Medical Journal of The Islamic Republic of Iran
Year:2000 | Volume:14 | Issue:1|Papers Count:21

In this study we have described our varicocele cases, in terms of associated symptoms/signs. In addition, we have tested the correlation between semen parameters and varicocele grades and compared the relative frequencies of associated symptoms/signs in different varicocele grades. 119 referred cases of varicocele were categorized based on clinical criteria into 3 grades by one examiner. The relative frequencies of associated symptoms/signs of the grades were compared. 52 of the cases whose semen analyses were performed at the same laboratory were included for comparison of semen parameters.Most of the cases were single conscripts. Age range was 18to 38 years and the mean age was 23 years. Pain was the most common associated finding in our mostly singlephysically active cases. Of all the 119 cases, 9 were grade 1,63 grade 2, and 47 grade 3. Mean sperm concentration was 60.3 million per cubic centimeter. No significant difference was found in the relative frequencies of associatedsymptoms/signsamongdifferentgrades.Differenceinsemenparameters among grades was negligible and not significant at 0.1 (0.05 as well).Pain could be the most common associated finding in young singlephysically active varicocele cases. It seems that varicocele grade bears no significance over the relative frequencies of associated symptoms/signs. Our data is against any clinically and/or statistically significant relationship between varicocele size and semen parameters.

156 Iranian patients with primary malignant tumors of the small intestine were reviewed. Malignant lymphoma was the most common tumor type, comprising 128 patients (82%), followed by adenocarcinoma (22 patients, 14.1%), leiomyosarcoma (4 patients, 2.56%) and characinoid tumor (2 patients, 1.28%). Lymphomas and adenocarcinomas were primarily located in the duodenum or jejunum, whereas leiomyosarcomas were more common in the ileum. Abdominal pain (73%), weight loss (68%), diarrhea (41%), and nausea or vomiting (35%) were the most common symptoms with these tumors.Among the lymphoma group 95 patients (74.2%) had non-IPSID (immunoproliferative small intestinal disease) lymphoma and 33 patients (25.8%) had IPSID related lymphoma.In contrast to the western world and Far East countries in which malignant small intestinal tumors are a disease of middle and old age groups and adenocarcinoma is the most common tumor type, in our area, similar to some other middle east and north African countries, lymphomas are much more frequent. Although Iran is endemic for IPSID related lymphoma, the majorities of these tumors is non-IPSID lymphomas and appear in a very young age group (meanage 27 y).

Prostatic intra-epithelialneoplasia (PIN) is considered a precursor of invasive carcinoma, characterized by proliferation and anaplasia of cells lining prostatic ducts and acini. In this study, we applied the PIN grading system on one-hundred cases of prostatic carcinoma and one-hundred cases of benign prostatic hyperplasia, then compared the results. 74% of prostatic carcinoma and 51% of prostatic hyperplasia cases showed PIN foci. Most of the prostatic carcinomas (61%) showed foci of high-grade PIN including grade II (46%) and grade III (15%). In benign prostatic hyperplasia cases, only PIN grade I (26%) and grade II (25%) were seen.It is concluded that PIN and invasive adenocarcinoma of prostate are closely associated and the likelihood for coexistence is higher in patients with high grade PIN and especially if other factors such as prostate specific antigen and positive findings on sonography are also considered.

Between 1993-1996 seventy-three consecutive patients (33M, 40 F, mean age 35.4) with newly diagnosed achalasia underwent one or more pneumatic dilatations with the Rigiflex balloon using a protocol of graded dilatation with a fixed inflation pressure of 10 psi and constant duration of 30 seconds for all patients without using fluoroscopy. Using Vantrappen's classification for assessment of response, excellent or good results were considered as cure and fair or poor results as failure. Durati, on of symptoms and the amount of weight loss before dilatation averaged 5.2 years and 10kg, respectively. In 62 patients one, in 5 patients two, and in 4 patients three dilatations were performed. Dilatation failed in one patient because of previous surgery and was followed by perforation in one patient (1.4%) and bleeding in another patient (1.4%). Follow up period averaged 20 months (range 6-38months) with a cure rate of 90% (57 excellent, 9 good) and failure rate of 6.8% (3 fair, 2 poor). We conclude that graded pneumatic dilatation without fluoroscopy is a safe and very effective treatment for achalasia with 90% of patients having a sustained response lasting at least for an average of 20 months.

