Tehran University Medical Journal
Year:2006 | Volume:64 | Issue:3|Papers Count:20

Background: Intra-rater agreement in observing and decision making in diagnosis of any disease is of great importance. This investigation is to observe and read ultrasound pictures of ovarian cysts and distinguish its category for any radiologist.Distinguish ability is one of the related entities in this matter and radiologists' ability in correct diagnosis is of great concern.In this study, we evaluated radiologist's distinguish ability of ordered categories of ovarian cyst diseases (benign, borderline and malignant) in ultrasonography. To do this, we measured intra-rater agreement of radiologists by Weighted Kappa coefficient, and then by the help of "square scores association model" and "agreement plus square scores association model" we evaluated their distinguish ability in diagnosis of the severity of the ovarian cyst's diseases.Methods: In this analytical cross-sectional study, two radiologists and three radiology residents assessed ultrasounds of 40 patients separately and independently in two periods (with the interval of one week). Patients selected from those who were referred to Mirza Koochak Khan Hospital in January 2005. Ultrasounds were performed by an expert radiologist and by a single apparatus.Result: Data from radiologists was evaluated by "square scores association model" due to their superior results of distinguish ability. Mean of Weighted Kappa coefficient was 0.81 and intra-rater agreement was 0.99 for our radiologists, but due to weaker results of our residents, we used "agreement plus square scores association model" for analyzing and mean of Weighted Kappa coefficient was 0.65 and intra-rater agreement was 0.97 for them.Conclusion: Although radiologists had a better function than their residents, all of them showed appropriate distinguish ability and intra-rater agreement in diagnosis and categorizing of the ovarian cyst's disease. To distinguish benign category from borderline was more difficult than to distinguish malignant category from borderline and radiologists showed better results in this than their residents did.

Background: Heroin is a simple derivative of morphine that is the most used drug in Iran among opioids. Its harmful effects on body organs have been studied. Considering the important effects on the genital system and fertility, studying the effects of heroin on testes seems to be necessary.Methods: In this study a total of 30 male mice (Balb/c) were selected and divided into 5 groups of control (Intact, sham I, sham II), experimental I and experimental II. After addiction of the experimental groups to heroin via intra peritoneal injection, the histological structures of testes were studied microscopically.Results: Histological study of heroin on testes showed that the thickness of the basement membrane of the germinal epithelium and reduction in cell accumulation around some of the somniferous tubules. Irregularity in spermatogonia, spermatocyte and spermatic, increased distance and degeneration in seminiferous tubules were observed. Increasing connective tissue between somniferous tubules, decreased number of leydig cells, with a hypochromatic cytoplasm and reduction in their secretary granules, and congestion of tactical tissue were also observed.Conclusion: The results of this study show that heroin used in Iran can result in changes in the structure of testes. Consequently using heroin can influence the reproductive system.

Background: Occlusive disease of lower extremity arteries is so common and cause severe stenosis or complete local obstruction in arteries as it need treatment.The treatment could be surgery or interventional procedures like angioplasty or implant of stent. Sometimes such treatments are impossible because of severity or location of complication and cause amputation. The purpose of this study is an assessment about more common locations of arterial obstruction in lower extremities which is necessary for treatment planning and prediction for efficient supplements.Methods: In this descriptive study from 2000 until 2005, 100 patients with occlusive disease of lower extremity arteries who underwent angiography in medical imaging center of Imam Khomeini hospital in Tehran had been studied according to location of arterial obstructions. In the point of view of homodynamic conditions, obstructions over 70% consider important, so all of these patients had arterial obstruction over 70% up to 100%.Results: Our findings show that the most common locations of arterial obstruction in lower extremity are superficial femoral artery (47%), arteries of leg (21%) and iliac arteries (19%).Conclusion: This study can show appropriate assessment of the most common locations of arterial obstruction in lower extremity to predict supplements that may be needed for treatment of these patients.

Background: Mental health of prisoners, as a high risk group, is of considerable importance. Unfortunately limited data is currently available about psychiatric morbidity of this group in Iran. This study was designed to determine the prevalence of axis I disorders in prisoners and their correlation with the type of offense. Methods: Using stratified random sampling 351 prisoners from five offense categories (54 from financial, 71 from violent, 74 from nonviolent, 72 from drug related and 80 from immoral acts subgroup) were recruited into the study, and examined by Structured Clinical Interview for DSM-IV.Results: Eighty- eight percent of the prisoners had experienced at least one axis I disorder throughout their lives, and 46.9% met the criteria for current disorders.Substance related (78%) and mood disorders (48.7%) were the most prevalent of lifetime disorders. However, mood (30.7%) and adjustment (12.6%) disorders had the highest amounts in current diagnoses. The total number of disorders was lowest in the financial subgroup. The drug related subgroup had lower rate of anxiety and higher rate of substance related disorders.Conclusion: Compared to western studies, the prevalence of axis I disorders in this study are among the highest. The fact that about half of all prisoners at the time of study suffered from at least one axis I disorder shows the emergent need of this group for more mental health care and services.  

