Journal of Medical Council of Iran
Year:2004 | Volume:22 | Issue:3|Papers Count:20

Craniopharyngiomas make up about 1-3 percent of primary tumors of the CNS. This tumor can develop at any time from birth to old age, but more than 50% of patients are younger than 20 years. Most of them are suprasellar, but nearly 25% have an intrasellar component. Most of the clinical manifestation of tumor are related to their compressive effects, and include headache, visual disturbance, hydrocephalus and endocrine abnormalities. Two distinct variants of craniopharyngioma are recognized, the classic adamantinomatous type and a recently described papillary form.In this study we describe clinicopathologic findings of 71 patients diagnosed with craniophayngioma.The majority of patients were male, patients age ranged between 4 to 51 years and headache was the commonest presenting symptom.Microscopically most of them were adamantinomatous type and only 5 cases were papillary type. The most common post operative complication was recurrence of disease, and all of them were adamantinomatous type.

Hearing Loss is the most common sensory disorder in children. In an authorized newborn screening project in the United States, they concluded that in each 100/000 births, 3 had PKU, 2 Galactosemia, 2 adrenal hyperplasia, 28 hypothyroidism, 47 sickle cell anemia and 314 cases had hearing disorders. Screening is being done in newborns for two main purposes: The first is early detection and timely rehabilitation in a period of time in which a child*s CNS has the highest potential and ability of neuroplasticity. Considering this potential aural rehabilitation will yield the best result.The second is prevention of disability occuring secondarily. The only way of timely diagnosis of children s hearing loss is new - born hearing screening.The best age of hearing disorder detection is before three months and the best time for aural rehabilitation is by six months of age. In our study, hearing loss spectrum is not comparable to other studies in developed countries. We believe that most parents and some physicians don t care for mild and moderate hearing loss in children and these hearing disorders are missed.In reference to Deaf Welfare Clinic related to Behzisty Organization the lowest age of diagnosing of hearing disorder is 3 years, so, at best, we are faced with 2.5 yiars delay in diagnosis which is uncompensatable. In order to fight the dilemma of delay in the diagnosis of hearing loss, we should focus:1) New born hearing screening and its follow up up to six years.2) Offering more data on childrens hearing disorder to general practitioners and pediatricians about prevalence of hearing loss and importance of early detection.

Parasitic infections are one of the most common problems world wide specially in developing countries including our country. one of the commonest parasitic diseases is giardia lamblia. The objective was to compare effect of Metrpnidazol and Furazolidon on Giardiasis to evaluate the frequency of giardiasis in south of Tehran.The study is cross- sectional prospective. Between 23 october 1999 and 22 nd February 2000, a total numder of 650 stool specimens from patients with abdominal discomfort were collected for giardia lamblia in 3 laboratories that were located in the south of Tehran. Stool specimens were taken at 3 different times and stool exam was performed by conventional methods.Patients were divided to 3 age groups (0-10 years, 10- 20 years, >20 years) and questions regarding sex, age, symptoms, education, economic, water supply were asked. The patients with positive stool exam for giardia labmblia were divided to two groups, one group took metronidazol and another group took furazolidon, and two weeks after completion treatment their stool exams were repeated.A total number of 74 stool specimens were positsve for giardia lamblia, 36 (48.64%) men, 38 (51.35%) women; 36 (10.71%) in age group 0 - 10 years, 20 (25%) in age group 10- 20 years, and 18 (7.69%) > 20 years. The most common symptom in children was diarrea and in adult abdominal pain. 88.38% of patients were cured by Metronidazol and 94.11% by Furazolidon. There was no significant difference between metronidazol and furazolidon in the cure of giardia lamblia (P> 0.05, P= 0.6). In this study, women and age group 10 - 20 were infected more, and educationwas importantin age group 0 - 10 years, therefore, education about water supply, hygiene is effective in controlling giardiasis. Furazolidon was as effective as Metronidazol with fewer side effects, therefore, we can use Furazolidon in treatment of giardiasis.

