Tehran University Medical Journal
Year:2004 | Volume:61 | Issue:6|Papers Count:17

Background: Staphylococci as a micro-organism, has the most importance to cause nosocomial infections, particularly in patients with indwelling catheters or other medical devices. Unfortunately 90% of  taphylococci isolated from the nosocomial infections are resistant to methicillin, and methicillin resistance strains are also resistant to a wide range of antimicrobial drugs, therefore detecting of these strains are valuable to eradicate the infection elements. Despite guidelines published by the national committee for clinical laboratory standards (NCCLS) for testing of susceptibility to methicillin for Staphylococci, the phenotypic method for detecting methicillin resistance remains controversial. Therefore, the genetic assays have been used to detect antimicrobial susceptibility of Staphylococci to methicillin. Materials and Methods: Resistance to methicillin is coded by mec A gene in staphylococcus, and this gen must be detected in genetic assays. In this study 155 clinical staphylococcal isolates (70 coagulase- negative staphylococcus and 85 coagulase- Positive staphylococci) were evaluated for susceptibility to methicillin by using disk diffusion method. Results & Conclusion: Methicillin resistance was shown in 62 coagulase- negative staphylococcus (72.9%) and 27 coagulas positive staphylococcus (38.6%) but 63 coagulase negative Staphylococci (74%) and 28 coagulase positive isolates with mec a gene associated resistance were detected by PCR method. The results of this test were compared to the results for mec A gene detection by PCR test as a gold standard. The sensitivity, specifity and accuracy of the disk diffusion test for coagulase negative staphylococcus were 96.8%, 95.45% and 96.47% and for coagulase positive staphylococci were 98.43%, 95.45% and 98.32% respectively.

Kimura's disease (KD) is an uncommon, benign, chronic inflammatory condition of unknown etiology and pathogenesis involving subcutaneous tissue; presenting as a tumor like lesion with a predilection for the head and neck region. If parotid gland is affected clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnosis before tissue biopsy and fine middle aspiration (FNA) has only limited value. There is no evidence of malignant transformation and occasional spontaneous resolution occurs. Various treatment modalities have been suggested in the management of this condition but none is proved best and recurrence is common. we describe a 33 - year- old man with KD who presented with left parotid mass.

Background: Acute Pyelonephritis (APN) is one of the most common bacterial infections seen in children that may lead to renal scarring. Vesicoureteral reflux (VUR) is an important risk factor of renal damage but not the only one. Materials and Methods: In order to determine the association between dimercaptosuccinic acid (DMSA) scintigraphic and voiding cystourethrographic findings, a retrospective study was performed on 50 children (100 renal units) with APN that had been admitted to Bahrami Hospital from 1995 through 1998. Voiding cystourethrography (VCUG) and DMSA scan were performed in all patients within 1 to 2 weeks after termination of treatment and a second scan was performed 6 months later in patients whose kidneys showed cortical defects in the first one. The grade of reflux was based on international reflux classification (I-V). The DMSA scans were considered abnormal if one or more areas of decreased cortical uptake were noted (cortical defect). The scar was defined as persistence of these defects in the second scan. DMSA cortical defect and VUR were demonstrated in 42 (42%) and 26 (26%) of renal units respectively. Results: Fourteen out of 26 renal units (54%) with reflux had cortical defects and 28 out of 74 renal units (38%) without reflux had cortical defects (P=0.15). Permanent renal scarring was noted in 25/ 42 of renal units (62 %) in second scan. Conclusion: It seems that VCUG alone is insufficient as a screening modality to identify those kidneys at risk of damage and DMSA scan may provide additional information about this.

