Tehran University Medical Journal
Year:2006 | Volume:64 | Issue:7|Papers Count:14

A high percent of patients with inflammatory bowel diseases (IBD) experience non intestinal symptoms. Many studies demonstrated that hepatobiliary disorders are the most common. Corresponding disorders consist of primary sclerosing cholangitis, non alcoholic steatohepatitis (NASH), biliary stones, pericholangitis, autoimmune hepatitis, liver amyloidosis, liver abscess, liver granuloma, hepatocellular carcinoma and primary biliary cirrhosis. However most studies concentrate on identifying primary sclerosing cholangitis, the most dreadful complication of IBD, other disorders like NASH and biliary stones are common and because of the similarity of symptoms to the primary disease may be ignored. In this article we review these disorders.

Background: Cardiovascular diseases are the most important causes of mortality in Iran. Hypercholesterolemia is one of the major risk factors for cardiovascular diseases. Dietary modification such as cereal bran consumption is an approach to reduce this risk factor. The purpose of this present study was to compare the effects of rice bran and wheat bran on serum lipids in hypercholesterolemic women. Methods: This study was a randomized clinical trial in which 19 women aged 35-65 years with fasting serum total cholesterol 240-300 mg/dl randomly allocated in two groups of wheat bran and rice bran. All subjects recieved 40 g/day bran in addition to their usual diet for 4 weeks. Anthropometric measurements, dietary assessments by using a 24-hr dietary recall questionnaire and determination of serum lipids were done at the beginning and the end of the study. Data were statistically analyzed by t-test and paired t-test. Results: There were no significant differences between groups for mean body weight, BMI and dietary confounding factors. During 4 weeks, wheat bran significantly reduced serum total cholesterol and LDL-C by 11% and 21% respectively (P<0.01) but rice bran had no effects on these parameters. No significant changes were found in mean serum triglyceride, HDL-C levels, LDL-C/ HDL-C and total cholesterol/ HDL-C ratios in both groups. Conclusion: It is concluded that wheat bran have benefical effects on serum total cholesterol and LDL-C levels in hypercholesterolemic women in comparision with rice bran.

Background: The male antifertility activity of Gossypol, the active ingredient of cotton seed, inspired the idea for development of an agent with male contraceptive activity. The result of subsequent studies lead to the discovery of several class of compounds with antifertility activity. In this study the antifertility activity of iso-Propyl and iso-Butyl derivatives of dihydropridine were evaluated.Methods: The two aforementioned compounds were administered subcutaneously in (10 mg/kg/day) dose to male rats. The animals were treated and kept according to the TUMS committee recommendations on ethical and animal maintenance considerations. Sixty days after the first injection the following fertility and histological indices were evaluated, animal’s body weight difference (B.W.D), sperms motility, sperm viability, ESR (epididymal sperm reserve), DSP (daily sperm production), serum testosterone concentration, fertility index, GSI (gonado somatic index). Histological indices are respectively the area and circumference of seminiferous tubules, each testis and their crosswise dissections, the diameter of seminiferous tubules and the number of seminiferous tubules per square millimeter, that were determined.Results: The values of the two test groups were determined and compared with the results of normal group that were using normal saline only and the blank that were receiving propyllenglycol only.Conclusion: The significant inhibitive activity of candidate compounds on animal's physiologic indices were in accordance of our pervious estimation of compounds activity as (lead compound) for synthesis and preparation of new compounds with male contraceptive activity.

