TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2000 | Volume:58 | Issue:4|Papers Count:16

Epilepsy is a disease with high prevalence which interferes driving and may lead to car accident, this case - control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old.The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients.We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physican about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during geting driving liecence.

Thrombotic thrombocytopenic purpura is the result of multiple thrombus disseminated in small arterioles throughout the body. Principal damage is in the endothelium of small vessels and capillaries. From 1982 to 1999, 28 patients (16 female and 12 male) have been treated for TTp. The outcome was evaluated for risk factor and prognosis. These patients were 18 to 69 years old. All had neurological sings, fever, microangiopathic hemolytic anemia and thrombocytopenia. These patients did not have predisposing factors. All patients were negative for hepatitis C and B. Plasmaphoresis was the main treatment in all and was done. The patients had Plasmaphoresis from 1.5 to 6 liters per day. Minimum requirement was 4.5 liters to 95 liters in all. Replacement was Fresh frozen plasma in 16 patients. 12 patient had FFP and Cryopoor plasma half-and-half for replacement.22 patients completed the treatment and became well 6 patients died. Chronic head ache and progressive dementia was observed in 2 patients. Six patients did not recover and died.Platelets count over 100.000/ mm LDH lower than 500 units and disappearance of neurological distrubance was the end point of treatment.This study showed the good result of plasmaphoresis in TTp and graves outcome in patient with cerebral bleeding, Cardiopulmonary failure, Prolonged QT in EKG, Hypotension, and increased CPK.We did not observe any chronic cases in these groups. The causes of death were cerebral hemorrhage in two Respiratory failure in three patient. one of these patients had adult respiratiry distress synfrome and pneumonia in another patient.

This is prospective double-blind research which was carried out in Imam Khomeini Hospital in order to study the accuracy of color doppler ultrasonography for detecting the site & grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) & right internal carotid arteries (38.4%).We measured peak systolic & end-diastolic velocities (PSA & EDV) & ratios of PSV & EDV at stenosis sites to CCA (PSV Ratio & EDV Ratio).Results showed that PSV has the highest sensitivity & accuracy in all grades of stenosis: mild to moderate stenosis: sensivity (90.5%), accuracy (89.5%), severe stenosis: sensitivity (82.1%), accuracy (92.8%), total occlusion: sensitivity (93.88%), accuracy (96.5%).There is no difference between accuracy of doppler parametrs for detection of total occlusion (96.5%) but in other grades after PSV, EDV (mild-moderate 86%, severe 87.2%), EDV Ratio & PSV Ratio (mild-moderate both 84.8%, severe both 86%) have the highest accuracies.We concluded that color doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

The most common cardiovascular surgery in the world and Iran as well, is CABG. One of the most important post operative complication of this operation, that increase morbidity and mortality, is perioperative MI. Incidence of perioperative MI in CABG operations is between 2.5 to 5.5 percent. In this study we determined the prevalence and Incremental risk factors of perioperative MI in 300 consequative CABG operation, in the Imam Khomeini hospital.Diagnostic criteria for perioperative MI were positive ECG finding (New and persistent Q.Wave) and positive CPK-MB (serum level > 100 unit) at three different time:Just before operation in the ward.1) Just after operation in the ICU 2) First postoperation day (at 8. A.M.)In 300 patients positive ECG findings were seen in 7% (21 cases), positive CPK-MB was 12.7% (38 cases) and both of them were positive in 5% (15 cases). Therefore the prevalence of perioperation MI was 5% (15 cases).In cremental Risk factors in the patients with perioperative MI were history of diabetes mellitus, Hypertension, hyperlipidemia, left main disease, and Endarterctomy. Therefore because of high incidence of perioperative MI in CABG operation we should try to change the risk factors and decresase the prevalence of this complication

