TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2005 | Volume:63 | Issue:8|Papers Count:18

Background: Involvement of vascular changes in developing radiation myelopathy has already been reported. Therefore, we decided to detennine the irradiation responses of histopathological changes in irradiated rat cervical spinal cord and its contribution to radiation myelopathy.Materials and Methods: Wistar rats (5 per group) were irradiated with doses of 0,2,4, 6, 15,25,30 and 35 Gy of X-ray in a specially designed jig through 3 cm irradiation portals. Samples of spinal cord were prepared for histopathological studies at 24 hours, 2, 13 weeks and single group of 35 Gy at 17 post irradiation. Tissue sections of spinal cord were studied by light and electron microscopy for structural and ultra-structural studies, respectively.Results: Histopathological findings showed marked graded gliosis, vascular density reduction, demyelination and endothelial changes in our short-tenn study. Conclusions: Therefore, our results can further emphasize on the possible important role of vascular changes in toxic effects of irradiation. Long-tenn studies, up to 39 weeks post irradiation, are also undergoing to detennine late effects of irradiation including myelopathy.

Suicide by chalk eating is a rare method which causes foreign body in the gastrointestinal tract, ifthe management is delayed and needs laparatomy for treatment.This is a case report of chalk eating suicide and it's management.

Background: Malnutrition is common in developing and under developing countries and Urinary tract infection (UTI) is a well-recognized complication in malnourished children.Materials and Methods: We examined the incidence of UTI, bacteriuria and pyuria in Malnourished children. Of 61 patients (19 boys) 1 had severe, 15 had moderate and 45 had mild malnoutrition. A normally nourished control matched for age, sex and presence of fever was included. Clean catch midstream urine specimens from patients and control group were examined microscopically and cultured. Results: The incidence of UTI, bacteriuria and pyuria in malnourished subjects was 44% and 13 % respectively. The incidence of UTI, bacteriuria and pyuria in control children was 19 % and 11% respectively .E.coli is predominantly organism isolated in patient and control group.Conclusions: Our observations show that malnourished children are at risk for UTI. Urinalysis and urine culture is useful for screening for UTI in these subjects.

Background: Laparoscopic splenectomy (LS) has gained wide acceptance as a safe and effective alternative to open splenectomy (OS) in the treatment of hematological disorders (HD).Methods: 20 patients with intractable HD ITP (n=14), TTP (n= 4), Hemolytic anemia (n= 2)) underwent LS during the years 2004-2005 in our institution. 16 women and four men with a mean age of 27.80 years had a four-port approach in a right lateral kidney position to remove spleen and all accessory spleens. Results: All procedures were performed successfully, with no conversion to exploratory laparotomy. Surgical times and blood loss averaged 113 minutes and 200 cc, respectively. Two patients required blood transfusion. There was no perioperative .mortality and major morbidity. The mean post-operative hospital stay was 2.5 days with median post-operative NPO time for 1.5 days. Weight of spleen, amount of blood loss, and operation time were significantly lower in ITP patients than other  cases (P= 0.006, 0.002, 0.02 respectively). All patients with ITP and two of four patients with TTP developed normal platelet counts after operation, and all two patients with hemolytic anemia maintained a normal hemoglobin concentration after operation. Conclusion: LS for HD (especially for ITP) is safe, effective and associated with low morbidity, fast recovery and excellent cosmetic results. Thus, LS may be considered earlier in the course of ITP.

Background: osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This lead to increased bone frigidity and risk of facture, particularly of the hip, spine and wrist. This study with aim of assessment clinical tools for detection of patients with high risk for osteoporosis and decrease the number of patients to refer for bone densitometry was done.Material and Metods: This study is a predictive research from convenience sampling in 250 persons referred to bone densitometry center of shiraz. data gathering from two questionnaire about demographic then question about risk assessment tools. Analytic of data from SPSS (11/5) form descriptive statistic and Analytical statistic for assessing utility of these assessment tools was done.Result: Finding of this research was showed in bone mineral densitometry from lombosacral 37/8 and 11/2 percent and in bone densitometry of hip 59/9 and 9/2 was osteoperia & osteoporosis. Evaluation of assessment tools showed 42/5 percent in ORIO, 78/6 from NOF , 70 in BWC,38/4 in ABONE and %60/6 in score was need to more evaluation for osteoporosis. Also sensitivity and specificity & positive and Negative predictive value of this methods showed, high sensitivity of BWC and high specificity of NOF and positive predictive value and Negative Predictive value between( 25/7 from 80) was varied.Conclusion: We concluded that these risk assessment tools have limited for appropriately referring high risk person & is better these use for assessing patient in low risk factor. In other word inattention to low life expectancy to our countries must be reevaluate. Therefore this measurement can be use for early detection & assessing person with low risk factor for osteoporosis & financial bearing of other methods are decrease.

Recently malignant fibrous hystiocytoma (MHF) is the common sarcoma of the soft tissue in adults. The most common sites of MHF are the extremities and retroperitoneum. This lesion is rare in the head and neck. MHF of the larynx often is seen in the old men and after radiotherapy of the head and neck cancers. We report a case of MHF of larynx, without history of previous cancer and radiotherapy, that underwent the total laryngectomy.

