TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2002 | Volume:60 | Issue:2|Papers Count:16

Background: Food allergy is one of the most important among other allergic diseases. Although it is less prevalent in adult but in infants it’s prevalence was reported as much as 8 percent. In part, wheat is one of the six main food allergens in infant and in other part there is extensive cross reactivity between the cereals. Therefore the aim of this study is selection of the best food substitute for wheat among other cereals. Materials and Methods: 24 patients with definitive diagnosis of type one hypersensitivity reaction to wheat were entered in this study. Skin prick test and serum specific IgE (Eliza) with 6 members of cereals family (wheat, barley, oat, Rye-Rice & Corn) were performed for them and open food challenge test was also done with three more available of the cereals (corn, Rice, barley) in our food culture and so comparison between allergenicity of wheat flour and wheat bran with skin prick test were done. Results: The Skin prick tests (SPTs) were positive in 66.7 percent for Barley, 100 percent for wheat bran and 80-100 percent for other cereals. The results of specific IgE for wheat, Barley were positive in 94.5 percent, 68 percent, 39 percent of patients respectively and the results for other cereals were positive in less than 11 percent of cases. The results of food challenge test, for barley were positive in 60 percent of cases and for Rice and Corn were negative in all cases. Conclusion: In the base of food challenge test as the gold standard test, the best food substitute for wheat sensitive patient between other cereals, were Corn and Rice respectively. It is important to emphasis that will be needed to perform oral food challenge in hospital with complete emergency equipment before introducing any other cereals as food substitute for wheat, specially Barley.

Primitive Peripheral Malignant Neuroectodermal Tumor is a malignant neoplasm of neural origin with high mortality which occurs mostly in children and adolescents. The most common site of involvements are chest wall and paraspinal regions. Head and neck involvement is rare. The diagnosis is based upon histopathologic and immuno-histochemical studies. Treatment is combination of surgery, radiotherapy and chemotherapy. In this article we present a rather rare case of PNET which occurred in the neck area of a child.

Backgroud: Measles, as one of the most contagious diseases, because of the risks of mortality, mental and physical disabilities which may afflict on the patients, has always been so important to the scientists and researchers. With respect to burden of diseases, numerous measures have been taken to control and eliminate measles. In our country, vaccination is considered as the most important strategy to control the measles, however, the surveillance on the patients is on the second place. Screening (Active & passive), prompt and appropriate control of measles in high risk areas can help to control the disease. Materials and Methods: There are 1375283 people with a variety of demographic traits who live in southern Tehran. Southern Tehran covering 10th, 11th, 16th, 17th, 19th divisions of Tehran municipality consists of high risk areas. Because of too many immigrants, overcrowded areas, malnutrition and poverty, the south of Tehran is considered as one of high risk areas, predisposed to measles epidemics. So in 1999, a cross-sectional study was done. Results: On 230 subjects suspected to be measles in south of Tehran, 147 subjects were diagnosed as measles by para clinic evidence, 121 subjects of which were men. Most of these were of the age 20 to 24 years old who lived in the eleventh part of Tehran municipality area. The majority of patients were found among soldiers who lived in dormitories in Horr garrison and military training college located on the above-mentioned area. Unfortunately, most of them did not have reliable history of vaccination. Most of these patients had been in close contact with the colleagues who were measled (61.2 percent). The rate of measles incidence during winter soars at most. Conclusion: The most important factor to be researched is that, the age of these patients differs much from what is expected, due to unknown reason.

Background: Necrotizing soft tissue infections are one of the most dreaded infections in human and result in a very high rate of mortality. The treatment of these infections must be very aggressive and consists of radical debridement of all necrotic tissue accompanied by appropriate antibiotics. Materials and Methods: This study was undertaken to assess the mortality rate, the time from diagnosis to cure, and some of the parameters which may affect mortality in our patients. In this descriptive, retrospective study first files from patients attended by necrotizing soft tissue infections including Fournier"s gangrene or disease, gas gangrene, hemolytic streptococcal infections, myonecrosis, necrotizing fascitis and related subjects in Sina and Amir-Alam hospitals from 1989 to 1999 were studied. Data were extracted and analyzed by SPSS. Results: The total number of cases was 36. The median age was 47.69 years. Seven of the patients were female. The median time from onset to cure was 10 days. The most common site affected was the perineum and the most common etiology was perianal abscess. Diabetes mellitus was the underlying disease mostly observed. Half of the patients had received inappropriate treatments. In this group mortality was higher. Conclusion: It is crucial that general practitioners be acquainted with the diagnosis of necrotizing soft tissue infections so that patients are referred immediately to surgical centers. In our referral center the mortality was acceptable but it can be lowered further. The sex, sites of infection, underlying disease and etiologies in our patients were similar to patient in other countries except for alcoholism. It appears that data in foreign texts can be attributed to Iranian patients.

