TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2001 | Volume:59 | Issue:3|Papers Count:18

This Syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of:(1)- Visual loss due to occlusion of retinal artery branches.(2)- Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks.(3)- Bilateral sensory neural hearing loss with tinnitus.All of the symptoms and signs are pathologically due to microinfarcts. It’s pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies.In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeiny hospital with above mentioned symptoms and signes and was recognized as a case of this syndrome.

Diabetes Mellitus is the most common endocrine disorders in children. There is a close association between diabetes and other autoimmune disease especially thyroid disorders. As many as 20 percent of Insulin dependent diabetic patients may have thyroid antibodies in their serum. The prevalence is 20-25 times greater than observed in normal populations. In this study, 122 patients with Diabetes Mellitus type I who referred to Institute of Endocrine & Metabolism and private office during a 3 years period were studied. A complete history was taken and physical examination was done in all patients by Endocrinologist. The diabetic due to major Thalassemia excluded from this study. The grading of the goiter determined by WHO classification and T4 and TSH were measured by RIA method in all patients. All patients were on Insulin treatment. There were 64 girls (52.4 percent) and 58 boys (47.6 percent) in 2-16 years age group (mean age 11.2 years). The mean duration of diabetes was 4.2 years. Prevalence of Goiter was 53.2 percent and 7.3 percent of patients with goiter had hypothyroidism and 1.6 percent, had hyperthyroidism. Most of the patients with goiter were euthyroid (9.19 percent). The patients with hypothyroidism had marked growth retardation and frequent episodes of hypoglycemia. The finding of this study indicate that the risk of development of goiter and thyroid disorders is higher in our diabetic patients and decelebration of growth and brittle diabetes may be due to thyroid disorders. It is suggested that all of the diabetic children should be screened yearly for thyroid disorders.

The phenomenon of sleep is an active both nervous and biologic rhythm, which is under influence of neurotransmitters of central Nervous system. In this study, the influence of serotonergic system on sleeping time have been assessed by agonist-antagonist drugs using two methods of induction and non-induction behavioral and electrophysiology. The method used for measurement of total sleeping time was Angle method. For assessment of drugs impact on brain waves, after opening two holes in frontal and temporal regions, two non-polarized silvery electrodes were fixed in above regions and was connected to physiograph and computer by linkers for waves analysis. Injection intra-ventriculary is done by stereotax apparatus. Results indicate that diazepam (2.5 mg/kg) increases sleeping time in two stages of induction and non-induction (P<0.01). 5-HTP (15, 45 mg/kg) increases dose-dependence sleeping time. P-CPA (150, 300 mg/kg) shows biphasic influence on sleeping time. The 300 mg/kg dose of p-CPA reduces sleeping time while 150 mg/kg dose inverts sleeping time (P<0.05). interferential affects of drugs with (5-HTP) 45 mg/kg and p-CPA (300 mg/kg) doses are similar to control groups. Injection of 5-HTP inverts p-CPA affect. Intra-ventriculary of 5-HTP in 150 µg/kg and 300 µg/kg doses, decreases frequency of delta waves and significantly increases the frequencies of other waves but conversely, 500 µg/kg decreases it. Due to finding of this study, interferential affects of agonist-antagonist of 5-HTP, can not invert p-CPA affect. Supported by GABA affects, Diazepam induces its inhibitory affect in pre-synaptic and pos-synaptic membrane through ascending reticular both systems and blocking stimulation of brain cortical and limbic system. Affects of two other drugs on sleeping time and brain waves are probably caused by increment of released serotonin in pre-synaptic neurons. Although their interferential affects with other neurotransmitter system should be considered as well.

