Tehran University Medical Journal
Year:2004 | Volume:62 | Issue:3|Papers Count:16

Background: Bone Marrow Transplantation is one of the most important therapeutic methods in much malignant and nonmalignant disease. Patients with Bone Marrow Transplantation (BMT) following radiotherapy and chemotherapy will suffer from immuno-suppression. Therefore they are susceptible to get saprophytic fungi infection that sometimes are killer. Materials and Methods: The purpose of this cross-sectional survey is isolation of saprophytic fungi from patients with BMT and wards space and instruments. Therefore sampling from ventilator system (HEPA filter and common filter), air canal, air, hospital instruments and clinical samples (nasal discharge, sputum, urine) were done and cultured in sabouro dextrose agar with choloramphenicol (SC). In assessing total frequency from 4838 plates of wards space and instruments, 985 fungi colonies includes 21 genus were isolated.Results and Conclusion: Most fungi colonies present were Penicillium, Aspergillus and Cladosporium and low present were Trichoderma , Stereptomyses, Chrysosporium, Rhizopus.

Background: CBD stones are the commonest cause of obstructive jaundice and cholangitis and in elderly patients with major underlying disease has a high incidence of mortality. Materials and Methods: In this study, we overviewed 200 patients with CBD stones which treated with cholecystectomy and Endoscopic sphinctrotomy or cholecystectomy and open CBD Exploration, and compare them for surgery complication, treatment failure and hospitalization complications.Results: We found that these two groups were equal for surgery complication and morbidity. But in patients with Endoscopic sphinctrotomy they had added complication of this procedure. Failure in stone removal both immediately after procedure and in final assessment and costs was considerably higher in the patients that were treated with Endoscopic sphinctrotomy. Conclusion: These results do not support preoperative Endoscopic sphinctrotomy as a technique for stone removal on the basis of efficacy, morbidity rate and cost. But overall conclusion about comparison of two methods is dependant to other studies about long term morbidity and other factors that affect results.

Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4 (group Ill) as case groups and, 105 patients with 1.1<ABI<1.4(group II) as control group underwent an exercise test according to the "Bruce protocol.Results: 497 patients (52.4%) were women, and 451 patients (47.6%) were men. The mean age was 55.25 ± 10.08 years. 57% of participants had high blood pressure with superiority of female (P = 0.002).10.2% of the patients had an ABI= 60 years (P = 0.02). 238 patients were in group I (25.1 %),625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P @0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P ==0.00). Both I . hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1<ABI<1.4. & point="<1.1" cutoff with (ABI) Index Brachial Ankle Conclusion: ="0.003respectively)" (P="0.001&P">=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.

Background: Patellofemoral joint disorders are the most common cause of anterior knee pain in patients who referred to orthopedic clinics. Patellar lateralization cause anterior knee pain due to weakness of vastus medialis oblique muscle or tightness of lateral structures like lateral retinaculum or iliotibial band muscle.Materials and Methods: For evaluation of this abnormality, plane radiography, CT scan and MRI are useful. In plane radiography only one view in a single joint position can be obtained, because of that it is not a good method to detect abnormal tracking during knee range of motion. The purpose of this study was to evaluate patellar tracking by kinematics MRI during five serial degrees of knee range of motion (40, 30, 20, 10,0 degrees) in 30 patients with patellar lateralizationand 10 normal subjects, aged 18-30 years.Results and Conclusion: tistical analysis showed that in patients group, patella had the most stability in 40 degree of knee flexion and this stability reduced when knee reached to full extension. At this point, patella moved laterally and the most instability was seen during 20 to 0 degree of knee extension.

Background: Epidural injection of the drugs such as opioids has rather been a successful method in controlling post operative pain. Materials and Methods: In a clinical trial study, 50 Female patients, in a range of 20-40 years old and ASA class I, who were scheduled for gynecologic operation were investigated. They were randomly divided in two groups. Before induction of general anesthesia, an epidural catheter was placed for each patient. Sixty minutes after the end of operation, a 15-ml solution containing 50-microgram clonidine was injected through the epidural catheter in the first group. In the second group, a similar volume solution containing 50- microgram fentanyl was injected. The catheter was-removed after all the patients were followed for 4 hours and their pain was assessed by VAS (Visual Analogue Scale) method.Results: Our findings revealed that the clonidine group had more intense pain; however they had fewer complications than the opioid group.Conclusion: We concluded that although clonidine might act as an analgesic drug, but epidural injection of a single dose of 50 microgram of the drug could not be effective enough for postoperative analgesia.

