TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2001 | Volume:59 | Issue:4|Papers Count:18

Helicobacter pylori (H. pylori) is the most prominent causative agent of gastroduodenal diseases all over the world. Other manifestations such as urticaria and coronary heart diseases, also are suspected to be induced by H. pylori. Non invasive methods are preferred for diagnosis; and ELISA, because of its, reliability, speed, sensitivity and specificity is widely preferred as diagnostic tool. Previously we have used IFA, and here, we report an Indirect ELISA technique for H. pylori diagnosis. First, 9 strains, of H. pylori isolated from biopsies, were cultured, and the soluble crude antigen was used to coal ELISA plates. Antigen concentration and conjugated antiserum dilution were optimized using checker board method. In this study the gold standard was: rapid urease test, culture and direct smear. Patient serum dilution and the cut-off value was determind, using 22 Negative and 30 positive confirmed samples according to ROC curve and the results were compared with a commercial kit. The sensitivity and specificity of this method were 93.2 percent and 95.4 percent respectively. A commercial ELISA Kit, was used and compared simultaneously. The sensitivity and specificity were 87.8 percent and 73 percent respectively. Therefore, regarding the acceptable sensitivity and specificity, ease of work of ELISA, being economical and non-invasive, it can be employed in diagnosis of H. Pylori infection and also in epidemiological studies.

Prutirus is an unpleasant that provokes the desire to scratch. It has long been recognized as a presenting or concomitant symptom of many systemic diseases. Indeed, generalized pruritus is reported to be associated with underlying diseases in 10-50 percent of cases. This study was conducted to investigate the underlying diseases in pruritic patients without primary skin lesion. Seventy-five patients with at least one-month history of pruritus with no primary skin lesions, presenting to dermatological clinics of Razi Hospital, from April 97 until December 99 were evaluated. The work up procedure consisted of medical history, physical examination, laboratory findings (CBC, ESR, blood chemistry, thyroid function tests, urinalysis, stool exam), chest X- ray and in selected cases, additional specific tests. Fifty-four patients were female, and 21 male the mean age was 45.7y±16.41, and the mean duration of pruritus, 21.8±21. In 43 patients (75.4 percent), no abnormal finding was detected. Five patients (6.66 percent), had atopy. In the remaining 27 patients (36 percent),  the following abnormalities were found: Iron deficiency in 6 patients (8 percent), diabetes mellitus in 6 patients (8 percent), hyperthyroidism in 4 patient (5.33 percent), hypothyroidism in 2 patients (2.66 percent), lymphoma in 3 patients (4 percent), chronic hepatitis, hypocalcaemia, psychosis and chronic renal failure each in one patient (1.3 percent). Evaluation of patients with pruritus may be a valuable tool for early detection of underlying systemic diseases.

The use of Frozen-section during surgical procedures, gives the surgeon valuable in formation and guides him to perform the appropriate surgical. In order to determine the accuracy of Frozen-section in gynecologic surgery, We Compared the results of 172 gynecologic Frozen-section diagnosis with their final diagnosis in Mirza kochak khan Hospital, from 1378 to 1379. A total of 106 ovarian, 43 uterine, 10 lymph node and 13 other tissue Samples were obtained. The Frozen-Section diagnosis was Compatible with the Final diagnosis in 93.6 percent of cases. The sensitivity for non benign lesions was 82.5 percent and the specificity was 96.8 percent. The positive and negative predictive values were 84 percent and 98 percent respectively. 2.3 percent of cases were falsely positive, 1.7 percent falsely negative and 1.2 percent over estimated the degree of malignancy. There was no underestimation and 1.2 percent were uncertain. Frozen-section was found to identify correctly 8 of 8 metastatic ovarian tumors and 1 of 2 germ cell tumors. The accuracy of Frozen-Section was 25 percent in ovarian borderline tumors, 60 percent in ovarian mucinous and 80 percent in serous tumors. With the exception of borderline and mucinous ovarian tumors, Frozen-Section diagnosis is Sufficiently iccurate for clinical use. Performing multiple sections is recommended in the Frozen-Section diagnosis of mucinous ovarian tumors.

Considering the incidence of meconium-stained amniotic fluid (MSAF) in newborns and its complications, and also based on indirect reports pointing out relationship between nucleated red blood cell (nRBC), as a marker of chronic hypoxia, and MSAF in term newborns, and in order to determine this relationship more accurately, this study was done on women with uncomplicated singleton term pregnancy that admitted for delivery at shariati hospital in year 2000. After excluding confounding factors on nRBC, case group who includes infants with MSAF, and control group who have clear amniotic fluid were determined. Maternal age and parity, gestational age, birth weight, apgar score, neonatal out come, and FHR pattern as well as newborn hemoglobin values were evaluated. Venous cord blood was analyzed for nRBC counts per 100 WBC. Case and control groups were divided according to nRBC counts with cutoff point of 10 and then compared statistically. From the samples, 117 cases and 67 controls were evaluated. Maternal and neonatal factors were similar in two situations. Number of nRBC was 3.75±4.8 in control group and 12.04±11.7 in case group (p<0.01) and it was abnormal (>10) in 9 percent of newborns with clear fluid and 32 percent of MSAF (p<0.01). Cord blood nRBC count increased when meconium is passed intrauterine. This suggests that cases with MSAF may be at risk of chronic hypoxia. Cohort research is recommended to study the affect of delivery mode on the neonatal outcome in cases with MSAF and to evaluate the cause of fetal hypoxia in uncomplicated pregnancy with MSAF.