Typhoid fever is an endemic disease in Iran and other developing countries. This disease has gradually become resistant to the first line of drugs, and because of this resistancy we have studied a new alternative drug (cefixime) on typhoid fever patients and compared it’s effectiveness with chloramphenicol. For this purpose, by a randomized clinical trial in Emam Khomeini hospital between 1995-2000, we allocated 44 uncomplicated patient with established typhoid fever (positive blood or bone marrow culture) and by random selection, 24 patient were given cefixime (400 mg PO bid) and 20 patient received chloramphenicol (500 mg po Q6h). The duration of therapy were 10 and 14 days for chloramphenicol and cefixime group respectively. Median fever clearance times were 5±1.9 for cefixime and 3.8±1.2 days for chloramphenicol treated patients, but for improvement in other clinical and laboratory findings, there were but any significant difference. Bacteriologic and clinical cure rate for cefixime was 100 and 92 percents respectively. Though, even cefixime like other betalactam drugs is slow in helping the fever disappearance but our study suggests that oral cefixime is effective and can be used as an alternate treatment of typhoid fever.

Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United Stats. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgury. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The must reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of repoeration were: A- Valvular complications (female/male=3/1), B-Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidences of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

The aim of this investigation is to compare the effect of applying two transcutaneous electrical never stimulation (TENS) current with different frequencies (2 HZ & 100 HZ) on Hoffmann reflex recorded from gastrosoleus muscle of healthy people. Forty female subjects between 20 to 30 years of age were participated in this quasi-experimental design. Twenty of them were exposed to the 100 HZ current and the remaining 20 to 2 HZ current on dermatome S1 root. The excitability of the alpha motoneurone was measured by H-reflex amplitude (peak to peak max/2) before and after the application of the TENS current for 30 minutes. The reflex was recorded and at measured before (TO) and after the application of TENS at different times (T1, T% and T10) up to 10 minutes. The mean values were compared by multiple paired T test (alpha=0.00825). The results indicate a considerable decrement in Hoffmann reflex amplitutde after application of 100 HZ current in comparison with that of before the application. The effect last for 10 minutes after the TENS application, whereas the application of 2 HZ current results in increment of the Hoffmann reflex amplitude. The 5 and 10 minutes interval test does not show any significancy and the results were attenuated before 5 minutes. As a conclusion high frequency of TENS (100 HZ) has an inhibitory effect on excitability of alpha motor neurone reflex lasting for 10 minutes, while low frequency of TENS (2 HZ) has an facilatory effect on the same motoneurone with short lasting effect.

Erectile dysfunction is an important problem for men and their families which has an organic cause in about 50 percent of cases. When there is a vasculogenic etiology for this defect, radilogic assessment is unavoidable. Cavernosometry and cavernosography are ultimate procedures for diagnosis of venous leakage. There is no reliable data about these defects in Iran. The objective of this study was to determine the rate of venous leakage in patients with erectile dysfunction by Pharmarco-Cavernosometry and Cavernosography. In this case serirs study, 100 patient with erectile dysfunction who referred to radologic ward in sina hospital was selected and Pharmarco-Cavernosometry and Cavernosography were conducted for them. In Cavernosometry, after injection of Prstaglandin E1 and salin normal infusion into corpus covernosum, the pressure was determined. In cavernosography, diluted Omnipaque was injected and venous leaking and other defects were recognized. Myoclinic’s criteria was use for analysis of the results. Mean age of patients was 35.6±11.6. Most of the cases were in 20 to 40 age group. The frequency of venous leakage based on 50 mmHg reduction in pressure (from 150 mmHg), after 30 seconds discountinuance of normal salin infusion was 90 percent. This figure based on the ratio of Maintenance Flow Rate of Induced Flow Rate, was more than 92 percent. The frequency of venous leakage according to Cavernosography was 89 percent. There were no significant side effects in any of cases induced by procedures. The results of study, shows the high prevalence of venous leakage in patients referring for erectile dysfunction.

It is now generally recognized that anaerobic may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) were investigated. The anaerobic isolates from patients with perodontitis were 244 cases, abscess 32, enterocolitis 42.

