Medical Journal of The Islamic Republic of Iran
Year:2004 | Volume:18 | Issue:1|Papers Count:15

Iran is recognized as an endemic area for lung hydatidosis. Surgical removal of some hydatid cysts may have serious morbid consequences. To determine the characteristics of these special cysts, a retrospective survey was carried out on patients admitted to Modarres Hospital in Tehran between 1989 and 1998.We have found that ruptured, bilateral, lung located, and giant cysts (> 10 cm) cause more surgical and anesthetic complications, thus we named them "complicated cysts". Of 110patients, 62(56.4%) had complicated hydatid cysts. Of these, 2 individuals died during anesthesia induction because of hypoxemia, Since sudden severe hypoxemia did not respond to all essential measures, the patients were returned to the supine position (from lateral decubitus position), then rigid bronchoscopy was performed for drainage of cyst secretions and fragments oflaminated membrane. At the time of induction of anesthesia, the contents of a ruptured cystmay spill into the airway and cause hypoxemia and even death. In order to prevent this complication, two different approaches were used: (l)Achest tube was introduced into the cyst through the chest wall and its contents were drained; (2) Patients were placed in the sittingposition during intubation. Double Imnenendotracheal tube (DLT)may allow salvage of unaffected lung ITom inadvertent leakage of cyst contents or laminated membrane emboli formation, but it does not guarantee a safe operation. Thus, rigid bronchoscopy should always be available. Cystostomy was the most common surgical technique performed in our center (80%). Massive air leakage, bronchial fistula, and permanent lobar collapse were the main indications for lung resection in our series. Surgical complication rates of our study were higher than reports from the west. Coordination and cooperation of experienced surgeons and anesthetists can result in better outcomes following complicated cyst removal.

Massive cerebral infarctionis often accompanied by early death, secondary to brainedemaandtrans-tentorialherniation.Severalreportsindicatebeneficialeffectsof decompressive craniectomy in thissituation,butthe efficacy of thisprocedure is stilla matter of debate. An experimental study in a periodon years was doneon 23 patients with brain edema due to massive cerebral infarction; 11 patients were subjects andwere operated, and 12 were in the non-operated group who only underwent conservative treat-ment. All patientsin this study had GCS below 8. The mean age of the operated patients was 54.5 years and for the unoperated patients 64.4 years. Mean GCS in the operated cases was 7.00 and in the unoperated cases was 7.66. In the operated group 4 of 11patients lived (36.4%) and in the unoperated group 1 of 12 cases lived (8.3%). In the living operated cases, 1 had GOS 4 and 3 cases had GOS 3. In unoperated cases 1 patient lived that had a GOS of 2. These results show that decompressive craniectomy can be an effective lifesaving procedure fo rmalignant brain edema after cerebralin farction and can also give accept-able functional recovery.

To describe and compare the clinical outcome of infants born to mothers with gestational and pregestational diabetes mellitus, this study was conducted between Janu-ary 2000 to January 2002 in Tehran Vali -E- Asr Hospital. Among 4472 deliveries, we found 107 infants born to diabetic mothers out of whom 6 were twins. The prevalence of diabetes in total deliveries was 2.39%. Mean age of gestational and pregestational diabetic mothers was 30.9±5.86and 31±5.37 respectively. 74 infants (69%) belonged to gestational diabetic mothers. 50% of infants were male. Mean birth weight of infants was 3067±784.917 (700 -5600g). Gestational age in 57% of infants was less than 38 weeks.APGAR score at 1& 5 minutes was <6 in 10 and 5 cases respectively. Hypoglycemia was detected in 31%, hypocalcemia in 13%, hypomagnesemia in 4.5%, polycythemia in 6.8%, macrosomia in 28.6%, small for gestational age in 2%, respiratory distress syndrome in 8.2%, early sepsis in 9.2%,NICU admission in 23.7%, and hyperbilirubinemia in 34%. The incidences of most of these morbidities were higher in infants of pregestational diabetic mothers. The differences between the incidence of hypoglycemia, hypocalce-mia & 5 minute APGAR score in infants of pre gestational and gestational diabetic mothers were significant(p<0.05). There was a significant correlation between the incidence of hypoglycemia and birth weight of infants(p<0.05).The existenceof congenitalanomaliesin infantsof gestational diabetic mothers could be due to unrecognized cases of noninsulin depen-dent diabetes mellitus, and with respect to meanage of mothersit is advisableto detect diabetes before pregnancy in high risk groups and correct the level of hemoglobin A1c before pregnancy. Cleft palate and undescended testes among the anomalies support this hypothesis that prostaglandin deficiency may have a role in the pathophysiology of congenital malformations in these infants.

