MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2005 | Volume:48 | Issue:89|Papers Count:23

Introduction: Microwave energy is produced from electricity energy via a magnetron which is discovered about 60 years ago and according to its several capabilities, is used in most industries. One of them is laboratory utility, especially in pathology laboratory, which was introduced in 1980 decade by Boon et.al. Microwave doesn't use in IRAN because of expensivity.Histoprocessing in pathology laboratory takes time about 24 hours and diagnosis is delayed one working day. For reducing time in diagnosis and decreasing hospital and insurance costs, and introducing an applicable way, the aim of this study is microwave oven usage in optimal tissue processmg.Material and Method: In this study, each level of processing was done separately and finally all the levels were combined then results were verified.Results: According to details of tissue processing total time for all levels was 70 minutes. Distinction between each paithem was impossible and in many of them, microwave processing slides were better.Conclusion: Microwave processing could be used simply by pathology laboratories for reducing time of histoprocessing if correct calibration and setup is done.

Introduction: The term "small round cell tumour" describes a group of highly aggressive tumours composed of relatively small and monotonous undifferentiated cells with high nuclear to cytoplasmic ratio. This group includes: Ewing sarcoma (EWS), Peripheral neuroepithelioma (PN), Primitive neuroectodermal tumour(PNET), Neuroblastoma, Rhabdomyosarcoma (RMS), Desmoplastic small round cell tumour (DSRCT), Lymphoma, Leukemia, Small cell osteosarcoma Small cell carcinoma, Olfactory neuroblastoma, Merkel cell carcinoma, Small cell melanoma, and Mesenchymal chondrosarcoma.Their clinical presentation often overlap, thus making a definitive diagnosis problematic in some cases. Yet, a clear understanding of their clinicopathologic features usually allows for a confident diagnosis, especially if immunohistochemistry is used.Material and method: This is an immunohistochemistry study of small round cell tumours with unknown origin that were diagnosed in pathology service of Imam Reza Hospital from 1362-1382. In this period, we found 24 cases which were reported SRCT without definitive diagnosis the immunohistochemistry kits are from DAKO Company and applied as directed by manufacturers. Results: The SRCT is most frequent in the first decade of life (45%),13 cases were male and 11 cases were female. IHC influence on diagnosis in 11 cases (46%) confirm the first ordered diagnosis and diagnosis made in another 9 (33%) of SRCTs, and in 2cases(8%)the first diagnosis was changed.conclusion: Overally in review, 35 cases from 48 SRCTs with unknown origin (~%75) were diagnosed by routine stainings by light microscopy without immunohistochemistry.

Introduction: Gestational Diabetes Mellitus GDM is the most common metabolic disorder during the pregnancy with numerous fetal an mathernal complications. It seems that the frequency of GDM is increasing so it nacessitate a greater attention and more study in this field. The aim of this research is to find an alternative or at least an adjuvant method for diagnosis of GDM which is traditionally made by the time consuming and cumbersome 3 hour oral glucose tolerance test.Material and Method: This research is a prospectively designed study on pregnant women who were in the 24th to 32th week of gestation. The main purpose of this study is to defining the role of HbA1c (HPLC method) in the diagnosis of GDM in comparison with the 3 hour Glucose Tolerance Test (GTT), according to carpenter- coustan criteria.Results: 105 cases with a mean age of 29 years and an age range of 18 to 50 years were in the following groups:43 persons normal ,15 had impaired glucose tolerance (IGT) and 47 were in GDM group, range of HbA1c (mean+2SD) in these three groups were: %3.66 - %5.8, %2.81-%7.45 and %2.79-%8.91 respectively. There was a significant difference (p-value<0.05) between the means of HbA1c in normal, IGT, and GDM groups but due to the wide range of variations in persons with GDM, it wasn't possible to determine a suitable lower cutoff and only the upper cutoff of %5.85 for discriminating patients with GDM from other groups especially normal persons was achieved. This cutoff was able to diagnose %38 of GDM without any normal one (no false positive result). The most correlation exists between HbA1c with GTT3hour (r=0.55) and fasting blood glucose (r=0.504).Conclusion: Using the upper cutoff of %5.85 for HbA1c is able to discriminate persons with GDM who have higher than this value from normal ones, but due to the wide range of variations in lower values in person with GDM and overlapping of it with the normal values ,there is not a suitable lower cutoff (with high specificity and sensitivity).

