Medical Journal of Mashhad University of Medical Sciences
Year:2005 | Volume:47 | Issue:86|Papers Count:20

Introduction: Astrocytoma is the most common primary brain tumor, which comprises a wide range of neoplasms with different clinical courses. This study was performed to determine some epidemiological and clinical characteristics and treatment results of patients with astrocytoma. Some presumed prognostic factors were also evaluated.Material and Method: In this descriptive study we evaluated 324 patients with histological proven brain Astrocytoma who were treated in Qaem and Omid hospitals, Mashhad, Between April 1991 and April 2001. Information regarding individual characteristics, age. Sex, clinical presentation, type of treatment and surgery, side effects, imaging finding. Histological grad and follow up were collected.Who classification was used for the uniforming of histological reports. The collected information were analyzcd usin chi-square and Kaplan-Meier tests and and SPSS software.Results: 189 male and 135 female patients entered the study. There were 31 cases with grade I, 118 with grade II, 54 with grade III and 121 cases with grade IV astrocytoma. The median age for low grade and high-grade astrocytomas was 25 and 45 years respectively. The 3-year survival rate for grade I to IV was 94.7%.74.9%, 52.7% and 6.7% respectively.In multivariate analysis, for low grade astrocytomas, grade II, age> 50 and biopsy only and for high grade astrocytomas, grade IV and biopsy only were associated with adverse prognosis.Conclusion: The survival rate for grade I astrocytomas is excellent and for grade II astrocytomas is satisfactory. But high grade astrocytomas especially gelioblastoma multiform, have dismal prognosis. For both low -and high-grade astrocytomas, tumor grade and extent of surgery had significant impact on prognosis. Age over 50 was associated with adverse prognosis for low-grade astrocytomas.

Introduction: Although lumbur spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, dagnosis and treatment. The aim of this study is evaluation of results of surgical therapy for lumbar spinal stenosis in 100 patients.Material and Methods: In this article, we retrospectively analyzed the clinical, radiological, and surgical results of 100 patients operated in our neurosurgical clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 100 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good, same, and poor according to the clinical findings.Results: Fifty- three of the patients were males and forty-seven were females. More than half were between the ages of 40 and 60.The most frequently operated level was L4-L5. Ninety tow percent of the surgically treated patients demonstrated very good and good outcomes.Conclusion: Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome.

Introduction: Memory is an essential factor for any activity in humans. We cannot do any simple tasks without memory. So, scientists have done research on factors, which influence the memory and enforce it.the purpose of this study is evaluating the Effect of Ginkgo hiloba on the memory of healthy students who have volunteered in Mashad universities.Material and Method: The study consists of 141 healthy volunteered students (67 Female & 74 male) that primarily did not have any organic or non organic disease. The main inclusion criteria for being admitted in the study were getting a score below the cut of point in the G.H.Q., BDI & se1 90 of the screening tests. After that the students were divided into two groups randomly and the W.M.S - R test was done on them before and after prescribing Ginkgo to one group and placebo to the other one.Results: The Ginkgo can increase all subtests of WMS-R except INF and ORE subtest, MCO and vis.Conclusion: Extract of Ginkgo biloba can be a good and low risk alternative for increasing the memory of the youth and adults especially the ones with a memory failure background.