Inspite the emergence of potent and broad spectrum antibiotics and recent advances in bronchoscopy and pulmonary physiotherapy, still there is a high rate of morbidity and mortality because of lung abscess. The objective of this study is the indication of risk factors which have undesirable effects on the prognosis of lung absecess. In a retrospective study, all cases of lung abcess who was confined to bed during 1994 to 1999 in Rasht were collected and analysied.From 52 cases, 40 (77%) were male and 12 (23%) were female. The mean duration of stay was 20 day (15 to 35). The secondary cause for lung abcess was as follows:10 cases (19%) COPD, 10 cases (19%) preumonia, 15 cases (29%) bronchiectasia 2 cases lung cancer, 2 cases lung hydatid cyst and 3 case atelectasia. Extrapulmonary causes of lung absecsswere consist of: 10 case (10%) aspiration, 10 case (19%) esophageal diseases tending to reflux, 5 case (9%) periodontal disease. The factors which had underiable effects on prognosis of diseas were lung cancer, anemia, hypoalbuminemia, age over 60, abscess with pseudomonas, absecess cavity greater thus 8 cm, lower lobe in right lung and TB.Because of high morbidity and mortality of lung abscess, due attention for internal drainage, bronchoscopy, physiotherapy and timed surgery are seriously indicated.

Since its introduction in 1988, Laparoscopic Cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5- Imam Khomeini medical center- Tehran.In a retrospective descriptive case- series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existant clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intraoperative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed.343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: (1) recurrent biliary colic (88.4%), (2) nonspecific manifestations of gallstone (5.8%), and (3) asymptomatic gallstone (1.7%). Contraindications for LC are: (1) acute cholecystitis, (2) CBD stone and/or dilatation, (3) gallbladder cancer, (4) intra-abdominal malignancies, (5) the need for other elective abdominal operation, (6) history of upper abdominal laparatomy, (7) sepsis, (8) ileus, (9) peritonitis, (10) pancreatitis, and (11) morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision marking is based on patient’s general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: severe adhesions, technical and enforced. There was no death after LC.

Estimating fetal weight in utero, for better management of pregnancy and appropriate timing of delivery especially in high risk pregenancies is necessary. Our purpose to evaluate a simple method in estimating fetal weight in Iranian pregnant patients and also to compare was with a previous western study. This study was carried out in Arash Hospital, Tehran university of medical sciences in 1996-1999.In a descriptive- analytic study that was done prospectively on 464 pregnant patients, ultrasonic measurement of Biparietal diameter (BPD), mean abdominal diameter (MAD), and femur length (FL) performed close to delivery was conducted. Birth weight also was identified. Statistical analysis was done using multiple linear regressions on the data and also student’s t-test for comparison.Mean birth weight was 2320 gr. The outcome of linear regression analysis was the following model: Weight (gr) = 95.8× FL (cm) + 25× MAD (cm) - 15.6 ×BPD (cm) - 4632.1The effect of all parameters were statistically significant (P<0.02). A fetal weight estimating table was also developed. t-test anaysis showed a significant difference (P<0.05) in some final ranks of table (weight estimations > 4000 gr) in comparison with the rose & Mc callum study (1).Our study showed that ultrasound using the sum of BPD, MAD and FL is a precise method in fetal weight estimation. Application of other biometric measuremens may be needed for better elucidation especially in small and large for gestational age fetuses.

In this paper we report a case of jejual atresia that was detected prenataly. Polyhydramnios and multiple dilated bowel loops in the liwer part of fetal abdomen in ultersonography helped us to diagnose this abnormality. Postnatal barium enema showed it and also it was confirmed by laparotomy cinfirmed it. Pernatal diagnosis is important in these cases to facilitate delivery in centers where expert team of specialists are available to allow optimal neonatal care.