The basis of a research is to collect true statistics and information. This article presents the importance of stable statistics in assessing the healthcare system of Iran. For this purpose, several sources with disorders in their statistical information which are being used in different Healthcare centers during recent years are introduced. This disorders and chaos are analyzed for better understanding the value of three basic statistical indexes of successive years. The results are exhibited by appropriate charts. The deficiencies in healthcare system due to the disorders statistic are demonstrated and their remedies are proposed.

Background: The prevalence of tuberculosis in adult men is higher than in women. Cigarette smoking is prevalent almost exclusively among men, it is possible that tobacco Smoking may be a risk factor for developing pulmonary tuberculosis. The purpose of this hospital based case-control study is to determine the effect of smoking on pulmonary TB in adult Iranian men.Materials and Methods: The study subjects were 77 case men (age between 21- 50 years) with pulmonary TB and age-socioeconomic matched 154 non-TB control from male patients admitted to hospital during June 2003 to August 2004. All subjects selected from different wards and only persons who were RN negative, DM negative and free of other diseases or states on basis of exclusion and inclusion criteria to reduce biases, date were collected by direct interview using with questionnaires, univariate and multivariate analysis with measurement of odds ratio, chi-square, montel-haentzell and conditional logistic regression was performed.Results: The results of univariate analysis showed that cigarette smoking alone (OR= 2/281, p= 0.004), beginning age of smoking (OR= 2/951, P= 0.010 to OR= 3/463, P= 0.001), duration age of smoking (OR= 2.32, P= 0.043 to OR= 2.361, P= 0.018). And amount of cigarette smoking daily (OR= 3/632, P= 0.003 to OR= 5/397, p= 0.001) were significantly associated with pulmonary tuberculosis. Multivariate conditional logistic regression analysis showed that smoking as on independent risk factor increased risk of pulmonary tuberculosis (OR= 2/172, P= 0.009). In this analysis beginning age of smoking (OR= 9/296, P= 0.001) to (OR= 14/322, P= 0.0001) and amount of cigarette smoking daily (OR= 5/15, P= 0.008) to (OR= 8/54, p= 0.031) significantly increased risk of pulmonary tuberculosis.Conclusions: These date indicate that smoking is a risk factor of pulmonary TB and there is a positive association between this two problems. Therefore an effective anti smoking campaign is expected to have a positive repercussion on TB incidence and smoking cessation must be considered and promoted by all levels of heath care providers.

Background: Conservation laryngeal procedures are the original organ preservation techniques. Recently, new techniques for local control of malignancy and preserving function of the larynx has described. In partial operations sequel are low and included temporary teracheostomy, dysphagia and degrees of hoarsness. Study of the outcome of partial laryngectomy operations can be effective assessment for using techniqual surgery in our country. Material and Methods: This is a case series study. In this study the Outcome of various types of partial laryngectomies in Amir AAlam medical center from 1997 To 2003 were assessed according medical documents and follow up the patients. Data collection consisted of age, sex, technical imaging before operation, staging, pathology results, type of partial laryngectomy, dysphagia, dyspnea, satisfy of voice after operation, recurrence of cancer and survival rate. Analysis performed by descriptive statistical and X2 test with spss.10 software.Results: Total number of patients was 50 ( 45 male and 5 of patients were female). Median follow-up period was 42 months (range, 6-78) .Twenty nine of patients (58%) Were T1, nineteen of patients (38%). were T 2and Two of them(4%) were T3. 98% of patients had various types of SCC , and 2% of patient malignant mixed tumor. Study postoperative complications showed that 8cases(16%) had dysphagia,4cases(8%) had aspiration, 5cases(10%) had dyspnea. Patient self-perceptions of voice in 47 of cases were good. There weren't significant correlations between variations like satisfy of voice and postoperative complications with types of partial laryngectomy (P>0.05). Six patients (12%) had local recurrence and due to total laryngectomy. There were significant correlations between the staging and types of partial laryngectomy with recurrence the cancer (P<0.05) .The survival rate in this study was 100%. Conclusion: Conservation laryngeal surgery is precise surgery, and to achieve successful oncologic and functional results, surgeon should be select the patients. We recommend usage of various techniques of Imaging and consult with speech pathologists during pre operative and post operative periods.

Background: Allergic rhinitis is the most common chronic disease of human, which causes great morbidity. Cockroach is a common allergen in respiratory allergies. This study was done to evaluate the state of cockroach allergy among patients with cockroach allergy in Iran.Materials and Methods: Cockroach allergy was evaluated by skin prick test (SPT) and measurement of cockroach specific IgE for Blattella germanica in 116 patients with allergic rhinitis. They also underwent skin prick test for trees, weeds, grasses, mites [Dermatophagoid Peteronysinus (DP), Dermatophagoid Farina (DF)], feather, and cat.Results: Of the patients 31 (26.7%) had positive cockroach SPT and 2 (1.7%) had positive cockroach specific IgE. Positive SPTs for weeds, trees, grasses, DP, DF, feather, and cat were seen in 48.3%, 38.8%, 37.9%, 25%, 24.1%, 9.5%, and 6.7% respectively. The infestation of the patients' home with German cockroach was associated with more prevalent cockroach allergy (P<0.001).Cockroach allergy was more prevalent among female subjects than males.Conclusion:German cockroach was the fourth common allergen and the most common indoor allergen among patients with allergic rhinitis. As cockroach allergy was associated with the infestation of the patients' home with German cockroaches, elimination of the cockroaches may help management of the disease.

