TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2002 | Volume:60 | Issue:1|Papers Count:18

Background: Food allergy is affecting 6-8 percent of infants. Wheat is major source of carbohydrate and protein in the people"s nutrition in all worlds and also account for one of six main food allergens in children. The goal of this study is diagnosis of wheat allergic patients and description of its importance for better recognition of this disease.Materials and Methods: Among children with different symptoms of allergy (dermatologic - Gastro intestinal and respiratory symptoms) referred to Immunology and allergy Department of Markaz Tebbi Kodakan, during one year, 35 cases was suspected to have wheat allergy. Skin prick test and IgE specific with wheat for all of them and open food challenge test with wheat for 11 patients without history of anaphylaxy) were done. The criteria for diagnosis was based on a convincing history of anaphylaxis after ingestion of wheat or the positive result in food challenge with wheat in addition to positive skin prick test ( SPT) or specific IgE (Eliza) with wheat. Results: In 35 suspected cases to wheat allergy, SPT in.85/1 percent, specific IgE in 90/3 percent were positive. Food challenge test were done in 11 cases and was positive in 27/2 percent of patients. 24 patients were definitely diagnosed as wheat allergic ones. Anaphylaxis was the predominant clinical feature, accounted for 87 percent of acute symptoms which were repeated for two or more episode in 91 percent of the cases with anaphylaxis. In 50 percent of patients chronic symptoms like asthma and atopic dermatitis were also observed.Conclusion: The mean age of symptom was compatible with time of onset of complementary foods. Therefore, were proposed exclusive breastfeeding without maternal avoidance and not to be introducing wheat in infant regimen until 12 mouth of age. Anaphylaxis was occurred, repeatedly in these patients which demonstrate, in one part, severity of the reactions in our patients and in other part the probable existence of more cases with milder reactions in whom never been referred to us.

Background: Chronic otitis media and mastoiditis is a common otologic condition. Although it does not occur as frequently as acute otitis media, but remains a persistent and perplexing problem. Nowadays, although with improved access to medical care , advanced technology of imaging and entrance of new powerful antimicrobials, dangerous and deathful complications of c.o.m have become less common significantly, but unfortunately more of less serious complications is seen continuously.Materials and Methods: A retrospective study of 1500 patients with C.O.M that had been operated during the years 1991 -97 in Amir hospital was conducted. Results: patients had ages between 8 months to 78 years old with a peak incidence at 3rd decade of life. Among that patients, 56 patients (3.7 percent) had one of major C.O.M complications. Over ally, in order of frequency, we found: facial nerve paralysis 27 pt (1.8 percent) labyrinthitis and perilymphatic fistula 16 pt (1.06 percent) Intracranial abscess 5 pt (0.33 percent), lateral sinus thrombosis 4 pt (0.26 percent) Meningitis 2 pt (0.13 percent) and Bezold"s abscess 2 pt (0.13 percent) peak - age incidence of complications was 3rd decade of life and M/F incidence of complications was 3/2.Conclusion: The early diagnosis and treatment of C.O.M complications are very important (specially intracranial complications), but it can be possible if the physician thinks about it.

Background: This is a morbidity study about vascular trauma in Sina hospital, from 1974 to 1999. In this study morbidity is defined as amputation, wound infection, and recurrent thrombosis.Materials and Methods: We reviewed the Patient"s records and studied the effects of different factors such as type of trauma, associated injury, absence of capillary filling and presence or absence of distal pulse before and after surgery on morbidity.Results: Reviewing 100 cases, we found 83 percent of them were thrombosis. The mean age was 32.5 years old. From the patients, 76 percent had penetrating trauma and the reminder had blunt traumas. Type of blunt trauma, associated injury, absence of capillary filling and the status of distal pulse, before and after surgery, time of surgery, muscular response to cautery and duration of hospital stay, all were associated with morbidity (P<0.05).Conclusion: In this study it is concluded that prompt diagnosis of vascular injuries, primary resuscitation and transferring the patients to proper centers and appropriate care of complicated cases, will help us to reduce morbidity.