Introduction: Testicular biopsy is an useful method in infertility diagnosis and predicting prognosis, especially m patients With azosperrma and normal level of serum FSH that primary evaluating procedures can't differentiate spermatogenesis defect from obstructive one. If the etiology of infertility is an obstructive lesion the prognosis is often good and usually curable, by surgery. The purpose of this study was to evauate various histopathologic changes in incisional testicular biopsies of the infertile men in order to predict frequency of different tissue morphologies and especially interpreter these histopathologic changes for better understanding the diverse etiology of infertility.Material and method: In this clinicolaboratory study performed in Anatomic pathology department of mashhad Emam Reza hospital, Testicular biopsies of 120 Infertile men were histopathologically reevaluated and reclassified applying newly introduced criteria.Clinical data such as age, disease history, associated disorders and results of spermogram were gathered in designed forms. Final data were processed by descriptive statistical method and frequency distribution tables.Results: Median age of the patients was 27 years and duration of infertility 2 to 15 years. 84% of patients had azospermia in seminal fluid analysis and 16% sever oligospermia. In 16 cases Bilateral testicular biopsy was performed in wich 18.7% of them morphological features, in testicles were different from eachother.Morphologic patterns were as follows: 15% normal spermatogensis, 30.9% sertoli cell only syndrome, 17.5% complete & incomplete maturation arrest, 14.2% tubular atrophy, 14.2% hypospermatogenesis and 8.4% mixed atrophy.Conclusion: The most and least common histopathologic pictures in testicular biopsies of the infertile men observed in this study were Germ cell aplasia and Focal tubular atrophy respectively.Diverse diseases and etiologies could be associated with any of the histopathologic pictures so that it merits a logic interpretation of these histologic changes in regard to clinical findings to specify the true cause(s) of the infertility.

Introduction: The aim of this study was to investigate the effect of varicocele on abortion, and the relation between the semen analysis factor of patient with abortion was also considered.Material and Method: Between 741 patients with abortion, 251 had no specific reason, These Patient were recognized during 2/5 years. They were examined for a possible varicocele and ifs severity, 250 men were examined as a sample group.Result: In the group who had abortion, 73 men hdd varicocele while 38 cases were found in the sample group. In the first group recurrent abortion arid early abortion was prominent. The severity of varicocele had no relation with abortion.Conclusion: in this study we conclude that: varicocele may be the cause of abortion especially in the first months of pregnancy. Asthenospermia and abnormal morphology of sperms can cause abortion and now the question is may the varicocelectomy increase the chance of successful terminal pregnancy.

Introduction: Laparoscopy has been widely used in the diagnosis and treatment of impalpable testises. This study was done to report the first experience the use of laparoscopy in impalpable testises in the mashhad university of medical sciences (MUMS).Material and method: during 6 years, 43 patients with UDT were treated. In those were no evidence of existence of gonad in physical examination and ultrasonography, laparoscopy was done by the 5mm(0deg) lens. Position of testis, complications of operation and duration of admission in hospital was recorded.Results: In the 13 patients from 43 patients (30.23%) testise was not palpable in the inguinal canal. Also ultrasonography didn't detect the existence of testis, Therfore, laparoscopy was used. Average age of patients was 11.88±8.38 years. In 3 patients small remnant of testis was seen. Two patients had no testis. In 8 patients, normal gonads were seen that the treatment was done. No severe or mild complication was seen. All of the patients except on were discharged 24 hours after operation.Conclusion: Our study showed that laparoscopy is a benefit and safe instrument for correct diagnosis in impalpable testises and in some situation prevents from a unnecessary exploration of inguinal region and laparotomy. Also in patients that previous exploration was not benefit for them causes a correct diagnosis.