Despite the fact that pregnancy is delightful for most women but it causes apprehension.Post partum period is the most dangerous period for psychological diseases and post partum depression is considered as a severe psychological disroder. Depression after delivery occures in about 10% - 15% of women. This situation adversely affects the mother, and retards the developmental, cognitive and emotional growth of children. Since non-recognition of post partum depression after delivery may cause noneffective incompatibility of mothers with children and familty and a decrease in the knowledge and the absence of natural feelding following childbirth, and eventually leading to a change in the family set up , we decided to carry out a research to establish the prevalence of postpartum depression and the factors affecting it in Tehran.This research is descriptive -analytical study. 300 women referred to 16 health and treatment centers in Tehran affiliated to Shahid Beheshti University have been studied for 3 months. These women were between 2 weeks to 6 months after delivery and had referred to health and treatment centers for childcare service or family control. Edin Burgh questionnaire for assessing post partum depression and Enrich questionnaire for evaluating marriage satisfaction and Winfield & Tyggman questionnaire for social support assessement as well as two other questionnaire forms for Dempgraphy, Midwifery, neonatal state were utilized for this research.The results show that 23.7% of women were depressed and 76.3% were non-depressed. Statistical Test of variance analysis shows significant relation between post partum depression and husbands education level (P=0.047), marriage dissatisfaction (P = 0.000)and lack of social support (P = 0.000). T Statistical Test shows significant relation between post partum depression and unwanted pregnancy (P=0.021), congenital disorders of the newborn, disorders of newborns and post partum depression (p = 0.019) and nervous - mental disease and post partum depression (p = 0/000). There was no statistically signticant difference between age, age at marriage, employment status of the women, educational status of the woman, type of delivery, of deliveries, gender of the newborn, economic and social status and postpartum depression.

Because of referral of patients with syndactyly and the occurance of some of the complications of skin grafting, and seemingly an attractive site of the skin graft removal along with the specific characteristics of the skin of the prepuce, the effect of the prepuce graft was evaluated in children with syndactyly at Dr. Shariati and Baghiatallah hospitals.This clinical trial was performed on 8 patients with syndactyly .Initially following a circumcission, the prepuce was removed and kept in normal saline. Then the fingers release was accomplished and the prepuce utilized for skin grafting. The effect of the movements of the toes were evaluated during a 3 month follow up.The research was conducted on 8 children with a mean age of 1.8 years with syndactyly. During the last assessments, the color of the skin was normal, there was no evidence of any limitation in the movement of the toes and there was no restriction in their functional activity.  Use of the skin of the prepuce in this patients is highly satisfactory and its use is recommended. lt is suggested that circumcission be delayed in patients with syndactyly.

Drug acting on the central nevrous system(CNS) are widely used in the world as well as Iran due to social, economic and cultural factors. Thus because of the importance and wide prescription of drugs, prescription patterns of five groups of drugs including sedatives, hypnotics , antidepressants, antiepileptics, antipsychotics and antiparkinsonism were evaluated in Tabriz. 1461 prescriptions were collected from 24 randomized - selected pharmacies and analyzed. The results indicated that:1)-On an average 3.65±0.3 types of drugs were included in each prescription which was 1.8 times more compared to International standards. 2-Out of 1461 prescriptions, 288(19.71) contained at least one drug affecting the CNS.3- 41.41% of the total prescriptions were prescribed by general physicians, out of which 18.34% contained at least one drug affecting the CNS.4- Drugs acting on the CNS were prescribed in 94.87%, 58.18% and 36.66% of cases by Psychiatrists, Neurologists and Rehabilitists, respectively.5- Women received these druge more compared to men so that 62.5% and 35.77% of these prescriptions were advised for women and men respectively (p<0.01). Average mean ages of women and men receving these drugs were 41.76±4.2,  26.29±4.7 respectively and for children under 12 years 4.66±0.5.6- Sedatives, hypnotic agents were the most common prescribed drugs both for women and men. However, these agents were prescribed for women more than men (p<0.05). In contrast, Antiepileptic drugs were prescribed for men more than women (p<0.01).7- 58.68% and 26.04% of the prescriptions contained one or two of these agents, respectively and the rest contained 3-6 of them.Considering of these results, we conclude that the correct prescription of these agents, therapeutic monitoring of them, prescription by specialists and limitation of poly pharmacy may increase efficacy and safety of them.