Two-hundred and seventeen subjects underwent transvaginal ultrasound;-17 (8%) had unilateral polycystic ovary (PCO). Twelve percent of subjects with unilateral scan-PCO had oligomenorrhea, 24% were amenorrhea, 23% were hirsute and 29% had acne. Biochemical parameters were compared between subjects with unilateral scan-PCO and those with bilateral scan-PCO (n=200) as well as a group of scan-normal women (n=29). No significant difference was found between subjects with bilateral and unilateral scan-PCO suggesting that these 2 groups are biochemically similar. The existence of unilateral scan-PCO suggests that PCOS may be a primary ovarian disorder.

The most accepted method of secondary prophylaxis in rheumatic fever (RP) has been an injection of 1,200,000 units of benzathine penicillin G (BPG) every 4 weeks, but recurrences have been reported in some patients despite such a prophylaxis program. The WHO recommended BPG injections every 3 weeks in high risk patients and situations due to some published data in favor o inadequacy of once every 4 weeks injection of BPG.Our study was designed to determine serum penicillin levels (SPL) during the 4 weeks after an intramuscular injection of 1,200,000 units of BPG, in order to find the appropriate interval between BPG injections and also to assess the effects of weight and sex on this level. We included 42 RP patients (mean±SD=14.8±1.9 years) in our study. SPL was determined by disk agar diffusion method. In this study the minimum accepted SPL to be effective against group A b-hemolytic streptococci was 0.02 mg/ml. In 46% of the patients the mean SPL decreased to <0.02 mg/mL at the end of the third week (mean±SD=2.35±1.3 weeks). The mean SPLs were significantly higher in patients who weighed <45 kg (mean±SD=38.6±4.3 kg) in comparison with those who weighed ³45 kg (mean±SD=54.25±4.87 kg), with a p value <0.0001. There was no significant differences in mean SPL between boys and girls (p=0.145). Although in this study the mean SPL was <0.02 mg/Ml in 46% of patients at the end of the third week, we could not recommend every 3 weeks injections of BPG in all patients, except in high risk patients and situations as recommended by the WHO and also in those patients who weighed ³45kg.

Thirty-two exclusive and twenty-seven non-exclusively breast-fed infants were followed-up from birth to 4 months of age in a maternity hospital, with a rooming-in program. Face to face BF education was given to mothers in two groups after delivery and also during 4 months post-partum. Body weight (Wt), length (L) and head circumference (HC) of the infants was measured at monthly intervals, and their feeding patterns were recorded. The Wt of exclusively breastfed infants was higher than non-exclusively breast-fed infants. The filtering of infant's growth from 3 months of age was seen in both groups. From the age of 3 months, the Wt of non-exclusively breast-fed infants was lower than the 50th percentile of the reference value (NCHS), but Land HC increments were similar in both groups. Mean Wt, Land HC of exclusively breast-fed female infants were higher compared to non-exclusive females and also higher than exclusive male and non-exclusively breast-fed male infants. In the present study, the faltering of growth of infants was seen in the first 4 months of age, in comparison to breastfed infants in the Darling study.

Renal transplantation is considered one of the best long-term therapies for chronic renal failure, but unfortunately the incidence of malignancy significantly increases in renal transplant recipients. We analyzed nine cases of malignancy in 200 renal transplant recipients occurring in a 12-yearfollow-up in Imam hospital of Tehran University, Tehran, Iran. According to this study, the organ most commonly affected with malignancy in our series was the skin and the mean time of neoplasm occurrence after kidney transplantation was 2.9 years.