Background: Many recent studies have examined potential risk factors of H. pylori gastritis to improve our understanding of the early events in gastric carcinogenesis. We evaluated the extent and topography of chronic gastritis in a high risk area for gastric cardia cancer and investigated the critical role of H.pylori, risk index and age in its pathogenesis.Materials and Methods: During a national population-based endoscopic survey, we enrolled 508 participants aged ≥40 from urban and rural areas of Meshkin- Shahr, Ardebil province of Iran. After informed consent, all underwent complete upper GI endoscopy. At least one mucosal biopsy was obtained from 6 standard sites: three of antrum (sites 1, 2, 3), two of corpus (sites 4, 5) and on of cardia (site 6). Severity, activity and combined inflammatory scores (CIS) of chronic gastritis and H.pylori infection status were assessed according to modified Sydney Classification of Gastritis. Statistical effects of H.pylori, age, gender, and residency place on mean gastritis severity, activity and CIS were separately calculated in each site.Results: Total of 508 participants with mean age (±SD) of 54.6 (±SD) were enrolled. 234 (46.1%) were male and 274(53.9%) were female. histologically 80.5% of cases were H.pylori positive. Mean activity scores of all site except for site 5 are significantly (P<0.01) higher in h.pylori + cases. Mean CIS of all sites was significantly (p<0.01) higher in h.pylori+ patients . In 44% of infected subjects, CIS of the corpus was at least equally as severe as that in antrum. Also in 54% of h.pylori + cases, cardia s CIS was ≥than antral CIS. Age had a significant (P<0.01) negative relationship with CIS of antral site, but this relationship in cardi was positive and more potent. Conclusion: h.pylori is the main cause of  gastritis activity in all sites of stomach; this causality is more potent in antrum and cardia. Continuous cardia inflammation in advaced age may contribute to high contribute to high incidence of gastric cardia cancer in this region.

Background: Infants and children present with a wide range of congenital chest wall deformities which have both physiologic psysiologic consequences and are often associated with other abnormalities. Surgical intervention offers excellent cosmetic results with minimal morbidity and mortality. In order to investigation of chest wall deformities, and surgical results, this study was performed.Materials and Methods: A descriptive study on existing data on 60 consecutive patients with chest wall deformity during 10 years carried out. Patients characteristics such as age, gender, signs and symptoms type of operation, associated disorder, syndrome, and surgical complications were considered.Results: Pectus excavatum 60% and pectus carinatum 30% Poland syn 6.7% 9 sternal cleft 3.2. Inpectus, M/F: Was 3/1 and others were 1:1. Age of admission 4 to 27 years 13.4±6.82) and association syndromes were, turner, Morgue and marfan, most patients were operated in delayed time (75) and hence, scoliosis was common than others. Conclusion: Pectus excavatum was the most common deformity and if scoliosis was prominent and most operation was done in old age but surgical result was excellent no anyone expired and complication was a little. So we recommended that all of the chest deformities must be operated in anytime.