Cardiopulmonary Resusction (CPR) is one of the most important skills that every body must know it in medical services. In educational hospitals, the (newly-arrived residents are in first call for management of victims, specially in emergency rooms and at nights. Their knowledge and ability for successful CPR have a direct relation with prevalence of total mortality and morbidity. This research has assessed the knowledge and attitude of the new residents about CPR, and for answering to this question: "Is the CPR workshops necessary for all of the new residents in the begining of their courses". All of the 506 new residents were examined simultaneously in two separate years with a questionnaire consist of 50 questions about their CPR secence and skills and 8 questions about their attitude in CPR. These informations were analyzed by SPSS and Epi6 softwares. The mean correct answers were %55± 11.8 The best results were about arrythmias (%68.6) and airway management (%63.6%) and the worst were about IV access (%43.1) and pediatric CPR (%31.5). These finding were similar in two sequential years. Thier knowledge had significant relation with sex (P=0.002), their original university (P=0.031), their residency course (P=0.024) and their residency reception scores (P<0.001). Males had knowledge more than females. The max. Scores were from Kerman (62%) and Beheshti universities (60.5%) and the min. Score were from Hamadan (%48) and Kashan universities (%37). The orthopedic (%62.5%) and urologic residents (61.6%) had the most knowledge and the gynecology residents (53.8%) had the least. The knowledge had no relation with the time of graduation. About their attitude in CPR: their knowledge was moderate (65.8%), their abilities was moderate (58%) and their education about CPR in MD course had been low (51.5%). Their references for education had been individual studies (74.6%), CPR workshop had not been condected in the most universities (92.7%).Knowledge about CPR is  low (55.8%) and must be 100%. In advanced centers, continous educations in CPR is essential. Residents with low scores have accepted in courses that have more CPR situations. Difference in knowledge of residents from different universities, show the different educations. Primary knowledge was low and after years, this is lower. Attitude of residents show the low knowledge, low ability, low education in MD, courses.

Breakthrough Bleeding (BTB) is the cause of 50% of discountinuations of use by long-acting progestogen-only contraceptive users. BTB appears to be associated with capilaries of abnormal morphology and fragility. Disturbances in vessles integrity, intercellular junctions or alteration of the basement membrane (BM) composition has been proposed to contribute toward the fragility of these capillaries.In a clinical trial study, thirty-four healthy fertile volunteers were studied before and during use of levonorgestrel releasing subdermal contraceptive implant Norplant. Three endometrial biopcies were taken from each volunteer, one before insertion and two at different time intervals after exposure to Norplant. Then three major components of BM of endometrial vessels, Collagen IV (CIV), laminin and heparan sulphate proteglycan (HSPG) were immunostained and studied. The density of immunostained vessels by each antibody were measured and compared with density of vessels stained by CD34. Double immunostain of CD34 and laminin was also used for demonstration of vessels without BM.Significant decrease in vascular density showing BM components were shown in the study. The density of laminin-, CIV- and HSPG-positive vessels were decreased from 176 ±8, 166± 6.6 and 61± 6 vessels/mm2 (Mean± SEM) in the endometrium of Norplant acceptors before use control samples to 156± 6, 144± 6.2 and 33± 2.9 in the endometrium of Norplant acceptors after 2 to 13 weeks Norplant exposure, respectively (P<0.05). This was occuring at the same time as the overall density of small vessels in Norplant exposed endometrium was showing increase. Significant decrease was also demonstrated over 13 to 42 weeks of use in the densities of laminin and HSPG- positive vessels compared with control (P<0.05), although decrease in the density of CIV positive vessels was not significant.Percentages of vessels showing BM were also calculated in the study. Significant decrease in the percentages of vessels showing BM were demonstrated after 2 to 13 weeks of Norplant use. The percentages of CD34 positive vessels showing laminin-CIV- and HSPG- positive BM in control samples were 97± 3%, 88± 3% and 31± 2% (Mean ±SEM) which significantly decreased to 79 ±3%, 75± 4% and 20± 2% in Norplant users, rspectively (P<0.05).Decrease in the percentage of vessels showing BM was thought to be due to disturbances in the integrity of BM in endometrial vessels of women using Norplant which could be a cause for the fragility of the vessels. The decrease could also be due to decrease in the density of arteriols and increase in the density of venules and appearance of solid cords of endothelial cells. Double immunostaining of the endometrial vessels with anti-CD34 and anti-laminin clearly demonstrated loss of BM or weak staining of BM in the endometrial vessels of Norplant users.Clarification of the local mechanisms which leads to cappilary fragility and abnormal endometrial bleeding may lead to the development of better treatments or prevention and ultimately improve the acceptibility of these contraceptives.

Sarcoidosis is a chronic multisystem disorder of unknown etiology. All parts of the body can be affected but the organ most frequently affected is the lung. Otolaryngologic manifestations occur in 20% to 40% of cases of Sarcoidosis and the spectrum of lesions that may come under the purview of Otolaryngologist is broad.In this case report a patient is presented with large cervical lymphadenopatty and without other manifestation of disorder.