Mediastinitis is one of the ominous complications following cardiac surgery and has a higher degree of mortality. The aim of this study is to determine pre, intra and postoperative variables that predispose patients to mediastimitis. In this study, 27 pre, intra and postoperative variables were assessed. 1100 patients underwent coronary artery bypass surgery between June 1998 to 2000 and 35 (3.18%) patients developed mediastinitis (Group 1) who were compared with those who did not develop this complication (Group 2). Mean age of Group 1 and 2 were 64.6 + 12 and 58.3 +14 years respectively. Group 1 comprised of 26 men and 9 women whereas Group 2 comprised of 788 men and 277 women. There was no meaningful difference as far as smoking, hypercholestremia or hypertension were concerned, however diabetes mellitus, obesity and chronic obstructive pulmonary diseases were much more common in Group 1 (p<0.05). Majority of the patients in Group 1 compared to Group 2 were in class 3 and 4 based on New York Heart Associations severity of heart failure (p<0.05). Both left and right internal mammary artery grafts were used in 14.2% of Group 1 and 8.9% of Group 2 patients (p<0.01). 342% of Group 1 and 7.1% of Group 2 patients underwent re-operation because of hemorrhage. The need for mechanical ventilator for more than 24 hours was observed in 7(20%) and 91(81.5%) of Group 1 and 2 respectively. Multivariate analysis demonstrated that 4 out of the 27 variables had a crucial effect in the development of mediastimitis and these veriables included obesity, severity of heart failure, length of operation time, and re-operation. Postopertive one-month mortality was 14% and 4.6% respectively in Groups 1 and 2.The study documents that obesity, prolonged operative time, severity of heart failure, and re operation are the most important predisposing factors in mediastinitis following coronary artery bypass graft surgery.

Lead toxicity causes hemotological, gastrointestinal, and neurological dysfunction in adults and children. Dust, water, paints and paint chips are still major sources of lead toxicity. Lead has been known as a highly toxic enviromental factor for a long time. In recent years several epidemiological, experimental and clinical studies have indicated that even relatively low blood lead levels may affect the cognitive ability in young children. The following were the groups of subjects, who gave their informed consent in the study: I-Healthy controls, fifty-four haematologically and clinically (including physical examination) male normal subjects with mean age of 45 and from different jubs served as controls, 2-Occupationally exposed subjects, fifty male painter building workers exposed to lead (mean duration of working 13 years) with a mean age of 40, were included. Subjects with any indication of coexisting iron deficiency or any abnormal findings on physical examination were excluded from the study. The standard haematological, erythrocyte delta aminoleavulinic acid dehydratase and blood lead determinations were performed in two groups. The enzyme acitivity was significantly decreased in the occupationally exposed subjects (1304±146 µmole L / h versus 1535±181, p<0.001, t=9.56) as compared to control. In occupationally exposed subjects blood lead concentrations were significantly higher than controls (1.34±0.6 µmole/L versus 0.57±0.21, p<0.001, F=13.6). In the control group there was no significant correlation between blood lead levels and logarithm of ALA-D (r=-0.21, p=0.067)). In contrast, in exposed group a statistically significant negative correlation was noticed (r=-0.48 , p<0.05). In exposed group ferritin was significantly higher and TIBC significantly lower than in the control (76±23 µg/L versus 58.5±16, p<0.01 and 47±15 µmole/L versus 65±17, p<0.01 respectively). It is generally accepted that erythrocyte ALA-D activity is the most sensitive and specific biochemical index of acute and chronic lead poisoning. Since low blood lead leveles have been associated with decline in intelligence quotient, screening programs in urban centers and occupationally exposed workers are now identifying asymptomatic individuals with elevated blood lead levels.

