Medical Journal of Mashhad University of Medical Sciences
Year:2007 | Volume:49 | Issue:94|Papers Count:24

Introduction: Pleural effusion is the accumulation of excessive fluid in the pleural space. One way for detection of its etiology is to examine the fluid for its exudative or transudative origin. Until now, the best criterion is Light Criteria; following by is serum and pleural albumin gradient. This study was done to examinate the possibility of using albumin gradient as first criteria instead of Light Criteria.Methods and Material: In this descriptive study 100 patients with pleural effusion, detected by plane chest X-ray were studed. Light Criteria and albumin gradient for each patient was obtained. Regarding to final diagnosis, results from albumin gradient and Light Criteria were compared. Individual and laboratory data were gathered in a questionnaire and analyzed using SPPS software and descriptive statistics.Results: Based on the clinical diagnosis, 70 patients had an exudative pleural effusion and 14 transudative pleural effusions. Nine patients had no final diagnosis, one patient died before preparation of final diagnosis and six patients had pulmonary emboli that can produce both exudative and transudative pleural effusion. In patients with final diagnosis, 77 had exudative and 13 had transudative fluid. By albumin gradient 41 had exudative and 49 transudative fluid. Light criteria could diagnose 69 of all 70 exudative fluid and 11 of 14 transudative fluid, properly. In albumin gradient method it was 41 and 14, respectively.Conclusion: In according to our study albumin gradient is not suitable as first criteria to differentiate exudative and transudative pleural effusion. In cases that the pleural fluid has a transudative feature in clinic, but an exudative characteristic according to Light Criteria, albumin gradient is a useful criterion for exact diagnosis.

Introduction: Anemia is one of the most serious complications in patients under dialysis. The aim of this study was to investigate the influence of haemodialysis and continuous ambulatory peritoneal dialysis on anaemia during the first six months of treatment by Erythropoietin.Methods and Materials: This cross- sectional descriptive study was done in Dialysis Center of Imam Reza Hospital in the year 2005.53 patients on haemodialysis and 47 patients on CAPD were analyzed. They received low doses of erythropoietin ranging from 50 U/Kg/wk to 100 U/Kg/wk. The EPO dose/week, hemoglobin, ferritin, transferrin saturation (TS), albumin and intact parathyroid hormone (iPTH) were analyzed before and six months after study. Erythropoetin treatment was prescribed if HB < 11. Individual and laboratory data were gatherd in a questionnaire and analyzed by descriptive statistics and frequency distribution tables.Results: In the CAPD group, the mean hemoglobin level increased from 8.7 +/- 0.2 to 10.87 +/- 1.67 g/dl (P < 0.001) and hematocrit from 25.3 +/- 1.0 to 32.76 +/- 4.92% (P<0.001), while in the HD group the mean hemoglobin rose from 8.7 +/- 0.6 to 9.25 +/- 1.8 g/dl (P < 0.001) and Hct from 25.7 +/- 2.3 to 28.07 +/- 6.22% (P < 0.001). The CAPD group needed a significantly lower weekly dosage of erythropoietin than HD group (72 -/+ 18U/Kg/wk vs. 92 -/+ 8 U/kg, p < 0.01). At the end of the study TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.05 in both).Conclusions: Patients on CAPD exhibited significant correction of anaemia during the first six months of treatment and had a better erythropoietin response than the hemodialysis patients.