A periodic increase in blood pressure (BP) occurs during apneic episodes in patients with obstructive sleep apnea (OSA). Several factors including hypoxemia and an increase in heart rate (HR) were reponed to be responsible for this increased BP.To examine the contribution of these two factors in increasing BP, 35 healthy male subjects (mean age±SD=23.64±3.80) were studied in three experimental conditions, each condition for two minutes, including; breathing room air at rest (nonnoxic), breathing low O2 (10%) air (hypoxic), and exercising on an ergometer while breathing room air (exercise). During the last minutes of each condition, changes in mean BP (DmBP), HR (DHR), and arterial O2 saturation (DSaO2) were measured.The results showed that DmBP and DHR were significantly higher in both hypoxic and exercise conditions than nonnoxic condition (p<0.001) for both cases). However, DSaO2 was significantly lower in the hypoxic state compared to nonnoxic conditions. There was no significant difference in DHR between hypoxic and exercise groups, but both DmBP and DSaO2 were significantly lower in hypoxic than exercise conditions (p<0.005 and p<0.001 for for DmBP and DSaO2 , respectively). There was a weak correlation between DmBP and DHR in the hypoxic condition (r=0.3, p<0.05), but the correlation between DmBP and DHR in the exercise condition was stronger (r=0.57, p<0.001).These results indicated that although hypoxemia contributes to increased BP during hypoxia, an increase in HR is a stronger mechanism for this phenomenon.

To evaluate the correlation of cytomegalovirus (CMV) and coronary artery disease (CAD), one-hundred patients with CAD and the same number of healthy individuals as a control group were randomly selected and studied for anti-CMV using ELISA method. Ninety percent of patients and 77 percent of the control group were anti-CMV positive and statistical analysis showed a significant correlation between these groups (p<0.05). Certain risk factors such as hypertension, hyperlipidemia, diabetes, smoking, type A personality and familial history were also studied. The distribution of these factors in the patient group was higher than those of the control group and a significant correlation was observed between these groups, but no dependency was observed between anti-CMV and the above parameters in the patient group. Results of this study showed a meaningful correlation between the anti-CMV level and coronary artery disease.

Acetylcholinesterase (AchE) is a large glycoprotein that, aside from its known cholinolytic activity, co-exists with other transmitter systems and possesses other functions. In the present study, the effects of short-termrapid-eye-movement sleep deprivation (REM-SD) on AchE activity in the anterior hypothalamic area have been investigated.Using the flower-pot method, adult male albino rats were deprived of REM sleep for a period of 72, 96, and 120h and perfused brains were then sectioned with a vibratome and stained histochemically for AchE. In comparison to control animals, marked positive AchE activity was observed in neurons located in the preoptic area in the 120SD group only.Results of this study have shown that AchE could be involved in some unknown functions related to REM sleep physiology.

In this study cellular phosphates activity, referred to as enzyme developed color (EDC) assay, was used for an in vitro assessment of cell proliferation and cytotoxicity. Optimum conditions were established and found to be 10x103 cells / well at 37°C and 60 minincubation (for developing color).Under the same conditions a direct correlation between optical density (OD) and cell number was observed. Thus, the aDs for a cell line, Ish at 100, 50, 25 and 10 X103 cells/well were 1.08±0.05, 0.59±0.02, 0.33±0.02, and 0.17 ±0.0 1 respectively (r=0.995, p<0.001). When EDC was compared with another colorimetric assay, i.e. MTf, the results showed a direct correlation with r=0.995, p<0.001. Repeating the experiment with live and fixed tumor cells showed similar results. Thus, for the Ish line, the aDs at 50 and 10 X103 cells/well for fixed and live cells were 0.66:t0.Ol, 0.18±0.01 and , 0.64±0.03 (p>0.05), 0.19±0.01 (p>0.05), respectively. The assay was also shown to be suitable for the measurement of cell cytotoxicity and compared well with the MTT assay.These findings indicated that a simple, rapid and economical EDC assay could be used to investigate various cellular functions. The main advantage of EDC is it's suitability touse stored cells. This provides flexibility for testing samples stored over a long period in order to limit inter-experimental variations.