The provocative effects of sleep deprivation (SD) on patients with seizure disorder and on the electroencephalogram (EEG) are well known.The purpose ofthe study was to test its routine use and usefulness in the pediatric and adolescent age group with, or suspect of having, seizure disorder,especially those presenting with first unprovoked seizure. Between September 2000 and November 2002, among patients referring to the author"s clinic and the Pediatric Emergency Department of Nemazi Hospital, Shiraz, 598 children and adolescents were randomly assigned to a 10-minute surface EEG, either routinely, or after a period of partial or total SD. Those who refused or could not tolerate the SD procedure entered the routine group. The EEG"s were analyzed for the presence of epileptic abnonnality. Of 598 patients,544(91%)had clinical seizures;therest (54,9%)were seizure suspects or had seizure "rnirnickers" (syncope, night terrors, pseudo-seizures, etc). Of seizure patients, 210 ( 38.6 % ) suffered from a first unprovoked seizure, and the rest (334,61.4%) had more than one seizure episode at the time of EEG performance. Abnonnal epileptiform EEG"s were more frequently seen in the group of seizure patients who were sleep-deprived before performing the EEG, as compared to the routine group. Conversely, more normal EEG"s were seen upon routine performance of EEG (p value <00001, X2= 76.5). Similarly, more abnormal sleep-deprived EEG"s were seen in patients with first unprovoked seizure than when EEG was done routinely in this subgroup of patients. Patients with complex partial seizurehad signifIcantly more abnormal EEG"s when subjected to SD (p<00001). Older patients could tolerate SD better than the younger age group; so more routine EEG" s had to be performed in the younger age group.Younger children could only tolerate partial SD. There was no difference in the yield of EEG in patients with absence epilepsy between the two groups. In 5 patients withjuvenile myoclonic epilepsy, SD precipitated a generalized tonic-clonic seizure which necessitated acute antiepileptic dmg administration to the seizure activity. All patients with non-seizure episodes showed normal EEG"s. In conclusion SD can be safely applied in the work-up of selected pediatric patients with seizure disorder, especially in those with their first unprovoked seizure, in whom an abnormal EEG might dictate anti-epileptic dmg therapy. Not all children with seizure disorder need to undergo SD for EEG, as it may not Sleep-Deprived EEG for Seizure Disorder Diagnosis in Children be necessary in some, and intolerable in others. In non-seizure episodes, if used in appropriate pediatric age groups, it can be very helpful to ensure that a seizure disorder is not present.

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retroperitoneal masses within a 4 year period (1998- 2001) preoperative fine needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases.This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity (positive or negative for malignancy) is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm"s tumor, 77% accurate for lymphoma and 57% for germ cen tumors. There was no complication in any ofthe cases after fme needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases.

Magnesium(Mg)deficiency has not usually beenconsidered in clinical practice dueto lack of relevant blood tests and because the syrriptoms are often vague and non- specific. Serum concentrations may not adequately reflect Mgstatus.Mg LoadingTest (MLT)can provide information on total body Mg stores.We prospectively studied 21 critically ill patients(10male,11 female)admitted to the ICU,to investigate the prevalence ofMg deficiency.Their meanage was 50±21years.TodetermineserumMg, venous blood specimenswere obtainedjust before the MLT.Mgsulfate (30 mmol) was infused during an 8-hrperiod and 24-hr urine samples were collected from the starting of Mg infusion.Although low serum Mg(<1.8mmol/L)was presentonly in 2 patients, MLT showed Mg deficiency in 18 patients. MLT detected Mg deficiency in 13out of 14 patients with normal serum Mg, in 2 out of 2 subjects with hypomagnesemia, and in3 out of 5 cases with hypermagnesemia. Of7 fetal cases, 6 occurred in individuals with hypomagnesemia (6/18) and 1death occurred in the normornagnesemic group (113). There was no relationship between Mg retention, age (r= 0.33,p= 0.63) and serum Mg concentrations (r= 0.15,p= 0.925). There was a significant correlation between Mguptake and APACHE II score (r= 0.46,p= 0.035). In conclusion, Mg depletion is highly prevalent in ICU patients according to MLT. MLT is superior to serum Mg in determining actual Mg status in this group. Therefore, we suggest that MLT, and not serum Mg, should be carried out in patients when Mg deficiency is suspected.

