TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2009 | Volume:67 | Issue:4|Papers Count:14

Gliomas include a group of primary central nervous system (CNS) neoplasms with characteristics of neuroglial cells (eg, astrocytes, oligodendrocytes). The gliomas are classified commonly to WHO grade I-IV gliomas. The grading is based on the presence of nuclear atypia, vascular proliferation, mitoses, and necrosis. The malignant gliomas are progressive brain tumors that are divided into anaplastic gliomas and glioblastoma based upon their histopathologic features. Today, different modalities such as surgery, radiation therapy (in the form of external beam radiation or the stereotactic approach using radiosurgery) and chemotherapy have been used for the treatment of gliom’s tomors but unfortunately the prognosis and survival rate is poor in most of patients. The survival depends on the tumor's type, size, location and the patient's age. We reviewed the prognostic factors, diagnostic modalities and surgical management of patients with gliomas.

Background: Previous studies suggested that stressful events that release Glucocorticoid from adrenal cortex and also injection of agonists of glucocorticoids receptors probably affect emotional learning and memory process and modulate them. The aim of this study was to determine the effects of acute stress and systemic injection of Corticosterone (as agonist of glucocorticoid receptors) on acquisition (ACQ), consolidation (CONS) and retrieval (RET) of emotional memory in rat.Methods: In this experimental study we used 180 male Wistar rats (220-250). At the first rats was training in one trial inhibitory avoidance task. On the retention test given48 h after training, the latency to re-enter the dark compartment of the apparatus (Stepthrough latency, STL) and the time spent in light chamber (TLC) were recorded during 10min test. Intraperitoneal corticosterone in doses of 0.5, 1 and 3mg/kg injected 30min before, immediately after instruction and30min before retrieval test. Also some groups received10min stressful stimulation by restrainer at the same time. At the end locomotor's activity was measured for all animals.Results: The data indicated that administration of corticosterone 30min before ACQ (1mg/kg), and immediately after CONS (1, 3mg/kg) enhance and 30min before RET (1, 3mg/kg) impair emotional memory (p<0.05). Acute stress impaired emotional memory in all phases (p<0.05). Also acute stress and injection of Corticosterone have not significantly affect motor activity.Conclusions: These findings show that Glucocorticoid receptors in activation dependently plays an important role in modulation of emotional spatial memory processes (ACQ, CONS and RET in new information) for emotional events and these effects varies in different phases.

Background: Clindamycin is a suitable antibiotic for treatment of skin and soft tissue infections. Moreover, it can suppress toxin production in many pathogenic bacteria such as S. aureus. There are two mechanisms of resistance in this antibiotic. Constitutive resistance can be detected by standard disk diffusion method but in the case of inducible resistance, D-test should be carried out. The main aim of this study is to determine prevalence of clindamycin inducible resistance among methicillin resistant and susceptible isolates of S. aureus isolated from different clinical samples.Methods: A total of 87 clinical isolates from clinical samples were collected. Methicillin resistance was determined using standard disk diffusion method. Subsequently, D-test was carried out according to CLSI guideline. Presence of the sea gene (enterotoxin A) was detected by PCR using specific primers.Results: Out of 87 isolates, 18 (20.7%) were clindamycin inducible resistant while constitutive resistance was detected among 21 (24.1%) isolates. The 95% Confidence intervals for the proportion of inducible clindamycin resistance among clinical isolates of S. aureus was 12.2% to 29.2%. The inducible phenotype in MRSA isolates was more common than that of MSSA isolates (33.3% vs 5.1%). Significant differences were found between prevalence of inducible clindamycin resistance and type of infection (p=0.045). Importantly, there was a significant correlation between sea gene and the constitutive/inducible resistance (p<0.0001).Conclusions: Due to the high prevalence of clindamycin inducible resistance among clinical isolates of S. aureus, we recommend D-test to avoid treatment failure.

Background: CT scan was first introduced into clinical practice in 1972, and since then has grown into one of the predominant diagnostic procedures. In 1998, the UK National Radiological Protection Board reported that 20% of the national collective dose from medical X-ray examinations derived from CT-scans, although it represented only 2% of all X- ray examinations the aim of this study was to determine the X-ray dosage received by patients in brain CT scan.Methods: In this work, we have estimated patient dose arising from CT examination of brain in five hospitals in Tehran. Organ and effective doses were estimated for 150 patients who underwent CT examination of brain. “ImPACT” version 0.99v was used to estimate organ and effective dose. Brain examinations were performed with fixed Kvp, mAs and T (slice thickness) for each scanner.Results: Patients, who were scanned by CT of emam Khomeini center (Toshiba Xvision /EX Scanner), received maximum organ dose (brain) and minimum organ dose was delivered to patients who were scanned byCT of amir alam center (Toshiba Xvision /EX Scanner). Maximum effective dose was1.7 mSv acquired in this study for emam Khomeini haspital, smaller than the corresponding value obtained by National Radiation Protection British (NRPB).Conclusions: In two research centers with a system, the obtained results of measurement of effective dose and organ dose show utilization method of system and its measure of Kvp & mAs is very important factor in comparison with type of system.Because there are both minimum dose and maximum dose in two different centers.

