MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2001 | Volume:44 | Issue:72|Papers Count:28

Eclipse of the sun is a rare event in the nature in that time the moon is between the earth and sun. In a semi-exprimental study we studied the effects of eclipse and sunlight on newborns serum bilirubin samples in Imam Reza medical center NICU.The study results showed that Eclipse (eclipse 1 and eclipse 2) is more effective than sunlight on serum bilirubin changes of the newborns.Respectively serum bilirubin changes in eclipes were from 14.4±4.6 mg/dl to 3.6±1.4 mg/dl and 4.6±2.6 mg/dl and in sunlight from 12±4 to 5.5±3.6 mg/dl. The results were statisticaly significant (P<0.05).

Giardiasis is one of the most common intestinal parasitic infection among children. It is a world wide and an important disease in Iran.Abdominal pain, bloat, chronic or intermitant diarrhea and steaturrhea which cause malabsorption are the main clinical signs.The etilogic agent is Giardia lamblia which is found in the, form of trophozoite (pathogenic form) and cyst (infective form).In order to evaluate the efficacy of secnidazole (a new drug) and comparing with the effect of metronidazole, a study was undertaken over a 15 months period on 83 patients suffering from giardiasis in Imam Reza Hospital. After completing a questionnaire for each patient, the patients were treated with secnidazole (30 mg/kg single dose) and metronidazole (15 mg/kg tid for 7 days) randomly. Two weeks after the end of the treatment, direct and, formol ether faecal examination was performed on 3 consecutive days for each child.Examinations showed that secnidazole is effective in 94.4% and metronidazole is effective in 80% of infected children (P<0.05). Since secnidazole had milder side effects and was more effective than metronidazol, and can be used in single dose, it can be concluded as a better drug than metronidazole for treatment of giardiasis in children.

In order to assess the mechanical accuracy of Patil frame, a mechanical simulation of stereotactic biopsy process had to be introduced. For this purpose, four skull moedels each containing five graphite spheres (targets) of certain diameters (2, 2.5, 3 and 4 mm) were provided. The position of the targets were selected by the surgeon according to their anatomical and epidemiological importance. Each point was tested stereotacticly for six times. After the completion of each procedure, the scalar distance between the probe tip and the target point was measured, and the whole procedure was carried out 120 times. The results of statistical procession showed that the sum of mechanical error of Patil frame and the CT scanner error and the operator error with confidence interval of 95% is between (0.7-0.9 mm) which is a satisfactory amount in comparison with other frames. In addition it was concluded that the mechanical I accuracy of Patil frame does not depend on the position of the targets or their size.

The diagnosis and prediction of acute allograft rejection as well as differentiation of rejection crisis from other renal dysfunction have the most important role in renal transplant follow up.IL-2Ra is a member of the IL-2R that appears up on T cell activation in immune responses. As in general, cell-mediated immune reactions are more important for rejection of transplanted organs, most studies to tissue transplants have focused on T cell responses (esp on IL-2 and IL-2Ranetwork). For monitoring of renal transplant, serum I 1-2Ra (SIL-2Ra) was evaluated in 30 recipients and 20 healthy subjects. According to clinical diagnosis the patients were in two groups (successful renal transplant and acute rejection). The mean concentration of s1L-2Ra was 273 Pg/m I in control group. In the other hand, the mean concentration of s1L-2Ra pretransplantation was 940 Pg/m I in control goup. In the other hand, the mean concentration of sIl-2Ra pretransplantation was 940 Pg/ml in successful renal transplant and 1116 in acute rejection group which had a meaningful difference with control subjects (P<0.0001).Before transplantation no significant difference in s1L-2Ra was observed between two transplant groups, but 48h after transplantation s1L-2Ra level was 1020 Pg/ml in successful renal transplant and 1440 in acute rejection group with a statistical difference (P<0.02). In addition in acute rejection, 48h after transplantation, the mean s1L-2Ra concentration showed statistical significant increase compared with before transplantation (P<0.05). The mean level of sIL-2Ra in acute rejection group at the time of rejection crisis was 1808 Pg/ml and had significant difference in comparison with control group (P<0.001) and successful transplant group (P<0.005).The comparison of sIL-2Ra concentration between successful transplant and acute rejection groups showed that the maximum level was "observed at the time of rejection attacks (in acute rejection) and the minimum level was found in successful renal transplant befor transplantation (P<0.001).We concluded that at the first: sIL-2Ra in uremic patients (hemodialysis) is higher than healthy subjects and the second: follow up evaluation of sIL-2Ra had also predictive value with 85% sensitivity and 67% specificity at cut off 1000 P g/ml, but, increased level of creatinin is obseved only at the time of clinical diagnosis of acute rejection so that the predictive value of creatinin level is lower.