Background: Acne is one of the most common skin diseases especially in adolescence. Different studies have reported unequal rates of facial acne prevalence in different countries and populations. Only a few cases of acne in the trunk area (back and chest) have been reported in literature. Although our clinical experience shows lower prevalence of truncal acne in comparison with facial acne, a community based of study is needed to support this experience. Methods: A total number of 1001 high school students, selected randomly from 5 out of 20 education-ministry subdivisions of Tehran, were included. In each area two high schools (one for boys and one for girls) with almost 100 students per high school were selected. Demographic data, family history and clinical findings were recorded in the questionnaires.Consensus Conference on Acne Classification was used for acne grading.Results: One thousand one high school students, 503 girls and 498 boys, were included. Prevalence of acne was 91.1% for face (95%CI: 83-99%), 93.4% in boys and 88.6% in girls. It was 53.4% for back (95%CI: 46-62.2%), 58.5% in boys and 36.9% in girls. Whereas for chest the prevalence was 36% (95%CI: 27-45%), 34.9% in boys and 36.9% in girls.Mean age of the students with truncal acne was 16.1 years where as 15.9 in others.This difference was significant (P<0.05).Positive family history was higher in students with truncal acne (P<0.001).Conclusion: Truncal acne is less prevalent than facial acne. Acne on the back is significantly higher in boys than girls (P=0.002). Severe forms of acne in back may be more prevalent in boys. Positive family history can increase the risk of truncal acne.

Background: Hyperglycemia is a metabolic response to surgical stress. In this study, patients' blood glucose changes were measured before, during and after elective eye surgeries under general anesthesia, with two methods: glucometer and glucose oxidase enzyme lab assay. Probable influencing factors and the correlation rate of these two methods were evaluated.Methods: This analytic cross - sectional original study was performed on 230 American Society of Anesthesiologists (ASA) Class 1 or 2 non-diabetic patients. All the patients underwent a similar general anesthesia and their blood glucose levels were measured simultaneously with two cited methods on three occasions.Results: In all cases, post-surgery blood glucose in comparison to pre-surgery levels increased significantly in both methods irrespective of independent variables of the study. Considering these independent variables, increase in blood glucose levels was significant in most of the patients. The mean increase in blood glucose post-surgery in comparison to pre-surgery, measured with lab assay, had significant statistical correlation with the type of eye surgery but not with other variables like age, gender and duration of surgery. Correlation of the two methods was also partially significant statistically.Conclusion: Considering the results of this study and the fact that blood glucose changes under general anesthesia is usually unrecognized clinically, we recommend blood glucose measurement in non-diabetic patients during long surgeries. It is advantageous to use Accu-chek (Sensor model) glucometer for this purpose.

Background: This study investigated reliability and validity of the Persian version of Impact of Event Scale-Revised (IES-R) in a sample of people from Barn after the 2003 earthquake.Methods: The study was performed in 272 people, 4 months after Barn earthquake. For evaluating internal consistency we used α chronbach and for test-retest reliability (after 3 weeks) we used Pearson correlation coefficient. For assessing convergent validity, 50 samples completed GHQ 28 (General Health Questionnaire 28) in addition to IES-R.Results: The Persian version of IES-R has good internal consistency (α chronbach=0.67-0.87) and test-retest reliability (r=0.8-0.98, P<0.001) and also good convergent validity. Finally, factor analysis was conducted and 3 -factor solution which explained 41.6% of the variance, was retained.Conclusion: In spite of good internal consistency, test-retest reliability and convergent validity regarding the result of factor analysis, there is necessity for changing some items corresponding to the Iranian culture.

Background: Pos-transplant erythrocytes (PTE) are characterized by persistent hematocrit level above 51% that develops in 10-20% of kidney recipients, mostly 2 years after kidney transplantation. PTE is self limited in 25% of the patients but can be persistent in other patients with an increased susceptibility for thrombosis. The purpose of this study was to identify the risk factors for development of PTE in our center.Methods: We selected 45 patients who were transplanted at least 3 months before selection (minimum time required for detection of PTE) and were referred to the kidney transplantation clinic during 5 years (1998-2003) as the case group. At the same time, we considered 2 patients without erythrocytosis as control for each patient in the case group among kidney transplant recipients who were referred to the same clinic during 5 years (1998-2003).In total we had selected 135 patients, 45 patients with erythrocytosis as the case group and 90 patients without erythrocytosis as the control group. Patients who were affected by high hematocrit before transplantation (HC>51%), overt pulmonary disorder, and polycytemia Vera were excluded from this study. We collected basic information by using old charts and complementary information was added through phone conversations and physical examination in the clinic. All the information was entered in the digital questionnaire and was analyzed by the SPSS statistical package.Results: There was no significant difference between the case and control group for age, history of hypertension, diabetes, pretransplant hematocrit, pretransplant transfusions, function of graft and source of kidney. A significantly higher proportion of PTE patients were male, also the case group had a significantly higher frequency for personal history of polycystic kidney disease, glomerulonephritis and higher frequency of azathioparine, prednisolone and cyclosporine regimen. Conclusion: PTE is an important complication of kidney transplantation that can be fatal. There are multiple risk factors that should be addressed to prevent this complication.

