JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2004 | Volume:22 | Issue:73|Papers Count:21

Introduction. Nonstress test (NST) is a way to evaluate fetal well being. It is based on acceleration of fetal heart rate during fetal movement and in high risk pregnancies such as: post date pregnancy, Diabetes mellitus, PIR, oligohydramnious and polyhyramnious should be done two or more times a week, based on patient condition. Because sleeping periods of fetus is one of the most causes of nonreactive results. Sometimes we need to continue the test 40 to 90 minutes to see the acceleration. So if changing the position can cause more reactivity the test will be more valid. This study was performed to know the effects of maternal position on the NST results and determine the best position for NST.Methods. This is a clinical trial study. 125 patients entered the study by easy sampling. The high risk patients at 32 to 42 weeks of pregnancy who referred to Alzahra and Shahid Beheshti Medical Centers for prenatal care from 2000 to 2001. NST was done two times for each patient. In the first time patients were in semifowler position on the 10 minutes and then in left latral position for 10 minutes and in the second time the patients were left lateral position in first 10 minutes and then in semifowler position. The interval between the tests were one day to one week, analysis of wilcoxone and MC-nemur were used for statistical analysis.Results. In the first time in semifowler position %68 of tests were reactive and in left lateral 64/8% were reactive. The difference was not significant (P=0.667). In The second time the results were positive in semifowler position 64.8% and in left lateral position 48.8%. The difference was significant (P=0.006). Totally reactive results in all nonstress tests in semifowler position were 42.8% and in left lateral 37.6% (P=0.005) the difference was significant.Discussion. There is a relation between maternal position and nonstress test results and there are more reactive results in semifowler position. In a same study by Haberman in New York (1999) the semifowler position was the best position.

Introducion. Vesicoureteral reflux (VUR) predisposes patients to urinary tract infection and subsequent pyelonephritis and renal failure. The routine diagnostic modality is voiding cystourethrography (VCUG), which is invasive to some extent and requires exposure to radiation. This study was conducted to assess the value of sonography as a replacement for VCUG in the diagnosis of VUR.Methods. A total of 122 renal units (61 patients) were evaluated with songoraphy before and after voiding. VCUG was done for all cases at the same time. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonography in comparison with VCUG was calculated.Results. The sensitivity of songoraphy was 82.3%, specificity 88.4%, PPV 92.9% and NPV 73.1%. Discussion. Sonography may be considered as an alternative modality for screening and follow-up of patients with VUR, specially in grade 11to grade V.

Introduction. The relation between inflammation and coronary artery disease has been shown by several studies. The prognostic value of C-reactive protein in acute coronary syndromes is well established. There are few studies addressing the relation between CRP level and severity of coronary artery disease. In our study this issue is investigated.Methods. This is a cross sectional analytical study that was done in spring and summer of 2003 on 130 patients with stable angina in Chamran Hospital in Isfahan. The blood was tested for CRP level on the day of angiography, the angiographic films were interpreted by three cardiologists. After data collection the relation between angiography score and CRP level was tested by linear regression test.Results. There was no linear relation between CRP level and angiographic score in overall patients (P>0.05). But there was a linear relation between these (P<0.05) two variables in female subgroup of patients.Discussion. At present there is no evidence of direct relation between serum CRP level and severity of coronary artery disease.

Introduction. Thalassemia major is one of the most common hemoglobin disorders in the world. The geographic distribution of thalassemia has been known for many years. Diagnosis of thalassemia minor in people who want to marry with each other is the key for preventing of thalassemia major. Screening test for thalassemia minor has been started from some years ago in Iran, but there are still some new cases of major-thal syndromes annually, and we want to investigate for the cases.Methods. 54 new cases of thalassemia major, born from 1998 to 2002, referred to Saied AI Shohada Hospital, were evaluated for the etiology of thalasseinia. Results. According to these documents, 34 cases had not been screened, and except two, all of them were related to marriage before starting screening program in Isfahan. From the 20 cases that were screened, there were 10 falts negative, and one sickle-trait. From the 9 remainder cases, 5 cases refuse for prenatal diagnosis, and 3 cases that prenatal diagnosis confirm thalassemia major but refuse for abortion, and one falts negative PCR report.Discussion. According to this data, we suggest it is necessary to do close observation for laboratory unit of screening center, to extend work shop program for staff of these centers. and complement this screening program with sickle cell screening according to WHO guidelines for the control of hemoglobin disorders.