Introduction: Beta thalassemia major (BTM) is a hereditary severe and fatal hemolytic anemia associated with organ failure and iron overload. Cardiac complications are the major cause of morbidity and death in BTM. The purpose of this study was to assess early diagnosis of cardiac involvement by echocardiography.Material and Methods: This is a case-control study on 80 patients with BTM and 80 age and sex matched healthy children as control group from September 2002 to December 2003 in AliAsghar hospital of Zahedan> Complete echociirdiographic study was done and diastolic function indices compared with control group statistically.Results: From 80 patients 42 patients was male .The meaning age was 14.3±2.3 years. In compare with control group: The mean of ElA Ratio of left ventricle (LV) and right ventricle (RV) was 1.81±0.35 and 1.33±0.33 respectively that increased significantly (p< 0.05). The mean of deceleration time (DT) of mitral and tricuspid valves was 144.67±23, 134/87±25 msec respectively that decreased only significantly in RV. (P<0.05) Isovolumic relaxation time (IVRT) was the most frequent abnormal diastolic index increased significantly in both ventricles (p<0.05). The mean of pre ejection period/Ejection time (PEP/ET) ratio of LV and RV was 0.33±0.06 and 0.31±0.06 respectively. Although increased significantly in both ventricles (p<0.05) but abnormal PEP/ET was more frequent in RV. Only 9 patients had LV systolic dysfunction.Conclusion: In patients with BTM, diastolic dysfunction especially in RV was more frequent. and begun earlier than LV systolic dysfunction. In creased IVRT, PEP/ET ratio and decreased DT had more sensitivity in early diagnosis especially in RV. Therefore assessment of diastolic function in addition to LV systolic function is mandatory and leads to early diagnosis of cardiac dysfunction.

Introduction: Heparin is one of current necessary medications in Acute MI. Regarding narrow therapeutic dose and unpredictable pharmacokinetics of heparin, its anticoagulant effect should be measured precisely. Despite widely utilized heparin in method of intermittent fixed dose, body weight independent IV administration, our data about the range of aPTT as a monitoring marker is quite limited thus we prepared the study to measure if the custom method fills the target therapeutic range.Material and Methods: The study was performed cross-sectionally on 250 patients with acute MI admitted in cardiology department of Imam Reza hospital in 2001, receiving heparin 5000 units Q4h and having daily aPTT on three Sequential days. The data was gathered by a checklist and analyzed with SPSS software.Results: 14.8% of patients had a mean aPTT level of therapeutic range and 1.2% of patients had a mean aPTT level of more than therapeutic range and remarkably 84% of patients never achieved therapeutic range.Conclusion: Despite tolerability of this method by patients and staff, above results necessitate reconsideration in dose and interval of heparin administration in custom method (5000 unit IV Q4h) or changing into methods of continuous infusion or using subcutaneous low molecular weight heparins.

Introduction: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by any of the enzymatic steps required to synthesize adrenal hormones. Depending on the enzymatic step that is deficient, there may be clinical and laboratory finding. The aim was to evaluate. The epidemiology and clinical finding of CAH.Material and Methods: The clinical and laboratory characteristics of 68 patients with CAH who were managed in the pediatric Endocrinology unit of Imam Reza Hospital during 7 years were recorded in this study the clinical and, epidemiological characteristics of congenital adrenal hyperplasia were evaluated in 68 patients admitted Imam Reza Hospital in Mashed, also on patient has been followed in endocrine and metabolism pediatric clinic in this time, during 6 years retrospectively and 1 year prospectively.Results: Parental consanguinity rate among families of patients was higher than the general population in Mashad (73.8% vs 30%). In 44.6% of patients the history of disease was positive in sibling. 52.2% of patients were males and 47.8% females. 21- Hydroxylase deficiency was present in 60 patients (88.2%), salt -losing form in 40(66.7%) and simple virilizing form in 20 (33.3%) of them. 11- β hydroxylase deficiency was presents (10.3%). Also one case of 3- β OHSD was reported.The median chronological age at diagnsis in sall- losing form was 75 and 85 days in boys and girls; in simple - virilizing form were 46 and 43 months in boys and girls. 14 of girls were considered to be male before diagnosis was established.Conclusion: This study underscores the necessity for prospective neonatal screening, so that the benefits of early diagnosis and treatment can be realized.In addition the incidence of CAH is expected to be high due to a high rate of consanguinity in our population, here genetic counseling before marriage is beneficial in our population.