Background: The purpose of this study was to identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuver (CRM).Methods: This interventional study was conducted on 58 patients (14 males, 44 females, mean age 48.12±13.22) referred to the Vertigo Rehabilitation Clinic of the Rehabilitation School of Tehran University of Medical Sciences from 2002 to 2004.All patients were treated with CRM. According to the treatment efficacy the patients were allocated in three groups: completely treated, partially treated, and not treated.The effect of factors including age, sex, etiology, duration of BPPV, unilateral or bilateral disease, number of maneuvers, and number of sessions on outcome in patients was evaluated.Results: Forty-nine patients (84.5%) were completely cured. Age, sex, etiology, and duration did not significantly affect the treatment outcome. Unilateral BPPV can be treated significantly better than bilateral BPPV. Forty-seven patients who were completely treated needed 1 session and thirty-seven of them required 2 maneuvers.Conclusion: CRM is significantly effective for BPPV treatment. Treating unilateral BPPV is expected to be easier. As most of the patients will be cured by 1 or 2 maneuvers or in 1 session, patients who required more sessions or more maneuvers may not be completely treated.

Background: There are several million new cases of peptic disease annually. The disease has a various range of presentations. Gram negative helicobacter pylori bacilli are considered as an etiologic factor in this disease. Goal of treatment in peptic disease is eradication of the helicobacter pylori (HP).Combination therapy has been implemented in the treatment of this disease. Different modalities have been recommended up to now. In order to lower adverse effects, cost and drug resistance, researchers have introduced a new combination therapy in which honeyis substituted for metronidazole.Methods: A step II of clinical trial was designed. The sample size was 15 children.Diagnosis of HP infection was confirmed with histopathology. Treatment regimen consisted of omeprazole, amoxicillin, bismuth and honey. After a 3-4 week follow- up, eradication was evaluated.Results: 15 children completed the follow- up period. Mean age of patients was 9.4 years. Treatment effectiveness was 80 percent. Conclusion: Combination therapy with 3 drugs along with honey has significant effectiveness on HP eradication.

Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%.CAD risk factors change with time and there are very few studies in this field in Iran.These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets.Comparison of means was done by t-test and prevalence of risk factors by chi-square test.Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

Background: Cervical cancer is the second leading cause of cancer death among women. In this cancer, the effects of prevention, early diagnosis and treatment more than other cancers decrease the mortality rate. In 1970 human papilloma virus (HPV) was introduction as major etiologic factor of cervical cancer. Different studies throughout the world revealed strong correlation between HPV and cancerous & precancerous changes in epithelial cells. Since cell culture and serological methods can not recognize the virus and its subtypes, the importance of the molecular methods including polymerase chain reaction (PCR) in early and definite diagnosis of virus is obvious.Methods: In this study, after patient selection using the related protocol and completion of the questionnaires, 100 samples from cancer lesions of cervix selected. Then DNA extraction from paraffin blocks performed using standard method. Multiplex PCR with two pairs of primer (one as internal control) performed and the PCR product run on 8% polyacrylamid gel.Results: The results showed that 73% of the tissues were infected by HPV.Conclusion: This finding confirms the previous results based of correlation between HPV, and cervical cancer.

Background: Abnormal uterine bleeding (AUB) is a common presenting symptom indicative of abnormal menstrual bleeding patterns that may occur in anovulatory or ovulatory women. There are different ways to diagnose AUB, all requiring much time and energy. The purpose of this study was to evaluate and compare the value of endometrial biopsy, translational ultrasonography with dilation and curettage (D&C) which is the current gold standard procedure.Methods: A prospective-descriptive study was conducted on fifty patients referred to our center for refractory abnormal uterine bleeding who were candidates for hysterectomy. All patients underwent endometrial biopsy and translational ultrasonography, followed by D&C as a Gold standard procedure in operating room just before surgery.Results: Mean age of patients was 46.62 years. Transvaginal utrasonography offered a sensitivity of 70% and specificity of 68% demonstrating the lowest numbers compared to D&C. Endometrial biopsy had a sensitivity of 70% and specificity of 75% that was better than sonography alone.Conclusion: D&C was the most useful and valuable procedure and addition of endometrial biopsy with transvaginal ultrasonography will not be of high value in diagnosis.

Background: Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often delayed, with potentially serious results. Case: We report a case of tuberculosis mastoiditis with unilateral hearing loss, facial paralysis, and cervical lymph adenopathy on presentation.Conclusion: Tuberculosis mastoiditis must be considered in all cases of chronic refractory mastoiditis especially in the presence of demonstrable complications such as facial paralysis, other cranial nerve palsies, and destruction of middle ear osscicles.