Intaoduction. Breast carcinoma is the most common type of cancer in women. Invasive ductal carcinoma of breast shows varoious microscopic grades (from I to Ill) with different behavior and prognosis. Thus, accurate determination of microscopic grade is of great importance. Since there is interobserver variability in determining grade, use of an additional quantitative and less subjective microscopic criterion seems to be valuable in predicting tumor behavior and prognosis.Ki-67 is an antigen that corresponds to a nuclear nonhistone protein expressed by cells in the proliferative phases G1, G2, M and S. The goal of this study is to evaluate relationship between microscopic grade and cell proliferation index (Ki-67 positivity) in invasive ductal carcinoma, as well as the comparison (Ki-67) index cases of invasive ductal carcinoma of preand post menopausal women.Methods. In this cross - sectional study, 90 specimens of invasive ductal carcinoma of breast with different microsopic grades were studied. Sections from formalin - fixed and paraffin - embedded tissue specimens were immunohistochemically stained with monoclonal antibody to Ki-67 and cell proliferation index was determined. The relationship between Ki-67 positivity and microscopic grade was then studied. Results. The obtained results for mean value of Ki-67 positivity in various grades were as follow: grade I tumors: 3.03 (SD=2.5), grade 11 tumors: 9.3% (SD=3.8), and grade III tumors: 37.5% (SD=24.6). One-way analysis of variance showed significant difference between mean values of Ki-67 positivity in different microscopic grades (P <0.001, F=48.6). The mean value of Ki-67 positivity was 20.1% (SD=21.8) and 6.8% (SD=4.8) in carcinomas of premenopausal and postmenopausal patients respectively. t-student test showed significant difference in Ki-67 positivity between these two groups.Discussion. According to obtained results, invasive ductal carcinomas of greater microscopic grade show higher proliferative index (Ki-67 positivity) and vice versa. Therefore use of cell proliferation index is suggested as an acceptable alternative for tumor grade and as a valuable quantitative criterion for predicting tumor behavior and prognosis.

Introduction. Various studies indicate that elevated level of lipoprotein (a),triglyceride(TG)and F-VII are not only the riskfactor of myocardial infarction but also are effective in response to treatment, one of the treatment ways of MI is the use of thrombolytic drugs such as streptokinase (SK). There are different cross reaction factors that decrease the responsiveness to thrombolytic therapy. Streptokinase antibody and tissue-plasminogen activator inhibitor (P AI) are some these factors. Lp (a) is considered as a cross reaction factor because of its structural similarity to plasminogen, so it reduces the rate of response and the necrotic potency. Because of high prevalence of non-responsive to streptokinase in our population, it is very important to find factors cause it. In this study the serum level of Lp (a), F-VII and triglyceride in patients with MI who receive SK and its relation with positive response to treatment have been assessed.Methods. This cross-sectional study was done on 30 patients referred to Emergency Department that their clinical signs and ECG showed MI. Blood sampling and ECG were done for these patients, then 1.5 and 3 hours after getting SK, ECG was repeated and compared with the first one. The serum level of Lp (a), TG and F-VII of patients with positive response to SK and those with negative response to SK was measured. The results were statistically assessed by t-student, Man-Whitney tests and by correlation coefficient.Results. There wasn't any significant difference due to three factors in the group with positive response to SK and the group with negative response to SK. The mean Lp (a) in group with negative response to SK was less than the other group. The correlation of response to SK due to TG and F-VII was less than Lp (a).Discussion. The elevated level of Lp (a), TG and F-VII is related with the occurrence of MI. The more higher the serum level of Lp (a), the positive response to SK is reduced, because of interaction effect of Lp (a). Comparing the serum level of F-VII and TG with Lp (a) showed that measurement of LP (a) is more important regarding positive response to treatment. Comparing the mean Lp (a) in the community and in patients with MI showed that in patients with MI, Lp (a) level is more higher than normal level. So paying more attention should be done to it as a risk factor.

Introduction. Resistance to chemotherapy is a major obstacle in cancer treatment. This phenomen is termed multidrug resistance (MDR). One of the mechanisems of MDR involves the overexpression of the multidrug resistance gene (MDR1) products, P- glycoprotein. The aim of this study was to identify the normal expression from overexpression of MDR1 gene by RT-PCR for detection of the MDR1 expression in clinical samples.Methods. In order to identify the normal expression from overexpression of MDR1 gene, we used the parental K562 cell line and its resistant subline to Doxorubicin by RT-PCR method. Also, we studied expression of MDR1 gene on peripheral blood leukocytes from 16 normal individuals, 5 cord blood samples and 5 samples of mononuclear cells from peripheral blood BMT donors on GM-CSF treatment.Results. The results showed MDR1 gene expression in normal individuals peripheral blood mononuclear cells and in parental K562 cell line by a 35 cycle of PCR but expression was disappeared by a 30 cycle of PCR. Also, in different subpopulation of normal leukocytes, in spit T cells, gene expression was not observed in granulocytes by a 30 cycles of PCR: MDR1gene expression was observed in mononuclear cells from cord blood and peripheral blood from donor on GM-CSF.Discussion. Because of the high sensitivity of RT-PCR method and normal expression of MDR1 gene in normal peripheral blood mononuclear cells, the RT-PCR alone is not sufficient for detection of multidrug resistance in hematopoietic malignancy and the cycle number of PCR should be adjusted for detection of MDR1 gene overexpression or it should be down by semi-quantitative or quantitative methods. Also, the normal elements of peripheral blood especially T cells should be eliminated from clinical samples before RT-PCR method.