Background Scaphoid non-union without carpal instability or avascular necrosis can be treated successfully with traditional bone graft technique. In difficult cases especially in cases with avascular necrosis, vascularized bone graft techniques have been developed. Some authors recommend vascularized bone graft in treatment of simple scaphoid non-unions to decrease the time of union. We compared the time of union in simple non-union of scaphoid, treated with traditional & vascularized bone grafts.Materials and methods: In a randomized controlled trial study we treated 23 patients with scaphoid non-union without collapse or instability and without avascular necrosis on plain radiography, either with traditional iliac crest or Zaidemberg vascularized bone graft. The union time was evaluated by plain radiography. Operation time and complications were determined. The patients were followed until union.Results:10 patients in group A were treated with vascularized bone graft, and 13 patients in group B were treated with traditional iliac crest bone graft. All scaphoids were fixed internally with pins. Mean age was 25.9 year in group A and 26.69 year in group B. Union was achieved in all patients. Union time was 10.80(+/-1.39) weeks in group A and 12.38(+/-1.6) weeks in group B. The difference between union times in two groups was statistically significant (p=0.022), but clininically unimportant. Operation time was 99(+/-11.97) minutes in group A and 51.92(+/- 7.51) minutes in group B. In group A we had four cases with superficial radial nerve paresthesia. Because of short duration of follow up we did not evaluate wrist range of motion or grip force. Conclusion: We recommend to continue traditional techniques in non-complex scaphoid non-unions.

Background: The aim of radiotherapy is to destroy the cancer tissue and save structure of normal tissue. The effect on normal tissue will limit the ray that tumor receives. Acute dermatitis from radiotherapy, is one of the important side effects of every prevalent cancer like hand and neck, breast and so on. The acute response of skin in Radiotherapy is visible easily and the bound of it can form weak erythema to neckroz. Controlling the effects of radiation on skin so the patient can tolerate better the therapy.Materials and Methods:Results: In this study the breast cancer patients after radiotherapy divided into two groups. The first group used corticusteroid and second one only Vaseline. The patients was followed up during the period of study. Results &Conclusions: Variables like: age, menopause status, kind of surgery history of chemotherapy, weight, interval of time to cause dermatitis in two groups haven't significance difference but the severity symptoms, time and skin of therapy have significant difference. The result of this study show that the use of moderate corticusteroid to strong in the first day of radiotherapy until three weeks after/ radiotherapy against acute dermatitis that cause from radiotherapy recommended

Background: Long lesions & diffuse coronary disease present considerable challenges to the interventional cardiologist. Compared with discrete stenosis, percutaneous revascularization of long lesions is associated with decreased rates; of procedural success and increased incidence of acute complications, and a propensity toward restenosis. This study was done with the aim of evaluating early & late results of PCI (Percutaneous Coronary Intervention) of long coronary lesions.Materials and Methods: In this study all of the patients (60 cases) undergone long lesion (>l5mm) PCI in the catheterization department of Imam Khomeini hospital (Tehran) at year 1382 were evaluated for occurrence of early & late complications of PCI.Results and Conclusions: In accordance with early results, 2 cases of abrupt] closure & one case of per procedural MI was detected. In long term follow up (mean 10.8m) 24.6% of patients developed restenosis on the basis of clinical manifestations, exercise treadmill test, myocardial perfusion scan and coronary angiography.Occurrence of restenosis was related to lesion length & was higher in diabetic' patients.

Background: Salivary gland calculi are one of the commonest pathologies of these glands, specially in the background of chronic inflammation and swelling of clinical and imaging findings. Including findings on x-ray and ultrasound. We decided to demonstrate the frequency and prevalence of the salivary gland calculi by ultrasoundwith a cross- sectionaldescriptive.Materials and Methods: This study was conducted in the patients present with swelling of salivary glands in Emam Hospital during I year. We randomly found 33 patients which had swelling of salivary glands in clinical exam. We examined them with ultrasound using high frequency linear array transducer then our results analyzed with SPSS software. Results: Of all 33 patients with swelling of salivary glands, 42/4% had salivary gland calculi, 57.14% were male, in 71.42% age was less than 20 years, 62.8% of stones located in submandibular gland which hilum of the gland was the most frequent anatomic location. In 10 patients salivary gland tumor and in 6 patents just swelling were reported. In 3 patients no pathologic finding in salivary gland were found, but cervical lymphadenopathy.Conclusion: According to our results salivary glands stone formation is a common finding in patients with salivary gland swelling which most of them develop in submandibular region. Ultrasound is a non- invasive diagnostic method. It is also available and relatively cheep. It is reasonable to use it to diagnose salivary gland calculi and to find their locution.