Tehran University Medical Journal
Year:2002 | Volume:60 | Issue:3|Papers Count:14

The development of testicular masses in male patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency has been recognized for many years. We present here the eighth and ninth reported patient with bilateral testicular tumors associated with 11 hydroxylase deficiency. They were two brothers aged 7.5 and 5 yr. who had bilateral testicular tumors and diagnosed because of signs and symptoms of true precocious puberty and high blood pressure. The patients testicular enlargement is suggestive of bilateral testicular adrenal rest.

Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors. Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain. Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS. Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.

Background: Auditory brainstem response (A.B.R) is one of the most important electrophysiological tests in evaluating of auditory system, especially for diagnosing of auditory nerve and brainstem disorders. It is a non-invasive test and has reliability and validity characteristic. There is no contra-indication for this test. One of the most important of stimulation parameters of A.B.R is click polarity (rarefaction, condensation and alternative). Some of the investigators believed that different polarities have no effects on A.B.R are affected by different polarities. Materials and Methods: In this study, the results of ABR of 148 patients (296 ears) were compared with three different polarities of rarefaction, condensation and alternative half click stimuli. The cases were categorized in three groups of normal (60 cases), cochlear (62 cases) and retro-cochlear (17 cases). This classification were done according to the hearing level in pure tone audiometry results in three frequencies of 1000, 2000, 4000 Hz and to the site of the their disorders. The mean absolute latencies of waves I, III and V were obtained for each polarity. Inter-peak latency (I.P.L) of wave also measured in three groups (normal, cochlear and retro-cochlear). Results: The results were showed a significant difference between absolute latency of wave I among different polarities on three above mentioned groups (P<0.05). There were no significant discrepancy for other waves of III and V and Inter-peak latency (I.P.L) of wave I to (P>0.05). Conclusion: It was concluded that rarefaction polarity has better and more stable results of ABR tests.

Introduction: It is suggested that quadriceps muscle has an important role in stability & mobility of Knee joint in athletics and normal individuals; therefore, the purpose of this study was evaluation of the strength in Power Athletics (PA) and Normal Un-trained Individuals (NUI) groups. Methods and Materials: 31 Females (20 NUI & 11 PA) participated in this study. For measuring the strength, each individual performed 5 continuous concentric-eccentric maximal contraction at angular velocities of 90°/s, 135°/s. Twenty five percent of each individual (Maximum Voluntary Isometric Contraction) MVIC was determined and used as Pre-load force. Results: Averages concentric & eccentric torques were greater in PA group in comparison with NUI group. The significant difference (P<0.02) existed between PA and NUI groups. Average concentric torques of quadriceps muscle decreased (with increasing of speed from 90°/s to 135°/s) and average eccentric torques increased. Average eccentric torques were greater (P<0.01) in PA & NUI groups in comparison with average concentric torques. Conclusion: PA group strength was greater in comparison with NUI group. This is possibly due to the type of muscle fibers in this group have (greater type II fibers). Accordingly, it is critical to consider the role of eccentric exercise in PA group for preventing sport injury.

Introduction: Alcoholic and aqueous extracts and total alkaloids of the seed of (Syrian rue) peganum harmala L. as scolicidal compound against Hydatid cyst protoscolices were assessed in this study. Methods and Materials: This study was carried out both invitro and by inoculating inside the intact cysts in the shaking bath and dry incubator at 37°c. Different concentration of suspensions were tested in different exposure times. Mortality of protoscolices was determined by their loss of mortality, ability to take vital stains and inactivity of flame cells. Results: The results indicated that alcoholic extract had scolicidal effect against protoscolices; total alkaloids had stronger action and rapid effect on protoscolices.

Introduction: Reciprocal changes are ST depression ?1 mm in electrocardiogram of the patients with acute myocardial infarction in the reciprocal leads. This question that these changes are merely secondary to ST elevation in infarction area or that they are truly subendocardial ischemia secondary to involvement of coronary artery that perfuse that area is not clearly defined. Methods and Materials: In this study, 33 patients with acute myocardial infarction and reciprocal changes in ECG at the time of admission, were selected and coronary angiography was performed in them in a week of infarction. Results: Correlation between reciprocal changes in ECG and involvement of reciprocal coronary artery the coronary artery that perfuse area of myocardium related to reciprocal changes in ECG were studied. 32-63 percent of patients (1/3-2/3) with reciprocal changes had significant stenosis of reciprocal coronary artery in coronary angiography (CI=95 percent). The incidence of multivessel disease was about 60.6 percent. After coronary angiography 33.3 percent of patients referred for coronary arteries bypass graft surgery (CABGS) and 27.3 percent for percutaneous transluminal coronary artery angioplasty (PTCA). In the other words, 60.6 percent of our patients refered for revascularization, PTCA or CABGS. Conclusion: We concluded that because of the need for intervention in about 60 percent of our patients, coronary angiography could be recommended in all patients with acute myocardial infarction and reciprocal changes in ECG.