Information regarding 152 patients of cancer of tongue in cancer institute from 1978 to 1998 was collected and analyzed. From these cases, 53.5 percent were male with a mean age of 54.49 years (SD=16.23) and the mean age of female was 2.5 years more than of male. Positive lymphadenopathy in men was positive and significantly more than that of female (P<0.05). The physical appearance of the tumor was ulcerative (66.7 percent). Most of the referrals were in the range of T1 (62.8 percent) and were operated. Information from 88 patients was evaluated and it was found that 23.9 percent of the patients has died. One year survival was 92.05 percent and 3 years survival 83.3 percent and it was confirmed that advanced stage of the illness decreases the survival rate (P<0.001).

Liposomes as a drug carrier have numerous dominancy. Liophilization is the most propr form of these products for long-term maintenanace, but this procedure is affected by unstabilizing agent that results in destruction of membrane, release of content and change in size and microbial contamination; bence for prevention of the adverse effects, the protective role of sugars such as: Maltose, Fructose, Glucose, Galactose, Sacetose, Saccharose and Lactose were studied.For this purpose, after preparation of liposomal suspension, categorized in four duplicate groups and concentrations of 25, 50, 100 percent of these sugars were added to those. On the basis of color and consistency of products, the best method of freezing is as application of absolute alcohol and then chilling in-70 on for 16 h. in survey of protective substances concentrations 0.7, 1.4, 2.8, and 5.6 percent of the mentioned sugars were used for calculating of leakage percent (Upon on the ratio of optical density of treated samples to untreated).In this study, released maltose had highest effect. Level of fusion and aggregation had any significant difference between pre and post lyophilized samples in centrifugation with 10000 rpm. Microbial state of recent samples was studied by culturing in SCD and SCDA media that indicated microbial growth in both samples.

In this study we tried to assess the incidence rate of shunt complications and it’s association with age, sex, location of shunt, duration of surgery, and so on. For this purpose in a prospective study, 82 cased of hydrocephalus after shunt insertion, during the period of two years (1375-1377) in shariati were selected and all the complications were evaluated. From the pateints, 39 cases were female and 43 were male. The range for age was 15 to 73 years with mean age of 16.67 years (SD=22.77). In cases the complication of shunt surgery were observed. Shunt complications in our patients were infection (8.6 percent) and mechanical failure (17 percent). The mean duration of time for onset of complications was 3.11+-4.3 months. The complication rate at the beginning (under two) and the end of life much higher. In trying to reduce the rate of shunt complications, it is necessary to define and understand the causes of these problems they often arise from multifictorial etiologies.

The study was conducted to determine the clinical and etiology of cerebral venous thrombosis in Iran. Records of all adult patients admitted with a clinical diagnosis and MRI of cerebral venous thrombosis form 1993 through 1999 in three major hospitals of Tehran, Iran were reviewed. Fifty patient (39 women, 11 men) aged 14 to 56 years were identified. Headache the most frequent and often the earliest symptom, was encountered in 82 percent and papilledema, the most frequent sign in 56 percent of cases. Infection was the cause of cerebral venous thrombosis in 26 percent of our cases. Other causes included oral contraceptive (32 percent), vasculitis (6 percent). Behcet’s discase (4 percent), postpartum state (4 percent), myeloproliferative disease (2 percent), ulcerative (2 percent), antithrombin III deficiency (2 percent) and diabetic ketoacidosis (2 percent). Oral contraceptive was recognized as the most common etiology. Infection is an important cause whereas procoagulation disorders are uncommon.

Cleft hand deformity is a rare congenital anomaly of the hand with an incidence rate about 1.90000. It has two clinical types; Typical and Atypical. In this paper we are representing ten cases of this anomaly admitted during seven years from 1992 in Emam Khomeinie hospital. Some of the patients especially those with typical cleft hand deformity achieved good functional results after surgical correction of the deformity. In the younger age group we observed better functional results.