Medical Journal of The Islamic Republic of Iran
Year:2001 | Volume:15 | Issue:3|Papers Count:12

Our aim was to evaluate the short and long term efficacy of botulinum toxin therapy in Iranian patients with achalasia. In a randomized, double blind trial, 20 patients with achalasia, referring to Imam Khomeini Hospital, received either 80 units of botulinum toxin (BT) or placebo (PL) from 1995 to 1998. Two weeks later, the response to treatment was assessed on the basis of changes in the symptom score (measured on a scale from 0 to 9). Patients who received PL initially were subsequently treated with BT. After two weeks and six months, assessment was repeated. Two weeks after treatment, clinical evaluation revealed that in the BT group all clinical symptoms were improved and the total symptom score had significantly decreased from 6.2±1.4 to 1.9±1.66 (p<0.05) and no significant changes were seen in the clinical score of the PL group. No significant differences were seen in the BT group comparing thoracic pain after the first two weeks. Two weeks after the first injection, patients who did not show clinical improvement received toxin with the same previous dose and re-evaluation was performed two weeks after the second injection and six months after the first injection. After six months mean symptom score was 3.4±1.9 (p<0.005) in the BT group and 2.4±1.51 (p<0.005) in the PL group. At this time clinical responses persisted in 12 patients (60%). In conclusion, injection of botulinum toxin into the lower esophageal sphincter is an effective, safe and simple method of treatment for achalasia, especially in patients who cannot use other methods.    

Early wound excision and grafting of burn wounds is regarded not only as the method of choice in speeding up the healing process in deep burns, but also limits contracture and infection. On the other hand, smoking has generally been implicated in the delay of the healing process in a variety of surgical procedures. In this study we report the outcome of a cross-sectional study of all the 395 medical records of adult patients who underwent split-thickness autographing during a six month period (Sep. 1999 to March 2000) in Taleghani Burn Center, Ahwaz. The subjects, both male and female, who underwent auto grafting for deep burns, were allocated into smoker and nonsmoker groups. The results showed that rejection of the auto grafts was significantly more widespread and more common among cigarette smokers. The extent of rejection was 6.7±0.5% of the graft area as compared to 2.9+0.3% in the control group (p<0.01). The incidence of rejection and successful take was 66.6 and 28.7% respectively among the cigarette smoking group (O.R. 4.95). The reason for the increase in rejection may be due to the toxic constituents in cigarette smoke. We recommend that smokers be encouraged to abstain from smoking prior to and post-burn grafting surgical procedures, which may be a useful preventive measure. Further research in this field is undergoing in order to assess the effectiveness of this recommendation in reducing the incidence of graft rejection.      

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. This study was designed to distinguish AFS among patients with chronic sinusitis who failed to respond to repeated courses of antibiotics and were therefore candidates for functional endoscopic sinus surgery (FESS) in Sari. Allergic mucin and sinus lavage was collected during FESS from 100 patients meeting the diagnostic criteria for AFS and were submitted for mycology and pathology investigations. The specimens were centrifuged and the sediment was mounted in 10% KOH and Gram's stain for direct examination. The specimens were inoculated in Sabouraud's Dextrose Agar. Multiple fragments of mucosa were removed at surgery and stained with H&E and PAS for the pathology evaluation. In this study we report 9 proven cases of AFS (with demonstration of fungal hyphae by direct exam and culture) and 8 suspected cases (confirmed by direct exam or culture). The patient's age ranged from 12 to 62 years, with a mean age of 24.5 years with female predominance. All of the patients were immunocompetent. 47% of the patients had a history of atopy. Histopathologically, hyphae were not seen. The genera of the fungi were identifiable in all but one patient. 53% of isolated fungi were from the hyaline hyphomycete group particularly Aspergillus and Penicillium and 47% of them were members of the dematiaceous family particularly Cladosporium and Nigrospora. In eleven out of the seventeen, fungal hyphae were noted and in all of the seventeen there were positive fungal cultures. Fungal sinusitis should be considered in all patients with chronic sinusitis that fails to repond to repeated courses of treatment. Recent advances in endoscopy and computed tomography and physician awareness will lead to improved diagnosis and treatment and will prevent multiple surgical procedures.      

