Medical Journal of Mashhad University of Medical Sciences
Year:2004 | Volume:47 | Issue:83|Papers Count:27

Introduction: Interferon alfa has antiviral and immunomedulatory effects that can induce virologic and biochemical remission in chronic hepatitis B (CHB) infection.Material and Methods: Lamivudine 100mg per day and Interferon α-2b 10mega ut 3 times per week were given for 26 weeks to 22 adult patients with Liver biopsy-proved chronic Hepatitis B who had been treated with Lamivudine at least 52 weeks.The virologic, immunophoresis, Liver function tests and hematologic assays were evaluated.Results: the aim of this study was to evaluate the efficacy of high dosages of Interferon plus standard dosages of Lamivudine in precoremutant or lamivudine resistant chronic Hepatitis B.3. Groups of patients were found; group. I: HBeAg - tive, HBeAb + tive, HBV DNA PCR + tive CHB (6 pts).Group n: HBeAg - tive, HBeAb - tive, HBV DNA PCR + tive CHB (5 pts).Group Ill: HBeAg + tive, HBeAb - tive, HBV DNA PCR + tive CHB (11 pts).Clearance of HBV DNA occurred in 3 pts in group In and 1pt in each group I and II.Aminotransferase normalization in 9 pts in group III and 4 pts in group I & II.Conclusion: A six-months course of high dosages of INF α-2b in Combination with Lamivudine in patients with CHB infection made a sustained depression of HBV in HBeAg positive CHB. Significant studies with more patients are needed to confirm this study.

Introduction: Billroth first described Non-Hodgkins Lymphoma (NHL) with primary gastrointestinal localization (GI-NHL) in 1871. GI-NHL represents only 1-4% of the malignant tumours in the gastrointestinal tract, however, the gastrointestinal tract is the most common extranodal site of NHL. The disease predominantly affects the elderly with a median age of 60-70 years and a male: female ratio of about 2: 1. This study was undertaken to evaluate the epidemiology and histoligical features of GI-NHL specially using the recently introduced Revised European-American Lymphoma (REAL) classification, and Immunohistochemical staining with LCA, CD3 and CD20 for differentiation of T and B cell lymphomas.Material and Methods: From the 103573 Tissue Specimens during a 22 years Period (1981- 2003) in pathology archive of Emam Reza hospital of MashhAd, all with definite, differential or probable diagnosis of GI lymphoma were specified and reevaluated applying routine H/E, histochemical and new immunohistochemical staining. 65 were diagnosed as definite GI lymphoma, which were further stained for CD20and CD3 markers to determine their cell type.Finally they were reclassified according to REAL classification and their epidemiologic and pathologic features were specified.Results: Male: female distribution was 1.5:1. A peak incidence in the GI-NHL during the second to the third decade of life is observed. Eight patients (12.3%) had primary lymphoma in the stomach, 52(80%) in the small intestine, 2 (3%) in the large intestine and three (4.7 %) patients had ileocecal involvement. According to the Revised European-American Lymphoma (REAL) classification, IPSID lymphoma was the most frequent histologic subtype comprising 40% of the cases. Sixty-four cases were classified as B-cell lymphomas, and only one as T-cell type.  

