Tehran University Medical Journal
Year:2000 | Volume:58 | Issue:2|Papers Count:23

Systemic sclerosis is a generalized disorder of connective tissue in which the pattern of disease extent progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease; early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scelroderma, disease progression has occured mostly in the early phase of disease, but inpatients wit limited cutaneous scleroderma, disease progression was slow and incidious, so diseise progression has occured mostly in the late phase of the disease thus raymiud"s phenomenon, telangiectasia, hyperpigmentation. and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, dearly and extensive organ involvement was observed in patients with diffuse cutaneous scleroderma.

Squamous cell carcinoma, a cancer of keratinocytes origin mostly involves sun-exposed areas of the To study the pathologic and demographic features of this disease. records of 395 patients of squamous cell carcinoma of skin and lip were reviewed. Most bf the patients (83%) aged 40 years or more at the time of diagnosis.Rsepectively,74a% and 75.8% of eases with skin and lower lip carcinoma were men but in upper lip cases frequencies of both sexes were equal The number of patients referred from western and north-western provinces were much more than those of other provinces of the country The most frequtent histologic stage was grade I (53% and 58.8% in skin and lip carcinoma, rsepectively), showing that most patients visit physicians early enough, and are diagnosed in early stages of the disease.

Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media.we prospectively studied 126 patienic who underwent thes oporations in Amir Alam hospital in 1998. Eustachian tube function, technique of opation, use of silastic,age,sex,presence of cholesteatoma were evaluatwd each patient and graft vascularization after 6 to 8 weeks of surgery. was considered as successful. Out come Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

Invasive Salmonellosis is common in tropical areas. This study examines the performance of a clinical definition for its recognition among children ages 1 to 14 years admitting to a referral pediatric hospital in Tehran.60 Children were enrolled into the study during a period of 51 months. To facilitate analysis, cases were divided into 5 categories according to the likelihood of invasive salmonellosis with category A representing microbiologically confirmed salmonella bacteremia 17 (28.3%) and 6 (10%) with positive bone marrow cultures. And Category D representing those cases .in which an alternative diagnosis was firmly established. Salmonella serology supported invasive salmonellosis as the diagnosis in 17 (28%) of the nonbacteremic children (Category B and C).Salmonella serology suggested that invasive salmonellosis without detectable bacteremia was common. Blood culture proved and serologically diagnosed cases shows that the definition has a specificity of at least 60%.

Ultrasonography is a useful procedure in evaluation of spleen size in different clinical conditions. In this study, we used it to evaluate spleen size in patients with various hepatologic, hematologic and autoimmune diseases. To express spleen. size, a spleen index (SI), the product of the transverse diameter and its perpendiculr diameter measured on the maximum-sectional image of the spleen, was used.Splenomegaly was present in high percentages of patients with liver, blood, collagen or autoimmune diseases, even though a majority of these spleens were not large enough to palpate.By grading the 51, characteristic distributions of sf were obtained for patients with different types of diseases. Obtajning and grading the SI by the use of ultrasound appears to be a significant supplemental aid for evaluating spleen especially in patients whose spleen are not palpable.

Infant mortality and morbidity present important chalenges to those concerned with community health. did this research to study epidemilogy of diseases of infancy in city of Tehran.During 15 days, of 6395 deliveries in Tehran hospitals a cohort of 6267 live births entered this study. Follow up data were gathered in Ist,3rd,6th and 12th.months of birth. In this period, 5382 occurrence of disease v reported. The most frequent were cardiopulmonary (52.3%)and Gastrointestinal (26.6%) diseases. Most of events were seen in 6-12 months age group(30.5%). The lowest frequencies of infant diseases were seen in 19-35years of maternal age (15.3%),as compared with>35(35.4%) and <19 (49.3%)groups. Mortality ratio . was 32/1000 live birth (198 death). The most common causes of death were cardiopulmonary (38%)infectious (21%) and gastrointestinal (18%)diseases. Control of infectious .disease, developement of educational programs for breast feeding and planning of proper age and interval of pregnancy are effective measures for reducing infant mortality and morbidity.