Many studies have shown the clinical importance of CD7 expression in AML patients. To evaluate the clinical importance and response to chemotherapy in CD7 positive AML, This study was condudted. From the patients, 76 cases were studied during 3 years. In 3 years of this study 70.5 percent of CD7 positive and 89.6 percent of CD7 negative patients achieved complete remission with no significant difference between these two groups (P=0.11). We concluded that despite no importance of expression of this antigen in our patients, prevalence of CD7 positive cases in our study is higher than similar studies done abroad (52.6 percent versus 30 percent). It seems in respect of small number of our patients for evaluation of clinical and laboratory properties, larger study is needed.

Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium + E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D.) 1 disorder (manic episode) 24 were given E.C.T. + lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second of the group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001). These findings show that combination of E.C.T. and Lithium may not be harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

Tumor angiogenesis shown by Microvessel count (MVC) or Microvessel density (MVD). is  assessed by several studies as prognostic factor in some types of tumors, and also in colorectal carcinoma. This article is payed to correlation between clincopathologic factors and tumor angiogenesis. In this study, immunohistochemical techniques are used for vascular evaluation in specimens from twenty-nine colorectal carcinoma, and stained for factor VIII-related Antigen (F8RA) by using monoclonal Antibody. Uni and multivariate analysis disclosed that MVC was higher in tumor [76.3±33(×100=2.5mm2/filed) and 29.8±11(×200=0.87mm2/filed)] than in normal tissue [37.7±15.8(×100) and 17.6±7.8(×200)], (p=0.022, p=0.00009). Microvessel quantification was significantly higher in stage D (115±36.6, ×100 and 26.7±6.4, ×200, p=0.002 and p=0.04). in this study MVD has correlation with vascular invasion (p=0.024, ×100 and p=0.007, 200), the mean tumor vessel count although was increased with clinicophatologic findings such as age<60 years, male, right colon involvement, infiltration type, mucinous carcinoma, transmural penetration, grade III, lymphatic and perineural invasion, but was not statistically significant. Lymph node and hematogenous metastasis and size of tumor also, was not important. As a conclusion, MVD was increased in tumor and has shown correlation with metastasis, and vascular invasion. Resulting angiogenesis increase risk of metastasis.

Ovarian cancer is second prevalent cancer among gynecologic malignancies and the most common type on ovarian cancer is epithelial form (85-90 percent). To detect the risk factors for the epithelial ovarian cancer, a case-control study was conducted in Valieasr hospital in 1988. In this study, 118 cases with epithelial ovarian cancer (according histological records) and 240 control without any gynecological cancer in gynecologic clinic had been interviewed. For data analysis, T-test, Chi2 test and logistic Regression have been used at a=0.05 as level of significance. The mean age in cases was 50±13 and in controls was 49.9±12 years, without significant different. The mean number of pregnancies and parity in cases was less than controls, significantly (P<0.03). The mean months of breast feeding in cases was less than controls (54.9±71.2 versus 82.4±62.7) (P<0.001). The cases had a lower mean age of menarch than controls (P=0.03). 58 percent of cases and 21.3 percent of controls hadn’t used any contraception methods (P=0.00001). The mean years of contraception was significantly less in cases versus controls (P<0.001). The odds Ratio for epithelial ovarian caner was 0.24 (95 percent CI=0.13-0.48) in OCP users, 0.47 (95 percent CI:0.005-0.43) in TL method, and was 0.41 (95 percent CI=0.22-0.76) in other contraception methods, relative to women who hadn’t used any contraception methods. This study reveals that epithelial ovarian cancer risk increases significantly with earlier menarch, decreasing number of pregnancy, deliveries duration of breast feeding and use of contraception methods. Use of contraception pill and tubal ligation method decreases risk of epithelial ovarian cancer.

The pre-eclampsia/eclampsia is one of the commonest condition peculiar to pregnancy, to describe the occurrence of hypertension, proteinuria and edema in pregnancy. It is about seven times more frequent in first and uncommon before 20 week’s gestation. Serum BhCG levels were prospectively determined in 260 midtrimester singleton pregnancies where admitted form October 1999 until September 2000 at Mirza Kouchak Khan hospital, percent clinic. Obstetric chart review was undertaken after delivery to identify cases in which pre eclampsia developed. The median material age was 26.0 years, and the median gestational age at the time of blood collection was 19.0 weeks. Of these, 17 cases (6.5 percent) had pre eclampsia. The median level of the BhCG was 35060.5 mlu/ml in those with pre eclampsia, whereas that in those without pre eslampsia was 33755.1 mlU/ml. The difference was not significant (P=0.28). Although elevated midtrimester serum BhGC levels in clinically normal patients was reported in severely pre eclamptic women, this is not a good test for early detection of mild pre eclampsia.