Introduction: Cutaneous Leishmaniasis (CL) has 2 principal clinical forms in Iran:Anthroponotic & Zoonotic. These forms, previously called Dry & wet forms, are caused by Leishmania tropica and L. major respectively. Formerly, diagnosis of different forms was based on epidemiological status & clinical signs; but at present, definite diagnosis by advanced laboratory tests such as ELISA and Isoenzyme methods is possible. In order to investigate correlation between ELISA test, clinical appearance, and skin test, a study was undertaken in Emam Reza Hospital, Mashhad.Material and Methods: The study population was selected among the volunteers who had suspected skin lesions for C.L. Direct smear, culture & Leishmanin skin test was performed for 153 patients. ELISA using specific monoclonal antibodies (SMA) performed species determination.Results: The minimum and maximum ages of the patients were 19 months & 97 years old respectively. Most of the patients were Females (63.9%). Among 72 patients whose cutaneous lesions were approved for Leishmaniasis, 91.6% had ulcers with dry appearance and 8.4% had appearance of wet form c.L. The etiologic agents isolated from the skin lesions of the latter patients were L.tropica (66.6%), L.major (28.8%) and unknown form (4.2%). Among the patients who had skin lesions with wet appearance, the isolated agents were L.tropica (5.6%), L.major (1.4%) and unknown form (1.4%). The sensitivity of Leishmanin Skin Test was higher in-patients infected by L.major.Conclusion: ELISA method using SMA is a sensitive and reliable test for differential diagnosis of Anthroponotic Cutaneous Leishmaniasis (ACL) and Zoonotic Cutaneous Leishmaniasis (ZCL). Both ACL and ZCL are present in Mashhad. ACL is three times more prevalent than ZCL. Clinical appearance is not a valid factor for determination of species of Leishmania. The sensitivity of Leishmanin Skin Test is higher in wet form in relation to dry form.There may be other species of Leishmania causing cutaneous lesions in Mashhad. 

Introduction: Since content of mediastinal cavity as tract. Great vessels and heart are of vital importance. Mediastinal tumours should be diagnosed and treated exact, accurate and on time.Materials and Methods: We have operated 75 patients with mediastinal tumour in Valiasr Hospital (Tehran University of Medical Science) and Ghaem Medical Center (Mashhad University of Medical Science), from 1996-2002.Results: They were 37 female and 38 male, in similar reports in literature both sexes are equal. Frequency of various histologic diagnosis of these patient are: 25 lymphomas (33.33%), 22 thymic tumours (29.33%), 13 neural tumours (17.33%), 6 substernal thyroid (8%), 2 germ cell tumours, 1 cavernous hemangioma, 1 cystic higroma,1 benign tratoma, 2 invasive condrosarcomas, 2 misclaneus tumours.Our operative approach and procedure have been, 24 left or right thoracotomies, 21 sterenotomies, 14 anterior mediastinotomies, 9 lymph node biopsies, 6 thyroidectomies with cervical incision, 1 higroma resection.Conclusion: Mediastinal tumours are uncommon, regarding to other reports in literature 8 to 10 patients with mediastinal tumours are operated annually in referral centers. And mean rates of our patients have been 11 cases per year (2,3).

Introduction: Osteopenia is a recognized complication in VLBW infants. In adequate postnatal intake of calcium and phosphorus is probably important in the pathogenesis of bone disease in VLBW infants.This study is carried out to determine the effect of calcium and phosphorus supplementation on prevention of osteopenia in preterm infants.Material and Methods: In NICU at Ghaem Hospital for a period of one year 43 preterm infants with birth weight less than 2000gr, were followed from birth to six week after birth. Twenty babies (control group) received breast milk and 23 babies (case group) received breast milk and supplemented with calcium and phosphorus. All received a daily supplement of 400U vitamin D. serum calcium, phosphorus and alkaline phosphatase obtained every two weeks until six-weeks postnatal age, at the end of this time wrist x-ray for evaluating of osteopenia were done.Results: With biochemical criteria 15 patients developed osteopenia, which 7(30.4%) were in the case group and eight (40%) were in the control group. With radiographic criteria 23 patients developed osteopenia which 11(48%) were in the case group and 12(60%) were in the control group, these difference are not significant (P=0.35 and P=O.2).Linear growth during this period was 5.36cm in the case group versus 4.45cm in the control group, and weight gain was 19.76gr/day in the case group versus l6.61g/day in the control group.Conclusion: Calcium and phosphorus supplementation in VLBW infants that fed breast milk was effective on prevention of osteopenia. In addition this supplementation induced better linear growth and weight gain.

