TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2003 | Volume:61 | Issue:1|Papers Count:16

Introduction: Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced.Methods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:t11.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%). Valve thrombosis was the common cause of mechanical valve replacement (32%). Age younger Than 50 (P= 0.01) and interval after the first implantation more than 10 years (P= 0.01) affected bio-prosthesis degeneration.Results: Atrial fibrillation (P<0.01), Older age especially more than 40 (P<0.05) and mitral position (P<0.01) affected mechanical valve thrombosis. Cross clamp time (P= 0.005), Tricuspid insufficiency (P=0.001), NYHA IV (P=0.005) and emergent operation (P= 0.001) were independent determinants of hospital mortality.Conclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.

Spontaneous pneumothorax is a medical condition that potentially may be dangerous. Although several methods for management of this problem have been propounded, there is a great disagreement among the specialists about how to treat it and when more invasive treatments are indicated.Materials and Methods: This study carried out in two phases. In first phase, 26 patients who had admitted to Imam Khomeini hospital from March 20, 1996 to March 19, 2000 and 50 patients admitted to Bagiatallah hospital between March 20, 1992 and March 19, 2002 with the diagnosis of spontaneous pneumothorax were studied retrospectively. In second phase, these patients were followed up.Results: 39 patients (51.3%) had primary spontaneous pneumothorax, 35 patients (46.1%) secondary spontaneous pneumothorax and 2 (2.6%) neonatal spontaneous pneumothorax. 67 patients were male and 9 patients were female (male to female ratio: 7.5/1). Mean age of the patients was 35±20 years. Age peaks were the age group between 20 to 25 years old and age group more than 60 years old. Conducted treatments were observation in 3.9%, simple aspiration in 2.6%, thoracostomy alone in 81.6%, thoracostomy and chemical pleurodesis in 2.6%, thoracotomy and mechanical pleurodesis in 3.9%, thoracotomy and pleurectomy in 5.3% of cases. Mean duration of hospitalization was 8.9±7.3 days. Relapse of pnemothorax was seen in 36.9% of the followed patients. Mortality was 17.4% and all died patients had secondary spontaneous pneumothorax.Conclusion: It seems that the management of spontaneous pneumothorax should be re-evaluated and the exact indications for conservative or more invasive methods of treatment should be defined.

Introduction: Spontaneous intra-cerebral haemorrhage (SICH) is a relatively common neurological emergency, that is associated with significant morbidity and mortality. The goal of the present study was to estimate the neuro-imaging findings (initial CT scans), clinical presentation and possible risk factors in intra-cerebral haemorrhages.Methods and Materials: The clinical and radiographic findings of 380 patients with intra-cerebral haemorrhage were analysed retrospectively. Patients with haemorrhage secondary to traumatism, brain tumour, or hemorrhagic infarction were excluded. 300 patients considered eligible for final analysis. All CT scans were evaluated to define the location and extension of bleeding.Results: There were 160 men and 140 women, and the average age was 62 years, (range 26 to 87 years). The most common presenting symptom was consciousness (51 percent), headaches were present in 41.6 percent of patients, only 8.3 percent of patients were comatose at presentation. Location were lobar 36 percent, lenticular and thalamic 47 percent, possible risk factors included hypertension 60.3 percent anticoagulant treatment 9 percent and none 30.6 percent.Conclusion: Hypertension causes most cases, in which the SICH was located in the basal ganglia. Headaches were more commonly found in patients with cerebellar haemorrhage (70.3 percent). Intra-ventricular extension most frequently occurred in the thalamic haemorrhage and subarachnoid bleeding in lobar haemorrhage location. The majority of patients with SICH that resulted from hypertension were aged >45 years. The control of risk factors, particularly hypertension is crucial to prevention.

Introduction: Wide variations in the prevalence of asthma allergic rhinitis and eczema have been reported in the world, between regions and countries. The international study of asthma and allergies in childhood (ISAAC) was developed to provide standardized method to ascertain the prevalence of asthma and allergies in different regions. Comparisons of prevalence rates across geographic regions may help to identify factors that influence the development of these conditions in individuals.Methods and Materials: For doing this descriptive study the ISAAC written questionnaire was completed by the parents of 3000 school children aged 6-7 years in Kashan, the central area of Iran, with different geographic and cultural characteristics, during the fall of 1998.Results: The overall cumulative and 12 month prevalence of wheezing were 10.2 percent, 6.9 percent in the girls and 18.2 percent, 13.1 percent in the boys respectively. The prevalence of doctor diagnosed asthma were 1.3 percent and 2.2 percent in the girls and boys. Rhinitis symptoms were reported by 14.7 percent, 16.9 percent and chronic pruritic rashes by 5.1 percent and 8.3 percent of the girls and boys respectively.Conclusion: Allergic disorders are common in this area and prevalence is comparable to other parts of Iran and many other countries. Prevalence of asthma by medical diagnosis is relatively low with respect to other studies performed with the same methodology.