The effects and interaction between cAMP-analogue dibutyryl-cAMP and calmodulin antagonists were investigated on de novo syn thesis and secretion of lipidsin cultures of hepatoma McArdle-RH7777 cells and normal rat hepatocytes.Dibutyr-ylcAMP caused a significant decrease in the secretion of de novo synthesized triacyl[3H] glycerol in both cultures of Mc-Ardlecells and rat hepatocytes.The inhibi-tory effect of dibutyryl-cAMP was concentration-dependent and appeared at the lowest concentration examined,5µM.Dibutyryl-cAMPat a concentration of 50µMsuppressed secretion of triacylglycerol by approximately 38%(p<0.05)and secretion of phosphatidylcholine by 30%(p<0.05).Dibutyryl-cAMPdid not affect the synthesis of triacylglycerol and phosphatidylcholine,except at the highest concentration tested, 500 µM, where both triacylglycerol and phos phatidylcholine synthesis were sup-pressedsignificantly. Anticalrnodulin W-7 also inhibited secretion of newly made triacylglycerolin a concentration-dependentmanner in both cultures of McArdle cells andrat hepatocytes. W-7at a concentration of 20µM suppressed triacylglycerol secretion by about 37% (p<0.05), while the secretion of phosphatidy lcholine and synthesis of triacylglycerol and phosphatidylcholine were not affected,unlessat morethan20 µMconcentration, at which both triacylglycerol and phosphatidylcholine synthesis were decreased significantly.

The cytotoxic activity of natural killer cellsisusually tested by radioactive assay (Cr release assay),which detects the release of cytoplasmic contents after plasma membrane disintegration of dyingcells.In contrast to thisindirect evaluation of cytotoxicity, theassessment of cell damage by flow cytometry aims to provide a moreexact characterization of the death pathway via detection of the percentage of apoptosis and necrotic cells.Annexin V-FITC(Axv -FITC) can be used to label cells in the early apoptotic state,whil epropidium iodide(PI)indicates late apoptosis or necrosis. TheNK cytotoxicity of cord blood (CB)and peripheral blood (PB)was determined after 4 hours of incubationin the absence of cytokines.After 4 hours in vitro incubation,co-staining with AnnexinV-FITC(Axv-FITC)and propidium iodide(PI) pennitted discrimination between viable,early apoptotic and necroticcells.As we would expect, the cytotoxicity pathway inPB mononuclearcells(MNCs)consists of both apoptosis and necrosis pathways but in CBM NCs it almostconsists of early apoptosis; and necrosisis negligible.With escalating E:T(effector:target)ratio changesin the percentage of apoptotic cells in PB samples were significantly higher than CB samples. The mechanism(s)of the low cytotoxicity of restingcord NK cells isnot well understood. Complementary researchinthis field is recognized to elucidate the phenotypical and functional properties of CB cells and how they relate to maturational stages.CB studies are important for transplantation research and may provide insight to the sup-pressive mechanism by whichthehost- recipient could evade GVHD and rejection.

Bacterial vaginosis (BY) has been considered to be the most prevalent infection found in sexually active women. BV is thought to play an important role in the premature rupture of membranes (PROM) and preterm birth. Preterm delivery accounts for a substantial percentage oflow birth weight infants and perinatal mortality and morbidity. Bacteroides and Prevotella species have been isolated from the amniochorion of women with preterm birth and PROM. Women with> 104/mLPrevotella bivius (formerly Bacteroides bivius) have a 60-100% higher rate of preterm delivery. The purpose of this study was to determine wether some strains of Prevotella species isolated from PROM andBV patients produce proteases especially collagenase enzymes which faciliate the rupture of membranes leading to preterm birth. Vaginal specimens have been obtained from 120 women with BV and premature rupture of membrane in 30-44 weeks gestational age. Twenty anaerobic coccobacilli consisting of Bacteroides fragilis, black pigmented Bacteroides and Prevotella bivius were isolated and identified. The isolates were examined for protease activity, using porcine skine gelatin and casein as substrates by Martleys method. Elastase and collagenase activity were detected using elastin, guinea pig skin collagen, bovine achillestendon collagen,FALGPAand GP,VPKas substratesby Levenson method. Collagenase and elastase activity was detected in 90 and 100% of isolates. Gelatinase and caseinase activity was detected in 40 and 50% of isolates. Collagenase produced by Prevotella bivia isolates was purified by ammonium sulphate precipitation, gel filtration and ion exchange chromatography.The collagenase was cleaved from the synthetic collagen substrate FALGPA, and GP,VPK substrates. The activity of the enzyme was inhibited by EDTA, Antipain and PMSF. This study suggests that proteases produced by Prevotella bivia may be involved in the pathogenesis of premature rupture of membrane. PROM before 37 weeks has been reported to be significantly higher among patients with Bacteroides and Prevotella colonisation of the genital tract. The amniochorion consists of collagen and elastin which convey physical integrity to the placenta. Collagenase and elastase released into the genital tract may promote connective tissue destruction in the cervix and chorioamnion membranes.