Background: Autonomic nervous system dysfunction in diabetics can occur apart from peripheral sensorimotor polyneuropathy and sometimes leads to complaints which may be diagnosed by electrodiagnostic methods. Moreover glycemic control of these patients may prevent such a complications. Materials and Methods: 30 diabetic patients were compared to the same number of age and sex-matched controls regarding to electrophysiologic findings of autonomic nervous system. Symptoms referable to autonomic disorder including nightly diarrhea, dizziness, urinary incontinence, constipation, nausea, and mouth dryness were recorded in all diabetic patients. Palmar and plantar SSR and expiration to inspiration ratio (E:I) and Valsalva ratio were recorded in all diabetics and control individuals by electromyography device. In addition NCS was performed on two sensory and two motor nerves in diabetic patients. Results: There was no relation between age of diabetics and abnormal D: I ratio, Valsalva ratio and degree of electrophysiologic autonomic impairment. Also no relation between peripheral sensorimotor polyneuropathy and electrophysiologic autonomic impairment was found. Plantar SSR was absent in 80% of diabetics with orthostatic hypotension (p~0.019). Palmar and plantar SSR were absent in many diabetics in comparison to control group (for palmar SSR p~0.00 and for plantar SSR p< 0.015). There was no relation between diabetes duration since diagnosis and electrophysiologic autonomic impairment. Conclusion: According to the above mentioned findings diabetic autonomic neuropathy develops apart from peripheral sensorimotor polyneuropathy and probably with different mechanisms. Remarkable absence of palmar SSR in diabetics with orthostatic hypotension can be due to its sympathetic origin. Absence of any relation between diabetes duration and electrophysiologic autonomic impairment can be due to late diagnosis of type 2 diabetes or no pathophysiologic relation between chronic hyperglycemia and autonomic neuropathy.

Background: Ectomesenchimal cells, placed near the embryon~l tube, migrate to down and share in facial and cardiac structures. Migration or differentiation disorders of these cell causes cleft lip/ or palate and congenital heart disease (CHD). This item was performed to determine co-appearing of cleft and CHD and to know adjutant factors to that for better management of these patient. Materials and Methods: Two hundred children with cleft lip and palate were registered. Finding was analyzed by fisher's exact text and chi-square tests. Results: CHD is ten times of normal population in this research (p<0.01 and odd ratio 10.39) and incidence of CHD in cleft is high in cleft patient if another congenital animalies were presented (p<0.001, odd ratio 5.18). Conclusion: By attention to higher incidence of CHD in cleft patients, it is advised to cardiologist consulting before cleft surgery for better managing.

Background: The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on post-operative bleeding and need for allogeneic transfusion. Materials and Methods: In a prospective, randomized study, 200 patients undergoing CABG allocated into two groups: □ AT group = 100patientsreceived1-2units (300-450cc) autologousbloodafter termination of CPB □ TX group = 100patientsreceivedtranexamicacid, 15mglkgbeforethe injection of heparin and 15mglkg after protamin injection Postoperative bleeding, transfusions, complications, ICD stay and hospital stay were recorded. Results: The postoperative bleeding was lower in TX group (600 ml) than in AT group (1100 ml) (P <0.001). The rates of transfused patients in AT and TX groups were 72% and 65%. Patients in the AT group received more whole blood (2.82 units per patient vs. 1.93 units in TX group) (P<0.01). The numbers of FFP units administered per atient in AT and TX groups were 3.08 and 2.38 (P <0.01). In TX group, ICU stays and ospital stays were 0.8, 5.4 days (vs. 1.2s, 6.7 days in AT group). In AT group, there were 2 transient renal dysfunctions and two re-operations. There was no difference between all groups regarding to neurological dysfunction and coagulopathy. There is no hospital mortality in all groups. Conclusion: Tranexamic acid in comparison with intra-operative autotransfusion effectively reduces postoperative complications and allogeneic transfusions in CABG. In addition this technique due to shorter ICD and hospital stay is cost- effective.