Introduction: Captopril and Allopurinol have protective effect against renal warm ischemia with different mechanisms. The aime of this study was to evaluate this protective effect against induced 1 hour warm ischemia in dog's kidneys.Methods and Material: This experimental study was done in the year 2006. We performed the operation on 15 healthy dogs. During these procedures both kidneys were clamped for 1 hour, then left kidney was removed for pathologic evaluation and right kidney remained insitue for functional assessment. Five random dogs received 1 mg/kg/day caporal orally before and after surgery (captopril group); another five dogs received 10 mg/kg/day Allopurinol orally before and after surgery (allopurinol group). Five dogs of control group received no drugs. Serum urea and creatinine were measured preoperatively and on postoperative days of 1, 3, 5, 10 and 16in all groups.Results: Serum levels of urea and creatinine elevated in all groups but in Captopril group maximum levels of urea and creatinine were significantly lower than control (P<0.05). In Allopurinol group the maximum rise of creatinine was significantly lower in comparison to control group (p< 0.05), but the maximum levels of urea in this group had no significant difference when compared with control values (p< 0.05). There was no significant difference in pathologic changes in the three groups.Conclusion: One hour warm ischemia results in ATN so it is not safe for dog's kidneys. Although Captopril and Allopurinol do not prevent ATN after one hour warm ischemia; they can reduce its severity and improve renal function after warm ischemia.

Introduction: P53 is a tumor suppressor gene which is mutated in 50% of human cancers. The purpose of this study was to evaluate the association between the protein status in the serum / urine and tumors of bladder cancer.Methods and Material: This descriptive study was done on 38 patients with transitional cell carcinoma of bladder who had no history of chemo-or radiotherapy or immune system disease. The sera and urine of these patients were analyzed for P53 protein by Enzyme Linked lmmunosorbent Assay (ELISA) and tissue P53 by Immunohistochemical Technique. lndividul & laboratory data were collected in questionnaire and analyzed by descriptive statistics and frequency distribution tables.Results: Tissue P53 was detected in 29 of 39 (74.4%) patients. serum and urine PS3 protein were detected in the serum and urine of 20 of 39 (51.3%) and 27 of 39 (69.2%) patients, respectively. The mean serum and urine P53 level in positive Tissue P53 patients were 1.45 and 2.27 U/ml respectively, which was significanfly higher when compared with mean serum P53 level in negative tissue P53 patients (p< 0.01). In patients with positive serum P53 (n=20) tissue PS3 was positive in 18 (90%) patients and negative in 2 (10%), which was statiscally unsignificant. In negative serum P53 patients (n=19), tissue P53 was negative in 8(42%) patients and positive inll (58%). In patients with positive urine P53 (n=27), tissue P53 was positive in 25 (93%) patients and negative in 2 (%7), which was statically unsignificant. Statiscally significant correlation was observed between tissue P53 with pathologic grade of tumor (p= 0.05), but for serum and urine P53 such correlation was not seen.Conclusion: This study shew a strong relationship between tissue P53 protein overexpression and level of P53 protein in serum and urine of TCC patients. Therefore both serum and urine of patients with TCC were found to have significant clinical accuracy for determination of P53 gene status in patients with TCC of bladder.

Introduction: Vaginal candidiasis is one of the most frequent infections of the female genital tract in different countries. The goal of this study was to evaluate the efficacy of clotrimazile, nystatin and povidone iodine (betadine) in treatment of vaginal candidiasis in patients referred to gynecologic clinics of Mashhad.Method and Material: This is a clinical trial study on wemon referring to gynecologic clinics in Ghaem, Imam Reza, Imam Zaman & Ali - e - bn - e - Abi taleb centers, for vaginal discharge.Vaginal candidiasis was confirmed by direct fresh smear, Papanicolao staining, gram staining and culture. Among 300 cases, considering inclusion & exclusion criteria, 130 pateints suffering from vaginal candidiasis were selected. Each received either vaginal tablets of clotrimazole, nystatin or vaginal gel of betadine randomly.Results: Among 300 patients suffering from vaginitis symptoms, candidiasis was confirmed only in 43% of the cases, most of them between 25-35 years old. Clotrimazole was more effective than betadine clinically. There was no significant difference between nystatin, clotrimazole or betadine in treatment of patients. Betadine side effects were more prominant compared to clotrimazole and nystatine. Conclusion: It is concluded that compared to betadine, clotrimazole and nystatin are safer in treatment of vaginal candidiasis and because of shorter duration of treatment, usage of clotrimazole is more reasonable in treatment of vaginal candidiasis compared to nystatin and betadine.