Introduction: Although its clinical course is not well defined. This retrospective study reviewed the prevalence, nature and prognosis of epilepsy of cerebral palsy among children.Material and Method: Among 133 children suffering from cerebral palsy and children visited in Neuropediatric clinic of Imam Reza Hospital, during 1997-99,53 had epilepsy. A control group of 70 epileptic children with normal neurodevelopment status were seen during the same period, Epileptic group, commonly manifest with spastic qudriplegia.Results: When compared with controls, children with cerebral palsy had higher incidence of epilepsy with onset within the first year of age (52.5% VS 18.5%), history of neonatal seizures (20.7% VS 4.2%), polytherapy (76.3% VS 29.1%) and treatment with second line antiepileptic drugs (79.2% VS 23.1%) Thus epilepsy is more common in children with CP.

Subject: Epilepsy is one of the most important presenting symptoms of brain tumours. The slow-growing brain tumours may be treated for the idiopathic epilepsy for years. The relation of brain tumours and epilepsy is significant and early diagnosis of tumours presenting with seizure increases the social health level In this study we evaluated the relation between type and location of brain tumour, age of patients and epilepsy.Material and Method: In this study, we reviewed prospectively the clinical findings, the imaging, and the pathological reports of 288 patients who were operated for brain tumour in the neurosurgical department of Ghaem hospital, Iran, between 1992-1996.Results: Among 288 patients, 65 cases (22.6%) were 20 years old or younger and 223 (77.4%) were more than 20 years old. Seventy-eight patients (27.1%) had seizure. Among these 78 patients, 72 cases had supratentorial tumours and six infratentorial tumours. The seizure was significantly more common in supratentorial tumour than infratentorial tumours (p=0.0000021).Supratentorial tumours had seizure seven times more than infratentorial tumours (odds ratios=7.09).The tumours with more tendency of seizure were Oligodendroglioma (100%), low-grade astrocytomas (44%), high-grade astrocytoma (40%), meningioma (33.8%), and glioblastome multiform (26%). Seizure was not seen in any suprasellar and parasellar tumours. There is significant relation between tumour pathology and seizure occurrence (p=0.0000356).Conclusion: Neuroimaging should be carried out for every patient with seizure, especially for patients more than 20 years old. The MRI is preferred because of the high sensitivity of MRI for brain tumours.

Introduction: Polyuria and nocturia may be the first clinical manifestation of hyperthyroidism. Most of the reported studies about renal function in Hyperthyroidism are performed in animals.Material and Methods: In this study we have evaluated 12-hour urine volume and specific gravity of morning urine in 50 new hyperthyroid patients and we have compared the results with similar study in 34 normal persons from their families in the same age group (control).Results: We found significant increase in urine volume (p<0.001) and decrease in specific gravity in patients with hyperthyroidism (p<0.001). There was no significant correlation between urine volume and specific gravity with plasma concentration of thyroid hormonesConclusion: There is increased urine volume and decreased specific gravity. This should be considered in differential diagnosis of diabetes insidious.

Back ground: The most common cause of mouth ulcers is recurrent aphthous stomatitis (RAS). There is no effective treatment for RAS and its exact etiology is obscure. One of the postulated causes is viral or bacterial infection and the role of herpes simplex virus was mentioned and treatment with Acyclovir reported to cause reduction in severity of disease. Oral polio virus vaccine (OPV) is reported to be effective in treatment of recurrent herpes simplex (RHS), According to our observation during recent years OPV not only is effective in management of RHS but also in some patient with concomitant RAS reduced its severity and frequency.Objective: Evaluation of the efficacy of OPV in the management of RAS.Material and Method: In a longitudinal, case-controls study forty-eight patients with RAS recruited. 20 patients received OPV and 28 patients received placebo. OPV was given 4 drops in monthly Interval for 3 months and with similar manner for placebo group .The results were studied 3 months after the last doses.Result: In final Assessment, 40% of OPV group had significant reduction in the period of attacks as in placebo group was zero (p=0.048). The frequency of attacks was reduced in 65% of OPV group, and in 21.4% of placebo group (p=0.006). The severity of attacks was reduced in 60% of OPV group and in 14.3% of placebo group (p=0.008).Conclusion: OPV appears to be effective in management of RAS.