Introduction. During the recent years there has been significant progresses in infertility medicine specially in ART. Since both the patient, and doctors that are involvedin ART have a little of anxiousand mental stress about outcome of pregnancy so the purpose of this study was to find a simple and safe method to predict outcome of pregnancy as soon as is possible in ART and relief the stress of patients and their family.Method. This was a discriptive analysis and longitudinal study and was done on 116 patients that had referred to infertility clinics of Isfahan for induction ovulation after procedure of ART and ovulation induction. If serum B-HCG at 17th day after ovulation induction was positive, the patients entered the study and their characteristics: age, time of infertility, B-HCG titer, gravidity were recorded in questionaire and the patients were followed untill termination of pregnancy. The information of patients were analyzed with spss program with use of tests: ANOV A-X2-Fisher exact test and Pearson correlation test.Results. Mean±SE: 28.83±0.46 Mean of B-HCG 499.31±0.57 IU/lit. 92 patients had B-HCG > 100 and 24 had BHCG<l00 IU/lit, the rate of term pregnancy was 64.1%, preterm pregnancy =10.8%. Abortion: 20.6% and IUFD: 4.3%. In group with B-HCG< 100 the rate of term pregnancy was 29.1% preterm pregnancy and abortion 50% and IUFD: 4.1%. (Pv=0.019).Discussion: It seems with regard to results of this study the B-HCG level at 17th day after ovulation induction on ART can be a good and safe and simple test to predict the outcome of pregnancy.

Introduction. The lumen of the vascular system is covered by a continuous layer of endothelial cells, and any changes or damages to them is due to cardiovascular diseases especially atherosclerosis. Lead is one of the elements which may cause endothelial dysfunction. The purpose of this study was to determine the effect of lead on morphologic features of endothelium which may induce the endothelial dysfunction.Methods. Twenty white male rabbits divided randomly into two groups. Group A (n=11) were given regular diet with leaded water (547 ppm) and group B (n=9) were fed with regular diet and unlead water for 40 days. The animals were sacrificed and their aorta, left cornorary and middle cerebral arteries were dissected and morphological changes of endothelial cells studied by SEM.Results. Scanning electron microscopic study of endothelial cells of aorta, left coronary and middle cerebral arteries that received lead showed morphological changes. In aorta disruption and denuation of endothelial cells, exposure of the subendothelial layer and adhesion of red blood cells, leukocytes and platelets on surface of endothelium, and presence of craters showing disrupted surface was observed. Similary endothelial cells of left coronary and middle cerebral arteries were found to show irregular orientation.Discussion. Morphologic changes of endothelial cells of aorta demonstrated that lead can cause dysfunction. In coronary and middle cerebral arteries very limited morphological changes was observed.

Introduction. Observational studies demonstrate that hormone replacement therapy (HRT) reduces the risk of coronary events in post menopausal women. Because high levels of low-density lipoprotein (LDL) - Oxide and CRP predict cardiovascular disease, the effect of two regimens of HRT on these factors is of interest.Methods. This prospective, randomized, clinical trial study was performed on 38 hysterectomized, healthy post menopausal women. Those women who received either daily conjugated estrogen (0.625 mg/d) (E group) alone or combined with medroxyprogesterone (2.5 mg/d, E+ P group). Serum LDL oxidation metabolites (malondialdehydes and conjugated dienes) and CRP were measured at baseline then after 3 and 8 weeks after starting HRT.Results. No significant differences were found between mean levels of LDL oxidation metabolites before and after 3 and 8 week of HRT in both groups. But CRP level was significantly increased after 3 weeks.Discussion. Estrogen alone or with medroxyprogesterone after 3 weeks increased CRP that probably is associated with inflammatory condition which is a risk factor of cardiovascular diseases.