Background: We aimed to demonstrate the mechanism of fracture and functional outcome of patients with hip injury in our clinical setting.Methods: In a historical cohort, all women 50 years of age and older admitted to three university hospitals of Tehran University of Medical Sciences (Shariati, Imam Khomeini and Sina) with the diagnosis of hip fracture from 21 March 2003 to 21 March 2004 were included in this study (n=115). Follow up was conducted via telephone post and even home visit to record the  functional status of the patients at the time of study (5 Jan 2005) measured with Barthel index in addition to the exact mechanism of injuries.Results: The mean and standard deviation of age were 76.3±10.6 years. About 88.7% of injuries had occurred at home (65.2% on the carpet), the remaining happening in the streets. Mean length of hospitalization was 11±7.9 days. Among our patients, 71% could mobilize spontaneously without aids before injuries. This had reduced to 20% at the time of follow-up. The mean Barthel index was 97.2±8.2 before fracture and 75±21.1 at the present. Among our patients, five cases died during hospitalization and 29 of them died afterwards (total: 34 or 29.6%).Conclusion: The most common external cause of injuries in our cases was stumbling at home especially on carpeted surfaces. This necessitates preventive measures aimed at physical standards of houses and education of elderly on healthy locomotion, indoors.

Background: The purpose of this study was to measure isokinetic maximum and average peak torque of internal and external rotators of glenohumeral joint in volley ball and tennis players.Methods: This study was performed on 17 professional female athletes (7 tennis players &10 volleyball players) with age ranged 18-28 years. The subjects had played in a skilled team for more than 3 years. They were free from injury to their dominant shoulder in the past year. Subjects performed a five minute warm up by shoulder wheel and Maximum average Peak Torque (APT) were obtained unilaterally by a Biodex System 3 with the arm of players in 90 degree abduction at 120,180 & 210 o/s. Players performed five trails of concentric movements with 30 second rest between them.Results: Maximum and average of maximum torques of shoulder rotator, in both groups, expect for internal rotators of tennis players, reduced by increase of movement speed (P<0.05). There are not significant difference between two groups in maximum, average of maximum torques and normalized data (ratio of maximum torque to weight). There is significant difference between two groups in percentage of APT of External rotator/ Internal rotator ratio at 210 o/s (P<0.05).Conclusion: Volleyball and tennis have no effect on isokinetic strength of shoulder rotators. In high speed, ratio of External rotator/ internal rotator is reduced. This indicates that increase in movement speed increase internal rotator in comparison to external rotator in these professional female athletes.

Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma.Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1) Cisplatin and continuous infusion of 5FU and Epirubicin (ECF), and 2) Cisplatin and continuous infusion of 5FU with Docetaxel (TCF). Reduction in tumor mass, overall survival (OS), time to progression (TTP), and safety were measured outcome. Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass) was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0.002) and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0) resection had done in two of ECF and six of TCF tumors (p=0.015). Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups.Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

Background: To identify the risk factors of fourth-degree laceration during vaginal delivery.Methods: This is a retrospective, case control study. We reviewed 131802 records of vaginal deliveries within 14 years period from 1990 to 2004 in two obstetric centers. Cases were 93 vaginal deliveries with fourth-degree laceration and 7 cases were delivered at home, control subjects were 200 vaginal deliveries without third- or fourth-degree lacerations and were identified with the use of random selection. We studied the effects of: maternal age, nationality, parity, gestational age, hour of delivery, birth attendants, episiotomy use and duration of second stage of labor, use of oxytocin, use of forceps or vacuum, Infant birth weight, presentation and position of fetus, previous severe perineal injury, maternal medical illness and place of delivery.Results: We found 93 cases (%0.07) of documented fourth-degree laceration in 131802 deliveries.Conclusion: This study identified several factors associated with fourth- degree laceration. Median episiotomy should be avoided. Nulliparity, fetal macrosomia and OP position are significant risk factors that require caution by birth attendants during delivery.