Recently, smal incision cataract extraction by phaco and implantation of a foldable Intraocular lense with topical anesthesia has been used in an attempt to decrease the complication of general anesthesia and peribulbar injection. To compare effects and complications of topical, local and general anesthesia. 92 patients admitted to Immam Hosein hospital for cataract surgery, were randomly assigned to three groups and surgery was done under different methods of anesthesia. during routine ECCE, lid and globe movements, miosis and viterous bulg were observed more in topical anesthesia than the other techniques, but serious complications Such as posterior capsular rupture and viterous loss were not seen. Because of less systemic and local complications and rapid return of vision and possibility of outpatient surgery, topical anesthesia shoud be considered as an alternative to local and general methods.

Accurate measurement of refractive errbrin uncooperative patients and young children, requires cycloplegia. The aim of the present study was to determine whethere cyclopentolate by itself or in combination with 4 times instillation of atropine can be used as a substitute for 10 tims instillation of atropine. From 1994 to 1996, 39 patients aged 2-12 years were included in this study. Cycloplegia was undertaken by four different methods in subsequent visits: cyclopentolate 1% 4 times instillation of atropine, 10 times instillation of atropine plus tropicamide and 10 times instillation of atropine. 26 pationts (53% male, mean. age: 6.4 years) completed the four stages of the study, Spheric refraetion was significantly different between cyclopentolate. and 4 times and 10 times atropine grpups, but We didn"t find any significant difference in cylindric refraction between group. It seems that 10 times instillation of atropine is still the best method of cycloplegia in pediatric eye examination.

Despite the role of oral corticosteroids in management of sever asthma, use of these drugs needs careful awareness of its many side effects. There are controversies about the role of methotrexate in lowering the need for corticosteroids in these patients. In this study an attempt has been made to determine methotrexate effects in corticosteroid dependent asthma. Six patients were entered in a double-blind placebo controlled crossover trial and randomly allocated to two groups. Each group got a 12 weeks course of treatment with 15 milligrams of methotrexate or placebo wich thereafter was changed to the other regimen. In comparison with placebo, methotrexate caused a 62.5% less need for oral corticosteroid (P<0.01) and a 20% increase in FEV 1 (P<0.05). We concluded that the use of low doses of oral methotrexate results in less need for oral corticosteroid in treatment of corticosteroid dependent asthma.

There are now several tests available that can assess fetal status. A series of 164 cases of high risk pregnancies were studied in order to assess predictive value of a nonstress test. The majority (36%) of patients complained about postdate pregnancy. A nonreactive test was identified in 24 of the patients (14.6%).Fetal distress, low Apgar score in 1 and 10 minutes after birth and mean of Apgar score in 5 minutes, cesarean section due to fetal distress, congenital anomalies, need of neonatal care, IUGR, abnormal presentation and perinatal death were much more common in the group of pregnancies with a nonreactive NST than in the group with reactive test. The difference was statistically significant.A reactive test was found to be a good predictor of the healthy fetus. Negative predictive of the test were found 80% and 91.9%, respedively.The nonreactive test could identify a population at risk but it was .not helpful as a stand alone modality in decision making, because of the low sensitivity and posltive predictive value rates(33.3% and 58%).

Hepatomegaly, decrease in the liver paranchymal echo and increase in the gallbladder wall thickness has been shown in acute viral hepatitis. The present study was done to determine sonograpic changes in acute viral hepatitis. We performed liver and bile ducts sonography and specific tests on 42 patients (mean age:315 and 61% male) with acute viral hepatitis. Gallbladder wall thickness was seen in 45.2% and hepatomegaly in 33.3% of patients and liver parancymal echo was decreased in 19.3% .Age, sex, type of hepatitis, cholecystitis like symptolms, aspartate aminotransfrase, alanine aminptransfrase, alkaline phosphatase and bilirubin did not significantly corralate with these changes. Only raised. prothrombin time was strongly correlated to the thickening of the gall bladder and derease in the liver paranchymal echo and cholesistic like symptoms we can postulate that thickening of the gallbladder and decrease in the liver paranchymal echo is not dependent on the severity and speed of the paranchymal necrosis (as considered With ALT and AST) but they depend on the liver function disturbance (as considered with PT) because the thickening of the gall bladder is present in 45% of the patients and 10% of the normal population have gallbladder stones, one should not perform the diagnosis of acute cholocystitis, only on the basis of sonographic report without attention to the clinical and laboratory data.