Background: Obstructive cholestasis is associated with overproduction of endogenousopioids (EOP), nitric oxide (NO), and cytokins in the blood streams. Therefore we investigated the relationship between obstructive cholestasis and function of germ cells in adult male rats. Material and Methods: To study this, we used three groups of animals: Nosurgery, Sham-surgery, and surgical ligation of the bile duct. After 3 weeks all animal were killed by ether, serum concentrations of FSH, LH and testosterone were determined by Radioimmunoassay, apoptosis was evaluated by DNA fragmentation detected by in situ terminal deoxynucloetidyl Transfrase-mediated dUTP nike end labeling (TUNEL). Results: The mean of FSH level in cholestatic, control and sham groups were 13.22±1.038, 18.14±1.276, and 16.92±1.072ng/ml, respectively. The mean of LH level in cholestatic, control and sham groups were 0.83 ± 0.21, 2.058 ±0.26, and 1.84±0.17 ng/ml, respectively. In addition, the mean of testosterone level in cholestatic, control and sham groups were 1.52±0.16, 2.41±0.18, and 2.31±0.14 ng/ml, respectively. The results of this study were indicated that serum FSH, LH and testosterone were significantly lower in cholestatic than control and sham groups (p=0.0195, P= 0.0029, and P=0.0023, respectively). However there was no significant difference in apoptotic index between all of groups (P=0.195). The apoptotic index in cholestatic, control and sham rats were 9.897±1.374, 7.086±0.91, and 7.729 ±1.101, respectively. Conclusion: These findings have been shown which as obstructive cholestasis was decreased the levels of serum gonadotropins and testosterone but it has no significant effector testicular germinal cells apoptosis.

Background: Rhino cerebral mucormycosis is a rapidly progressive fungal infection that spreads from nose and sinuses to brain in short time. Cunent hypothesis about brain involvement explains that infection initiates in nose and progresses into orbit through ethmoidat sinuses via erosion of lamina papyranea. Then infection spreads from orbit apex to cavernous sinus and brain. Therefore, in addition to medical therapy surgical debridement of the sinuses plays a major role in treatment of these patients. The aim of this study is introduction of a new point of view about extension of mucor from the nose to orbit and brain. Also we discuss clinical implication of this perspective on surgery. Materials and Methods: Since 1997-2002 nine patients with mucormycosis involving nose. Sinuses and orbit were admitted in ENT ward of Imam Khomeini general hospital. 8 patients with positive pathology entered the study. Variable such as age, underlying diseases, symptoms, site of involvement, extent of debridement and its times, and outcome were studied. Results: After review of the history, surgical reports and pathological results, we found these findings in almost all patients: 1) facial pain, facial anesthesia, paralysis of buccal branch of facial nerve, paralysis of extrocular muscles, chemosis, periorbital edema 2) involvement of cheek subcutaneous tissue, buccal fat pad, IOF, SOF, orbital apex, infraorbital and maxillary nerves 3) involvement of pterygoid fossa with or without infratemporal fossa extension. Three patients have survived. Causes of death in other five patients were pneumonia, hypokalemia, and arrythmis during anesthesia. Mucormycosis was under control in most of these patients. Conclusion: Pterygopalatine fossa is the main source for replication and extension of mucor. After entrance to the nose, mucor reaches this site and after involvement of IOF and SOF rapidly extends to retrobulbar portion of the orbit. Paranasal sinuses, buccal space, cheek, palate and infratemporal fossa may be secondarily involved. Exploration and debridment of this area has beneficial effect on surviving of these patients.

Background: Morphine is the most important alkaloid of opium family which is found as much as ten percent in opium, and is in two types the sulfate morphine and the hydrochloride morphine. Materials and Methods: In this study morphological changes of uterus of surri mice due to oral consumption of sulfate morphine were studied. It was shown that, female surri mice following gradually increasing of morphine to water (0.1 and 0.01) mg/ml were depended to morphine. Female sum mice were classified in two age groups before puberty and depended to morphine during puberty. Each age group took morphine for 21 days. After finishing the period, the mice anesthetizing were weighted, then were anesthetizing and uterus was studied the length, width and apparent features. Results & Conclusion: In this study it was distinguished that length and width of uterine horn, between experimental and control groups, were significant (p< 0.01). Morphological changes such as anemia, the thinness and fragitidily walls of uterus and filiformity of uterine horns were observed.

