Tehran University Medical Journal
Year:2004 | Volume:62 | Issue:4|Papers Count:17

Conclusion: Despite the long history of surgical treatment in syndactyly repair, this reconstructive operation has still special complexities. Materials and Methods: In order to evaluation of results of our surgical reconstructions, we studied 77 patients (40 boys and 37 girls) with hand syndactyly (mean age at operation: 5.8±4.3 years) in Imam Khomeini Hospital from 1994 to 2003. All of these patients had been operated by standard surgical methods. Postoperative complications and functional, sensational, and cosmetic results have been assessed by patient records and physical examination after an average follow-up of 4.6±2.1 years.Results: Syndactylies were simple in 71 patients (92.2%), complex in 2 (2.6%), and mixed in 4 (5.2%). In 45 patients (58.4%), surgical repair had been performed without graft. The overall results of operations were good in 81.8%, moderate in 13%, and poor in 5.2%. The most common complications were: web migration in 9.1%, scar contracture in 7.8%, infection in 5.2%, necrosis in 3.9%, and angular deformity in 2.6%.Conclusion: In this study we shown that the standard methods in our center for correction of syndactyly, at least in recent 10 years, have been efficient and with good results.

Background: In order to evaluate bone induction and repair in cranial bone defects by the use of combination of Octacalcium Phosphate/Bone Matrix Gelatin (OCP/BMG), this study was conducted.Materials and Methods: We used 40 young male Sprague dawley rats (5-6 weeks age). A full thickness standardized trephine defect, 5mm in diameter, was made in the rat parietal bone and OCP combined with BMG was implanted into the defect. No OCP/BMG particles were implanted in control group that was otherwise treated identically. On the 5th, 7th, 14th, and 21st days after implantation, the rats were killed and bone samples collected. After processing the tissues by routine histological procedures, 5μm thick sections of bone were cut and stained with Haematoxyline and Eosin (H& E) and alcian blue and examined by light microscope.Results: On the 5th day after implantation, inflammatory cells were seen around the implanted materials, especially around the OCP particles. A few clusters of cartilage cells were observed between the BMG particles in the central position of defects on the 7th day after implantation. On the 14th day after implantation, osteogenesis was seen at the margins of the defects. In addition to bone formation from the margins toward the center, interstitial growth of new bone tissue was seen around the implanted materials. By the end of 21st day, almost all of the OCP/BMG particles were absorbed and bone trabeculae, bone marrow cavities and bone marrow tissues were seen. In the control group, at the end of 21th day, a few areas of new bone were seen near to the defect margins and host bone, but much less than in the experimental group.Conclusion: Therefore, implants of OCP/BMG appear to stimulate new bone growth in bone defects and these biomaterials could be used in the repair of cranial bone defects and injuries in clinical situations.

Background: Pulmonary Nocardiosisis an infrequent infection whose incidence seems to be on the rise due to a higher degree of clinical suspicion and to an increasing number of immunosuppressive factors. The present investigation was carried out to detect Nocardiosis in immunocompromised patients confined in the pulmonary ward of Tehrans Shariati Training Hospital through the use of indirect immunofluorescence assay (IFA) and bacterial culture methods. The comparison of the two methods and the correlation between the antibody titer and the statistical and epidemiological data were also investigated.Materials and Methods: 101 patients with advanced symptomatic pulmonary infection were studied in the course of a twenty-month period. Individual patients sputum, BAL (bronchoalveolar lavage) and blood sera were tested. From each sample three thin smears were prepared for microscopic observations. The samples were cultured in Sabouraud s dextrose, blood and paraffin agar. The detection of antibody against Nocardia asteroides was carried out in all study groups, using the IFA method. The medical history of patients was also obtained through questionnaires for further analysis.Results: Nocardia asteroides was isolated from only one patient suffering from Wagner vasculitis with an antibody titer of 1/512 in serum. The 41 patients suspected for Nocardiosis with an antibody titer ranging from 1/4 to 1/512 ,detected by IFA method, included 26 (63.4%) men and 15 (14.8%)women. The age of the patients varied from 7-80 years. Those with reasonable antibody titers included 15 (36.5%) housewives and 9 (21.9%) workers. Furthermore, in-vitro investigation for the differentiation of the isolates was performed and confirmed the notion that the organism which grew on the primary media was, indeed, the Nocardia asteroids complex.Conclusion: Our results revealed that the broncho-pulmonary infections, which occur in high-risk patients -T-cell deficiencies, long term corticosteroid therapy, immunocompromised hosts, HN infection, organ transplantation- was an important index for the primary diagnosis of Nocardiosis. As the important finding of the present research, the antibody titer of the 1/64 could be proposed as the criterion for the diagnosis of the infection. The probability of Nocardiosis was proposed when antibody titer was less or more than 1/64.

