Tehran University Medical Journal
Year:2010 | Volume:68 | Issue:2|Papers Count:14

Background: Rupture of pectoralis major muscle is a very rare and often athletic injury. These days in our country this injury occurs more frequently. This could be due to increase in professional participation of amateur people in different types of sport, like body building and weight-lifting (especially bench-pressing) without adequate preparation, training and taking necessary precautions. In this article, we have tried to review several aspects of complex anatomy of pectoralis major muscle, epidemiology, mechanism, clinical presentations, imaging modalities, surgical indications and techniques of its rupture. Complex and especial anatomy of pectoralis major muscle, in its humeral insertion particularly, have a major role of its vulnerability to sudden and eccentric contraction as the main mechanism of rupture. Also, restoration of this complex anatomy seems to be important during surgical repair to have normal function of the muscle again.

Background: Several studies have shown that propolis has antibacterial, antifungal, antiviral and antiparasitic activity. Furthermore propolis has been described to have medicinal usages in some fungal infections like Candidiasis. Our aim is to study the inhibitory effects of alcoholic extract of propolis on Candida spp. and Aspergillus spp.Methods: To determine inhibitory and fatality dose of propolis extract, we prepared serial dilution of the extract including 1/20, 1/40, 1/80, 1/160, 1/320 and 1/640 in 1 ml of liquid medium sabouraud broth. Given numbers of Candida yeasts in 1ml were added to above dilution tubes. Candida and Aspergillus cultures were incubated at 30oC and 25oC respectively for 24-72 hours.Results: We obseved that the concentration of 0.25 g/dl of propolis extract showed an inhibitory and killing effect on more than 50% of the isolates. But there were no inhibitory and killing by the concentrations 0.0312 g/dl and 0.0625 g/dl on Candida isolates. Our findings showed that 0.0312 g/dl of the extract was partially active on Aspergillus fumigatus and dilution of 0.125 g/dl was active on Aspergillus. niger. In the agar dilution method, some changes were observed on morphological features (depends on the extract dilution) as well as quantitative effects of dilution of extract on the colonies.Conclusion: We found that the alcoholic extract of propolis had a prominent antifungal activity and inhibitory effect on Candida and Aspergillus isolates.

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with presumed autoimmune origin. T cells are considered to play a pivotal role in orchestrating the self-reactive immune responses in multiple sclerosis (MS). This study was performed to investigate the role of polymorphisms of the programmed cell death 1 (PD-1) gene on susceptibility to ankylosing spondylitis. This gene codes an immunoreceptor named PD-1, which has a cytoplasmic domain containing two tyrosine residues located within immunoreceptor tyrosine-based inhibitory and switch motifs (ITIM and ITSM), suggesting that PD-1 is predominantly inhibitory which responsible for the negative regulation in T cell activation and peripheral tolerance. We investigated whether PD-1 gene polymorphism is a genetic modifier for risk and progression of MS.Methods: Blood samples from 150 Iranian Relapsing-Remitting MS patients (mean age, 34.98 years) and 202 healthy controls (mean age, 30 years) were enrolled in this study. The PD-1.3 (7146 G/A Intron 4) and PD-1.9 (7625 C/T Exon 5) polymorphisms were detected by Polymerase Chain Reaction and Restriction Enzyme digestion or Restriction Fragment Length Polymorphism (PCR-RFLP).Results: No significant association of the mutated alleles with the disease were detected. Because of the ethnic group genetic variation, our data is not like some of Asian population such as Korea and China.Conclusions: Our data suggest that PD-1 polymorphisms are not act as genetic modifiers of the progression of MS, possibly these polymorphisms don' t induce a partial defect in PD-1 mediated inhibition of T-cell activation.