Background: This study was performed in order to detect the frequency of different types of precocious puberty, predisposing factors and to show which group of patients need to treatment. Materials and Methods: In this study, 74 patients who referred to pediatric endocrine clinic of Imam Khomeini Hospital and private office from 1993-2000 were assessed. A complete history was taken and physical examination was done in all patients by pediatrics endocrinologist. Bone age was done in all patients and specific hormonal tests were measured in some of them. Results: Among 74 patients, 50 cases (67.6 percent) were female and 24 cases (32.4 percent) were male. The age of the patients was between 0.8-10 years old with mean 5.37 year. 75 percent of male patients had central (complete) precocious puberty and 25 percent had peripheral (incomplete) precocious puberty. 40 percent of female patients had central precocious puberty, 46 percent had premature telarche, 8 percent had premature pubarche, 2 percent had premature menarche and 4 percent had other kinds of precocious puberty (one case with hypothyroidism and one case with Mccune-Albright syndrome). 10 percent of female patients with central precocious puberty had predisposing factor and 90 percent of them were idiopathic. 38.8 percent of male patients with central precocious puberty had predisposing factor and 61.2 percent of them were idiopathic. 100 percent of male patients with peripheral precocious puberty had congenital Adrenal Hyperplasia. 38 percent of female patients and 100 percent of male patients needed to treatment. Conclusion: According to this study and references, precocious puberty in female usually benign but in male patients it should be evaluated thoroughly because they usually have a serious disorder which needs treatment.

Background: Endoscopic sinus surgery has been used for diagnosis and treatment of chronic inflammatory diseases of paranasal sinuses since recent years. Materials and Methods: In this study 104 patients with chronic sinusitis (with or without polyps) which were managed with endoscopic sinus surgery (ESS) were followed for 6 to 24 months after surgery (24 patients refused to continue follow up) and the recovery rate of symptoms were evaluated. Results: The effectiveness of this therapy is statistically approved and the most important symptom which diminished was nasal obstruction (from 95 percent to 18.5 percent), the least important symptom which diminished was anosmia (from 57 percent to 21 percent). Conclusion: This study confirmed the efficacy of functional endoscopic sinus surgery in improvement of chronic sinusitis symptoms.

Background: The first step in assessment of children with precocious puberty is to determine whether the cases are of benign nature or have more serious causes. It seems that two criteria of "height age" and "bone age" are helpful for this decision. Materials and Methods: To evaluate the usefulness of those criteria, a retrospective study of 74 children (50 girls and 24 boys) with precocious puberty whom be visited between years 1993-2000 was performed. According to the medical history, clinical signs, and certain laboratory tests (in some cases) the patients were classified in different groups of precocious puberty. Results: Height age and bone age were determined for all the patients. Those patients for whom treatment of any kind was required were also identified. The results of the statistical analysis of the findings were as follows: - No clear relation between "height age", "Bone age", type of precocious puberty, and the need for treatment was found in the male patients. All (100 percent) of the boys needed treatment. - Among the female patients, those with progressive complete precocious puberty (16 patients) had a significantly advanced height age and bone age comparing to the other groups. There was also a direct relation between the need for treatment and the advanced height age (11 patients), and between the need for treatment and the advanced bone age (10 patients). Conclusion: All the boys with precocious puberty should be evaluated thoroughly because they usually have a serious disorder which needs treatment. However among the girls with precocious puberty, those with benign causes can be detected using the criteria of height age, bone age, and clinical signs. Therefore, unnecessary laboratory tests and treatments can be avoided in a percentage of these patients.

Background: Stereologic methods are used to obtain quantitative information about three dimensional structures from histologic sections. The aim of present study was using new and unbiased stereological techniques to investigated changes in volume and number of glomeruli after chronic lead acetate intoxication. Lead is one of the heavy metals that have adverse effects on renal function. Its effects can involve both renal tubules as well as glomeruli. So many studies based on observation and qualitative reports. Some of which report changes in volume and number of glomeruli. Materials and Methods: Male Wistar rats were randomly divided to four groups (n=9). During a period of 8 weeks, the treatment groups were given 0.5 percent and 1 percent lead acetate in drinking water and the control and sham control were given distilled water and 0.4 percent acetic acid solution respectively. Stereological analysis based on Cavalierie"s principle was performed to determine the reference volume (VRefrence), the fraction volume of glomeruli (VVGlom) and total glomerular volume (VTGlom). Furthermore, for estimating the numerical density (NVGlom) and total number of glomeruli (NTGlom), the physical dissector was utilized. Results: Results showed that the number of glomeruli in treatment group which received 1 percent lead acetate in drinking water decreased significantly (P<0.05), but no changes occurred in 0.5 percent group (P>0.05). On the other hand glomerular total volume in both 0.5 percent and 1 percent groups increased significantly in comparison to control and sham control groups (P=0.000). Conclusion: This experiment is in agreement with other qualitative reports by using unbiased method of stereological methods and showed changes in volume and number of glomeruli following lead acetate intoxication.