Diabetes mellitus is one of the most common endocrine diseases during pregnancy. In order to compare maternal and Neonatal camplications in diabetic pregnant versus nondiabetic pregnants, a retrospective study was conducted at the obstetric department of Vali-E-Asr university hospital during 1370-1375 which included of 96 diabetic and 100 nondiabetic pregnant patients, the latter being accidentally chosen among 18000 pregnant women who has been reffered this center.The results showed that all maternal and obstetrical complications were higher in diabetic pregnant women with a C/S (cesarean section) rate of 71.3%, Preeclampsia 16.5%, hypertension 24.3% and poly hydramnios 4.3%. There was significant statistical difference (P=0.0001) between the two groups in all the above mentioned parameters except hydramnios. C/S was the most common maternal complication with a rate of 39.1% due to macrosomia compared with the control group with a C/S prevalence of 13% due to previos C/S.A significant statistical difference (P=0.0001) between the case and contol group was also observed in the frequency of macrosomia and metabolic disorders in newborns infants. Hypoglycemia (25.2%) was the most common metabolic disorder in the case group.Based on the results achieved, it can be concluded that although nowadays, maternal and perinatal complication have decreased substantially in diabetic pregnant patients, pregnancy in still associated with higher risks in this group.

The term histiocytosis refers to a group of idiopathic clinical entities characterized by diffuse proliferation of mature histiocytes associated with tumorlike masses of foamy reticuloendothelial cells containing lipoid droplets with variable number of eosinophiles & connective tissue. This cells causes tumorlike masses in the bones and other vicera in the body thus it may have very different clinical signs & symptoms. Also it may have acute and fulminant form or chronic and slowly progressive.We have an interesting case with multiple organ involvement and chronic otitis media with granulation in the external audiotory canal and perforation of tympanic membrane. The patient was three years old with diabets insipidus and visceral involvement such as hepato-splenomegaly. Histologic diagnosis was Hand Schuller Christian disease.

The problem of AIDS had not been recognized upto 1981 and in 1984 it was found that HIV virus is factor of this disease. For the time beings AIDS/HIV infection has chanched to a pandemic and cases affected to it are now reported from all over the world. In our country the first case was reported in 1987.Regarding the importance of disease and recognition of its prevention and transmission routes, based on disease epidemiology in country, this survey was conducted. This study was performed in 1999-2000 and is retrospective descriptive study. The main pupose of study is epidemiology of AID in Iran from beginning until now.Total information of cases of AIDS/HIV from beginning in Iran and all performed activites were obtained from ministry of Health center for disease control- AIDS Dept. 95 files existing in the archives of Imam Khomeini Hospital related to AIDS were also studied.1953 cases of HIV + have been reported until march of year 2000. at the same time 250 cases of AIDS have been reported which 215 of them died. Among transmission routes, in AIDS disease the most common way of transmission was transfusion of infected blood or its components but HIV + case the most one was drug injection. With respect to age, the higher and lower rate of affected people were in 30-39 and 0-4 ranges years respetively. The sex percentage in AIDS affected and HIV + persons were 90.8% and 9.2%, 95.2% and 4.8% male and female respectively. 130 from 1953 HIV + cases had travel to abroad.

Hemorrhoid is one of the Anorectal disorders in children which is reported to be complication of portal hypertension. This condition is not common in children. We found only 7 cases from 30000 operation done in Tehran university hospital on pediatric group between 1983-1999.The main complain of these 7 cases was anorectal mass (43%) and pain due to thrombosis (28.5%) treatment of all 7 cases was successful and no other pathology found.

This descriptive study is carried out to determine the effectiveness of family planning programmes in Iran for years 1991-96.The study revealed the following outlines:- Contraceptives prevalence rates increased from 42% to 67% during years 1991-96. Zaro Couple years of protection increased for Norplant, Injectable contraceptive, IUD, Vasectomy and Tubectomy, but for Candom it is decreased in year 1996 (comparing to earlier years of the study).- A decrease in use failure rate of contraceptives was observed during the period of the study.