TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2013 | Volume:71 | Issue:4|Papers Count:13

Background: Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF (In vitro fertilization) cycle following laparoscopic unilateral cystectomy of endometrioma.Methods: In a case control study, we enrolled 30 women with history of unilateral laparoscopic cystectomy of ovarian endometrioma in stripping method who underwent IVF cycle in women Hospital, 2009-2012. The numbers of follicles in response to controlled ovarian hyperstimulation during IVF cycle in the ovary with history of unilateral laparoscopic cystectomy of endometrioma were compared with those from the contralateral ovary.Results: The mean age (±SD) of patients was 32.3 (±3.4). The mean (±SD) diameter of excised ovarian endometrioma was42.4 (±10.4) mm. Interval since ovarian surgery to induction ovulation was2.7 (±2.6) years. Mean number of follicles in the ovary with history of unilateral laparoscopic cystectomy of endometrioma was2.5 (±1.2) with the range of1 to 5 and in the control ovary 3.9 (±1.4) with the range of 1 to 6. There was significant difference in the number of follicles in the ovary with laparascopic cystectomy of endometrioma compared with opposite one (P<0.001).Conclusion: Laparoscopic cystectomy for unilateral endometrioma is associated with a reduced ovarian response to controlled ovarian hyperstimulation during IVF cycle. We did not find any statistically significant difference in reduced ovarian response with regard to patients age, body mass index, size and location of the cyst, and time duration since ovarian cystectomy.

Background: High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities.Methods: This retrospective study conducted on twenty nine patients (36 knees) undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD) 27.64 (±10.88). The mean (±SD) of follow up time was 4.33 (±1.7). All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in15 cases (42.5%) casting and in the rest T. Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC) and modified Larson indices were improved after operation, but there was no significant difference between two groups.Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

Background: Detection of retained foreign bodies remains a significant problem in the emergency department. Foreign bodies can go undetected causing infectious complications ultrasonography is too inaccessible and expensive. The purpose of this study is comparison of ultrasonography with radiography for the detection of cervical esophageal foreign bodies Methods: This cross-sectional study evaluated 58 patients referred with suspected upper esophageal foreign body in the Emergency Department, Amir Alam. Patients were evaluated with ultrasonography and x-ray. After surgical exploration, different type of foreign bodies were recorded. The SPSS statistical software was used for analysis. For applicable efficacy outcome measures, a Spearman correlation was used. Differences were significant when P<0.05. All values were expressed as the frequency and present.Results: Fifty eight patients were studied.25 patients (43.4%) were male and 31 patients (56.9%) were female, in 28 (48.2%) patients foreign bodies were detected in radiography. 30patients (51.8%) were not recorded in techniqe. It was found in patients 22 (78.6%) organic body, and six cases(21.4%) non-organic body. radiographic outcomes in patients with foreign bodies were positive in26 patients (92.9%) and in two patients (7.1%)were negative. Ultrasound results were positive in 27 patients (96.4%) and in one patient (3.6%) were negative. Association of ultrasound and radiography results were significant in patients with foreign body (Spearman correlation=0.896, P=0.001 Kappa=0.890).Conclusion: These reports suggest that result of ultrasound with radiography for the detection foreign bodies in cervical esophagus have good agreement. The use of ultrasonography in the emergency department to detect and eventually remove foreign bodies by emergency physicians is an important issue because there is not always an ultrasound technologist or radiologist available.