Introduction: H.pylori infection has a worldwide distribution and has been shown to be involved in gastro-intestinal and other diseases. Epidemiological pattern of this infection differs between developing and developed countries. In developing countries individuals are mostly infected in childhood and most adults are already infected. In this study, the relationship between this infection and factors such as age, sex, socio-economical situation, family size, diet, BMI, and ABO blood groups was studied.Methods and Material: This descriptive study was done in Clinic Laboratory of Imam Reza Hospital in the year 2005 on 184 individuals referred for H.pylori serologic evaluation. All patients were examined clinically; and their weight, height and BMI were measured. Individual, economic, diet, ABO blood group, Rh group, and H. pylori infection data was collected in a questionnaire. Data was analyzed using descriptive statistics, frequency distribution tables and x- square test. Results: 77.8% of individuals were serologically positive for H. Pylori. Sero-positivity had a significant correlation with the age of participants. There was no significant correlation between H. Pylori infection and sex, economical situation, diet, BMI, cigarette smoking, addiction, alcohol consumption and ABO blood grouping. However, individuals from bigger families had a higher chance of sero-positivity. Conclusion: This study shew that the age pattern of H. Pylori infection in Iran is between the age patterns of developed and developing countries. Significant change is seen in the second and third decade of life. This study shew the correlation of H.pylori with age and family size; however there was no significant relationship with other factors.

Introduction: The main neurological manifestation of Human T-cell Lymphotropic Virus type 1 (HTLV-1) is spastic Paraparesis, of progressive nature, also known as HTLV-I Associated Myelopathy (HAM) or Tropical Spastic Paraparesis (TSP). Despite various CNS complications described in HAM/TSP a relatively little attention has been directed toward disorders of the peripheral nervous system (PNS). The aim of this study was evaluation of HAM/TSP patients about concomitant neuropathy by clinical and neurophysiologic methods.Methods and Material: In this descriptive Study 73 Patients with HTLVI associated myelopathy in Neurology Clinic of Ghaem Hospital were assesed by clinical and neurophysiologic evaluations in 2002-2004. Questionnaire was completed for each patient, and then Median and Ulnar nerves from the upper extremity and Proneal, Tibial and Sural nerves from the lower extremity were evaluated by electrophysiological studies (NCV). Data was analyzed using descriptive statistics and frequency distribution tables.Results: 65.8% of patients were clinically suspected to neuropathy. In 54.8% of patients with HAM/TSP, there was concomitant peripheral nerve disease. Mononeuropathy in 15 (20.54%), multiplex mononeuropathy in 5 (6.8%), motor sensory polyneuropathy in 17 (23.3%), motor polyneuropathy in 2 (2.7%) and sensory polyneuropathy in 2(2.7%) of patients were present. Conclusion: According to this study electrophysiological compromise of the peripheral nerve is frequent in patients with HTLV-1 associated myelopathy. Furthermore, electrophysiological compromise could arise even when the patient did not present clinical manifestations denoting this kind of problem. Hence, the study of nerve conduction has to become a routine test for patients with HAM/TSP.

Introduction: Seizures are frequent and important disorders in patients admitted in emergency wards, and arise from a variety of underlying conditions. This study was done to evaluate the etiology of first seizure in Neurology Emergency Department.Methods and Material: In this descriptive study, 170 patients referred to Neurology Department of Ghaem Hospital in the year 2003 were studied. Obtaining medical history and performing clinical examination, a questionnaire was filled and preclinical studies (peripheral blood examination, EEG, bran CT scan and, in some cases, MRI) were done. Data was analyzed by descriptive statistics and frequency distribution tables.Results: Out of 170 patients 97 were male and 73 female; mostly 33- 60 years of age. Most common etiologies of seizure in this study were: idiopathic, stroke, neoplastic, trauma, withdrawal syndrome, CNS infections, congenital and degenerative diseases.Conclusion: In this study the most common cause of first seizures was idiopathic epilepsy; but cerebrovascular diseases, head injuries, and opioid withdrawal syndrome were among the frequent causes of first seizures, wich can be controlled to reduce the number of seizures in our society.