The effect of epinephrine on triacylglycerol secretion was investigated in isolated rat hepatocytes. The effect appeared at concentrations of more than 1mM and reached a plateau at 10mM. Epinephrine concentration for half of the maximal bioeffect (EC50) was about 1mM. Epineplnineat a concentration of 10mM suppressed triacylglycerol secretion by 33%andincreasedits cellular content by approximately 18%. The total triacylglycerol content of the system (sum of the cell and the incubation medium) was constant at all concentrations of epinephrine. Time course experiments for triacylglycerol secretion exhibited relatively similar results on the basis of lipid analysis with or without lipid extractions. On the former basis triacylglycerol secretion versus time followed a linear relationship with a slope of 1.47±0.11 mmole TG/3h/g wet liver. Time course curves of cellular lipids revealed that cellular triacylglycerol and phospholipid contents in the presence of epinephrine were higher than the control at all time points, and the difference was constant during time. Furthermore, in the presence of glucose (20 mM) and oleate (0.25 mM), intracellular triacylglycerol content increased markedly (³45%) whereas cellular phospholipid content remained constant. It is proposed that epinephrine exerts an inhibitory effect on VLDL secretion probably through blocking in the secretary pathway. 

In this study, the influence of dopamine receptor agonists and antagonists on antinociception induced by baclofen has been examined in the formalin test. The OABA-B agonist baclofen induced antinociception in bothphases of the formalin test in mice. The dopamine receptor agonists SKF 38393 and quinpirole also induced antinociception in both phases of the test. SKF 38393 but not quinpirole potentiated the response to baclofen in the first phase of the test. The dopamine receptor antagonists SCH 23390 and sulpiride increased the response to baclofen in the first phase. Both drugs induced antinociception in the first phase of the formalin test. However, low doses of sulpiride increased the pain response in the second phase. The peripheral dopamine receptor antagonist domperidone did not alter the effect of the test by itself. Dopamine receptor mechanisms appear to interact with baclofen-induced antinociception.

The antinociceptive effect of Elaeagnus angustifolia fruits was studied in mice. The antinociceptive effect of ethanolic and boiling water extracts was studied using two thermal stimuli, the hot-plate and tail-flick tests. The intraperitoneal and oral administration of the ethanolic extract of seed (1.75-7.00 g/kg), but not pericarp and medulla had significant antinociceptive activity in the hot-plate test. Naloxone pretreatment did not inhibit the antinociceptive activity of the extract. The aqueous extract of different parts of the fruit (seed, medulla and pericarp) had antinociceptive activity in this test. The ethanolic extract of the seed had no antinociceptive effect in the tail-flick test and its effect was not abolished by naloxone. A 70% failure rate in the traction test (a muscle relaxation test) was induced by ethanolic extract of the seed (3.5g/kg), compared withthe75%induced by the reference drug diazepam (2.5mg/kg). It is concluded that the antinociceptive effect of E. angustifolia may be mediated by a supraspinal effect and muscle relaxation activity.

In order to identify the effects of vitamin B12 and folic acid in reducing methanol induced retinopathy, ERG waves were compared before and after methanol intoxication in rabbits. In this study 34 rabbits were divided in to 4 groups. All groups received 4 g/kg of methanol intraperitoneally. In addition, the second, third and fourth groups received vitamin B12 injection, oral folic acid and a mixture of vitamin B12 and folic acid, respectively.Baseline ERGs were recorded for all rabbits prior to intoxication and then second ERGs were taken 48-72 hours following methanol toxicity. Compared to baseline ERGs; a severe reduction in the b-wave amplitude as well as reduction in the oscillatory potential were noticed. Among all groups, the first group had the most and the fourth group had the least decrease in b-wave amplitude as well as oscillatory potential. It is therefore believed that vitamin B12 has a synergistic effect with folic acid in attenuating ophthalmic toxicity of methanol in rabbits. Further studies are needed to evaluate these effects in humans.