Background: Pedicular screws are currently the gold standard of internal fixation of spinal column. Pedicular screws have their own complications, however the surgeon should be aware of morphometery of pedicles, as well as the anatomy of surrounding neural structures to minimize these risks. No national study has ever examined the physical characteristics of lumbar pedicles and this study is unique for this purpose.Methods: This study covers the patients undergoing lumbar spinal CT-scanning due to variable causes.25 vertebrae were selected in either gender, 18 years or older and EFilm computer software was employed to measure different diameters of pedicle and the results were analyzed with p£0.05 regarded as significant.Results: L5 pedicle was the widest (16.8 mm), while L1 was the narrowest (8.25 mm).this figure was 8.82, 10.48 and 12.86 mm for L2, L3, L4 respectively. Longitudinal depth of pedicle was 47.98, 48.68, 50.42, 48.32 and 47.8 mm for L1, L2, L3, L4, L5 respectively. Statistically significant differences were found between some dimensions detected in our study and similar studies.Conclusions: The advantages of pedicular screws and rods to stabilize spinal column are well known. To avoid neurological complications, an understanding of anatomy and pedicle orientation is mandatory. The shape and diameters of pedicles are different base on races. Some differences were found in our study regarding pedicle dimensions.

Background: Behcet’s disease (BD) is a multisystemic inflammatory disease with unknown origin characterized by recurrent oral aphtous ulcers, genital, ocular and skin lesions. A single point mutation 1691G to A in the factor V gene increases the risk of venous thrombosis. This study designed to determine factor V Leiden mutation in Behcet’s disease, and to find out it's relationship with the clinical manifestations in Khuzestan province, Iran.Methods: One hundred patients with Behcet's Disease (44 males and 56 females) based on international diagnostic criteria and 70 healthy subjects were included in the study. Patients and controls were tested for the presence of factor V Leiden mutation using polymerase chain reaction method.Results: The prevalence of factor V Leiden mutation was significantly higher in BD (10 out of 100, 10%) compared with healthy control subjects (1 out of 70, 1.4%), (p=0.025). Vascular lesions in this study were deep vein thrombosis (DVT) (7%), subcutaneous thrombophlebitis (5%), stroke (1%) and retinal vasculitis (39%). It was found that there was no association between venous thrombosis and the factor V Leiden mutation in Khuzestanian patients. Also, no association between other vascular lesions and the factor V Leiden mutation was recognized. On the other hand there was a significant association between DVT and anterior uveitis (p=0.033).Conclusion: In this study we did not find any association between clinical manifestations in BD patients and factor V Leiden mutation in Khuzestan province, Iran but in BD patients with DVT, factor V Leiden mutation might be a risk factor for the development of anterior uveitis.

Background: Sepsis is one of the most important causes of mortality in severely ill ICU patients. At least, a part of high mortality rate in sepsis patients is due to less specific clinical symptoms for prompt diagnosis. Recently some studies report that serum levels of procalcitonin will increase in these patients but changes of serum levels following treatments is not known. This study was designed to determin procalcitonin levels in patients with bacterial infectious disease in ICU, initially and during therapy and compare the levels during response to treatment.Methods: This prospective cross-sectional study was conducted on ICU patients with infectious diseases, blood specimen collected on day 1 and then in days 3 and 7 of ICU admission. The semi-quantitative PCT-Q test was performed.Results: Thirty five patients, 22 (62.9 %) men and 13 (37.1%) women, were enrolled in this study.18 (51.4%) patients died. Procalcitonin level in most patients in admission day was more than 10 ng/ml [16 (45.7%)] but in patients that react to treatment, decline to lower than 0.5 ng/ml [14 (77.8%)]. Mean rank of procalcitonin level from 1.14 ng/ml in first day reached to 2.72 ng/ml in seventh day (p<0.0001).Conclusions: This study showed that serum procalcitonin levels in ICU patients with bacterial sepsis significantly decrease following response to treatment. The measurement of serum procalcitonin in ICU patients with bacterial infectious diseases at first arrival day and following treatment is recommended.