Introduction: Patients with Parkinson's disease (PD) have higher concentration of plasma homocysteine (Hcy). Elevation of total serum Hcy level has been known as a risk factor for neurodegenerative diseases. The aim of this study was comparison of serum Hcy level between PD patients with stage =< 2.5 and PD patients with stage> 2.5 (according to modified Yohen and Yahr method), and assessing the association between the duration of disease and Hcy levels.Methodes and Material: This case - control study was done on 50 patients with Parkinson's disease in the year 2005 in Al - Zahra Hospital of Isfahan. Patients divided into two groups: control group 1 included 23 patients with mild disease (stage=<2.5); 27 patients with sever Parkinson's (stage>2.5) were put in the case group 1. Considering the duration of the disease, also, patients were divided into case 2 (more than 4 year duration with 24 patients) and control 2 (less than 4 year duration with 26 patients) groups. Hcy level was measured in all patients and compared in different groups. Individual and laboratory data were collected in questionnaire and analyzed using descriptive statistics and frequency distribution tables.Results: The mean serum Hcy level in severe PD group was 24.96 µmol/lit and in mild PD group was 25.07 µmol/lit. There was no significant statistical difference between them. The mean serum level of Hcy, without any significant difference, in patients with duration of disease lower than 4 years was 23.51 µmol/lit and in group with duration of more than that was 26.40 µmol/lit.Conclusion: The present study showed that serum Hcy level doesn't have any relation with stage and duration of disease, and cannot be used as a predictive value for the progression of PD.

Introduction: Endoscopic third ventriculostomy (ETV) is currently being performed for patients with obstructive hydrocephalus, who also have preservation of communication between the subarachnoid space and the venous system, and in whom the basilar cisterns are still open. Despite the shunt complications, most children are shunt dependent permenantly or for many years. Recently, neuroendoscope is used to treat some of brain tumors, arachnoid cysts, some of congenital disorders and medullary diseases. The aime of this study was to evaluate primary results of neuroendoscopy in neurosurgery department.Methods and Material: In this prospective study, all of the patients who were operated by neuroendoscope in neurosurgical department of Ghaem Hospital for 24 months were reviewed. Age, sex, underlying diseases, clinical findings, complications, CT or MRI findings before and after neuroendoscopy were studied. Data was collected in questionnaire and the processing of the results was achieved by SPSS (11.5) and statistical analysis with descriptive methods.Results: From 30 patients in our study, 26 had obstructive hydrocephalus (two of them had intraventricular tumors and four cases had parenchymal tumors), 3 had arachnoid cysts, and one patient had loculated hydrocephalus. All of them have been operated by neuroendoscopy. From 26 patients with obstructive hydrocephalus, 4 had been operated by VP shunt before. From 26 patients undergoing neuroendoscopy for obstructive hydrocephalus, 14 cases within one week and 10 cases whit in one month after neuroedoscopic third ventriculostomy had normal size ventricules. The results were excellent in treatment of arachnoid cysts, intraventricular tumors, and loculated hydrocephalus too.Conclusion: With respect to excellent results of neuroendoscopy in treatment of obstructive hydrocephalus, arachnoid cysts, and shunt malfunction; and in regard to many complications and severe dependency in shunt surgery, neuroendoscope is recommended as the first step of treatment of these diseases.