Background: Scleroderma is an important chronic disease with unknown etiology and two subtypes: limited type: Skin involvement limited to distal of extremity and face. Diffuse type: Skin involvement is both distal and proximal of extremity, face and trunks. Thyroid dysfunction is a main problem in these patients but there is no published data of Iranian scleroderma patients.Methods: This is a cross-sectional study to determine the prevalence of hypothyroidism (clinical, sub clinical and autoimmune) in patients with scleroderma 125 patients with scleroderma selected and T3, T4, TSH Anti Tpo Ab and Anti TG Ab measured in them.Results: 33 patients with scleroderma had hypothyroidism (%26.4). Two patients with scleroderma had hyperthyroidism (%1.6). %12/8 had clinical hypothyroidism. And %13/6 had subclinical hypothyroidism, %33.3 of patients with sub clinical hypothyroidism and positive autoantibody had limited type. Where as %66.6 of patients with sub clinical hypothyroidism and autoantibody had diffuse type, %28.5 of patients with clinical hypothyroidism and positive auto anti body had limited type. Where as %71.4 of patients with clinical hypothyroidism and auto anti body had diffuse type. All of patients with hyper thyroidism had diffuse type and autoantibody positive.Conclusion: It seems hypothyroidism has an increased prevalence in patients with scleroderma and we suggest that thyroid function test must be done in primary evaluation of these patients.

Background: Atrial fibrillation is the most common arrhythmia following CABG. This complication can cause palpitation, significant hemodynamic instability and thromboembolic events. This prospective randomized study evaluate prophylactic effects of propranolol low dose amiodarone and high dose amiodarone in patients candidate for CABG.Methods: Three hundred consecutive patients undergoing elective CABG were randomly categorized into three groups (each group contains 100 patients). Patients in group1 (control group) received 10mg/TDS propranolol per oral (P.o), preoperatively. Patients in group 2 received 10mg propranolol TDS, P.o plus 350mg/24h amiodarone. Patients in group 3 received 10mg propranolol TDS P.o plus 1000mg/24h amiodarone 24 hours before operation.Results: Atrial fibrillation occurred in 12 patients (12%) in group 1, four patients (4%) in group 2 and 10 patients (10%) (P=0.035) in group 3. AF occurred in 10.36% of men and 3.84% of women. There was no AF in off- pump groups and 9.73% in on-pump groups.Conclusion: This study suggested the combination of propranolol plus low dose amiodarone for post CABG atrial fibrillation prophylaxy.

Background: Multiples sclerosis is a common demyelinating disease of CNS and the main cause of disability in young adults all over the world so any research in different aspects of the disease has great value. Researches in Iran are few in quantity and low in sample size. To determine clinical course and prognosis of the disease in Iranian MS patients we have studied these items in a considerable sample size.Methods: Two hundred and three definite MS patients (according to MC’ donalds 2001 criteria) included in this study and a planned questionnaire completed by visiting the patients or by degree of disability estimated according to EDSS (Expanded Disability Status Scale) scores system. The results analyzed with SPSS software.Results: Mean age of the patients was 35. All required examinations have been done by a neurologist and 60.6 percent were female. Mean duration of disease was 8.3 years. The main form of onset of symptoms was sensorimotor (mixed). Mean Attack rate was 5.5 times during the disease duration. Clinical course in 72.4 percent was relapsing-remitting type. Mean disability scale number according to EDSS was 5.2. Death rate was two percent. 69.3 percent of patients were able to work in the society. The degree of disability increased with increasing age, in lower educational state, in longer duration of the disease and in male gender.Conclusion: The results of clinical course and type of MS, mean of disease duration from the onset and mean EDSS are compatible and comparable with similar studies in other countries though some results are different. For future large sample, multicenter studies recommended.

Background: During general anesthesia in patients with mediastinal mass compression effect on the heart, great intra thoracic vessels, or tracheal tree can lead to decrease venous return, cardiovascular collapse or tracheal obstruction. These complications may be worsened after induction of general anesthesia or prescribing muscle relaxants.Case report: A twenty one years old female with huge anterior mediastinal mass was a candidate for right sided thoracotomy. Compression effect on the adjacent structures has been reported in chest CT scan and in echocardiography. Awake oro-tracheal intubation was performed in sitting position. Then patient positioned to left lateral decubitus for thoracotomy during surgery asystole occured. We changed the position to remove compression effect on the heart and great vessels. Fortunately these maneuvers changed asystole to sinus rhythm.Conclusion: Decreased thoracic muscular tone and removed spontaneous ventilation after muscle relaxant may threaten patient’s life. Change of patient’s position can remove the compression effect.