Introduction. Left venticular end diastolic pressure (LVEDP) is a important hemodynamic variable that is important to determination of cardiac function. LVEDP increases both in left ventricular systolic and diastolic dysfunction. Diagnosis and evaluation of heart failure and efficacy of drug and nondrug therapy, effect of other drugs on left ventricular functionand prognosis of heart patients is possible by measurement of LVEDP. The goal of this study is evaluation of accuracy of left atrial pressure (LAP) measured by Doppler Echocardiography in LVEDP estimation.Methods. In this study, 25 patients were selected that scheduled for left heart catheterization with any indications and diagnosis of mitral regurgitation (1+ or more) cofirmed with ventriculography in catheterization. LVEDP was directly measured by a left ventricular catheter and systolic blood pressure (SBP) by a mercurial manometer, then MR jet peak velocity was measured by echocardiography and with using of Bernolli equation and SBP, LAP was calculated, and by Pearson Correlation test, correlation coefficient between LVEDP and LAP was calculated.Results. Correlation test showed a direct correlation exists between LAP measured by Doppler Echocardiography and LVEDP measured by catheterization, and correlation coefficient was r=0.76. (P<0.001). This study also showed that on the basis of regression line equation (y on the basis of x) LVEDP on the basis of LAP can be estimated and predicted. (LVEDP=0.183+0.851 LAP).Discussion. Doppler Echocardiography is an acceptable procedure in estimation of LVEDP in patients with MR, in contrast to catheterization (Golden standard procedure) and since echocardiography is available, non invasive, repeatable, bedside procedure (if need) with low complications, Doppler Echocardiography is introduced as an available and accurate alternative procedure in LVEDP measurement in patients with MR and LVEDP as an available variable in bedside for evaluation, diagnosis and treatment of heart failure with MR.

Introduction. Shigellosis is an important problem for healthcare system in our country. Nowadays pattern of antimicrobial resistance to shigella spp changed due to irrational and inappropriate usage of antimicrobial drugs and changes in its genome per se. Antibiotic resistance is an emergent problem because it can interfere with control of disease in the community. The aim of this study was to determine the antimicrobial susceptibility of shigellosis in children admitted to Isfahan Al-zahra Hospital.Methods. Two hunderd and five children under 15 years old whom their stool culture was positive for shigella and presented with acute gastroenteritis, enrolled in a descriptive and cross sectional study since April 2000 till October 2003. Neonate exclude from the study. Pattern of antibiotical susceptibility determined for all of them.Results. Nearly all of the isolated bacteria were sensitive to third generation cephalosporin (ceftriaxone 95/6%), 93.7% were resistant to co-trimoxazol, while resistance to nalidixic acid had declined from 9.25% to 3.9% in two consequent years. More than 66% were resistant to two or more than two antibiotics. Discussion. According to our study it seems that co-trimoxazol is not effective against shigellosis in children in Isfahan and we recommend nalidixic acid as an alternative choice. Inappropriate and over usage of antibiotics will change the pattern of resistance of shigella.

Introduction. The role of stray dogs in distribution of parasites specially those that are common in human and domestic animals is well known. In the present study cestodes of dogs from Isfahan region were isolated and identified and their prevalence rate were also determined.Methods. For this purpose 105 stray dogs were captured randomly from different parts of Isfahan city and their cestodes were studied after autopsy. Identification of isolated cestodes were determined base on morphology of rostellum and stained mature and gravid segments with azocarmine dye.Results. Results showed 69 dogs (65.7%) were ifected with various type of cestodes. Among them 13 (12.3%) stray dogs were infected with Echinococcus granulosus, 36 (34.2%) Taenia multiceps 30, (28.5%) Taenia hydatigena, 15(14.2%) Taenia ovis, 6(6.6%) Mesocestoides lineatus, 12 (11.4%) Dipylidium caninum and 5 (4.7%) Joyuxiella echinorhincoides.Discussion. Taenia ovis, Mesocestoides lineatus and Joyuxiella echinorhincoides were isolated and reported for the first time from Isfahan stray dogs.

Dermoid cyst is a tumor arises due to embryogenesis impairment. It accounts for less than 0.3 percent of all intracranial masses. The most common intracranial site is posterior fossa, but third ventricle is less commonly involved. Presenting a 35 year old man who referred. for a tonic clonic seizure without any significant past history. In physical examination, there was loss of olfaction, decreased visual acuity, optic disc effacement on the right side and behavioral disorder. Imaging study (Brain CT and MRI) revealed a large mass in subfrontal region, near the base and between two hemisphere, with slight extension to the left side, which propounded epidermoid cyst as diagnosis. The patient had a craniotomy and cyst was totally removed. Operative findings and histopathological report confirmed the diagnosis of dermoid cyst with olfactory groove origin.Unusual aspects of this case comes into consideration as follows:1- Cribriform plate origin (In the past it was not recorded), 2- Elder age of the patient (usual age of presentation is childhood and adolescence),3- Unusual imaging appearance (resembling a black epidermoid cyst).

Spinal cord is not a frequent place for tuberculous infection. Motor, sensory or sphincter dysfunction are clinical manifestation of spinal tuberculosis. According to the localization of the lesion, upper, lower motor neurons or both were involved. Awareness of the physicians, early diagnosis and medico-surgical treatment decrease the severe complications. In this article two rare cases of spinal tuberculosis (intramedullary tuberculosis and syringomyelia secondary to tuberculosis) were reported.