To evaluate the diagnostic value of Image guided Fine guided needle Aspiration (FNA) in breast lesions, the cytologic results of 401 patients were studied. All patients had either unpalpable masses  or lesion who were hardly possible to localize by palpation and FNA was performed by single radiologist under Ultrasound guide in all cases. The cytologic results were divided into four categories (inconclusive, benign, suspicious and malignant. Pathologic results were also divided into two categories (benign, malignant) and additional statistical was conducted find the cut-off point between benign and malignant cytologic results. Following cytologic results were obtained: 7.98 percent Inconclusive, 67.83 percent benign, 10.97 percent suspicious, 13.22 percent malignant. Of the patients undergone breast operation after Image Guided FNA, the surgical pathology of 128 cases were found. In this study the sensitivity, specificity and accuracy of Image guided FNA were calculated as 94.34 percent, 82.67 percent and 87.5 percent respectively. Pearson’s coefficient analysis revealed significant correlations between FNA diagnosis and surgical pathology (p<0.001, r=0.66). Thus, Image guided FNA of breast lesions can be a reliable substitute for the excisional biopsy or breast operation in many patients.

Ellis-van Creveld syndrome (Chondroectodermal dysplasia) is a hereditary form of short limb disproportionate dwarfism characterized by diffuse involvement of skeletal system and visceral organs. Two brothers affected by this syndrome are presented are presented here following a brief account of the disease’s manifestations.

Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubations and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, etc. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and Cuffed Pharyngeal Tube (CPT). From the patients, 120 ASA: PS-I cases, were selected, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. their operations were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used of one group and CPT for others. Immediately after Operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P<0.001).

Inflammatory bowel diseases are one of the important reasons of the referral to GI practitioners in our country and Ulcerative Colitis is more frequent type of this disease in IRAN. In this study 200 cases of Ulcerative Colitis, which has been referred to Imam Khomeini Hospital during the last 5 year, were studied. Data was collected using the patient’s records and face to face interview with them and their relatives. Majority of the patients were female (55 percent). Positive family was seen in 28 percent of patients, autoimmune disease history in 8 percent, smoking history in 11 percent and smoking cessation history in 13 percent of patients. Most prevalent symptoms in the patients were nocturnal bleeding, rectal bleeding and bloody diarrhea. The most common involve area were recto sigmoid (58 percent) and descending colon (42 percent). Pan colitis was seen in 8 percent. Most people had complications and the most common complication was fissure (14 percent). Recurrence was seen in 83.5 percent of patients. With logistic regression analysis the only variable which showed significant relation with recurrence was male sex. According to the results of this study, it seems that ulcerative colitis clinical and epidemiological pattern in Iran is similar to many other countries, but the higher rate of recurrence and extra intestinal manifestations in patients shows that there is a growing need to reconsider the treatment efficacy in patients and correct the treatment methods.

Drug interaction may cause sever adverse drug reaction in patients. The high amounts of prescribed medication in hospitalized patients will cause higher incidence of drug interactions. Therefore, the study of drug interactions in hospital patients seems to be worth. We have, studied drug interaction in internal and surgical units, in Kashani hospital in Shahrekord. Factors included in this study were: mean of prescribed medications, frequency of drug, interactions, correlation between these two parameters, and the most frequent drug interactions. The frequency of drug interactions in different units of hospital, was as follows: 26.4 percent in surgical unit, 30.7 percent in internal unit and 34 percent in cardiac unit. The mean of prescribed medication was as follows: 3.09 in surgical unit, 3.92 internal unit and 5.86 in cardiac unit. There was a positive correlation between the number of medications and the frequency of drug interactions n prescriptions. Six different drug interactions, occurred frequently. There fore, it seems if physicians consider these interactions, the percent of drug interactions would be reduced considerably. We also found that most of drug interactions occurred when two or more diseases were managed concurrently. Therefore, it seems, having attention to these cases, would cause drug interactions to be reduced significantly.

Teratomas are emberyonal neoplasms derived from totipotential cells that contain tissue from at least two and more often three germ layers (ectoderm, enoderm and mesoderm) in the midline or paraxial location from brain to sacrococcygeal region. The primary objective of this study is to determine this rather common newborn and children teratomas in different areas of the body. The secondary objective is studying the incidence and is pathology and comparison of the data with literatures.In this research, 91 involved children in two hospital of the Tehran University of Medical Sciences from 1982 to 1999 has been studied.From 91 children 60 cases were sacrococcygeal teratoma, 14 cases were sacrococcygeal and pelvic (tot… 74), 9 cases in ovaries, 3 cases in the retroperitoneum 2 cases oropharyngeal, 2 cases in testis and one case in neck area. From these cases, 71 were neonate, the rest were infant or were more than 2 years old. From the cases 88 underwent surgical treatment, 3 cases died because of surgical complication and 3 cases died before operation. In this study, 84 percent of teratomas were benign and 16 percent were malignant.The comparison of these findings with literature showed little differences.