Introduction: Atherosclerosis of peripheral arteries occurs in 12% of individuals with 65 years of age or older. Peripheral arterial disease (PAD) is one of the chronic diseases that is responsible for a significant number of mortality or morbidity in the developed countries. At least 28% of these patients have coronary heart diseases and 10% of them have cerebrovascular diseases. In addition, PAD is an independent predictor of both all causes and cardiovascular mortality.The aim of this study is to calculate agreement between the two diagnostic tests of PAD, ankle brachial index (ABI) and ultrasound duplexes scanning (UDS) and to evaluate the results of these tests against symptoms of patients we designed this study on PAD patients.Material and Method: Forty symptomatic PAD patients that referred to the department of Sonography to complete their work up were enrolled in this validation study. Demographic characteristics, risk factors, symptoms, ABI and UDS measurements were recorded. Based on symptoms, AB! and UDS findings, patients were divided in to four groups and were compared with each other. Finally, agreement and association of these findings were analyzed.Results: 32 patients (80%) were men with the mean age of 62±12.8 years (26-90). Smoking (75%) and hypertension (100%) were the most common risk factors in men and women respectively and diabetes was ranked as the second common risk factor had the second degree in both genders. Agreement between ABI and UDS in men was significant, but was not significant in women. (P=0.02) Agreement between symptoms & ABI was significant (P=0.04) and between symptoms and UDS was not significant (P=0.037).Conclusion: ABI is an appropriate tool for estimating the severity of arterial stenosis and lower extremity circulation.

Introduction: An elevated serum C- reactive protein (CRP) has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, little information is available regarding CRP levels in predialysis renal failure. The aim of our study was, determine the significance of high CRP levels in pre dialysis patients.Material and Method: In a cross- sectional study 100 pre dialysis patients were studied. The CRP levels, nutritional data [body mass index (BMI), serum albumin, cholestrol, triglycerides], hematocrit (HCT), hremoglobin (Hb), serum creatinine, creatinine clearance, urinary protein levels and blood pressure were measured and compared between patients with high (>6mg/l) or low (<6mg/l) CRP levels.Results: In 100 chronic pre dialysis patients mean age was 48/8±12/8 years. CRP was greater than 6mg/1 in 35%. We found some statistical relationship between high serum CRP levels and BMI, creatinine clearance, serum Albumin, serum cholestrol and high blood pressure. Conclusions: The prevalence of inflammation is high in predialysis patients. As occurs in dialysis patients, predialysis inflammation predicts morbidity in pre dialysis stage but further investigation should be done in this regard.

Introduction: There is over 10 years that β - IFN for the treatment of MS is presented to the world of medicine. As there are some doubts about the Pathophysiology of MS, there may be some differences between our patients and other ones; so a study of this type for our own patients is essential.Material and Methods: This is a descriptive-analytic and clinical trial study. According to the clinical and paraclinical findings, the patients with the diagnosis of Relapsing Remitting MS included for this study.Severity of disability (according to EDSS and FS) and the numbers of attacks were estimated before and after treatment with IFN β. Side effects of IFN β were evaluated, too. RESULTS: 69% of patients were female and 31% male. Mean age of onset is 26.93 years old and mean duration of disease 5.13 years. Mean relapsing rate before and after of treatment was 1.79 and 0.74 respectively; the difference between these two is significant (P<0.05).The mean of EDSS at the months of 0, 3, 6, 9, 12 was decreased significantly (P<0.05). The most common side effect of IFN- β in our study is flu like syndrome (27.5%).Conclusion: Epidemiologic findings of this study such as M/F ratio and age of onset are similar to other studies. Statistical tests revealed the effects of IFN β on the decrease of disabilities and relapse rate, but there are no differences of these effects between male and female.