Background: Many of hospital acquired infections that cause so much morbidity and mortality and have great economical burden are transmitted via contaminated hands of health care workers (HCW).Prevalence of these infections can decrease up to 30% with hygienic measures. In this study we assessed the prevalence of careers and microbial spectrum of HCWs hand and relation between detergent used for washing and reduction of microbial load of HCW s hand.Materials and Methods: This study was done in two part: Descriptive part (cross sectional) and analytical part (before -after). Cases were Consist of all staff Working in wards of center of pediatrics hospital (Including attends, residents, interns, nurses and workers). In first part ,we assess hand microbial spectrum and contamination load of 72 staff and in second part, we assessed and compared hand microbial spectrum and load before and after of washing with four detergent: plain soap (60 staff), liquid soap (60 staff) , betadin scrub in ward (60 staff) and betadin scrub in operating room manner (26 staff).Results: %87.5 of personnel had positive cultures-The most prevalent bacteria were staph. epidennidis (%79.4), staph. oreus (%42.9), klebsiella (%12.7), E-coli (%12.7). The rate of reduction or negative cultures in groups used betadin were greater than the first two group (P>-value<0/05).Thirty staff (10 with plain soap,10 with liquid soap and 10 with operating room betadin scrub) dried their hands after washing. Forty percent of first, fifty percent of second and ninety percent of third group have negative culture after drying. Also 11 samples were drawn from faucets that all of them were positive.Conclusion: Prevalence of careers is high among HCWS and drying of hands can an important role in hospital infection rate. Faucets have heavy contamination and can transmit bacteria to hands after washing. For theses reasons education and of staff to correct hand washing and drying before every contact with patients and used of faucets without direct hand touching can play a great role in lowering hospital infections.

Background: As increase of cytokines (like IL-1b , IL-6 , IL-8 and TNF- a) in platelet concentrates (PCs) during storage are involved in Febrile Non Hemolytic Transfusion Reactions (FNHTRs) after Platelet transfusion, the aim of this study was the survey of these cytokines level in PCs produced in Tehran Blood Center.Materials and Methods: This study proposed to determine if WBC reduction in PCs by pre-storage leuckodepletion filters reduced the levels of these cytokines during storage uo 3 days. Each of the PCs (n=54) was prepared from single random donor (RD) by Platelet-Rich-Plasma (pRP), then were divided in four groups: 1- unfiltered non-irradiated RD-PCs (n= 13) 2- unfiltered and y-irradiated RD-PCs (n=16) 3 - filtered non-irradiated RD-PCs (n=14) 4-filtered and y-irradiated RD-PCs (n=11). Cytokines levels in PCs supernatants were measured by EUSA kits according manufactures instructions.Results: Our results showed: IL-8 was increased in unfiltered non-irradiated and IL-18 in g-irradiated RD-PCs but not in the filtered RD-PCs in day 3 . Compared to unfiltered PCs in filtered units. pre-storage filtration prevented a rise in the IL-8 and TNF- a in day 3 of storage. The concentration of  IL-1b was lower than the minimal detectable concentration by the kits used for this purpose. IL-6 was detected only in 7 units of all filtered PCs in day 3.  Conclusion: These data indicate that pre-storage leuko-reduction of PCs can prevent accumulation of IL-6, IL-8 and TNF-a during storage.  

Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation.Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

Background: The aim of this study was to assess the knowledge, attitude and practice of pregnant women about benefits and doses of folic acid consumption during pregnancy. Materials and Methods: A simple randomized study has been done with 300 pregnant women in (Mahdied, Shohada, Shariati) hospital. Women were asked about their information and about consumption of folic acid in order to prevent nural tube defect and reasons for not taking it.Results: There were 300 women, 150 (50%) had been recommended before to consume folic acid but only 46 (31%) of them used it during pregnancy. There were 37 (12%) who aware about taking it.Conclusion: Although 50% of women had been recommended to consume of folic acid, less than 50% of the women who were surveyed have been taking it. Strategies are required to increase folate intake among pregnant women and inform of the benefits of folate supplementation by the health eduction.