Introduction: Distal Radius Fracture Specially Colle's fracture is one of the most common fractures among the old patients it has many complications and causes a lot of problem for patients.Objective: One type of fracture is unstable fracture, which its treatment is more difficult, and there are different kinds of treatment for it. So we to decided study 543 patient with unstable distal radius fracture that had been treated with pin and plasterduring 1997- 2001.Material and Methods: we studied 543 patients with unstable fracture of the distal radius. In this method after reduction we insert two pins one distally into the base of second and third metacarpus and other proximally inside of the ulna or some time radius bone and after reduction We incorporate both sides of the pins into plaster for 6 to 8 weeks and finally we remove the cast and pins and follow up the patients.Results: in this study 189 cases were men and others were women .the ages of the patients were between 20 and 90 years.The complications were pin site infection 46 patients (8.4%), restriction of wrist movement in pronation and supination 43 patients (7.9%), flextion and extention 41 patient (7.5%), malunion in dorsal angulation of distal fragment 48 patients (8.8%), shortening of distal radius 44 patients (8.1%), nerve entraptment (carpal tunnel syndrome) 17patients (3.1%), lateral displetment of distal radius 27 patients (4.9%).Conclusion: The advantages of these methods are simplicity of application and cheapness for the patients and safety for the surgeon and patient with good result in compare of other methods the same as external fixation, open reduction internal fixation or percutaneous pin fixation under fluoroscopy.

Introduction: Psoas Compartment block (Perivascular approach) is a type of the lower limp blocks, which can block the nerves of knee area. The advantage of peripheral nerve blocking to general anesthesia is early patients discharge from hospital, lower cost and lower complications.Material and Method: In this study, 50 patients who underwent knee arthroscopy received Psoas compartment block. The Success rate of this kind of anesthesia was evaluated in these patients.Results: 76% of patients showed a good or moderated degree of painless but most of patients experienced some degree of anxiety and nervousness and only 20% of patients were satisfied completely from this kind of anesthesia. From the surgeons point of view 80% of patients had a good cooperation during surgery. In addition, the majority of patients had increased HR and BP during surgery.Conclusion: As a result, Just Psoas compartment block couldnt provide an adequate anesthesia for knee arthroscopy. If the block proceeded by adequate sedation or a light anesthesia, may result in a good anesthesia.

Introduction: Cardiac disease and early death due to myocardial injuries because of Iron overload and hemosiderosis are still the major problems in the management of patients with beta-thalassemia major (BTM). Valuable echocardiographic techniques have been limited in early detection of cardiac dysfunction in these patients. A new Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for assessment of global ventricular function in many cardiac diseases. The purpose of this study was to assess global ventricular function in children with BTM using Tei index and also to determine its correlation with hematologic parameters.Material and Methods: This analytic cross sectional study was performed on 59 patient with Beta-Thalassemia Major during Jan.2003 until Feb.2004 in hematologic clinics of Imam Reza and Dr. Sheikh Hospitals. Complete physical examination and Doppler Echocardiographic study was done for all the patients and patients Tei indexes were compared with normal values in other studies statistically.Results: The mean Tei index of left ventricule (LV) and right ventricule (RV) was 0.35±0.11 (mean±SD) and 0.28±0.12 (mean±SD) respectively. There was a significant difference between both right and left ventricular Tei index in-patients with BTM and healthy children. There was also a significant correlation between mean blood transfused volume per year and Tei index in both right (PV? 0.05) and left ventricule (PV? 0.05). We also find a significant difference between two groups of thalassemic patients according to their mean pre-transfused Hgb per year (Hgb? 9 g/dl and Hgb >9 g/lit) for left ventricular Tei index.Conclusion: The Tei index is a simple, feasible and reproducible measure of global cardiac function in-patients with BTM with early myocardial dysfunction.