Introduction: Human T cell lymphotropic virus 1 (HTLV1) infects an estimated 15-50 million individuals world wide, HTLVI was the first virus demonstrated to be involved in the etio10gy of a human cancer, Adult T cell leukemia / lymphoma (ATLL).Khorasan province in the northeast of Iran was introduced as a new endemic area with 2/3% sero prevalence for HTLVI in 1985 (12, 13, 14). This is the first comprehensive report of a case series study of the clinical and laboratory features of Iranian ATLL patients that compared whit other endemic area: Japan, Jamaica.Material and Method: In this study review total cases of ATLL between march 1995 and September 2001 was report to Ghaem and Emam reza Hospitals (mashhad university).These cases were included in the study if they had clinical and paraclinical signs for ATLL, positive HTL V Ab, and establish T cell malignancy with history and at least 5 points according to the Levine registry criteria for definition of ATLL.Then result of BMA, lymphnode and skin biopsies recorded. With shimoma criteria total patients divided to four group.Results: There were 30 patients include 17 female and 13 male (M/F: 1/1.3) with a mean age of 47 years (22-71 year) (fig 1).The majority of cases were acute type (53.3 %) followed by lymphoma (26.7%), chronic (10%) and smoldering (10%) type (Chart 1).The most common clinical features were skin lesion (63%) fever and weight loss (40%), gastrointestinal problems (37%), respiratory symptoms (26%) malaise (20%) and bone pain (10%) (Fig 2).The most important clinical findings of patients were lymphadenopathy (67%) skin lesions (63%), splenomegaly (63%) hepatomegaly (23%). The characteristic pattern of skin manifestation was maculopapular and nodular rash (Fig 3).Conclusion: The comparison of the distribution pattern of subtypes and mean survey time Iran with other endemic region, especially Japan, Jamaica was revealed close similarity to Jamaica figures. However skin lesions were more common in or report, and hypercalcemia and lyric bone lesions were less common in Iranian ATLL cases.

Introduction: Tinea Versicolor is a common superficial fungal skin infection. Topical drugs are often effective in limited lesions; but in extensive cases, systemic drugs are more suitable. Previous studies have shown that Ketoconazole and Fluconazole are effective in 42-97% and 74-100% of lesions respectively.The aim of this study is to compare the effectiveness of a single dose of 400mg Ketoconazole with two doses of 300mg of Fluconazole with 2 weeks interval.Material and Method: Sixty patients with extensive tinea versicolor (body involved area ≥25%) were randomly assigned to treatment with either a single dose of 400mg of Ketoconazole or with two doses of 300mg of Fluconazole with 2 weeks interval. One month after the treatment, the improvement rate and side effects were evaluated by clinical examination and questionnaire.Results: Sixty patients were participated initially in the study. Sixty cases (66.7%) completed the study. They were 51 males and 9 females, with a mean age of 30 years. At the follow up visit (one month after the end of treatment), the improvement rate for Ketoconazole (87.9 %) was not significantly different from Fluconazole (81.5%). (Fisher test: P=0.37)Conclusion: Fluconazole has shown to be as effective as Ketoconazole in the treatment of extensive tinea versicolor. Due to the hepatotoxicity of Ketoconazole, Fluconazole appears to be more suitable in the treatment of extensive tinea versicolor.

Introduction: The most serious result of inappropriate usage of antibiotics is increased prevalence and emergence of multidrug resistant organisms.Material and Method: We studied antibiotic prescribing for hospitalized patients in Infectious diseases, Medical emergency, Pediatric emergency and General Surgery wards of Imam Reza hospital for 4 months. We completed 535 questionnaire forms and evaluated them.Results: Inappropriate usage of antibiotics was 100%, 66.2%, 84.96%, 50.77% in general surgery, infectious diseases, Medical emergency and pediatric emergency wards, respectively.The most common error in antibiotic prescribing in surgery ward was related to the time of prophylactic antibiotic use preoperatively. However, the most common error in antibiotic usage in medical wards except pediatric emergency ward was improper dosage of antibiotics, and in pediatric emergency ward was inappropriate choosing of antibiotics.Conclusion: In our study, inappropriate use of antibiotics was in unacceptably high and much higher than most other countries.