Background: The aim of this investigation is to evaluate the histologic results of biopsy in women with atypical squamous cells of undetermined significance (ASCUS) cytologic diagnosis.Materials and Methods: We reviewed a series of cases with ASCUS pap smears from March 1999 to Feb 2002 in Imam Khomeini Hospital (n= 104), Who had cervical biopsy indirected colposcopy (103) and in Onec endocervical biopsy obtained without colposcopy. In 60 patients before colposcopy and biopsy repeat pap smear was tabled.Results: Biopsy revealed 28.8% SIL (14 LSIL and 16 HSIL),1 invasive carcinoma and 1 endometrial carcinoma. Pap smear repeated for 60 women before colposcopy examination, which 7 (11.7%) of them were normal. ASCUS persisted in 45 cases (75%) and 8 cases (13.3%) turned out to be SIL (6 LSIL, 2 HSIL) of 7 normal repeat smear, 2 marked as LSIL by biopsy. In colposcopic examination 22 of 103 (21.4%) had normal view which one of them was LSIL histologically.Conclusion: Based on these findings, it seems immediate colposcopy and directed biopsy are appropriate procedures for management of ASCUS and to detect underlying SIL.

Background: This research was conducted for the purpose of determining the effect of hormonal and non-hormonal contraception on the mother milk and infants growth among lactating women received by south Tehrans Health Centers. In this regard a broad spectrum study from December 2000 until February 2001 was done by Tehran university.Materials and Methods: By sampling method, 200 lactating women were chosen randomly. They were divided into two groups according to their preferred method of contraception: 67 women chose hormonal method and 133 women chose non - hormonal method. Results & Conclusion: During the time of the study on infants growth (increase in head circumstances, increase in height, increase in weight), There was no significant difference between the two groups. If we take the effect of contraceptive methods into consideration, the Triglyceride levels in non-hormonal group were increased considerably compared to the other group. Other ingredients were almost the same.

Background: The important of angiogenesis for the progressive growth and viability of solid tumors is well established. Only few data are available for hematologic neoplasms.Materials and Methods: To investigate the role of angiogenesis in the acute myloid leukemia (AML) bone marrow biopsies from 30 adults with newly diagnosed, untreated AML(day 0) were evaluated. Further studies were done after completion on remission induction of treatment (day 35 of 7x3 regimen n=13, complete remission in AML (m3) treat with arsenic trioxide n=17). Micro-vessels were scored in at least 3 areas of highest micro-vessel density in representative section of each bone marrow specimen using immunohistochemistry for Von Willbrand factor.Results: Median micro-vascular density (MVD) were in AMLM3 patients before treatment, %6.81±3.58 and after treatetment %3.48±3.06 (p<0.0001). In other AML patients MVD were befor treatment %3.38 and after treatment %3.6.Conclusion: In conclusion, there is evidence of increased micro-vessel density in the bone marrow of patients with AML, which supports the hypothesis of an important role of angiogenesis in AML. MVD was reduced with chemotherapy and arsenic. Furthermore, these finding suggest that antiangiogenesis therapy might constitute a novel strategy for the treatment of AML.

Background: Mediastinum includes the vital organs like the heart the major respiratory passages and the major vessels due to this vicinity, the masses of this area with malignant or benign etiology or cause systemic diseases such as metastatic malignancies or granulomatous reactions can be potentially fatal.Materials and Methods: According to the priority of the problem, a ten years comprehensive retrospectively study of mediastinal masses in children was conducted In children medical Center (Tehran University) from the points of view of incidence, clinical manifestations and diagnostic and treating ways.Results & Conclusion: In our study there were 34 patients from 1992-2002 who were reviewed. No differences between boys and girls with mediastinal masses were observed. The most prevalence age for mediastinal tumors was form 5-10 years (38%). The most prevalent sign was fever (53%) and the most common symptom was coughing (44.4%). Basesd on this research, mediastinal masses have been the most prevalent finding in chest radiography (53.8%). CT-Scan with double contrast was recognized as the most common and easiest ways for diagnosing masses. Anterior masses were the most common finding in our study (41.7%). Most of these masses were removed by surgery and the most common operation in our patients was thoracotomy and removing the masses (61.7%). Lymphoma was the most common masses (35.2%) and masses with neural orgins occupy the second grade. According to available documents and with regard to mean follow up of patients in 3.2 years the rate of survival was 54%.