Background: Graft-versus-host disease is one of the major complications after allogenic bone marrow transplantation, but it is not easy to anticipate the onset. Cytokines released by type 1 T-helper cells are thought to play a pivotal role in acute graft-versus-host disease (aGVHD). The ability to predict the likely occurrence of graft-versus-host-disease (GVHD) after BMT would be extremely valuable. By serially measuring serum levels of soluble IL-2 receptor (sIL-2R), 1L-18 and following allogeneic bone marrow transplantation (BMT), we tried to define their relationship to aGVHD as complication of the transplantation and determine useful markers for aGVHD predictors. Materials and Methods: Serum sIL-2R, IL-18, and levels were measured by sandwich ELISA in 219 sera samples from 39 patients (with hematological disorders before and after allogeneic BMT) and 28 controls. All patients received BMT from HLA-identical siblings. Results: 25 patients developed aGVHD and serum levels of sIL-2 R and IL- > 18, in sera drawn before transplantation, in patients with acute graft-versus-host disease (aGVHD +), were increased in comparison of patients without acute graft versus- host disease (aGVHD -) and control group and there wasn t any significant differences in serum levels of sIL-2 Rand IL-18 in aGVHD - patients and controls. Serum level of IL-18, in aGVHD +patients, was increased during day 3 -24 after BMT, and there was a significant difference in patients with GVHD 0 – GVHD III . In majority of patients with acute GVHD (60 %) , the peak levels of IL-18 and IL-2R was achieved on day 10 after BMT and the rise in sIL-2R and IL-18 preceded of clinical signs of GVHD (mean day 15 after BMT). Level of IL-18 in patients with aGVHD had strongly correlated with the severity of aGVHD on Day 10 after BMT. IL-18 level mean (before BMT), in patients who received Busulfan and Fludarabin to treat aGVHD, was lower than in patients who received Busulfan - Endoxan, or Cyclophosphamide.Conclusion: Our data concluded that IL-18 plays an important role in the development of aGVHD and IL-18 level might be an indicator for aGVHD, reflecting. the severity of the disease. These findings suggest that IL-18 may play important roles in the pathogenesis of aGVHD and that measurement of serum IL-18 levels can be useful predictor of aGVHD.

Background: Depression is a common problem and reduces function of persons. Evaluation of this matter in Gifted Intelligence-because superior their beneficial ness- have more importance. Our aim in this study is to determine relative frequency of depressionin Gifted Intelligence as compared with Normal persons. Materials and Methods: In the context of a case - control study 90 Normal volunteers and 56 very superior volunteers - aged between 20 and 30 years, so that matched in respect of gender- were investigated by Beck Depression Inventory. IQ identification was performed by both Wechsler Adult Intelligence scaling and Ravens progressive Matrices. Results: out of 90 Normal persons, 36 were depressed (40%) and among 56 Gifted Intelligence, 35 were depressed. (62.5%) In other words relative frequency of depression in Gifted Intelligence- with significant differences- is more.(p<0.05).Conclusion: Although Gifted Intelligence have more ability in opposition to stress- because higher level of IQ-but in this study was observed that prevalence of depression in Gifted Intelligence is more. This finding may be by reason of higher perception of them and the result of it- actually- more meeting of stress.

Background: GDM (Gestational Diabetes Mellitus)is the most important medical complication in pregnancy. Its prevalence is about 1-14 percent. It is necessary to follow up patient with GDM in order to detect any Glucose intolerance and improve their long term outcome. The aim of this research is to find the relationship between GDM and metabolic disorder (such as glucose intolerance. Lipoprotein profile disorder and androgen disorder), which are known as cardiovascular risk factors. Improvement of these agents is achieved by changing the life style. Materials and Methods: In this study 107 patients with recent GDM were assessed 6 months after delivery. Fasting Glucose, glucose intolerance, lipid profile, and androgens were measured. Clinical and obstetrical history based on GDM recurrence, history of macrosomia, amount of insulin to control blood sugar, breastfeeding and contraception after delivery, menstrual changing, hirsutism status were assessed and analyzed statistically.(ANOVA, x2, Fisher test) Results: The result of this study shows 19.6 percent diabetes and 15.9 percent impaired glucose tolerance test that point out significant relationship between the recurrence of GDM, obesity, macrosomia, as well as the need of more insulin in pregnancy with prevalence of Diabetes after delivery. In patents with Diabetes and IGT comparing to normal group, lipid profile disorders such as high total cholesterol, LDL cholesterol, triglyceride and low level of HDL cholesterol were seen. There was a significant relationship between diabetes after delivery and high prevalence of hypertension.Conclusion: Considering the high prevalence of diabetes in patients with gestational diabetes and interfering of some cardiovascular risk factors. We suggest correct follow up planning of patients with GDM by health care provider after discharge, and appropriate training of biomedical personals in this field.

Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003. Materials and Methdos: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant .brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases.(40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.