Journal of Medical Council of Iran
Year:2004 | Volume:22 | Issue:2|Papers Count:14

Fine needle aspiration biopsy (FNAB) is a safe, simple, and cost -effective method for the evaluation of palpable persistent (>3 wk.) lymphadenopathy. Differential diagnosis of persistent cervical lymphadenopathy is widely variable and include benign disorders & malignancies (primarye.g. Lymphomas & secondary including metastases). In a procedure evaluation study, we evaluated 61 cases of persistent lymphadenopathy referred to the Dr.Shariati s hospital in 2000 - 2001 in whom no cause for the lynphadenopathy could be found. We initially performed FNA and then open biopsy from the same lymph node. The specimens are evaluated for cytology and histopathology respectively by two pathologists in a double blind manner.Diagnosis was classified into three categories including: benign disorders, lymphomas, and metastatic carcinomas that in the FNAB group included 37.8%, 31.1%, 31.1% respectively and in the open biopsy group included 29.5%, 36.1%, 34.4% of patients respectively. In 55 patients the results of FNAB and open biopsy were similar. Out of the remainder, in 4 patients the result of FNAB was benign and of the open biopsy as lymphoma. In the other 2 patients the result of open biopsy showed metastatic carcinoma and of the FANB showed benign in one and Iymphomainanother. Sensitivity, specificity, positive and negative predictive values, and accuracy of FNAB in contrast to open biopsy for benign disorders are 100%, 88.4%, 78.3%, 100% and 91.8% respectively. The above values for lymphomas are 81.8%, 97.4%, 94.7%, 90.5% and 91.8% and for metastatic carcinoma are 90.5%, 100%, 100%, 95.2% and 96.7% respectively.In all above three diagnostic groups the results of FNAB in contrast to open biopsy are remarkable and it can replace open biopsy for diagnosis of many cases of persistent cervical lymphadenopathy.

Asthma, one of the most common a priority for research in our country. One of the most important problems in this disease is management of an acute attack. It appears that in most of our emergency centers, there exist problems in the assessment of the severity of asthmatic attack and its management.In a case series study in 1999, 90 patients with acute asthma exacerbation ere studied. The attack, method of treatment (class, dose, route, frequency and order of drug administration), assessment of the effectiveness of drugs, and effective factors in discharging the patients. In the process of evaluating the severity of an attack, the effectiveness of a treatment and the attempt of discharging patients, Peakflowmeter was not used. Salbutamol was used in a low dose, and despite the fact that all the patients were treatedvia MDI (metered dose inhaler), Spacer was not used in any of the cases. furthermore. Pulseoximetry in none of the cases was used and the order of drug usage was not based upon any specific algorithm.In conclusion, by presenting some simple guidelines and providing some inexpensive instruments such as Spacer and Peakflowmeter most of the issues involved in dealing with our patients will be resolved.

Pregnancy is considered as a critical period of womans life. Laparotomy is one of the accidents that could occur during this period In a preceded by acute abdomen, ectopic pregnancy, torsion of ovarian cyst, all of which may result in abortion, premature labor and teratogenicity secondary to anesthesia.Comparison of pre and post surgury diagnosis, and pathological diagnosis in pregnant women who have undergone laparotomy could help in the prevalence of appendicitis, ectopic pregnaney etc. Paraclinicaltools can help in the diagnosis of these diseases and help in overcoming the complications due to surgical delay in thes a patients.This study is discriptive and cross- sectional. During the 1997 to 2002 in Imam-Hossein hospital 5480 births took place. 103 of the patients underwent abdominal exploration. The chief complaint of patients was extracted from their files, also pre and post diagnosis surgery and pathological diagnosis were extracted.90 cases had ectopic pregnany , 6 Appendicitis, 6 torsion of ovarion cyst and I case had trauma. In all cases the cheif complaint was acute abdominal pain. Pathological diagnosis is all cases, exept one, is compatible with presurgical diagnosis as appendicitis.In ectopic pregnancies 97.5% post surgical diagnosis was compatible with pathological diagnosis.Diagnosis of appendicities is performed clinically and paraclinical investigationsare of little help.In diagnosis of ectopic pregnancy special ultrasonography is more helpfull.