Introduction: Constipation occurs in 11- 40 pregnant women and has side effects like hemorrhoid, fissure, depression and anorexia. Because of the believe in movement and hyper activity with decreasing effect, in pregnant employed women and tension of the job with increasing effect in contrast with housewives and also lack of research in this field, this research is accomplished by the objective of comparing the occurrence and intensity of constipation in pregnant housewives and employed women.Material and Methods: This analytic, profile sectional research was done on 150 pregnant employed women and 310 pregnant housewives that each group is in three different sections, in first, second and third trisemester of pregnancy and has become constipated for at least 2 weeks and with no diseases, no medical therapy, and no suitable condition for constipation in the winter of 2000.Sampling was done by multi-stages method and data was gathered by utilizing interview form and measuring the rate of constipation by researcher for both of two groups in the health care center and gynecologist offices.Data was analyzed by using of descriptive and analytical statistics by X2 test, on way analysis of variance, log-linear and co-variance analysis by % 95 coefficients, and utilizing SPSS software.Results: Rate of occurrence in employed women was 32.6 percent and in housewives %20.9, so there was a significant difference between two groups (p=0.009), the constipation occurrence mean in employed women group was 15.9+6.6 and in housewives 12.23+4.14 then, there were significant differences between two groups as well (p=0.01). Also chance of constipation occurrence in pregnant employed women was doubled in contrast with housewives (oods Ratio=2).Conclusion: Job should be considered as "risk factor" in pregnancy constipation. So researchers propose doing similar researches by provident method prospective and study of manner of job - effect on this process.

Introduction: ALS is a neurodegenerative disease due to degeneration of both upper and lower motor neurons (UMN & LMN). There is no treatment for this disorder and it is important to distinguish from other conditions that may mimic ALS. Material and Methods: This is a descriptive study since September 2002 until September 2004 among the patients whom referred to neurology department of Ghaem hospital.Results: 21 patients were studied (14 men). Mean age was 41.58 years.UMN and LMN symptoms were the presenting complaint of our patients except 5 cases with bulbar onset. Symptoms began before age of 40 in 40% of our all patients, and 27% of Charcot type of ALS.15 Cases had charcot type of ALS, 4 cases had juvenile ALS, I case had Kennedy syndrome and finally 1 case had Madras motor neuron disease (MMND).Conclusion: In this study we found the first case of MMND in Iran. There was a large proportion (40%) of cases with age of onset below 40 years in comparison with previous studies. More epidemiological and toxicological studies should be done.

Introduction: One of the most important problems in the treatment of epileptic patients is the drug effects. Na Valproate is a widely used drug for the treatment of epilepsy. The side effects of the drug include digestive disorders, increasing liver enzymes, fatal hepatitis, cognitive disorder, behavior disorder, insomnia, hyperactivity, tremor, stupor and coma, metabolic disorders, hair waving, curling, thinning and loss, pancreatitis, blood effects, fetal hydatoine syndrome, irregular menstruation and secondary amenorrhea.Material and Methods: In this descriptive study 170 patients with epilepsy were evaluated. These patients were referred to Neurologic clime of Imam Reza Hospital over a period of 3 years from September 1996, and treated with Na Valproate. Sixty-five percent of patients were male due to the fact that females avoid Na Valproate during the fertility period, Our study was done to determine complications of Na Valproate, and the following complications developed in our patients transient neutropenia as the most common complication, 12 cases (7% ), weight increasing, 7 cases (4%), diminished appetite, 4 cases (2.5%), tremor, 1 case, abdominal pain, 1 case, and ALP increasing, 1 case.Conclusion: Regarding to the limited side effects of Na Valproate and its good therapeutic effects in controlling different types of epilepsy, it is suggested that this drug is very effective in treatment of epilepsy except of children aged less than 2 years and women who are in the fertile ages.