Background: "Arterial Thromboembolism" is the most common cause of "Acute Arterial Ischemia" of extremities. In this study, It is attempted to collect retrospectively some documentary information of all "acute arterial thromboembolic occlusions of the limbs".Materials and Methods: In descriptive retrograde study in Sina General hospital, all related records in this regard were collected from March 1991 to March 1997. To reveal the statistical outcomes and analysis the associations between them as well, the statistical tests like nonparametric ones were employed.Results: Total number of the cases was 24 with " Acute Thromboembolic Arterial limb Ischemia" (3 in upper and 21 in lower limbs). The results were as follows: Female to male ratio =1/2, "Range of Age": 34-91, "Mode"=8th decade of life, "Mean"=64.48, "Etiology": Cardiac Origin in majority of cases ("A.F" in 57 percent) and Unknown Origin in 1/4 of cases. "Pain" was find in 95 percent, Grade III ischemia in only 38 percent of patients on presentation and the others in Grade n. The most common "site of embolic occlusion" was "Femoral Ar." (76 percent). "Simultaneous Embolic Events" were fined in 29 percent. "Embolectomy" was performed in 79 percent (84 percent success rate) and "Primary Amputation" in 12.5 percent. "In hospital Mortality Rate" was fined in 24 percent and "Limb Salvage rate" in 68 percent. In conclusion, there were some logic relationship only between "Limb Salvage rate" and "Ischemic Grading" and also "Delayed diagnosis". There was also some significant direct relationship between "Mortality rate" and "Concomitant Embolic events".Conclusion: This study was an explorative one that paves the way for further complementary investigations. Although there are many recommendations due to upgrading knowledge, attitude and practice of physicians as well as lay people Besides, the upgrading of educational and curative facilities should not be neglected.

Background: Xerostomia is one of the disturbing side-effects of the radiotherapy to the head and neck region. Pilocarpine has been approved for the treatment of this I condition in the chronic phase, but its use concurrent with radiation could also be beneficial for prevention or reducing the subsequent radiation-induced xerostomia. We undertook to test this hypothesis in a clinical trial.Materials and Methods: All 18- to 70-year old patients who were to be irradiated to the head and neck, with both parotid glands in the radiation fields, were eligible for this study. Patients with any medical contraindications for pilocarpine were excluded. Randomization was performed at the start of radiotherapy to either pilocarpine 5 mg three times daily or placebo in a double-blind setting. The drug was started with irradiation and continued until 3 months after the end of radiotherapy. Serum pilocapine levels were measured in a randomly selected number of patients by high pressure liquid chromatography (HPCL). Xerostomia was evaluated about 6 months after the end of radiation by an analog-scale questionnaire, and the objective grading of xerostomia was recorded by two separate observers.Results: A total number of 60 patients were randomized into the trial (31 pilocarpine, 29 placebo), mostly with nasopharyngeal carcinomas. Mean parotid dose was 5, 818 cGy. Mean pilocarpine serum level was 14.65ng/ml. No serous side-effect was observed. Thirty-nine patients were analyzed for xerostomia at a median time of 7 months after radiotherapy, 18 in pilocarpine and 21 in placebo groups (9 patients died and 12 patients did not come back for xerostomia evaluation). Mean subjective xerostomia was 40.3 mm in the pilocarpine group and 57 mm in the placebo group (p= 0.02). Also mean objective xerostomia grade was 2.2 in the pilocarpine group and 2.6 in the placebo group (p= 0.01). Subjective and objective xerostomia results were positively correlated (level 0.01). Age and the parotid dose did not have a significant effect on xerostomia.Conclusion: Pilocarpine as prescribed in our trial produced the standard serum level required, and no serious side-effect. Compared to polacebo, pilocarpine used with radiotherapy could lead to a diminishment of subsequent radiation-induced xerostomia.