In Vivo, after administration of treatment, concentrations of antimicrobial agents will reduce to sub-inhibitory levels (sub-MIC) and may therefore affect the properties of target bacteria. The purpose of the present study was to investigate the in vitro effect of sub-minimum inhibitory concentrations (sub-MIC) of ampicillin, gentamicin and nalidixin acid on morphology, growth, ammonium production and urease activity of proteus mirabilis. Proteus mirabilis is well recognized as an important urinary tract pathogen.Materials and Methods: Several of its properties have been studied in relation to pathogenesis manifested in urinary tract such as urease activity.Results: In the presence of ampicillin, long filamenteous cells was produced and the length of the cells was increased at the higher concentration of ampicillin. SubMIC of ampicillin and gentamicin affected the growth pattern and prolonged the lagphase of growth. This affected was significant when gentamicin was used. Nalidixic acid of 1/2 MIC greatly reduced the growth rate, while the lag phase was not changed. In the presence of sub-MICs of ampicillin and gentamicin, the amount of ammonium production increased. In medium with 1/2 MIC of ampicillin, the ammonium production was 30 times of control, while the urease specific activity of sonicated cells did not show any significant changes.Conclusion: It seemed that the antibiotics enhanced the cell membrane permeability for substrate and enzyme. Nalidixic acid didn"t show any significant effect on ammonia production, and urease specific activity of proteus mirabilis. The results indicate that the sub-MIC of antibiotics can effect virulence factors of proteus mirabilis.

Introduction: Infection by M. tuberculosis can be demonstrated by tuberculin testing. On sequential PPD some person show a marked increase in the size of their skin reactions which may not be due to recent or past tuberculous infection. This phenomenon (booster effect) can occur as soon as a week after the initial test and persist for as long as a year.Methods and Materials: The purpose of this research is studying the size of induration following repeated PPD tests (booster effect) that studied in children who came to our clinic or imbedded in pediatric unit and the group of student in grades 4 and 5 at elementary school (totally 80 cases) for one year.Results: Increase of induration in 25% of all (20 cases) was 5 mm or more and in 75% of all (60 cases) was less than 5 mm and between these two groups, differences was meaning full (P<0.05). The increase of induration in 12.5% was 7 mm or more.Conclusion: Because there is not shown definite increase of induration (more than 5mm) on sequential PPD in children, we must to consider to new infection.

Introduction: In the patients with smear-positive pulmonary tuberculosis (TB) bacteriologic assessment of sputum for detection of acid bacilli (AFB) Has essential role. This evaluation is accomplished by direct sputum smear & sputum culture. These examinations must be done in regular and preferably monthly after beginning of treatment. These tests have two important aims, including, determining of treatment efficacy & duration of isolation.Methods and Materials: Most of the studies have that classic six month regimen led to sputum smear conversion & negative sputum culture in 85% of patient. This treatment regimen has two phases, including, attack phase and maintenance phase. In the attack phase we use four drugs, including, Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB) for the first 2 months and if necessary until the end of third month. In the maintenance phase we use INH and Rif for the remaining of treatment course. The main objectives of this study were to determine the time needed for smear conversion and assessment of probable factors which may influence the smear conversion until 4 months after beginning of therapy. The factors that were assessed, were, Age, nationality, sex, clinical symptoms, underlying diseases, chest radiography (number of cavities), smoking, drug abuse and concentration of AF13 in the sputum Generally, we did this cross sectional study on the patients records, who had been observed in Imam Khomeni Hospital, west health service center and masih daneshvary hospital between. Results: This study showed that from totally 218 patients, 138 (74.6%) patients had sputum conversion at the first 2 months of treatment and until the end of 3rd & 4th month this rate reached to 83.3% respectively. So in the end of fourth month only 32(14.7%) patients did not show sputum smear conversion. On the other hand this study showed that two factors including presence of cavities in chest radiography & concentration of AFB in the sputum are influencing this rate strongly.Conclusion: Role of other factors such as age, nationality, Smoking, diabetes mellitus and weigh loss are controversial and another studies are necessary for cofifirming their roles. Other factors including sex, clinical symptoms has not been show to be important. Some factors such as drug abuse and immunosuppressive therapy has not been assessed in this study, because number of cases were not enough for statistical analysis.

Introduction: In this research, the effects of heroin in the placenta of addicted mouse were studied properly. Methods and Materials: For this reason we used of addicted female mice before, during and after gestation and also a control group of healthy mice. The male mice were in two groups of addicted and healthy. Heroin were used in concentration of 0.1, 0.3 and 0.5 mg/ml in tap water. Placenta of mice separated from uterus in 17th days of gestation and compared with placenta of non addicted mice, with diameter, weight and abnormal conformations. Results: The results showed that there were significant comparison between diameters and weights of these two groups (p<0.0001). In morphological studies, there were changes in size (small placenta, giant placenta), joining and hemorhagic state placentas.Conclusion: According to the results we concluded that the opioids even with with very small doses can induce harmful effects on gestation and non-pure heroin in Iranian smugglery is much more harmful than the pure one.