Background: One of the important problems in fertilization in vitro (IVF) is failure of implantation. This could be the result of estrogen and progesterone effects in endometrial acceptance during ovulation stimulation. Although progesterone has a vital role in primary phase of pregnancy, but the estradiol role in luteal phase is unknown. The aim of this study is assessment of the ratio of estradiol to progesterone in embryo transfer day on Intracytoplasmic sperm injection (ICSI) outcomes.Methods: This is a cohort study. The subjects were 311 infertile women referred to Urmia Kosar infertility clinic & Urmia reproductive health research center who treated with ICSI method between August-Jan 2011. Five cc blood was drawn for determine of estradiol and progesterone in transfer day. Transfer occurred after a variable in vitro culture period ranging from 48 to 72 hours after ovulation induction. Chemiluminescent ELICA the level of mention hormones was used to determine the ratio of the progesterone level to the estradiol serum level and was compared based on treatment outcomes.Results: A total of 311 patients, 115 (37%) were pregnant and happened abortion were 18 (5.8%). The mean ratio of estradiol to progesterone in transfer day in two groups of miscarriage/ non miscarriage and pregnant/ non pregnant was 32.26±23.86, 28.17±26.5 and28.58±2.4, 36.09±4.39 respectively. There is no significant difference between two groups in regard of estradiol on progesterone ratio (P=0.5, P=0.2).Conclusion: The results of this prospective cohort study show that there is no effect of estradiol to progesterone ratio on day of embryo transfer, successful pregnancy in ICSI cycles and abortion rate following of ICSI.

Background: Alopecia areata (AA) is a common cause of noncicatricial alopecia that occurs as a patchy, confluent or diffuse pattern. Exact etiologic factor of AA not yet recognized. Among many hypothesis, relationship between AA and autoimmune disease, especially thyroid disorders, was more interesting. The objective of this study was to determine the prevalence of thyroid test disorders in the patients with alopecia totalis and universalis in comparison with normal population.Methods: We analyzed medical records of 100 patients, including 44 male and 56 female in Tehran Razi Hospital from1388 to 1389. The mean age was 24.1 years.Patients having totalis and universalis form of AA considered as case group while 100 normal person (42 male and 58 female with mean age of 26.1) who had not any form of AA considered as control group. Both groups had not any sign of thyroid disease at clinical examination according to their available medical records. Collected data were analyzed statistically in SPSS software 17th version.Results: In the majority of patients (54%) the disease was manifested in the first two decades of life. History of atopia was seen in9.8% of patient. Presence of the similar disease in first-degree family members was seen in14.3% of patients. Abnormal T3, T4 and TSH were significantly higher in case group. Abnormal T3 uptake was higher in case group but not statistically significant.Conclusion: Paraclinical thyroid disorders were significantly higher in the alopecia areata patients than in normal population. There was no significant association between the age, sex and duration of disease and presence thyroid dysfunction.

Background: Urinary tract infection (UTI) is one of the most common infections in infants and children, especially in their first decade of life. These patients are more susceptible to renal scars and other possible complications like growth retardation, arterial hypertension, proteinuria, isostenuria, and finally chronic renal failure. Trace elements like vitamins and minerals are essential for efficient metabolism and proper function of various body systems namely immune system. In this trial we compared the relation between serum levels of zinc, vitamins A and D in children inflicted with UTI and control group.Methods: This was a cross-sectional study on 25 patients with UTI admitted to pediatric wards of Rasul Akram Hospital and Bahrami Hospital. They were compared to40 other patients admitted in surgical wards for elective surgery. Serum levels of zinc, vitamins A and D were measured in both groups.Results: Seventy two percent of the patients were male and 28% female. The average age was 2.17. Despite the lower levels of vitamins A and D in cases than controls, the difference was not significant (P=0.4 and P=0.9, respectively). However, serum levels of zinc were significantly lower in cases than controls (P<0.05).Conclusion: Vitamins A and D may play some role in patients’ vulnerability to UTI, but this supposition needs more research on larger samples, considering differences among patients of various age groups and their nutritional status.According to the study, lower levels of zinc were associated with susceptibility to UTI; thence, its administration might be helpful.