Introduction: Spinal TB (pott's disease) is one of the important and common types of TB. The purpose of this study is the evaluation of neurological findings and result of surgical treatment in patients with Pott's disease in Mashhad Ghaem Hospital during 1994-2004.Methodes and Material: In this cross-sectional descriptive retrospective study, 32 patients with Pott's disease, referred to Ghaem Hospital during the years 1994-2004, were studied. Data were analyzed using chi2 test and frequency distribution tables.Results: The mean age of patients was 42.5 years old, with the highest prevalence in the range of 50-59. There was no significant difference between male and female sexes in patients. The most common chief complaint was weakness of lower limb presented in 75%; most patients had lower limb weakness of 2/5, 3/5 Kyphosis was seen in 3/1%, collapse in 62.5%, kyphosis with collapse in 25%. There was no structural problem in 9.4%. Involvement of thoracic vertebrae 9-10 was the most common. 50% of patients had urinary sphincter dysfunction and 40.6% had no problem in urinary sphincter. The mean of the follow up period was 7.4 years. Among all of our 32 patients 8 cases (25%) received only medical treatment; and 24 cases (75%) had combined medical and surgical treatment. The most surgical procedure used was vertebral fusion without device.Conclusion: Medical treatment for at least 9 months combined with surgery (if needed) and proper follow up results in approximately total improvement in patients with spinal tuberculosis.

Introduction: It's assumed that, while tear of meniscus and ligament causes joint line tenderness; locking or giving way and instability of the knee joint may have other reasons too. In this study, clinical and arthroscopic findings in knee internal derangements were compared.Methods and Material: This descriptive study was done in the year 2004 - 2005 On 92 patients (100 knees) referred to knee clinic of Ghaem Hospital with signs and symptoms of meniscus and ligament tear of knee, and admitted in orthopedics ward. All patients were re-examined clinically (with and without GA) and with arthroscopic method, and were managed definitely. Patients with intra - articular fractures and chronic synovitis excluded from the study. Individual, clinical and arthroscopy data were gathered in a questionnaire and processed by Excell software, descriptive statistics, and frequency distribution tables.Results: The age of patients was between 13-71(mean of 32.1) years, and duration of symptoms was from 15 days to 2 years (with mean of one year). 60% of patients had stable and 40% unstable knee. Common findings with arthroscopic examination of these patients were: Meniscus tear (75%), degenerative changes (23%), synovial hypertrophy (4%), loose body (4%), osteochondral fractures (2%). In 16% of the knees, no pathological finding was noted. Thirty seven present of patients who had knee locking in clinical examination, had normal meniscus in arthroscopy and 34% of patients who had giving way had normal meniscus arthroscopically. Only 27% of patients who had joint line tenderness had tear of the meniscus in knee arthroscopy. In clinical examination 57% of patients had positive Mac Murray test. Only 33% of false negative results for this test was found after arthroscopy.Conclusion: Arthroscopy of the knee is the best method for diagnosis and treatment of the meniscal injuries, but clinical examination is a reliable method to detect these knee injuries.

Introduction: Coronary intervention has been accepted as best optional therapy for many patients with coronary artery disease (CAD). Slight increases in serum cardiac markers frequently occurred after even successful Percutaneous Coronary Intervention (PCI) and are considered, by some, as a predictor of long term morbidity and mortality. The aim of study was to evaluate postprocedure CTnI, CKMB; and whether such elevations bore any relationship to clinical, angiographic and technical variables.Methods and Material: 122 consecutive patients with stable CAD who underwent elective uncomplicated PCI (direct and conventional stinting) at Ghaem Hospital, Mashhad, between July 2003 and October 2004 were studied. Patients with recent history of ACS and who developed major in - hospital complications (nonfatal MI, death, CABG) were excluded from this study. Blood sample was routinely taken from all patiets at 20 hrs after procedure. In our institution the upper UNL for CTnI is ≤ 2 ng 1cc and for CKMB is ≤  24 IU/L. The relation of postprocedure level of markers and clinical (age, sex, risk factors for CAD, Severity of symptoms as defined by CCS class, previous Acute coronary syndroms) and angiographic or procedural (ACC IAHA Lesion type, severity single or 2 2 VPCI and direct versus conventional stinting) characteristics were analyzed using Chi-Square, T-Student and ANOVA tests.Results: Abnormal post procedural values of one or more markers were observed in 49.5% (N=57) of patients. CTnI elevation was observed in 32% (N=39) and CKMB elevation in 26/3% (N=31) of all patients. The incidence of abnormal CTnI was higher than that of CKMB (P= 0.1). Older age (>57y/o) was associated with higher elevation of CTnI after PCI, compared with younger (p= 0.01). Elevation of CKMB in hypertensive patients was significantly higher than normotensive ones (p= 0.01). There was no significant difference in enzyme elevation between types a & bland b2&c lesions, variant degrees of severity of stenosis, single and multivessel PCI, and direct vs. conventional stinting. Also, associations were not observed with other clinical, angiographic or procedural variables.Conclusion: The results of this study indicated that enzyme elevation is not uncommon after elective, uncomplicated PCI in patients with stable angina. Elevation of CTnI, (although nonsignificant) is more common. Older patient and hypertensive ones had significantly higher elevation of cardiac markers after PCI. Such association was not observed with other clinical, angiographic or technical variables.