Introduction: Urinary stone is one of the most common cause of ureteral obstruction. Degree of obstruction has an important role in choosing time and method of treatment. The aim of this cross-sectional study is comparison between Color Doppler Ultrasound and Intravenous Urogram in diagnosis of ureteral obstruction in patients with ureteral stone.Material and Method: 35 patients with unilateral renal colic were studied from October 2004 to June 2005. In all patients the presence of stone in the ureter was confirmed by Sonography. Mean age was 36.9±9.1 years. After analgesia and determination of serum creatinin level, color Doppler ultrasound (CDU) was done with semi-distended bladder.Number, velocity, and duration of ureteral jets were observed in five minutes, bilaterally. Immediately after CDU, the patients were transferred to the next room to perform standard IVU.All data was recorded and analyzed with statistical methods.Results: %71.4 of patients were male and 28% were female. Mean serum creatinine was 0.9±0.18 mg/dl. In all patients with complete ureteral obstruction in IVU, ureteral jets were diminished (42.1%) or absent (57.9%) in CDU. In patients with partial obstruction in IVU, diminished jets in CDU were noted in 86.7%; and only in 2 patients (13.3%) normal jets were seen. Number of jets in one minute was 0.84±1.46 in patients with complete obstruction, and 5.18±3.4 in partial obstruction (P<0.001).There was a significant difference in velocity and duration of jets between complete and partial obstruction (P<0.014 and P<0.001 respectively). The number, velocity, and duration of the jets in the normal side was not significantly different between the two groups of patients (P=0.31, P=0.51, and P=0.27 respectively).Conclusion: This study showed that CDU can determine ureteral obstruction in renal colic patients in most cases. It is a safe, fast, and noninvasive test

Introduction: Labial fusion is a common benign prepubertal gynecologic condition that is defined as partial or complete adherence of the labia minora. Most cases are mild and/or asymptomatic, but in some cases may be presented with urinary symptoms.Material and Method: Clinical course and management of 87 cases with labial fusion and urinary tract symptoms, presented between 1372 and 1382, was reviewed retrospectively.Results: Patients age was between 8 months to 6 years (mean= 2y and 8 mo).56 cases had been visited by physicians but without genital examination. None of mothers were informed of normal genital condition.36 cases (41%) had UTI without urologic abnormalities. Topical conjugated estrogen was effective in all patients with minor side effects. Recurrence was noted in 23 cases (26%) which responded to estrogen re-treatment.Conclusion: All of girls with any complaints especially urinary symptoms and UTI must be examined with high index of suspicion for labial fusion.

Introduction: Chronic ulcer with any kind of etiology is one of the therapeutic problems for patients and medical services. With respect to appropriate effects of retinoids on different stages of wound healing, we decided to evaluate efficacy of 0.05% topical solution of tretinoin on topical treatment of ulcers in comparison with 1% topical cream of phenytoin ,that its effects on wound healing has been approved in several studies.Material and method: In an interventional, clinical trial topical effect of these two drugs on healing of chronic ulcers of 30 patients with 37 ulcers was compared. with random allocation patients divided to two groups and finally 15 patients with 18 ulcers treated with 1% topical cream of phenytoin and 15 patients with 19 ulcers treated with 0.05% topical solution of tretinoin. Then followed up for 6 weeks and evaluated for criteria of clinical recovery (size, depth, secretion and pain) in weekly visits. Analytic tests were done by using the chi-square test and P<0.05 was accepted as significant.Results: At the end of, the treatment in phenytoin group 42.6±44.9% and in tretinoin group 44.71±43.4% of ulcers width were reduced. Also at this time ulcers' depth were diminished whereas in phenytoin group 55.6% and in tretinoin group 26.3% of those were in superficial dermis. Before treatment in phenytoin group 55.6% of ulcers were without pain though after it 100% of them had no pain. In tretinoin group ulcers without pain increased from 78.9% before to 84.2% after treatment. Percentage of ulcers with no secretion increased from 33.3% to 55.6% in phenytoin group and from 26.3% to 68.4% in tretinoin group.Conclusion: With respect to results, tretinoin solution as phenytoin cream can be used as an appropriate topical treatment for chronic ulcer.