Background: Sepsis is one of the most critical medical emergency situations. Treatment with anti microbial drugs should be initiated as soon as samples of blood and other relevant sites have been cultured. Available information about patterns of anti microbial Susceptibility among bacterial isolates from the community, the hospital, and the patient should be taken in to account. It is important, pending culture results, to initiate empirical anti microbial therapy.Materials and methods: In a descriptive study during 3 years (1377-1379), microbial and anti microbial susceptibility patterns evaluated in Amir alam clinical laboratory on 2000 specimen of blood culture received from 765 hospitalized patients at Amir Alam hospital wards.Results: 113 specimens from 77 patient (10 percent) were positive for microbial growth. Enterobacter, S. aureus, S.epiderrnidis, Pneumococci, Ecoli, and Pseudomonas were the most common isolated etiologic agents(80 percent) . The most common organism was Entenobacter in 1377, S.aureus in 1378 and pseudomonas in 1379 There were significant change in patlern of organisms, increase resistance to some important available antibiotics and change in antibiotic susceptibility pattern during three years (disc diffusion method).Conclusions: According to Results of this study due to change in pattern of organism and their antibiotic susceptibility, dynamic microbiological study provide important data for Ordering empirical and culture oriented treatment of patients with bacteremia. Sepsis, anti microbial Chemotherapy, anti microbial susceptibility empirical anti microbial therapy, microbial pattern.

Background: This study is carried out to determine effective risk factors for early death and their causes in those who died due to intra cerebral hemorrhage within 30 days.Materials and Methods: From patients who have been admitted in Neurologic ward of Imam Khomeini hospital in Tabriz, We enrolled 100 patients with intra cerebral hemorrhage and the causes and risk factors effective in early death were evaluated among these patients by age, sex, blood pressure, level of consciousness, location of hematoma, CT findings and other risk factors.Results: We enrolled 100 patients who died due to intra cerebral Hemorrhage among 358 patients with LC.H, 62 male and 38 female, with mean age of 60.8. The time course of hospitalization was 4.5 days. The most important risk factor was hypertension on 90 percent of patients, previous C.V.A on 28 percent other risk time of admission in 66 percent of patients with G.C.S under 8.Conclusion: Hypertension was the most common and important risk factors and male gender and age were the second risk factors for early death with intra cerebral hemorrhage.

Background: CMV belongs to herpes viridea family and it is the largest human virus. Prevalence of CMV depends on age, race, geographic and socioeconomic factors. CMV infection has been a recognized complication of transfusion for about three decades, in an immature or compromised immune system situation. If a transplant candidate has not been infected with CMV and no CMV specific antibodies can be detected by serology, a primary infection could be transmitted via transfusion or transplantation. Patient who are under dialysis are susceptible to CMV infection, in addition of increase serum levels of b2-MG (Beta-2Microglobulin).Materials and Methods: we detected anti CMV (IgM -IgG) antibodies for 128 renal transplant candidates who were under intermittent heamodialysis and 1040 blood donors, as controls and compared serumb2-MG levels in 48 of the patients with 35 controls with ELISA technique. For 15 patients, R5 (Cuprophan) and for 7 patients S2 (Polysulphone) filters were used.Results: Our data showed:1-90 percent of normal blood donors and 89.8 percent of the patients were IgG positive. Statistical analysis showed no significant difference between these two groups (p<0.01). This reflected high prevalence of CMV .2- 0.2 percent of normal individuals and 2.3 percent of the patients were positive for IgM. There was significant difference in IgM between these two groups (p<0.01).3- b2-MG levels in patient group were elevated and there was a significant differences between two groups (P<0.05 ) and no differences between common used dialysis filter in this study.

Amyloid is a term used to describe a collection of proteinaceous material that has certain microscopic characteristics. Amyloidosis of the larynx is a rare benign process but is the most common site for isolated amyloid deposits to occur in the head and neck. Three cases of localized laryngeal amyloidosis were identified with the supraglottic region as the major site of involvement in two of them. Hoarsness was the presenting symptom. High resolution computed tomography scan was used to evaluate the extension of desease. Endoscopic and open surgical approaches were used for management of the patients.