Combined oral contraceptive pills (OCP) exert different pharmacodynamic effects such as effect on the lipid metabolism. Because the OCP effects on serum lipid and lipoproteins depend on the amount of hormone and biologic effects of estrogen and progesterone in body, this semi experimental and prospective study was done to compare serum lipid and lipoproteins before and after three months use of triphasic and monophasic levenorterol oral contraceptive pills in seventy subjects who were referred to six community health care centers in Shahrood and made a request for oral contraceptive pills. Between two groups there were no differences in age, parity, BMI, serum Cholesterol, Trigeliceride, HDL-C and LDL-C. The results of the research showed that: Serum cholesterol, HDL-C and LDL-C did not change after three months use of the triphasic levenorgestrel pill but there were meaningful differences in mean of serum triglyceride. Serum cholesterol and LDL-C increased and HDL-C decreased after three months use of the monophasic levenorgestrel as well and there was no meaningful differences in mean of serum triglyceride.In this study monophasaic contraceptive pill had a negative effect on HDL-C as a protective factor for heart disease which is compatible with other studies. The role of changes in serum lipids in producing coronary artery disease in women consuming OCP is not know, however a decrease ,in these changes seems logical, therefore the use of combined contraceptive pill with low levonorgestrel hormone and conducting an epidemiological survey to study the long term effects of oral contraceptive pill is suggested.

lnsulinomas are rare diseases but remain the most common causes of hypoglycemia secondary to endogenous hyperinsulinism, and should be considered in patients with hypoglycemia. This study was designed to determine the clinical and paraclinical characteristics of insulinoma. We retrospectively reviewed medical records of patients with biochemical or histologically confirmed insulinomas in hospitals of Tehran university of medical sciences. The data was analyzed by statistical software of SPSS.Mean age at diagnosis was 39 years and 47% of patients were females and 53% males. No difference was noted between males and females with respect to age of diagnosis. The mean duration of symptoms before diagnosis was 39.9 months. As many as 84% of patients were mistakenly admited by other diagnoses such neurologic (CVA, epilepsy) and psychiatric disorders. Noradrenergic and neuroglycopenic symptoms were recorded in 89.6 and 97 percent of patients, respectively. For tumor localization, transabdominal ultrasonography, pancreatic CT Scan and celiac angiography had been done. Surgical treatment had been done for 55 patients. The mean diameter of tumor was 2.9 cm and 87.8% of tumors were single and 94.2% of them were benign. Outcome of surgery was good in 70% of patients.This review showed that misdiagnosis of insulinoma is a common problem that may lead to serious complications and even death. The comparison of characteristics of insulinoma in our patients compared with other countries showed a lower age of occurrence, clinical presentation accompanied by convulsion, stupor and dementia, and a bigger size of the tumor. It is recommended that new technologies and skilled persons be used for tumor localization.

In Patients with long standing diabetes mellitus, microalbuminuria (urinary albumin excretion rate of 20-200 mcglmin which is equivalent to 20-200 mgldl) is a valuable predictor of persistent proteinuria and diabetic nephropathy. Early intervention may prevent or reduce the rate of renal complications. The Micral urinary test strip claims to have the ability of measuring low levels of urinary albumin. This study has tried to assess the performance of Micral-test strip in detecting microalbuminuria.Ninety patients who were high risk for diabetic nephropathy and hypertension were selected. Those who had obvious proteinuria detectable with routine urinary test tapes, were excluded. In selected cases urinary albumin and protein were measured by Micral-test strip, precipitation method, urinary albumin to creatinine level, compared with standard immunonephelometry method. Albumin concentration> 20 mg/L, total 24 hours protein excretion> 150 mg and albumin(mg) / creatinine (gr)> 30 Were considered as cut off points for determination of microalbuminuria and proteinuria. The results show specificity of micral-test, total protein of 24h urine and the ratio of urinary albumin / creatinine ratio as 59%, 75% and 77%, respectively arid the sensitivity of these tests as 93%, 54% and 89%, respectively.Comparison of this results demonstrate that using 24 hours urinary protein which is used in most laboratories, to detect proteinuria does not have an acceptable sensitivity and specificity. Micral-test strip although having a high sensitivity has a low specificity, but if used along with urinary albumin / creatinine ratio, could yield better results.