Purpose: To evaluate stricture and disruption of the male urethra with the help of sonography and to evaluate the efficacy of sonourethrography (S.U.G.) and up and down sonourethrography as compared to conventional radiographic procedures as retrograde urethrography (RUG) and up and down urethrography.Material and Methods: In the period of 25 months, we evaluated 35 patients (31 patients with urethral strictures and 4 patients with urethral disruption) with urethrography and S.U.G. Age of the patients varied between 12-85 years (mean 39 y).We analyzed stricture length, depth of spongiofibrosis, urethral defect, and satisfaction and compared the results. We also analyzed the results of imaging with urethroscopic and surgical results.Results: The depths of spongiofibrosis concluded grade A in one (3.2%), grade B in 12 (37.8%), grade C in 11 (35.4%), grade D in 2 (6.4%) and grade E in 2 (6.4%). Spongiofibrosis wasn't valuable in 3 (9.6%) patients.The length of the stricture was better demonstrated by sonography (p= 0.000). We didnt find important differences concerning results of up & down sonourethrography and up and down urethrography in patients with urethral disruption (p= 0.18).Patients were more satisfied from sonographic study than urethrography (p=0.000).Conclusion: S.U.G. is a simple and available procedure without radiation exposure S.U.G. is more sensitive in defining the length and the depth of strictures.Grade B was the most common from of spongiofibrosis in our study. Patients were more satisfied from sonographic study than urethrography.Up and down sonourethrography could be helpful in defining the length of defect in urethral disruption.

Introduction: It is generally appreciated and continues to be cited in standard textbooks of medicine that the source of Upper gastrointestinal bleeding (UGIB) in-patients with Esophageal Varices (EV) is usually nonvariceal. Although some recent reports are not in agreement with this conclusion, these reports come from western countries in which ethanol is the leading cause of cirrhosis and (EV). Alcohol per se has many acute and chronic effects on esophagogastroduodernal mucosa, which may be a source of (UGIB). Therefore conclusions regarding the source of (UGIB) in these patients may not be necessarily true in nonalcoholics with portal hypertension (PH) and (EV).Material and Method: The aim of this study is to define the sources of (UGIB) in nonalcoholic patients with (PH) an (EV).Emergency endoscopy was carried out in 161 nonalcoholic patients with cirrhosis and (EV) within 24 hours of a major (UGIB) during a nine years period (1994 - 2002). Accepted endoscopic criteria for definition of (PHG) mucosal erosions ... were used.Results: In 153 cases (95%) endoscopy was successful and source of (UGIB) was Clearly documented. In 124 cases (81.1%) varices were the source of bleeding and 29 patients (18.9%) had nonvariceal bleeding.Conclusion: A variety of acute and chronic lesions made up the non-variceal group (DU=41.37%,Garstric and/or duodenal erosions = 27.58% PHG = 20.68%, GU = 10.36%).In contrast to western reports, source of (UGIB) in Iranian nonalcoholic patients with (PH) and (EV) is usually variceal.