Different ossificant materials have been used used for induction of bone repair in many studies, and bone matrix gelatin which contains bone morphogenic proteins one of the best ones.In present study we evaluated the role of this mat erial in acceleration of bone repair in rabbit tibia.A hole of 305mm diameter was made on right tibia of 10 and 12 rabbits as study and control group respectively, In the experiment group, in addittion to Bone Wax, we applied bone matrix glatin in the hole. Radiographic images were taken in days 0, 20, 40 and 53 after operation In 6 rabbits of each group, photographic pictures were also taken after exposure of entire bone. In 6 controls less degree of restoration were seen on day 53. In 4 experimental animals restoration were completed by this time and in 2 speciments repair processing were better then controls. This results shows that bone matrix gelatin can be used as an acclerator of bone repair.

Metabolic alkalosis is characterized by high HCO3 - as it is seen in chronic respiratory acidosis, but PH diffefentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely.We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized at Pediatric Medical Center in tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent; 64 percent male and 36 percent female). Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height). More than 60 percent had hypqkalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis shoud beconsidred in every pediatric patient presented with projectile vomitting.

Rheumatic heart diseaes is a serious health problem in developing countries. The present study was conducted to evaluate clinical and echocardiographic findings of Mitral stenosis and their relationship with patients functional classes. We studied records of 400 patients with symptomatic mitral stenosis (71% female, mostly in 20s or 30s and 54% function class II) treated in two hospitals in Tehran, Imam Khomeini and Amir-alam Hospitals, from 1994 to 1998. Clinical and echocardiographic data were extracted and analyzed. The most prevalent symptoms were dyspnea (96%), palpitation(41%) and chest pain(26%). orthopnea, paroxysmal nocturnal dyspnea, hemoptysis and right heart failure were significantly correlated with functional. class and severity of mitral valve stenosis (P<0.05).41% of patients presented with atrial fibrillation at admision or during hospitalization. This arrhythmia had no relationship with age and mitral valve area, although it was significantly correlated with left atrial diameter (P<0.05). Diagnosis and management of rheumatic heart diseaese need accurate physical examination and history taking and careful application of noninvasive and invasive procedures.

β2 microglobulin (β2M) fibril has been rccognizell as the major factor of dialysis -related amyloidosis.Elevated serum levels are thought to be the basis for tissue deposition.In order to evaluate the effect of cellulosis membrane (FB 110) and treatment duration on Sβ2M levels, we determined serum levels in 23 hemodialyzed patients with end - stage renal failure. Sβ2M levels were markedly elevated in all patients with a mean of 74.71 (SD=21.2 mg/l, range: 46 mg/l after 2 years hemodialysis - 123.8 mg/l after 10 years treatment) that statistically is higher than healthy subjects (P<0.0001). Serum β2M in 19 healthy subjects was 2.36 (SD=0,4 mg/l, rang: 1.58-33 mg/).Although in hemodialysis group, no significant correlation was found between Sβ2M and age or sex but increased serum levels of β2M had significant correlation with duration of hemodialysis treatment (r = 0.53, P<0.01).Since the dialysis membrane has a very effective role in clearancce of Sβ2M,we suggest that the particular effort shoud be made twords improvement of diaslysis membranes.

sex determination is the first step in identification of dead body and hip bone or its components are reliable in sex discriminantion. The present study was done to determine the applicability of some osteometric parameters of human hip bone in sex identification. Sixteen different variables for the anterior border of 50 human hip bones from a skeletal collection were studied. Statistically significant differences were detected between means in relation to sex for four variables, including: distance from the anterior superior iliac spine to the pubic tubercle, distance from the anterior inferior iliac spine to the iliopubic eminence, distance from the anterior inferior iliac spine to the pubic tubercle and length of the notch between the anterior inferior iliac spine and the iliopubic eminence. These variables could be used for sex determination of the unknown human hip bones.

Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptornatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were ohtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%). Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection preterm delivery and pyuria pvalue < 0.05.We suggest routine urine culture in first visit of high risk and 16 th week of low risk pregnancies.

Lithium is a lmmunomodulator that can increase Immunoglobulins to confront infectious deseae. It is also able to increase the productlon of interleukins, interferon gamma and prostaglandins. We comducted this study to evaluate the correlation between lithium consumption and humoral immunity. Blood samples were obtained from 76 patients under lithium treatment. We classified .the patients according to their serum Lithium level in. to five categories. Using Single Radial Immuno diffusin technique, we measured IgG, IgA ,IgM,C3 and C4 levels in the blood samples of our patients and a group of 100 controls. as well. Analysis of variance method was used for comparison of groups. We found significant differences between groups in level of IgG, IgA ,IgM and C3 (P<0.05).This findings show that lithium has many effects on humoral immunity.