Introduction: Complications of Coronary artery disease remain the most common cause of morbidity and mortality after vascular surgical procedures. Goldman risk factor analysis has been suggested as peri-operative noninvasive screening method to detect significant coronary artery disease in emergent vascular procedures.Methods and Materials: In this study, the accuracy of the Goldman scale was assessed with regard to the development of cardiac complications such as asymptomatic ischemic change in ECG, arrhythmia, myocardial infarction and cardiac death. We studied 100 patients that were required emergent vascular procedures from 2000-2001. Data about perioperative complications were extracted and analyzed using SPSS computer program. Results: Our study indicated there is not statistical correlation between cardiac death, infarction, arrythmia, ECG change, age, sex and cardiac class.Conclusion: We concluded that Goldman scale could not be regarded as a screening method to predict peri-operative cardiac complications in emergent vascular procedures.

Diabetes mellitus is the most common endocrine disease in childhood and adolescence. It has significant effects on growth and development of the involved patients.Many studies have proved that in long term, diabetes causes an obviously decreased bone mass and linear growth in affected patients. Various studies have been done to determine the cause of these problems. In diabetic patients various degrees of calcium loss in urine have been detected.Normally, the amount of calcium loss in urine of general population is less than 4 mg/kg/day, and the Ca/Cr ratio in a random urine sample is less tan 0.25. Hypercalciuria may be the underlying cause of osteopenia and linear growth defect in diabetic children.In our study, the urinary calcium loss of 50 diabetic children was determined. We tried to find a correlation between the amount of calcium loss in urine and plasma glucose.These patients have been referred to Children s Medical Center during a 6 month period in year 2000. They had very higher incidence of hypercalciuria than the nondiabetic population, but we found no significant correlation between the severity of hypercalciuria and severity of hyperglycemia in them.

Introduction: Primary nephrotic syndrome (PNS) accounts for approximately 90% of nephrosis in childhood. There are well defined therapeutic protocols for childhood nephrosic syndrome to minimizing side effects of corticosteroid and repeated relapses. The aim of this study was to assess the clinicopathological aspects and results of treatment in children with PNS.Methods and Materials: We evaluated 502 patients with PNS from 1981-2000. Among these children 5 (1%) achieved spontaneous remission, and 313 children were initial responder. One hundred eighty four patients received at least 1 kidney biopsy (78 prior and 106 after initiation of treatment).Results: Of these patients histology showed minimal change nephrosic syndrome (MCNS) in 67 (36.4%), focal segmental glomerular sclerosis (FSGS) in 41 (22.3%), diffuse mesangial proliferation (DMP) in 28 (15.2%), membranoproliferative glomerulonephritis (MPGN) in 21 (11.4%), focal proliferative glomerulonephritis (FPGN) in 12 (6.5%), congenital nephrosic syndrome (CNS) in 8 (4.3%) and membranous nephropathy (MN) in 7 (3.8%). Of 103 children with frequently relapsing steroid sensitive and steroid dependent idiopathic nephrosis, levamisol induced prolong remission in 33 (31.7%) patients. Cyclophosphamid and cyclosporine induced remission in 49 (50%) of 98 and 28 (41.3%) of 68 patients respectively.Conclusion: Our observation suggests that patients with steroid-dependent nephrosic syndrome or MCNS had better response to cyclophosphamide or cyclosporine than patients with steroid-resistant nephrosic syndrome or FSGS (P<0.05). Additionally , our experience indicate that levamisole treatment is of considerable clinical benefit in patients with frequent relapsers and steroid dependent nephrosic syndrome.

Introduction: Tuberculosis is the most widespread epidemy of the world. It is estimated that one third of the worlds population are infected with mycoboacterium tuberculosis, producing a burden of 8-10 millions of new cases and 3 millions of dead" each year in the world. Epidemiological studies are indicating that genetic susceptibility can predispose to prevent from tuberculosis infection and its severity.Methods and Materials: In the present case-control analytic study, 40 sputum positive pulmonary T. B. patients HLA-class II alleles (DRB, DQA 1 and DQB 1) are detected and compared with 100 healthy subjects by PCR-ssp method for the first time in Iran.Results: The frequencies of alleles DQA1 *0101 [OR: 2.662 (95% CI: 1.15-6.44) and DRB*07 (Pc= 0.0252, OR: 2.710 (95% CI: 1.197-6.135) were significantly) increased in P.T.B patients when compared with healthy subjects. By contrast, frequencies of alleles DQA1*0301 [OR: 0.254 (95% CI: 0.075-0.865): and DQA1* 0501 [OR: 0.539 (95% CI: 0.304-0.954)] were significantly decreased it patients with P.T.B. There was no significant statistical predisposition/ prevention it DQB 1 locus alleles frequency or any haplotype disequilibrium.Conclusion: The HLA system appears to have an important genetic influence on P.T.B. development.