Maxillary sinus atelectasis is a rare and relatively unknown disease. Most patients present with non-sinonasel complaints. Negative intracavitary pressure due to ostial obstruction is suggested as the most probable etiology. Two patients with sinus atelectasis are presented in this paper: Case 1 presented with enophthalmus and maxillary sinus opacity and atelectasis in imaging. Endoscopic uncinectomy and midle antrostomy was done for this patient. Case 2 presented with mid-facial deformity and depression. Caldwel-Luc procedure with inferior meatal antrostomy was done. In 1 year follow up, they were asymptomatic and with no deterioration of facial deformity.

Introduction: As spinal cholinergic receptors exhibit an action against somatic pain, this effect could be potentiated by intrathecal injection of cholinesterase inhibitor-neostigmine. This study was designed to evaluate the role of interathecal neostigmine on local back pain relief after single level lumbar disc surgery. Methods and Materials: In an interventional-expremental study (Imam Khomeini Hospital, Jun. 2000 to sep. 2001), sixty-six patient with unilateral herniated lumbr disc at one lumber space were randomely allocated into two groups including, control (C) group and Neostigmine (N) group. Both groups underwent fenestration employing same anesthetic techniques. At the end of surgery 2 ml normal saline in groups C and 100 micrograms neostigmine methylsulfate (0.2 ml combined with 1.8 ml normal saline) in group N were injected intrathecally postoperative local back pain was measured with 10 cm chart method using Visual Analogue Scale (VAS) at 1, 4, 8 and 12 hours. Total dosage of morphine, as an analgesic rescue, used during the first 24 hours following surgery and observed complications were recorded. Results: Mean VAS score postoperatively at 1st and 4th hours were 2.24 (Standard Error Mean, SEM=0.36) and 1.82 (SEM=0.28) in group N and 5.36 (SEM=0.39) and 5.61 (SEM=0.37) in group C respectively. Mean morphine used in the first 24 hours was 0.9 (SEM=0.4) in group N and 4.7 (SEM=0.65) mg in group C. All result were found to be statistically different in the two group (P<0.05). There was no neurologic deficit or CSF leakage in both groups postoperatively. Regarding nausea and vomiting, the difference between two groups C (15 percent) and N (24.2 percent) were not significant statistically. Conclusion: In this study, we have found that injection of 100 micrograms hyperbaric neostigmine intrathecally is a safe and effective method with minimal complications or side effect for pain relief and curtails postoperative opiate demand.

Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (Coronary Artery Bypass Graft) is one of the therapeutic methods in ischemic heart disease.Methods and Materials: Considering the increased incidence of coronary artery disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999). In 635 patients 467 male (73.5 percent), 168 female (26.5 percent) about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease), history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and coronary endarterectomy. Results: Cigarette smoking (P=0.40), CHF in female (P=0.003). Endarterectomy in both gender (P=0.0001). Pace maker in both gender (P=0.00006), palpitation in both gender (P=0.0001). CPR in both gender (P=0.0000001), were associated with increased risk of mortality after CABG. Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.

Background: Transbronchial lung biopsy (TBLB) is an attractive alternative to open lung biopsy as an initial diagnostic procedure for patients with diffuse parenchymal disease or localized densities beyond direct endoscopic vision. TBLB can be carried out safely without fluoroscopy in patients with diffuse lung disease. Since in our bronchoscopic department fluoroscopy is not available, we planned to evaluate the blind (without fluoroscopic guide) TBLB being performed in our department to determine the success rate in obtaining lung tissue, the sensitivity of the procedure and the risk of complications. Materials and Methods: Sixty-Four TBLB were done in our department during a 6 month period (March-September 1999). Results: Lung tissue wasn’t detected in two (3.1 percent) samples. Pathological results were helpful in 46 (71.9 percent) cases. No evidence of hemoptysis was found after the procedure. Three (4.68 percent) cases of pneumothorax was detected. Only one of them required chest tube (1.51 percent). Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

Background: Urinary tract infection is a common bacterial infection in children and may lead to irreversible renal damage. TC 99-m Dimercaptosuccinic acid renal scintigraphy is the most sensitive method for diagnosing acute pyelonephritis. We designed a study to evaluate the ability of DMSA scan and ultrasonography to detect renal paranchymal lesion. Materials and Methods: 62 children 1 month to 12 years of age with the first episode of acute pyelonephritis were prospectively studied with DMSA scan and ultrasonography during acute phase of infection. A Voiding Cystourethrogram was performed in 60 children when urine culture became negative. Children with renal paranchymal changes were older at the time of acute pyelonephritis (P=0.04) but no difference was found between the groups with regard to levels of CRP, ESR (P>0.05). Results: Changes on the DMSA scan were found in 106 (85.5 percent) kidneys of 62 children but ultrasonography showed renal changes in 19.4 percent (sensitivity=20 percent, specificity=83 percent) (Kappa=0.06). Vesicoureteric reflux was found in 14 children (23.3 percent) but 83 percent of the affected kidneys were drained by non-refluxing ureters. Conclusion: It is concluded that DMSA scan is more sensitive than ultrasonography in detecting renal paranchymal changes in acute pyelonephritis and we found out that renal paranchymal changes after acute pyelonephritis is common, even in those without VUR.