Introduction: Lung cancer is the most lethal cancer in both male and female. Properative detection of lung cancer metastasis to the main carina can alter the operative approach, eliminate further staging procedures and save the patients from thoracotomy.The aim of this study was to define the carinal involvement inpatients with lung cancer.Material and Method: In this descriptive study, between 1381-82, we bronchoscopically evaluated 51 consecutive lung cancer patients who refferd to Ghaembronchoscopy center. In addition to biopsies from main lesion, three to five blind biopsy specimen were obtained from the main carina during fiberoptic bronchoscopy. Our analysis of data was done by X2, fischer, t student and with 95% coefficient.Results: Carinal involvement was histologically diagnosed in 8 patients (15.7%) who underwent main carinal biopsy. In five patients (9.8%) with carinal involvement normal appearing carina were seen.We found no significant difference between the carinal involvement with the type and location of primary tumor.Conclusion: It was concluded that carinal biopsy should be done routinely in all clinical and radiologically operable patients with suspect lung cancer. It can save the patients with lung cancer from inappropriate or unnecessary thoracotomy and further staging procedures.

Introduction: Human T cell Lymphotropic Virus Type 1 (HTLV-I) infection has been recognized as the causative agents of two diseases; HTLV-1- associated myelopathy tropical spastic paraparesis (HAMITSP) and adult T- cell leukemia (ATL). Approximately 15- 20 millions people are infected with HTLV-I all over the world. The North- East Iran (Mashhad) has been considered as a new endemic area for HTLV- I infection especially Neishaboor. The purpose of this study was the seroepidemiologic study of HTLV-1 in Neishaboor.Materials and Methods: This cross-sectional study was done in Neishaboor in 2002. Neishaboor (without rural areas) is divided into 5 health sections. A total number of 1003 subjects were selected randomly proportional to the population of each region. 5cc of venous blood was obtained from cach subject and assessed serologically by Eliza method at immunology laboratory of Ghaem hospital. A questioner was provided for data collection of each person. The collected data was analyzed with using of T, Mann Whitney and regression tests.Results: 1- The seroprevalence of HTLV-I infection was 3.4% in Neishaboor (95% CI= 2.3- 4.5%).2- Male/female ratio was 33/67 in serum positive population.3- HTLV-I infection was increased with age.4- As expected, the prevalence of infection did not show a uniform distribution throughout the city: a. The most ancient part (region 2) of the city had the highest prevalence (4.9%). b. The rate of infection was more prevalent in the center of city (region 1, 2) in comparison with the peripheral regions of the city (regions 3, 4).5- The main risk factors for acquisition of HTLV-I infection are breast feeding, blood transfusion, surgery and sexual transmission.Conclusion: Our results strongly suggest that screening of blood bank donors for HTLV-I infection and limiting of other routes of HTLV-I transmission such as breast feeding, surgery and sexual transmission should be considered to prevent of HTLV-I infection in Neishaboor and other endemic areas.

Introduction: Some studies reported the relationship between near- work activity and progression of myopia. The objective of this study is to investigate longitudinal changes in refractive errors of the participant s student in entrance exam of the Universities (EEU) in educational zones of Mashhad.Material and Method: In this study, 49 students in the final year of high school were randomly chosen and followed longitudinally study using standard objective and subjective refraction methods. Their refractive errors were determined in two succeeding visits; first: before the EEU (October) and second: after EEU (August of the following year). The data were then statistically analyzed by SPSS.Results: From 49 students (20 boys and 29 girls) the results of this study indicates that after EEU, the amount of myopia (spherical equivalent) increases from-0.088 to -0.357 dioptres (P=0.001) in, boys and from -0.085 to-0.365 dioptres in girls (P=0.008). Amount and type of astigmatism did not change significantly in boys and girls after EEU. Conclusion: These results support the idea that longtime reading and intensive near vision working in short distance relates with increasing the amount of myopia, but it does not correlate with the amount and type of astigmatism.