Argyrophilic staining of nucleolar organizer regions (AgNOR) has been considered to be useful in the diagnosis and prognostic evaluation of different cutaneous turnors. In order to evaluate the role of the AgNOR technique in discriminating aggressive from non-aggressive basal cell carcinoma (BCC), paraffin-embedded histologic sections from 30 cases of aggressive BCC (BCC2)and 30 cases of non-aggressive BCC (BCC1)were investigated for  nucleolar organizer regions (NOR), and these cases were categorized on the basis of histologic criteria. The means of AgNOR counts were higher in BCC2 than BCC1 without overlapping in the range of NOR numbers. In BCC2 the majority of the dots had irregular borders and was of varying sizes, whereas in BCC1, the dots had regular borders with little variation in size. The means of AgNOR counts were 4.81 with an SD (standard deviation) of 0.88 for aggressive and 2.39 with an SD of 0.61 for the non-aggressive group. The difference was statistically significant (p value= 0.000). The AgNOR number, their configuration and size, may provide information to be useful for recognition of aggressive BCC. Considering histologic criteria, AgNOR counting and clinical features, we can predict the behavior of most BCC tumors.      

121 women with Polycystic Ovarian Syndrome and clomiphene citrate resistance underwent laparoscopic ovarian cautery. 63 patients were type I or typical PCOS with ovarian volume >8mL and 58 patients were type n PCOS with ovarian volume <8mL. Serum concentrations of Luteinizing Hormone (LH), Follicular Stimulating Hormone (FSH), Prolactin (PRL), Testosterone (T), and Dehydroepiandrosterone Sulfate (DHEAS) were checked before cautery and 10 days after operation. This prospective study showed that PCOS patients with large ovaries have higher LH levels than patients with normal size ovaries. LH and T levels decreased after laparoscopic ovarian cauterization only in type I. The overall ovulation rate was 91.5% in type I and 89.3% in type n. Pregnancy rate was 60.8% in type I and 66.7% in type n. There was no significant difference in ovulation and pregnancy rates between the two groups of PCOS (p>0.05).It therefore appears that the result of laparoscopic ovarian cauterization does not depend on ovary size in clomphene citrate resistant patients with PCOS.        

The cytotoxic activity of ethanolic extracts of Thymus vulgaris, Thuja orientalis and Achillea millefolium was investigated on various growing tumor cell lines. MTT colorimetric assay was used for measuring the inhibition of cell proliferation. All of the three extracts showed a relatively dose-dependent inhibition of proliferation of human breast cancer (SK-Br-3, MDA-MB-435) and leukemia (U937 and K562) cell lines. The most sensitive cells to the effect of Thuja orientalis and Achillea millefolium extracts were K562 and SK-Br-3and to Thymus vulgaris were U937 and MDA(50% inhibition at 10 µg/mL). Hela cell line was less sensitive than other tumor cell lines (% inhibition range -10 to 46). Despite this potential cytolytic activity against tumor cell lines, low concentrations of the extracts showed stimulatory effects on the growth of Vero, a non-malignant cell line. Proliferation of these cells was increased by 10 to 100 µg/mL of Achillea millefolium and Thymus vulgaris (% inhibition range-48.8to -6.25) and suppressed by a concentrationof 400 µg/mL (%inhibition 6.25 and 27.6, respectively). Various concentrations of Thuja orientalis showed stimulatory effects on this cell line (% inhibition range - 34.00to -21.4).Study of the effect of two low and high concentrations of the extracts on mitogen-induced human lymphocytes resulted in a slight increase at 50 µg/mL (Stimulation index, SI range 1.19 to 1.37, p<0.01).In conclusion, although the extracts showed strong cytotoxicity for tumor cell lines,theproliferativelymphocytesandthenon-malignantcelllineusedin this study were clearly less sensitive.      