The study has strived to compare the leucocyte-esterase stripe activity on sputum samples with gram-stained direct smear microscopy. This is for the demonstration of white blood cells (WBCs) and so to develop a simple method for selecting suitable sputum samples for cultural examination and laboratory diagnosis. A total of 17(34.0%) out of 50 samples studied were shown to be unsuitable for microbiological examination and for identification of mycobacterial infection. Sputa of patients between the ages of20-29 years old were found to be more positive by demonstrating more WBCs and squamous epithelial cells (SECs). Webelieve this technique should offer an alternative to the conventional direct smear microscopy used for examining patient"s sputa in our hospital laboratories.

In this descriptive cross-sectional study 14 national basketball team players attending the preparatory camp for the Asian games with mean age of25.6±3.1 yrs, height of 191±6 em, weight of 87.3±8.1 kg and BMI of 23.9±1.7 were surveyed. The subjects underwent anthropometric, aerobic power, body fat content and VO2 max measurements in three stages ofthe training period (before training, during training and before the actual competition). In two stages (before and during training) nutritional assessment and food intake using weighing method in 7 intermittent days was made. Anthropometric measurements showed body weight and BMI changes during the period of study to be negligible and non-significant. Subcutaneous fat was reduced significantly (p< 0.02). Also VO2 max increased appreciably (p<0.001)from 42.3±3.3 in the first stage to 44.3±4.4 and 44.5±2.2 mL/Kg body weight per minute in the second and third stage respectively which demonstrates the positive role of exercise on maximum oxygen uptake or VO2 max. The results of quantitative food intake assessment showed the energy intake to be at 3900 kcal per day. At this stage carbohydrate, fat and protein provided 50,35 and 15% of energy respectively. In the second stage energy intake was 3600 kcal with 55, 30 and 15% of energy coming from carbohydrate, fatand protein respectively which were in the nor-mal range in both stages. Regarding vitamins and minerals, intake of iron, calcium and ascorbic acid was above the range, while thiamin, riboflavin and niacin were within the range and vitamin A as well as B6 were below the recommended levels. Further research regarding nutrient intake monitoring, nutrition education of athletes and coaches as well as international nutrition research offering a defined menu in preparatory camps is necessary.

In his book "Canon in Medicine (AI-Ghanoon)", Avicenna has specified a chapter containing two sections pertaining to fever.After defining fever and explaining it"s different stages, he divides it into three types: hectic fever, infection-induced fever and daily fever.After accurate attention to the patient"s history and key-points in examination, he focuses on fever signs and its treatment regarding each type of the three. In this article, we intend to discuss Avicenna"s views on fever in comparison to those of modem medicine.

Testicular schwannoma is a very rare benign scrotal tumor. It is a painless mass, but sometimes referred because of pain or sensory losses. Tumor markers are normal and radical orchidectomy is its best treatment. Here we present an unusual case of intrascrotal schwannoma in a 57 year oldman, with a review of the literature. MJIRL Vol. 18, No.1, 85-86, 2004.

Congenital cutis laxa is an exceptional condition. No large scale pedigree has been reported from Iran. We report a family with 106 members with two members affected with cutis laxa. Our cases were two patients (male and female) with pre- and postnatal growth retardation, cutis laxa, characteristic facies and other manifestations which proved that they were affected with cutis laxa. Their family history was studied and a large pedigree was drawn up. Based on the fmdings in their pedigree pattern, in addition to clinical and pathological studies, one can say that cutis laxa in this family is autosomal recessive. Wealso showed obligate carrier members in the family. Recent studies have shown that cutis laxa is a heterogeneous group of conditions both clinically and genetically.Autosomal dominant, autosomal recessive,X-linked and also acquired forms have been reported. Our study indicates that our case is an autosomal recessive type I.We discussed the pedigree that covers five generations.

We present an infant girl with hyperekplexia, hypertonia, hyperreflexia and a char- acteristic exaggerated response to nose tap.This disorder is important to recognize because of the increasedrisk of apnea and sudden infant death.ecau This infant responded to clonazepam.