shiraz School of Medicine in the same period.Dr. Khosrow Nasr One of the major reasons I decided to join the faculty of Pahlavi University (now Shiraz University) was because of Dr. Khosrow Nasr. I met him in Baltimore, Maryland in 1971 during his short visit to the United States.