Anemia is one of the main nutritional problems in developing countries and its most common cause of this. According to WHO reports, about 3,000,000,000 of the world population are suffering from iron deficiency anemia. The spectrum of Iron deficiency varies from a decrement in iron sources without anemia to iron deficiency anemia. Iron deficiency is also considered as a major problem in Iran. Taking into consideration the complications and consequences of anemia in children such as growth retardation, decreasing intelligence quotient, educational defects, decreased immunity and higher frequency of diseases and low physical and mental capabilities, estimation of the frequency and severity of anemia would be essential.In this study, the prevalence of anemia has been evaluated in children 2-12 years old during a national health and diseases survey done in 1999. During this study 22 clusters from each province were selected and in each cluster 8 families were evaluated. Totally, 1/1000 of the Iranian population were studied. Data were gathered during interview, physical examination, blood and fecal sampling. For the measurement of anemia 4170 children in 2-6 years group and 8461 children 7-12 years group were studied. In the first group 7.4% suffered from mild anemia, 2.5% from moderate anemia and 1% from severe anemia. In the second group 10.9% suffered from mild anemia, 3% from moderate anemia and 1.1% from severe anemia. The prevalence of anemia was significantly higher in rural as compared to urban areas (P<0.001).According to WHO estimation, the prevalence of the iron deficiency is 2.5 times more than anemia, so the prevalence of iron deficiency in Iran is estimated around 16 to 21% in 2-6 years group and 23.5 to 32% in 7-12 years group in rural and urban areas, respectively.Because of the undesirable consequences of iron deficiency anemia in children, the appropriate and specific interventions must be taken to prevent and control this problem in the country.

Myopia is the most common refractive error involving a host of genetic and environmental causes but the precise contribution of these factors and their interactions are not known. The objective of this project is to examine familial relationships for myopia among siblings of myopic patients and the distributions of hereditary and environmental factors on it.In this study, 602 (71.9%) siblings out of 838 invited siblings participated from 245 families. The participants aged 15 years and above, had myopia of at least 0.5 diopters in one or both eyes. We performed visual examinations and interviews for data on the manifest refraction, age, sex, ethnic, height, education and the amount of near works.Odds ratios (OR) were used as a measure of familial aggregation and logistic regression with approach of second order Generalized Estimating Equations was fitted to control the passiblity of confounding factors.Of the participants, 466 (77.3%) were myopic. There was a strong evidence for a familial aggregation, as the odds ratio for myopia among family members was 5.75 (95% CI=2.97-11.14, P<0.001).Among other variables, none showed a significant association with myopia; after adjustment for these factors, the familial aggregation persisted with OR=5.22 (95% CI=2.43-11.24,P<0.001).In conclusion, we found an obvious familial aggregation for myopia, and this association remained after adjusting for other confounding variables. Further studies especially in population are needed to evaluate the effect of other environmental variables and to quantify their respective effects.

This case report pertains to a man aged 42 years who presented with pain along the sciatic nerve distribution and difficulty in walking 15 years after susfaining a shrapnel injury in the gluteal region in the Iran - Iraq war; and was being investigated for discopathy. In the CT Scan and other investigations, no evidence of a herniated disc was present except for a mass in the pelvic region for which the patient was referred to the surgeon. On exanination, a pulsatile mass in the gluteal region was felt. Sonography and angiography confmned a pseudoaneurysm of the gluteal artery which dated back to a shrapnel injury years ago. The patient was scheduled for surgery, and after ligature of the right iliac internal and right gluteal arteries via a retroperitoneal and pelvic approach, and thenafter changing the position of the patient and gaining access to the pseudoaneurysm in the gluteal region, the pseudoaneurysm was evacuated and its pressure on the sciatic nerve released. This resulted in total disappearance of the patient s symptoms. In literature review, only six patients presenting with pain in the distribution of the sciatic nerve secondary to gluteal artery aneurysm could be found which world be discussed.

Most medications, which are used for the treatment of different diseases are metabolized in the liver. These changes at times produce harmful metabolites that may result in acute or chronic hepatic side effects if not detoxificated by liver enzyme systems. Some drugs are directly hepatotoxic. Drug induced liver diseases consist of a wide range of hepatic disorders including acute and chronic hepatitis, cholestasis, cirrhosis, vascular lesions and even malignancies. This hepatotoxicity is divided into twocategories: Type A, in which predictable side effects related to pharmacologic specifications can occur and type B, with unpredictable, allergic or idiosyncratic presentations. Age, gender, and concomittant preseription drugs are important risk factors that are to be taken into consideration while prescribing drugs with known hepatotoxic effects. One should keep in mind that drug induced liver disease could be possible cause of any hepatic malfunction. The best protocol is to discontinue the drug if elevation of liver enzymes or any other liver symptoms appear following consumption of a particular as most drug of hepatic side effects are reversible and no sequel remains after discontinuing the drug. For some special hepatotoxic drugs like Acetaminophen, Isoniazid and Metothrexate, there are special therapeutic and follow up methods which should be known to every physician.