Background: Renal transplantation is ideal treatment of chronic renal failure. Pulmonary infection is a common and serious post transplant infection requiring hospitalization and is associated with high mortality. Increased susceptibility to infection is due to a decrease in the patients' immunological response caused by immunosuppression through drug administration, and by other influences. Materials and Methods: This study was case series and prospective, from July 2001 to July 2002 in Imam Khomeini hospital of Tehran. Results: 164 renal transplant recipients were studied, 14 patients (8.5%) had pulmonary infection, 11 of them (78.6%) were female and 3 (21.4%) were male. The mean age of them was 42.6 years. The patients were followed up for 9 to 12 months. All patients were on triple immunosuppressive regimens. The interval between transplantation and the appearance of pneumonia was 2 months to 10 years. The time of beginning infection in 3 cases (21.4%) was between 1 to 6 months post transplantation, 11 cases (78.6%) were occurred beyond 6 months after transplantation. In 7 cases (50%), pulmonary infection was occurred during first year after transplantation. None of the 14 patients developed pulmonary infection in first month after transplantation. BAL were used in 6 cases (42.8%) of pulmonary infection, and organism were detected in 5 of them (83.3%). The most common clinical feature was fever. Six cases were due to mycobacterium tuberculosis (42.9%), this organism was the most common ethiology of pneumonia. In this study tuberculosis was seen in 3.6% of renal transplant recipients. One patient had pulmonary mucormycosis. All patients with pulmonary TB were cured, and other cases with unknown case, were cured with empirical treatment. Conclusion: Our finding indicate the invasive diagnostic procedures are required in order to earlier and reliable diagnosis and then better outcome of transplantation.

Background: Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The aim of this study was to evaluate the effect of autologous transfusion on patients' hematocryte value, intra and postoperative blood loss, hospitalization time, the development of infective complications and other factors. Materials and Methods: Between June 2001 to April 2002, 208 patients were, underwent cardiac surgery in cardiac surgery ward in Imam Khomeini Medical Center. One or more blood units donate from 104 Patients before cardiopulmonary bypass and heparin injection, and transfused to them after CPB and Protamin injection (autologous Group, group 1). 104 patients underwent cardiac surgery routinely (control group, group 2). Results: Mean of age was 55.9±8.6 in group 1 and 56.6±9.3 in group 2 (P=NS). 73 male and 31 females were in group 1 and 79 males and 25 females were in group 2 (P=NS). Smoking, familial history, hyperlipidemia, diabetes mellitus, renal failure, hypertension, stroke, and history of myocardial infarction was similar in two groups. Severity of angina, urgency operation, number vessels disease, duration of cardiopulmonary bypass, duration of aortic cross clamp time, use of internal thoracic artery graft, and number of grafts was similar in both groups. Mean of bleeding post operation was 548 cc in group 1 and 803 cc in-group 2 (P=0.003). Bleeding that need to operation was 1.8% in group 1 and 8.6% in group 2 (P=0.002). Wound infection, mediastinitis, renal failure, ventilatory prolonged, stroke, need to Intra-aortic Balloon Pump (IABP), intraoperative bleeding, and hospital stay was similar in both groups. Mean of extubationt time was 10.2 hours in group 1 and 14.8 hours in group 2(P=0.001). Conclusion: Preoperative and intra-operative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.

Background: Illicit drug abuse is a major area of interest for clinicians, as well as for public health and social authorities, but one of the major concerns is the illicit drug abuse during the periconceptional period and throughout pregnancy, because of its potential effects on the embryo and fetus. In this study we investigated the prevalence of illicit drug abuse in the first trimester of pregnancy in women who referred to Iran, Tehran and Shahid Beheshti universities of medical sciences, for prenatal care. Materials and Methods: In this descriptive cross sectional study, a non-randomized sample of 2000 pregnant women that were in their second and third trimester of their pregnancy, were interviewed about drug abuse in their first trimester. Collected data were analyzed by SPSS software. Results: The prevalence of illicit drug abuse in the first trimester was 2.5% which the majority of these drugs were in group B. The prevalence of drug abuse was 0.9% and alcohol usage and alcohol abuse was 0.2%, cigarette smoking was the most common drug abusing phenomena. Variables such as husband education, infertility and satisfaction with pregnancy have significant relation with drug abuse. Conclusion: The results of this study support the need for continued education and this education must end in by itself to make dramatic changes in behavior. So results of this study showed that, improving education and knowledge of mothers and consultation with them in regard to risks and complications of drug abuse during pregnancy, would make dramatic changes in their behavior.