Introduction: Congestive heart failure (CHF) is a major public health problem. Several hospitals - based reports have documented that a high proportion of patients with CHF have a normal LV systolic function. Some of the clinical and preclinical findings during heart failure episodes show presence of a normal left ventricular ejection fraction (LVEF). We evaluated the utility of these predictions in patients with HF during an acute pulmonary edema (APE) episode.Methods and Material: In this descriptive study, done in cardiology emergency ward of Imam Reza Hospital in 2000 - 2001, 117 patients with sign and symptoms of HF presented with APE were selected based on history, physical examination, and laboratory tests. Eligible patients underwent 2D/ Doppler echocardiography during the 2ndor 3rd day of hospitalization. Normal systolic function was diagnosed if LVEF≥45%. Using simson method, patients with acut MI and exclusively chronic lung diseases were excluded from the study. Data was analyzed using frequency distribution tables and descriptive statistics.Results: Out of 117 patients, 72 (62%) were male and 45(38%) female. Mean age of patients was 66.6±1.5 years. Left ventricular systolic function was evaluated on the basis of ejection fraction and LVEF >= 45% was regarded as normal. 51 (43.6%) patients with HF had normal systolic function; systolic dysfunction was observed in 62.5% of males and 46.7% of females. 65% of patients with normal systolic function had late relaxation diastolic dysfunction, and sever restrictive type was seen in 6%. In 91% of severe diastolic dysfunction patients, meanwhile, the systolic function was also abnormal.Conclusion: Results of this study shew that in a significant proportion of patients with heart failure, systolic function of LV is preserved. Systolic dysfunction is more common among men. In most patients with heart failure and normal systolic function, delayed relaxation pattern of diastolic dysfunction was present, although in patients with systolic dysfunction more severe type of restrictive pattern was seen.

Introduction: Numerous studies have suggested that postoperative atrial fibrillation(AF) occurs in 30 to 50% of patients, leading to significant morbidity, including hypotension, heart failure, thromboembolic complications, prolonged hospital stay and increased hospital costs. The purpose of this study was to evaluate the safety and efficacy of preoperative administration of prophylactic IV single and loading doses of Amiodarone, Digoxin and Hydrocortisone (DHA) in the prevention of new onset postoperative AF in patients undergoing coronary artery bypass grafting (CABG) with out cardiopulmonary by pass facility.Methods and Material: In this prospective study, 100 patients were randomly divided into two groups: 50 patients (study group) received intravenous Amiodarone in a dose of 300 mg, Digoxin 0.5 mg, and Hydrocortisone 200 mg, and 50 patients treated routinely in control group.Results: Preoperative patient characteristics and operative variables were similar in two groups. Postoperative AF occurred in 4 patients (%8) in study group and in 12 patients (%24) in control group. Conclusion: Preoperative intravenous single and loading dose of Amiodarone, Digoxin and Hydrocortisone appears to be effective and safe in the prevention of new onset AF after off-pump CABG.