A 25-year-old man was evaluated in clinic because of fever, chills, sweats and bicytopenia.3 months ago, the patient had a trip to south of Iran, where he received vaccines against Hepatitis B and Meningococcus Meningitis and had begun taking Resochine for prophylaxis against Malaria. During his trip he consumed local food and stream water, as drinking water. The patient received many insects' bites. After finishing his trip he returned to Mashhad and discontinued Resochine prophylaxis. This man was well until two months later when he begun having a high fevers (40° C). Chills sweats, dark urine and mild jaundice. The next day the patient fever was high Nausea developed and had one bout of diarrhea. That evening he came to a private clinic. Physical examination revealed palpable spleen, Mild jaundice. His temperature was 39°C, hematologic tests were performed and Dextrose water serum and antipyretic started. On the next day hematologic lab data received: Hct 39.5%, WBC 3900 (mm3), Neut 74%, Lymphocyte 15%, Monocyte 4%, Eo 1%, Baso 1%, Platelate 105000, ESR 22, Bilirubine 2.7 mg/dl, SGOT 60, SGPT 59, the level of glucose, Creatinine, Amylase were normal, HBV, HCV, HAV Markers were negative. On the next day he was well but on the following day, fever returned and the patient came back to clinic where his temperature was, 40.2°C, on physical examination the findings had not changed. Blood sample was cultured, febrile agglutinin tests, CBC, LFT, Mono test, urinalysis and chest radiograph was done. The patient was unmarried but he denied any illegal sexual contacts.On the third day, examination of patient revealed. Slightly pale sclera without skin rash and lymphoadenopathy, but just a palpable spleen. In lab report, the level of creatinine, glucose, electerolytes SGOT, SGPT, were normal, blood culture remained negative and CBC showed bicytopenia and urine exam was positive for protein, bilirubine, and urobilinogen and the sediment contained no RBC, 5 WBC, and a few bacteria per hpf.

The urachus connects the bladder with the allantois during development, at birth it retracts from the bladder, but its lumen may persist within the bladder wall and results in cyst or epithelial neoplasms.In this paper a very rare case is presented, that is a male 68 years old patient, who admitted with a huge abdominal mass.He had a history of a small periumblical mass that was positional. Laparatomy was done and the mass resected and path-lab report was urachal adenocarcinoma.

A 29-year-old man presented with abrupt onset of fever and shaking chills. Thick and thin smears of patients peripheral blood showed different stages of P.vivax; but with regard to the atypical pattern of fever and obvious signs of meningeal irritation further study was performed and mixed infection with Borrelia spirochetes was discovered.

Precocious Puberty is the result of premature activation of LHRH neuronal function due to structural damage of the neuroendocrine brain systems, or generalized activation of the neuronal glial mechanisms. In this article we present two sisters with idiopathic precocious puberty, one of them recived medication and the other under follow up.

Among the infections, requires the consideration of many entities: acute viral infections like infectious mononucleosis and other viral infections. Such as prodrome of viral hepatitis as initial infections with HIV are considerable, but the patient, had no adenopathies or hepatomegaly, acute salmonella infection is usually recognizable by blood culture in the first week of illness. Patients with SBE present with prolonged fever and usually heart valves symptoms.Unconjugated hyperbilirobinemia raise the possibility of hemolytic anemia like an autoimmune disorder. Autoimmune hemolytic anemia may be induced by drugs or cold reactive antibodies produced by infectious mononucleosis or mycoplasma pneumonia. Microangiopathic hemolytic disorders- DIC,HUS and TTP usually have a more rapidly declining clinical course and they have renal failure and bleeding, none of these finding were found in this case.This patient had a trip to south of Iran two months ago. Each geographical location has specific rates of infections. In south of Iran, malaria is prevalent, malaria is transmitted by the bites of anopheles mosquitoes within minutes after a bite sporozoites invade the liver and after, 8-to-21 days, merozoites enter the blood stream and invade erythrocytes where they pass through trophozoite and schizont stages and produce merozoites again which continue the cycle and expand the infection. The symptoms of malaria are non-specific and once the diagnosis is made, identification of the causative species of plasmodium is necessary for treatment. P. falciparum and P. Vivax account for the majority of infections world- wide. Including south of Iran, P. malaria is very rare and doses not have a hypnozoite phase, but it can present after a long period of latency. Information on the travel history and incubation periods is useful for identifying the probable species but morphologic features observed on the blood smear are definitive. In the management of malaria, to examine a number of parazites on the blood smear to allow correct identification of the species and to rule out possibility of infection with more than one species. In this patient; thick and thin blood smear were examined, over all on blood smear, P. Vivax was found.