Background: The role of gram-positive cocci especially Staphylococci species in causing urinary tract infection are well known. Among the Staphylococci species Methicillin Resistance Staphylococcus aureus (MRSA) is the most important. The rate of MRSA is increasing worldwide. This is alarming because the danger of these organism in public health. Therefore the aim of this study was to determine the sensitivity of gram-positive cocci, as well as MRSA to vancomycin and other antibiotics.Methods: This was a descriptive study, and were carried out on 300 patients with urinary tract infections(UTI) caused by gram-positive cocci, referred to Imam Khomeini hospital during eight months. Prior to the antibiotic sensitivity testing all the isolates were identified according to the standard conventional biochemical procedure, and then the antibiotic susceptibility test were carried out according toBauer-Kirby method.Results: Among the gram positive cocci causing UTI, the most abundant were Staphylococcus saprophyticus (37.7%), followed by Staphylococcus epidermidis (22.3%) and Staphylococcus aureus (18%) respectivley. The sex distribution of patients were 163 female (54.3%) and 137 male (45.7%) respectively, and the prevalence rate of urinary tract infections in female was(8.6%) higher than male. The rate of sensitivity of isolated Staphylococci were as followed, sensitive to vancomycine (100%), Ciprofloxacin (89.2%), rifampin (87.6%), and amikacin (71.8%) respectivley, but were resistant to penicillin and amoxicillin (100%). The antibiotic sensitivity rate of isolated Streptococci was to vancomycine (85.1%), ciprofloxacin (50.7%) and penicillin (79.1%) respectively.Conclusion: Vancomycin is still a suitable antibiotic for the treatment of Staphylococcus infections. Although6% rate of enterococci resistance to vancomycin is alarming, and use of this antibiotic in the treatment of other gram-positive bacteria should be done with precaution.

Background: The purpose of this study was evaluation of risk factors of peripheral artery disease (PAD) and effective markers on it.Methods: This descriptive-analytical study was done during 2010-2011 in the surgical units of Khorramabad Shohada Hospital. Fifty patients who had symptoms of PAD undergoing CT angiography and biochemical markers for them were measured. The investigated variables were family history, site of arterial obstruction, underlying diseases, smoking history, physical activity and stress level. A control group was considered for the study. The comparison was made between these two groups.Results: Aging showed a significant role in prediction of PAD (70% sensitivity and 64% specificity). Homocysteine had the highest sensitivity (80%) in prediction of PAD, compared with other biomarkers. CRP (74% sensitivity) was the best marker that had positive predictive value for PAD. Fasting blood sugar (FBS) showed a significant role in prediction of true positive cases of PAD (72% sensitivity and 74% specificity). HbA1C with68% sensitivity and 64% specificity and TG with 50% sensitivity and 44% specificity could be considered as factors related with PAD.Conclusion: The levels of C-Reacative protein, homocysteine, and FBS were correlated with PAD, HbA1C and TG levels were associated with PAD, but lower than the previously named markers. In this study a significant relationship between lipoprotein levels and PAD was also observed. PAD was associated with sex and age.

Background: Cerebral venous thrombosis (CVT) is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI)showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin(LMWs) are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

Background: Patients with hematologic malignancies are at risk of advanced tuberculosis. The prevalence of tuberculosis between these patients is 2.1-2.6 percent. The cellular immune deficiency caused by hematologic malignancies and or its treatment increases the risk of tuberculosis in these patients. Multiple Myeloma is malignant proliferations of plasma cells that involves different classes of immune system. Cellular and humeral immune deficiency due to the Multiple Myeloma and drugs for its treatment results in susceptibility to unusual infections. Infections are of the important factors of morbidity and mortality in patients suffering from multiple myeloma, but coincidence of Multiple Myeloma and tuberculosis is rare and very little has been reported.Case presentation: In this paper a 60-year-old woman from Kermanshah, Iran who is suffering from back pain, weight loss, weakness and sweating will be introduced. Spondylitis was seen in her lumbar imaging. Her husband suffered from pulmonary tuberculosis. In diagnostic studies tuberculose spondylitis and multiple myeloma were diagnosed simultaneously.Conclusion: Although the accompanying of Multiple Myeloma and tuberculosis is not common, but immunodeficiency caused by a hematologic malignancy as well as a history of close contact with a patient with tuberculosis resulted in tuberculosis of spine in this patient. Clinical features of abovementioned diseases are very similar. But in endemic area for tuberculosis, this disease should be considered because delay in diagnosis leads to increment in mortality and morbidities. Diagnosis of tuberculos spondylitis is based on radiologic and histologic features of the disease and on the response to treatment because the sensitivity of definitive diagnostic tests such as culture and PCR is low in extra pulmonary tuberculosis.