Introduction: Although the conventional technique in coronary artery bypasses surgery (CABG) consists of using long-acting opioids and muscle relaxants, but in some situation usage of long acting drugs may be hazardous. Administration of remifentanil followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. This study was performed to evaluate intra thracheal intubation without muscle relaxants in CABG.Methods and Materials: This double - blind clinical experimental study was done in the cardio surgery department of Imam Reza Hospital in the year 2004. Intubation conditions and hemodynamic and ST changes in premeditated patients, candidate for CABG surgery was compared. 90 patients with New York heart association class I-Π were assigned to one of three groups (n=30). After prehydration with ringer solution, sufentanil 1µ/kg or remifentanil 2 or 4µ/kg was injected followed by 1.5mg/kg propofol. Ninety seconds after administration of the propofol, laryngoscopy and intubation were attempted. Intubation conditions were assessed using a four-point scoring system. ST changes, heart rate and mean arterial pressure measured invasively before induction to five minutes thereafter (6 time point). Data was analyzed using descriptive statistics, chi 2 and T tests, and frequency distribution tables.Results: Tracheal intubation was successful in all patients without any problems. Intubation conditions were also clinically acceptable in all groups. Mean arterial pressure, HR and ST changes were not different between the groups significantly.Conclusion: It is concluded that varying doses (2-4 µ/kg) of remifentanil administered before propofol provides acceptable tracheal intubation condition and hemodynamic changes comparing to conventional technique in patients with coronary artery disease.

Introduction: Inherited factor VII deficiency is a rare autosomal recessive coagulation defect. The most prevalent bleeding symptoms in these patients are mucus membrane type bleeding, such as epistaxes. This study was done to report disease in a family due to its rarity and widely variant differential diagnosis.Case repost: A 4.5 years old son was admitted with recurrent epistaxes. This symptom had been observed in his younger brother, too. Parents and his sisters were asymptomatic. Parents were causins. Laboratory finding in two symptomatic brothers consisted of increased PT (prothrombin time) with patient PT to control ratio greater than 2, and F VII coagulation level less than %1. In parents and one of their daughters, mild increase in PT and some decrease in F VII coagulation level in the range of % 50-60 was observed.Results: The most prevalent symptoms in congenital FVII deficiency are mucus membranc bleeding, including epistaxes and menorrhgia. Patients with level of factor VII less than 1% of normal, usually present with severe clinical signs. The level of Factor VII in carriers (heterozygote) is 25-75% of normal, but in hemozygote state it is less than 25%. In our cases with hemozygote state, the only clinical sign was recurrent epistaxes but carriers had no sign. In hemozygote patients the level of factor VII was less than 1% and in heterozygote ones between %50-60.

Introduction: Lissencephaly, which literally means "smooth brain", is a brain formation disorder characterized by the lack of normal convolutions (folds) in the brain, and an abnormal small head size (microcephaly). It is caused by defective neuronal migration, the process in which nerve cells move from their place of origin to their permanent Location. The incidence is unknown. Manifestations occur in neonate or in childhood. There are multiple anomalies in eyes, heart, kidney and gastrointestinal system.In this study, we introduce a female neonate with poor feeding and microcephaly. The aim is to enhance the importance of diagnosis and to distinguish this disease from preventable diseases with similar manifestations.

Introduction: Pretibial myxedema is a rare dermatologic disease with unknown pathogenesis, which occurs very rarely, in non-thyrotoxic thyroid diseases. Review of literature, showed only two cases of hypothyroidism with ophthalmopathy and dermopathy.Case Report: The case was a 48-year-old man presented with preorbital edema, mild proptosis, thyromegaly and pretibial skin lesions. There was no history of hyperthyroidism in the past. Laboratory tests showed primary hypothyroidism with high titers of Anti-TPO antibody and hypercholesterolemia. CT scan of orbit showed no extraocular muscle involvement. Sodium levothyroxin was prescribed. Sometime later hypercholesterolemia resolved and patient became euthyroid. Because of limited skin lesions, no dermatologic treatment was prescribed.