In this study we investigated the effects of endothelium removal and L-NAME on responses to a-adrenoceptor agonists. Male Wistar rats were killed by overdose with pentobarbitone sodium, after which the left and right common carotid arteries were removed. Rings of arteries 3-4mm in length were cut from each vessel and then mounted in 10mL isolated organ bath, bathed in Krebs maintained at 37°C and gassed with 95% 2 plus 5% CO2, The preparations were allowed to equilibrate for an hour. L-NAME was added approximately 10-15 minprior to the onset of cumulative concentration-response curves (CCRC) to an agonist. In some preparations the endothelial layer was removed mechanically by gently oiling the tissue around a thin wire. Removal of the endothelium was confirmed pharmacologically by a lack of relaxant response to the potent endothelium dependent vasodilator acetylcholine. Inhibition of NO synthesis by L-NAME results in significant vasoconstriction. L-NAME prevented the relaxation of rat carotid artery by acetylcholine, suggesting that both basal and stimulated release of nitric oxide can regulate vascular tone in this artery. Mechanical disruption of the vascular endothelium reduced, but did not abolish, the ability of L-NAME to produce contraction. This suggests an extra-endothelial site for nitric oxide synthesis in rat common carotid artery. Inhibition of nitric oxide syntheses with LNAME potentiated responses to phenylephrine and UK-14304 but not to noradrenalin. Mechanical disruption of the vascular endothelium potentiated responses to UK-14304, phenylephrine and noradrenalin. We suggest that constitutive NO activity has substantial inhibitory influence on vasoconstrictor responses to phenylephrine and UK-14304 but not to noradrenalin.

Traumatic false aneurysm of the thoracic aorta is not uncommon. But accordingly this case is unusual in its ten year delay between injury and presentation and treatment A victim of the Iran-Iraq war is presented with a false aneurysm of the thoracic aorta ten years after a bullet injury to the chest and thoracic spine. Penetrating chest wounds, mechanisms of injury and diagnosis are also discussed in detail.

Reported here are two cases of delayed postsurgical brucella abscess within the cranium, treated successfully byreoperation and appropriate medical therapy.Both patients had an occupational exposure to the pathogenic organism. Systemic symptoms of brucellosis became manifest postoperatively in case I and were present in case I long before operation. The diagnosis was confirmed by serology and positive culture. Later an intracranial abscess developed in both cases at the previous operative sites.Hematogenous spread of bacteria to the locally low resistance host tissue was speculated as the possible mechanism. Successful management was accomplished by reoperation, comprised of local drainage and debridement followed by a combined antibrucella drug regimen for a period of 6 months.

Acute scrotal swelling is an urgent urologic condition, and its failure in diagnosis is "one of the litigious issues in urologic practice. Although acute scrotal pain is due to spermatic cord torsion in 25-35% of cases, the urologist should either rule it out or treat it immediately. We operated a case of acute scrotal edema in a two-day-old boy who had, according to clinical results and color Doppler imaging, been diagnosed as having spermatic cord torsion. Operation, however, confirmed that the cause was spermatic cord hematoma, not torsion.

Thalassemias are the world's most widespread genetic disorder known in m,m.22According to a WHO report,25 thalassemia carriers are estimated to exceed 100 million persons Md some 100 thousMd affected babies are born each year. The incidence, prevalence and clinical forms of thalassemia vary in different parts of the world. However, the most common clinical forms of thalassemia vary in different parts of the world. However, the most common clinical presentation observed is thalassemia trait or the heterozygous state of either beta or alpha thalassemia. Betathalassemia is highest in prevalence in the Mediterrcmean area and parts of Africa Md Asia, whereas alpha-thalassemia is highest among Asian populations in which 3.5% of the people are alpha-thalassem iacarriers.4 Thalassem ias produce a massi ve public health problem in mMY countries but occur at a very high frequency in a broad belt stretching from the Mediterranean basin through the Middle East, India, Burma and Southern Asia.22Thalassemia is a hereditary hemolytic disease accompanied by hypochromic microcytic anemia. It is inherited as M autosomal recessive trait Md encompasses a broad range of clinical manifestations. In all thalassemias, there is a reduction in the rate of synthesis of the globin chains that form normal hemoglobins. Thus, if there is a reduction in alpha chain synthesis the condition is an alphathalassemja. If the reduction is in beta chain synthesis the condition is a beta thalassemia. When the mutation leads to a complete lack of the alpha or beta chain the thalassemia is classified as alpha-0 or beta. Orespectively. If there is reduced alpha or beta chain synthesis they are called alpha+ or beta+ thalassemias.