Background: It is extremely important to validate psychological (psychometric) tools before use in research projects. In fact without reliable and valid psychological tools, we can not rely on research results. TCI contains subscales designed to measure seven different personality traits and characteristics. This paper presents complementary findings to a previous study. In fact, the aim of this study was to summarize a normative data of TCI for an Iranian sample of men and women with different ages.Methods: At first all research workers, who collected data in present study, were trained for the skills needed in order to communicate with the participant and to conduct the questionnaire. Randomly selected participants (n=1212) completed TCI questionnaire.Results: The results showed normative data for the subscales novelty seeking (NS), harm avoidance(HA), reward dependence (RD), persistence (Per), self directiveness (SD), cooperation (Co) and self transcendence (ST) for different gender and age classes.Conclusions: Similarities and differences of the present findings and other studies will be theoretically discussed. The sample of participants in this study allows us to generalize the collected data. The results shows that now we can benefit from using the questionnaire in Iranian society. Different applications of TCI in various clinical and normal settings will be discussed. The present results is complementary to the previous findings reported in the same journal.

Background: Pulmonary resection is one of the most common thoracic surgeries Bronchial stump closure is important topic and still is controversy Bronchial stump closure with stapler is a new method that in addition to rapidity, lowering separation and dehiscence of suture line and lowering contamination of the operative site with bronchial secretions, and lowering the main complication after pulmonary resections which is sustained air leak- main factor in delaying discharge and patients dissatisfaction.Methods: Two groups of 16 patients in a randomized clinical trial compared. In one group bronchial stump closed with stapler and the other stump closed with hand sewn method. Bronchial closing time, Operative time, time of airleak, time of chest tube, time of discharge and complication recorded and compared.Results: In the stapler group time of bronchial closing was significantly shorter. Operative time was not different. time of air leak was not statistically different. No patients with long airleak, and the number of patients without airleak was greater. In the stapler group, time of having chest tube was statistically shorter and time of discharge in stapler group was shorter than hand sewn group.Conclusions: Bronchial closing with stapler in pulmonary resection is a safe method and in addition to rapidity, time of chest tube and time of discharge was shorter. Although Time of air leak was not statistically different but patients in stapler groups had less Days with air leak and long air leak was zero in this group.

Background: The aim of this study was to describe the prevalence of different types of maxillary fractures, concurrent fractures and accompanying signs and symptoms. Trauma is the second cause of mortality in Iran, after cardiovascular diseases. In traumatic patients, head, neck and facial bones fractures are common. The maxillary fractures are seen much less commonly than the fractures of the mandible, zygoma, or nose. Maxillary fractures include: (Le fort I, II, III fractures- alveolar process fracture and Sagittal fracture). The most common cause of maxillary fracture is motor vehicle accidents.Methods: This descriptive cross sectional study designed on 56 patients with maxillary fractures in a referral educational trauma center of Tehran. Sample size was the patients who referred to this hospital with maxillary fracture during past seven years.Results: Forty eight (86%) patients were male and 8 (14%) were female. Male to female ratio was 6/1. Mean age of patients was 30 years. The most common type of maxillary fracture was infra orbital rim and floor fracture. Among Le fort fracture; Le fort type II was the most common. Paresthesia of infra orbital nerve and malocclusion were more common than the other especial signs of maxillary fracture. Concomitant fracture with maxilla include: zygomatic fracture in62%, mandibular fracture in 25%, nasoethmoidal fracture in9% and skull base fracture in 4%. Management of maxillary fracture was reduction of displaced bone fragment and fixation for osteosynthesis. The most common way for osteosynthesis was fixation with miniplate and screw.Conclusions: Face fractures are a piece of all problems in multiple trauma patients as the tip of iceberg. Early diagnosis of maxillary fractures and immediate treatment will prevent the future deformities and complications.

Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed.Methods: Forty one healthy adults (age range: 18-55 years) with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint. Duration of operation and volume of serum used for irrigation during the procedure; pain and analgesics requirement, during and after arthroscopy; VAS (Visual Analogue Scale) score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed.Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in80% of procedures had excellent or good satisfaction with intra-articular block.Conclusions: Considering high level of satisfaction in both patients and surgeon and mean of VAS, complications of other modalities of anesthesisa and simplicity of the technique, intra-articular block can be used as an easy, safe and efficient method for knee arthroscopy.

Background: Polyethylene glycol (PEG) solution can induce complications when used as preoperative bowel preparation. The aim of this study was to compare two methods for mechanical bowel preparation in elective operations of colon.Methods: In a randomized clinical trial, 129 patients elected for anastomosis of colon and referred to the surgical clinic of Imam Khomeini Hospital of Tehran between March2008 and March 2009 were included. They were randomly allocated into two groups ofPEG1 (1liter of PEG or 70gr plus 15 mg bizacodil, n=63) and PEG4 (4 liter of PEG), according to the way of bowel preparation; and on the day before surgery, they received oral and IV prophylactic antibiotics and cleared solutions. In the morning of the surgery, they received their medication during 240 minutes. Then, they underwent anastomosic surgery of colon. The principle variables recorded were nausea, vomiting, flatulence, Na and K in the night before surgery, patients’ and surgeons’ satisfaction from bowel preparation and postoperative infection and leakage.Results: The majority of the patients were male (62%). Nausea (28.57% vs.98.48%, p=0.001), flatulence (36.51% vs.95.45%, p=0.001), and vomiting (4.76% vs.75.76%, p=0.001) were significantly lower in PEG1 and the patients’ satisfaction were significantly higher (59.02% vs.1.52%, p=0.001) Peroperative Na was significantly higher inPEG4 group (141.21±3.63 vs.139.94±2.97mg/l, p=0.001) and serum K was significantly lower (3.55±0.25 vs.3.76±0.21, p=0.001). Surgeons’ satisfaction were significantly higher in PEG4 group (good to very good 72.73% vs.43.54%, p=0.001). Postoperative infection of surgical site, anastomosis leakage and ICU admission were comparable between study groups.Conclusions: Bowel preparation with 1 liter of PEG plus 3 bizacodile pills instead of 1 liter of PEG in patients undergoing elective anastomosis of colon is not only associated with lesser nausea, vomiting, flatulence, but also increases the patients’ satisfaction and tolerance, lessens electrolyte disturbances and do not influence postoperative infection of surgical site and anastomosis leakage.

Background: Gestational diabetes mellitus is diagnosed as carbohydrate in tolerance demonstrated for the first time in the course of pregnancy. The aim of this study was to evaluate the selective screening method for gestational diabetes mellitus(GDM) based on: 1- recommendation of the fourth workshop- conference on GDM 2- evaluation of risk factorsMethods: A case- control study was performed on 370 pregnancies inflicted by GDM in Hazrat Zaynab Hospital, Shahed University. The maternal and perinatal outcomes and prevalence of risk factors based on recommendation of the fourth workshop-conference on GDM in these women with GDM were compared with the same data and risk factors of randomly selected600 pregnant women at the same time and in the same hospital, they all underwent universal testing for GDM, and their OGTT were normal.Results: The prevalence of all risk factors was significantly higher in the group with GDM, but 45 of these women (12%) had no risk factors.107 women (29%) with GDM were at low risk and would remain undiagnosed if selective screening method was used. The main neonatal complications in the low- risk group did not differ from the complications in other women with GDM.Conclusions: The universal screening of all pregnant women seems to justified whereas the recommendations for not screening low- risk group are doubtful and require further examination.

Background: Low-birth-weight (LBW) children are at higher risk for failure to thrive. The aim of the study was to establish the trend of physical growth in Until now their growth was evaluated with normal birth weight baby’s chart.Methods: In this cohort study we investigated demographic characteristics and growth trend during the first of life406 newborn divided into three groups: LBW (Low Birth Weight) n=103, VlBW (Very Low Birth Weight) n=20 and NBW (Normal Birth Weight) n=303. Body weight, length and head circumference were measured at the time of birth and several follow ups until12 months of chronological age.Results: NBW growth trend adopts the standard chart. Significant differences in terms of physical growth (weight- height- head circumference) were seen between the two groups of preterm (LBW & VLBW) and NBW children. Although it was demonstrated that growth velocity of preterm & NBW children were the same. Significant differences for weight was seen between VLBW and LBW group only until 6 months after birth. This difference was seen for height and Head circumference until the end of the first year of life.Conclusions: VLBW and LBW babies need special growth charts. But the adjustment method of anthropometric traits to gestational age may be useful to evaluate LBW baby’s growth.