Background: Inhibin is a dimeric glycoprotein that has a depressive effect on the anterior hypophys secretion. The level of this tumor marker is undetectable in menopause women. In patients with gynecological cancer, especially granulosa and epidermal-type (mucinous), ovarian cancers considerable increase in the serum level of inhibin has been reported. The increased level of inhibin has been reported in patients with recurrent ovarian cancer.Methods: We measured total serum inhibin and CA125 tumor marker level in 38 postmenopausal women with pathologically confirmed ovarian cancer before and after surgery out of 51 suspected women. Our control group were postmenopausal women that attended to our clinic for routine gynecologic check up. Both tumor markers were measured in these patients too.Results: Among 38 women with ovarian cancer, 13 (34.2%) had elevated serum levels of total inhibin. Among the 16 women with serous adenocarcinoma, 3 patients (18.8%) had elevated serum levels of inhibin. All the three women with granulosa cell tumor had elevated serum levels of inhibin (100%) and 3 of 4 (75%) women with mucinous ovarian cancer had the same result. three out of 38 women in control group had elevated serum levels of inhibin. Among all 38 patients, 6 (15.7%) showed tumor recurrence, that all were concomitant with rising of both serum CA125 and Inhibin levels (p=0/001).Conclusions: Serum inhibin level is a usefull tumor marker in granulosa cell and in mucinous tumor of ovary. In this study combined inhibin and CA125 assay showed better results in early detection of ovarian cancer in comparison to either CA125 or inhibin alone.

Background: Behavioral changes in patients with epilepsy could cause comorbid psychiatric disorders such as anxiety disorders. This study is concerned with investigation of obsessive-compulsive disorders and assessment of obsessionality as a personality trait in patients with complex partial seizure.Methods: Seventy six patients with complex partial seizure, 74 patients with generalized epilepsy that referred to Shiraz psychiatric professional center during three month (from July to September 2009), and 76 matched healthy controls were randomly selected and evaluated using the Yale-Brown obsessive compulsive scale (Y-BOCS), short form of Minnesota multiphasic personality inventory (MMPI) and clinical interview.Results: Complex partial seizure and obsessive-compulsive disorder (%13.15) are significantly more prevalent than generalized seizure (%2.70) and than control groups (%1.31) (p<0.001), and mean of psychasthenia scale (Pt scale) scores in patients with complex partial seizure is more than mean of Pt scores in generalized epilepsy and control groups (p<0.001). There is significant relationship between total score of Yale- Brown scale and Pt scale in MMPI (r=0.79, p<0.01).Conclusions: Patients with complex partial seizure are suffering from obsessivecompulsive disorder more than healthy persons and patients with generalized epilepsy, and obsessionality can be a personality trait in patients with complex partial seizure. So, in addition to drug therapy, psychological intervening for treatment of anxiety disorders in patients with complex partial seizure seems necessary.

Background: Constraint-Induced movement therapy (CIMT) is a promising treatment for improving upper limb function in adults after stroke and traumatic brain injury. It involves constraint of the less affected limb and intensive practice with the more affected limb. The purpose of this study on children with hemiplegic cerebral palsy (CP) was to evaluate the effects of CIMT on upper extremity and to make a comparison with conventional treatment.Methods: I a randomized clinical trial twelve children (seven females, five males; aged between 48 and 72 months with mean±standard deviation of 59.91±9.15mo) were randomly assigned in two groups. An intensive occupational therapy program including five hours per day for 21 consecutive days was performed for all of them, while less affected limbs were placed in sling for immobilization. Before and after intervention, upper extremity function, spasticity, and motor neuron excitation were evaluated by means of peabody developmental motor scales, modified Ashworth scale, and H reflex and H/M ratio, respectively.Results: The children who received CIMT did not improved their ability to use their hemiplegic hand significantly more than the children in the control group (p>0.05). However, reports of caregivers and clinical observations showed increases in more affected limb frequency of use and quality of movement.Conclusion: Results suggest that the use of CIMT needs to more studies and should be considered experimental in children with hemiplegic CP.

Background: Primary clear cell adenocarcinoma of cervix (CCAC) is usually seen in women with a history of in utero exposure to diethyl acetyl bestrol (DES). We report two cases of clear cell adenocarcinoma of cervix with no history of exposure to DES in embryonic period.Case presentation: The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic lymphadenectomy and for the another one external beam radiotherapy and brachytherapy was performed. There was no any recurrence or metastasis after an 18-24 months follow-upConclusions: Primary clear cell carcinoma of cervix could be unrelated to HPV infection or exposure to DES during embryonic period and in approach to these patients this subject should be considered.