Introduction: TAPVc is a rare and known cardiac malformation in which there is no direct connection between any pulmonary vein and the left atrium, rather, all pulmonary veins connect to the right atrium, thus the ASD or PFO is necessary for survival after birth.This anomaly has four types that include: cardiac -supra cardiac-infra cardiac and mixed type. Based on drainage of pulmonary veins, that treatment in all types, soon after diagnosis is made is surgical treatment.The prescribed surgical technique, after median sternotomy and hypothermic circulatory arrest, the first stage is ligation and division of vertical vein (connection between left pulmonary vein and innominat vein) and then total correction based on the anatomy.If total correction was done in neonates and infancy period, operative mortality seems be low but in old age is high because of pulmonary artery hypertension.The aim of this study is to introduce a two stage repair in patients who don't tolerate one stage repair. The vertical vein is kept intact and snared, If pulmonary hypertension and failure occur, opening and appropriately banding this vein will relieve the pulmonary hypertension and associated failure.Methods and materials: Two patients with TAPVC types cardiac and supra cardiac in GHAEM HOSPITAL had cardiac surgery with CPB as usual manner, we ligated vertical vein but not divided it, and then total correction had been done via right atrium and in final of operation we closed ASD, but weaning from CPB was impossible and pulmonary edema and hypotention occurred. With opening of vertical vein, all symptoms were obscured and weaning from CPB was done very well and patients were transferred to ICD division with hemodynamically stability condition.Results: Because of older age of these patients and occurred pulmonary hypertension (PA pressure = 50 mmgh) and lower left atrial cavity we had hypertensive pulmonary artey crises, and with opening of vertical vein, all symptoms resolve, therefore, recommended: in older children with TAPVC, first ,vertical vein should not be closed and in latest stage of operation if condition of patient is good then closure of it done.

Introduction: Encephalitis due to herpes simplex virus (HSV) is the most important cause of fatal Sporadic encephalitis that prompt diagnosis is necessary because there is effective antiviral treatment for this disorder. In the fatal cases, severe meningoencephalitis is associated with diffuse destructive changes in the brain tissue and is following the reactivation of latent virus. Recent studies demonstrate increased hypercoagulopathy state due to HSV infection in the endothelium and footprints of virus has been found in the vascular thrombosis.Case Report: In this issue, one of the very rare manifestations of HSV encephalitis, which has so far been reported in a neonate, is presented. The patient presented with the signs of encephalitis including stupor state and agitation, headache, seizure and neck stiffness. The diagnosis of HSV encephalitis is confirmed by the PCR test of CSF fluid .MRI and MR venography of the patient's brain demonstrated the thrombosis of sagital, rectus and lateral venous sinus. The patient survived with the specific treatments.Conclusion: Herpes simplex virus type I can be a cause for the development of cerebral Venus thrombosis. This case report is a conformation for the studies demonstrating hypercoagulopathy state in the setting of HSV infection.

Introduction: The term "Noonan syndrome" has been applied to males and females who have certain phenotypic features that occur also in turner syndrome, but these boys and girls have normal karyotypes.The disorder is usually sporadic, but affected siblings of the same and different genders have been reported.The most common abnormalities are short stature, webbing of the neck, pectus carinatum or pectus excavatum , cubitus valgus, and congenital heart disease.We describe a case of Noonan Syndrome that admited in hospital with initial diagnosis of Turner syndrome and referred for routine evaluation of cardiovascular abnormalities. Physical examination, electrocardiogram and chest x-ray and echocardiographic finding confirmed severe nonobstructive hypertrophic cardiomyopathy. After chromosomal analysis that revealed normal 46xx karyotype diagnosis of Noonan syndrome have been done.We concluded that Noonan syndrome should be considered in differential diagnosis short statue in girls with Turner features.