Background: Bacterial infections are seen in patients with visceral leishmaniasis. This study was conducted to determine the incidence of such infections and the more common infections agents. Materials and Methods: During the 15-years period in a prospective study from 1986 to 2000, 123 patients with visceral leishmaniasis were studied in the Children Medical Center. Results: From all the cases, 41 (33 percent) patients had Also bacterial infections. Respiratory tract, urinary system, Middle ear were the most common sites of infection. Conclusion: When bacterial Infection is suspected in these patients, empiric antibiotic therapy should be started immediately after appropriate diagnostic procedures are taken.

Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000. Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing. Results: From the cases, 64 patients (32 percent) referred without delay and 136 patients (68 percent) referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004), lower education level (P=0.002), and lower economic status (P=0.001). The frequency rate of single were lower among them (P=0.001), fewer percent were residual of big cities (P=0.01) and they had less rate of available physician (P=0.004). 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001). 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E) (P=0.002) and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01). 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference. Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late.

Background: Cyclosporin A (CsA) is now commonly used in the management of children with steroid-dependent and steroid resistant nephoitic syndrome. It has been reported to be effective in maintaining remission in 70-100 percent of patients with SDNS but somewhat SRNS 0-100 percent. The aim of this study was to evaluate the efficacy of long-term (CsA) in children with refractory nephrotic syndrome (RNS) and steroid dependent nephrotic syndrome (SDNS). Materials and Methods: The long-term effect of (CsA) in 91 Iranian children aged 3 months to 11 years (54 with RNS and 37 with SDNS) was assessed between 1984 and 1999. Eighty of 91 children received renal biopsy prior to introduction of (CsA), and the other 11 patients had not consent for kidney biopsy. If the patients did not show remission aftre receiving 3-6 months of (CsA), the medication was discontinued. Results: All patient were treated with (CsA) in combination with low dose alternate day prednisolone. In children with RNS and SDNS, therapy with (CsA) induced, remission in 25 of 54 (46.2 percent) and 27 of 37 (73 percent) respectively (P<0.02). Of the 32 patients with minimal change disease (MCD), 23 (72 percent) responded to therapy, compared with 4 of 18 (22 percent) with focal segmental glomerulosclerosis (FSGS) (P<0.005). Twenty-four (48 percent) of 50 who entered complete remission, had relapse 1-12 months after cessation of (CsA). The duration between the onset of nephrotic syndrome (NS) and administration of (CsA) and sexuality of patients had no effect in result of treatment. Side effects occurred in 25 patients (27.4 percent). No patients exhibited raised transaminases, 8 (8.7 percent) of the children developed hirsutism, 7 (7.6 percent) hypertension, 7 (7.6 percent) gingival hyperplasia, (2.2 percent) neurological toxicity and 1 (1 percent) increase in serum creatinine. Conclusion: Our findings suggest that (CsA) can be used to induce a complete remission in a significant proportion of patients with RNS and SDNS, and patients with SDNS have areasonable potential for remission than children with RNS. Resistant to steroid and cyclophosphamid.

Background: Osteoid osteoma is a well-known benign tumor of bone. It occurs in children and young adults and is rarely seen above the age of 40. It is uncommon in hand and wrist. If it occurs in hand and wrist, its diagnosis is difficult because of its unusual presentations both clinically and radiologically. Materials and Methods: We encountered ten patients with osteoid osteoma of hand during the last ten years in orthopedic department of Emam university hospital from 1970 to 1979. Results: The average age of ten patients with osteoid osteoma of the hand and wrist that were treated in Imam hospital from 1369 to 1378, was 22.9 years (range, 14 to 33 years). Five lesions were in proximal phalanx, one in middle phalan x, and one in distal phalanx. In the wrist, one lesion was in the capitate, one in the lunate, and one in the hamate. The average time from onset of symptoms to successful treatment was 20 months (range, 4 months to 60 months). Three of ten patients had had treatment elsewhere, all of them had had unsuccessful operative procedures related to incorrect diagnosis. All patients had a minimum follow-up of 6 months (range, 6 months to 9 years, mean: 4.6 years). The operative treatment were successful in all ten patients without any signs or symptoms of recurrence. Only limitation of proximal interphalangeal joint range of motion was remained in one patient due to 60 months delay in diagnosis and treatment. Conclusion: High index of suspicion is necessary for diagnosis of osteoid osteoma of hand because of unusual presentation of it. The most important factors for successful treatment of osteoid osteoma of hand are accurate diagnosis and exact preoperative planning.