Background: In recent years off-pump coronary artery bypass surgery (OPCAB) has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and reintervention (PTCA or CABG), we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery.Materials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB.Results: Of 150OPCAB cases, 146 (97.3 percent) were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6). Total 595 distal grafts anastomosed to LAD (140) diagonals (140), right coronary artery (145), left circumflex (164). Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein.Conclusion: OPCABis a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

A 25-year-old woman with a history of five years of bilateral verrucous hyperkeratosis and darkening of both nipples and areolae is reported herein. The histopathology was suggestive of hyperkeratosis of areola and nipple. Hyperkeratosis of areola and nipple is a rare condition which is seen unilaterally or bilaterally in both sexes. Three types of hyperkeratosis of areola and nipple are described: type I is literally the extension of epidermal nevus, type n is associated with ichthyosis and acanthosis nigricans, and type ID is an idiopathic or isolated nevoid form. The patient presented herein is a case of bilateral hyperkeratosis of areolae and nipples associated with benign acanthosis nigricans. In other words, the patient was suffering from type n hyperkeratosis of areolae and nipples.

Background: Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases.Materials and Methods: To determine the efficacy of this method in Iran in patient"s with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months. Results: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement.Conclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.

Background: The most common congenital diseases in children is congenital heart disease. Factors "such as environment, genetic, old maternal age during pregnancy, maternal disease and using medicine in pregnancy, prematuritiy, and specific seasons are significant in the prevalence of disease. Materials and Methods: A cross sectional study was conducted to investigate the status of children with congenital heart diseases, among 665 child that refereed to Children's hospital medical center, Tehran University of Medical Sciences and Health Services, during 1 year (2000 to 2001). The researchers due to the lack of existing appropriate tools developed the instrument for the study. The questionnaire Was 15 items, nominal, ordinal and interval scale. All items were verified using major authoritative pediatric cardiologists references and were subjected to face and content validation by three experts. Convenient sampling was utilized for collecting data. All subjects were examined in cardiology department and echocardiography was done for them. Results: From a total of 665 children with congenital heart defects, 56.2 percent were male and 43.8 percent were female. 32.6 percent were born in autumn. Septal defects were predominant lesions, which account for 36.1 percent of lesions. 89.8 percent of children have never extracardiac defects. Children of mothers age 20-35 years had a percentage of 86.2 percent of developing congenital heart disease. Percentage of children who their birth weight less than 2500 gram was quite small, at 24.1 per cent overall. There was no significant relationship between selected variables and congenital heart diseases. Conclusion: With regard to the prevalence of disease and preventing therapeutic costs, parents and teachers education have an important role in preventing congenital heart disease. Therefore, the formation of a learning curriculum model for a life free of congenital heart disease and congenital heart diseases registration is essential.

Background: Schizophrenia is one of the most important and disabling mental disorders in the world. Males and females are equally affected. Diagnosis is a very difficult problem in this disorder. Because the diagnostic systems such as ICD-IO and DSM-IV are mainly subjective, they are not valid and reliable. Essentially, in the future, we will need to more objective criteria in psychiatry especially in diagnosis of schizophrenia. Neurological soft signs are an example of these objective criteria. In this study we evaluated the prevalence of neurological soft signs in schizophrenic patients and compared it with the prevalence of these signs in other psychotic patients (except mood disorders with psychotic features) and normal subjects. Methods: We compared the neurological soft signs (sensory motor integration, motor. Coordination, consequent complex motor acts, primary reflexes, and eye movements) in 30 schizophrenic patients, 30 other psychotic patients (other than mood disorders with psychotic features) and 30 normal subjects. Diagnosis of schizophrenia and also other psychoses were based on DSM-IN criteria. Normal subjects have been selected form the staff of Roozbeh hospital randomly. Results: The difference between the means of motor coordination subscale of neurological soft signs in schizophrenia and other psychotic disorders (other than mood disorders with psychotic features) were significant (P value<0.04). There were no significant differences between the means of other subscales of neurological soft signs in two groups of patients. Conclusion: There are some disturbances of motor coordination subscale of neurological soft signs in patients with schizophrenia. It seems that, these disturbances are evidence of involvements of basal ganglia, motor cerebral cortex, and cerebellum. So it may be suggested that motor coordination as a marker can be used in differentiation between the schizophrenia and other psychotic disorders.