This paper studies the relationship of DNA analysis ploidy and stage of ovarian dysgerminoma and its prognosis with flowcytometric evaluation. The files and specimensfrom24 cases (mean age 18/2± 4/5 years)seen at Mirza Kouchak khan and Imam Khomeini hospitals between 1992 and 1997 were assessed and the patients followed for period of five years. There were llcases (45/8%) in stage I, 2 (8.3%) in stage 11,7 (29.2%) in stage III and 4 (16.7%) in stage IV. DNA aneuploidy was revealed in 13 (54.2%) of tumors. There were 6 (15%) deaths, 7 (29.2%) recurrences and 11 (45.8%) tree trom the disease during the follow-up. DNA ploidy was significantly related to prognosis (p = 0.0006) and stage (X2= 15.9, P = 0.04). The deaths and recurrences in cases with DNA aneuploidy were 30.5% and 53.8% respectively; only 7.7% were free. The most frequent aneuploidy was in stage III and IV (85/7% and 75% respectively). Within microscopic data, mitosis, pleomorphism, necrosis and hemorrhage significantly related to DNA ploidy (p< 0.05).The trequency of aneuploidy was greater in mitosis> 8 in HPF, higher pleomorphism and presence of necrosis and hemorrage. Our study revealed that DNA aneuploidy in ovarian dysgerminoma is related to higher staging and poor prognosis.

Fully quantitative cytological techniques for the analysis of hematopoietic chimerism are very limited and are largely restricted to sex - chromosome detection after sex - mismatched bone marrow transplants (BMTs). The aim of the present investigation was to evaluate the application of FISH technique in peripheral blood interphase nuclei of three patients who had received sex - mismatched bone marrow transplants. The FISH technique shows 40% to 85%(average 61%) chimerism in these patients. All the three studied patients having undergone bone marrow transplants have achieved complete remission now. Evaluation of mixed chimerism has potential applications in controlling self reactions avoiding rejection of the transplant.

Rupture of the liver is a rare and threatening complication during pregnancy. This important accident is more common during preeclampcia and HELLP syndrome. It is also reported in old multiparous. Hemorrhagic shock is usually the most common symptom and sign. Maternal and fetal mortality rate is more than 50%. A 39 year old gravid 9 para woman presented to the emergency room with abdominal pain and signs of hemorrhagic shock and , fetal distress. Urgent laparatomy was planned, the uterus was intact and gross hemorrhage was present in the. pelvic and abdominal cavity. The fetus was delivered by cesarean section and the exploration proved 8 cm rupture in the right lobe of liver which was repaired. Both mother and fetus were saved from the effects of this dangerous complication. Liver rupture should be considered when there occur pain in the upper part of the abdomen and signs of hemorrhagic shock, even in the case of an uncomplicated pregnancy.

Congenital adrenal hyperplasia (CAH) is an of autosomal recessive disorder of adrenal steroidogenesis leading to a deficiency of cortisol.The deficiency of cortisol results in increased secretion of corticotropin which, in turn leads to adrenocortical hyperplasia and overproduction of intermediary metabolites. In 90% of the cases, with this disease, there is a problem with the enzyme 21 hydroxylase (21 OHD). Severe and mild forms of these disorders, caused by variations in the severity of the genetic mutations have been reported. Depending on the enzymatic step that is deficient, there may be signs, symptoms and laboratory findings of mineralocorticoid deficiency or excess; incomplete virilization or premature androgenization of the affected male and virilization or sexual infantalism in the affected female. It appears that this disease is more prevalent in Iran because of the custom of family marriages, however its exact prevalence needs correct diagnosis and documentation of cases. In this article the process of the disorders, diagnosis and treatment will be discussed.