The polymerase chain reaction (PCR) as applied to detection of a foreign DNA in clinical specimens could provide a sensitive instrument for rapid detection of viral DNA persisting in tissues of patients suspected of latent infection. Human cytomegalovirus (HCMV) DNA was found in arterial plaques of patients with atherosclerotic lesions using a PCR assay with nested primer oligonucleotides derived from the major immediate early (MIE) exon 4 region of the genome. In order to approach a possible part of HCMV DNA in the mechanism of atherogenesis, the nature of found MIE exon 4 sequences was intimated using restriction endonuclease mapping of the amplified DNA. Comparison of the restriction fragments length polymorphism (RFLP) produced by endonuclease treatment of viral DNA amplified from urine, blood, culture and arterial plaques displayed a distinct difference in the DNA alignment for arterial specimens compared to that of other sources. This approved the specific origin of the MIE DNA found in plaques and suggested involvement in endothelial cell metabolism changes. It could thus be established that PCR has exhibited the promise for investigation of the role of latent viral infection in the process of atherosclerosis.      

We have already shown that low intensity pulsed ultrasonic treatment increases rabbit radial fracture healing. The present experiment was undertaken to find out the best duration for treatment. A complete transverse fracture was made in the right radial bones of 21 adult male rabbits by a Stanley knife. The animals were divided into 4 groups: group 1, control; groups 2, 3, and 4, experimental groups, which received ultrasound (0.5 W/cm2, 1MHz, 2 msec on-8 msec off) for durations of 5,10, and 15 min/day, respectively, from the day after surgery until complete fusion was observed. Radiological studies indicated that mean duration of healing was longer and rate of healing was lower in the control compared with those of the experimental groups (p<0.05). However, group 3 showed the least mean healing duration and group 2 and 3 showed the highest healing rate. Our results revealed no deleterious effects of ultrasound on treated and untreated ipsilateral and contralateral bones during the experiment or one month after complete fusion of the bones, at which time ultrasound treatment was terminated.      

Carbamazepine, a drug effective in pain, seizure, and affective disorders, was studied for its effects and toxicity on spontaneously beating isolated guinea pig atria. Carbamazepine (20-30 µg/mL) has a negative chronotropic effect on artria, without any significant effect on contractile force. The most significant effect (12.5%) was seen with 30 µg/mL of carbamazepine on atria. With higher doses (>30 µg/mL) carbamazepine produced toxic effects which resulted in atrial standstill. Pretreament of atria with theophylline (5-50 µg/mL) prevented the negative chronotropic effect of carbamazepine (30 µg/mL). Three dose ratios of carbamazepine (1.33,2,2.33) in the presence of three different doses of theophylline (30, 50 and 60 µg/mL) were obtained. These results suggest that the negative chronotropic effect of carbamazepine and its toxicity may be due to its action as an agonist on adenosine Al receptors and as an antagonist on A2 receptors of the atria. Moreover, using adenosine antagonists such as theophylline may overcome the toxic effect of carbamazepine on the heart. This may explain the reason for the interaction between carbamazepine and theophylline in clinical settings.    

A dot immunobinding assay (DIA) was used for a quantitative and qualitative assay of rubella antibody. Purified antigen and conjugated anti-humanimmunoglobulin (RAHIg) were prepared. Nitrocellulose paper dotted with the antigen was added to serially diluted sera or blood samples. The reacting antibodies were visualized by a peroxidase system. Development of a colored insoluble substrate was taken as a positive result. The adapted DIA was applied to test 105 serum samples. The sensitivity and specificity and immune titer of DIA were compared with hemagglutination inhibition (HI) test.    

Following an epidemiological survey of zoonotic cutaneous leishmaniosis (ZCL) in some villages of Badrood, a rural district north of the city of Natanz, central Iran, Phlebotomus (Phlebotomus) papatasi Scopoli were found to be naturally infected with Leishmania (Leishmania)major zymodeme MON-26. Sandflies were collected and dissected biweekly from rodent burrows during sand fly season, April- October 1998.Leptomonadinfectionrates varied between 6.7-22.0% during sand fly season, being greatest in September, coinciding with peak activity of P papatasi, 2-3 months before the highest incidence of ZCL human cases in November-December. Leptomonad infection rate was 1.1% in 94 P papatasi indoors.      

Malakoplakia is a rare disease with undefined etiology that has been almost exclusively reported in urology and pathology journals. We are presenting a case of colonic malakoplakia in an I8-year old young man who was referred to us with a four-year history of intermittent rectorrhagia. The pathological examination of the endoscopically resected specimen revealed pathognomonic features of malakoplakia, von Hansemann cells and Michaelis-Gutmann bodies.