A 59 Businessman presented to private clinic in Mashhad with one-week history of jaundice, anemia weakness and vertigo. He reported having had dark urine, loss of appetite and tiredness. This man was a proved Case of PNH since 9 years ago, and he had been on prednisolone 30 mg every other days. When the diagnosis of PNH by Ham test and Sugar test was confirmed and a bone marrow aspiration showed no sever abnormality except. B.M Hyperplasic. Because of sever hemolytic anemia he received several times blood transfusion. In many developing countries, one of the primary routes of HCV infection is post blood transfusion In spite of transfusion of screened blood products. In screening the patient for viral Hepatitis, HBsAg and anti HBC markers were negative but HCV antibody by 3ed generation Elisa assay was positive. A quantitative HCV PCR assay was positive with more than 12 million Virus copies per ml, Liver function tests were high (ALT and SLT). Ultrasonography of liver showed a fatty liver without symptoms of portal Hypertension and ascitis.Pegasys (Peg interferon α-2a Roche) with 180 mcgr. Per week started but because of declining of platelets, Neutrophyls and Hb after 4 injections, the peg interferon dosage was decreased to 135 mcgr per week and after 20 weeks to 90 mcgr per week. In spite of decreasing peg-interferon dosage, the Number of platelets and Neutrophyls were under normal limit. Because of hemolytic side effect of Ribaverine we did not, prescribe this drug. In another HCV-PCR assay, it was strongly positive and liver enzymes were high, and PT was 19 seconds despite of injection Vit K and infusion of (factors 8 and 9) FFP. Prothrombine time did not change. The patient in a trip to Paris in Necker hospital was evaluated again and a transjugular liver biopsy was done. The report of .liver pathologist of Necker Hospital by Metavir scoring was: A1 F2 and by Knodell scoring was: O+1+1+1.So peg interferon discontinued and a complete check up of patient after Peg interferon D.C was evaluated good condition. Liver enzymes were at normal range, total Bilirubine, less than 3 mg, WBC at a normal range, and no hemorrhagic abnormality. The patient now is in Mashhad with a good condition in spite of HCV-PCR Positive. He is on a monthly clinical and laboratory surveillance and probably second liver biopsy should be done after one-year interval.

Introduction: Diastematomyelia is one of the uncomon and occult spinal dysraphisms.The term is derived from two latin word: diastemato means split and myelous means cord. The pathological characteristics consist of longitudinal cleft in the spinal cord of the lower thoracic and upper lumbar spinal colummn in children and rarely in adults.This report has encountered with 4 cases during one year (2003-2004) in M.R.I. centers of university and private clinic that MRI showing a midline dimple shape and hemicord appearance.This study and article found that patient diagnosis with MRI is more reliable and more accurate than other radiological techniques specially CT scanning, because of multisectional and multiplanners for a better view of the lesion.In this study most of patients are a female infant with a majority of clinical neurologic findings including motor and sensory loss in the lower extremities and bladder dysfunction.

Autoimmune polyendocrinopathy syndrome with mucocutaneus candidiasis and ectodermal dystrophy is a rare syndrome which appears in the first decade of life.The first manifestation of this syndrome is mucocutaneus candidiasis in the breast feeding period and the last is adrenal failure.In this study we present3 cases of APECED syndrome who were admitted in the hospital with convulsion due to hypocalcemia. In physical exami:qation the nails were small and dystrophic, and hare bilateral keratitis, skin almost dry and alopia was also seen.We aimed to show the significant role of poly endocrinopathy type I as a benign cause of hypocalcemia and it's easy treatment with early diagnosis.

Introduction: Severe upper abdominal pain is a dominant and distressing feature of advanced pancreatic cancer.Material and Method: We performed videothoracoscopic left splanchnicectomy in a patient with intractable upper abdominal pain due to advanced pancreatic cancer.Results: Pain was reduced significantly after the operation and the patient enjoyed consistent pain relief during the postoperative follow-up. The adequacy of the analgesic management improved. The patient did not require opioids.Conclusions: Unilateral left thoracoscopic splanchnicectomy is a simple, minimally invasive.effective, and safe procedure that can be recommended as the method of choice for the management of intractable pain due to advanced pancreatic cancer.