Organophosphate (OP) compounds have been used as pesticides and in chemical warfare (nerve agents). Two nerve agents called tabun and sarin were used by Iraqi army against the Iranian troops in Majnoon Island and during Halabjah massacre, respectively.Atropine sulfate has been used successfully in large doses to counteract the muscarinic effects of OP poisoning. The effects of oximes in human OP poisoning have not been well studied. Our aim was to study the effects of pralidoxime and sodium bicarbonate in treatment of OP pesticide poisoning. The patients were divided into three groups: Atropine (A), Atropine + Pralidoxime (AP), and Atropine + Sodium Bicarbonate (AB).Eighty-two patients with a mean age of 25 years were studied in the three groups (28A, 20AP & 33 AB). Atropine was given (IV) initially until controlling the muscarinc effects of OP poisoning and continued in constant infusion until discharge death. Loading of pralidoxime was 30 mg/kg in one hour followed by 8 mg/kg/hr as constant infusion. Sodium Bicarbonate was given as an initial dose of 3meq/kg in Dextrose 5% over one hour and the same dose in Dextrose 5% for every 24 hours until the Atropine was discontinued.Clinical features on admission and thereafter at certain intervals was recorded in a pre-designed forms and paraclinical investigations were also recorded. The results were analyzed statistically using computer software of Statistical Package for Social Sciences. There were no significant differences in major clinical findings and acetylcholinesterase activity on admission between the groups. Although the severity of intoxication particularly mechanical ventilation was higher in the AP group than the other two groups (P<0.05), there were no statistical significant differences in mortality between the groups. Acetylcholinestrase reactivation was higher in the AP group than the other two groups (P<0.01).Although pralidoxime increased acetylcholinestrase activity, it did increase morbidity and did not reduce mortality. However, pralidoxime may be effective in certain OPs. It is thus required to investigate more cases of each OP and higher doses of sodium bicarbonate (5meq/kg) is required to be used under arterial blood gas control, which is currently undertaken in the Centre.

Dermatophytosis is a common skin disease in Mashhad, Iran. The disease is treated by several methods. In order to esitmate the relative rate of dermatophytosis and to evaluate the different methods of treatment: systemic (oral tablets of griseofulvin), local (topical cream of miconazole nitrate 2%) and the combined form, a study was undertaken over a nine months period and 100 patients were treated by 3 methods mentioned above.The results showed that tinea capitis is common in boys and tinea cruris is common in men and prevalence of dermatophytosis is high in poor hygienic regions.Also, 100% of patients receiving griseofulvin, 84.2% of persons receiving mixed treatment and 76.9% of patients receiving miconazole, were cured. Most of the patients who had tinea capitis did not respond to miconazole & combined therapy; which shows griseofulvin alone is more effective for tinea capitis and miconazole reduces the effects of griseofulvin in this case.

Objective: To determine the safety of large volume paracentesis (L VP) with albumin replacement in management of malignant ascites. Material and Method: Prospectively, 36 patients with malignant ascites were studied. 23 patients (63.9%) were female and 13 patients (36.1%) were male with mean age of 58.3 and 56.6 years, respectively. Gastric (19.4%) and ovarian (16.7%) cancers were the two most common causes of malignant ascites. LVP (mean 5860cc) with albumin replacement (10 g/lit) was done. pulse rate, blood pressure, serum sodium, potassium, urea, creatinine and hematocrit were measured before, 24, 48 and 72 hours after LVP and the results were compaired by t test (paired).Results: None of variables had statistically significant changes after LVP.Conclusion: LVP with albumin replacement can be used safely in management of malignant ascites without significant early hemodynamic and /or metabolic complications.

Acute leukemia one of the most common hematologic malignancies. For monitoring of these patients, some parameters were used that IL-2Rα is one of them. IL-2Rα is an immunological marker on the surface of T lymphocytes and various types of leukemic cells that may increases in leukemic patients.This study was performed in 50 leukemic patients, 25 with ALL and 25 with AML (The mean age 27.6 yr). Serum IL-2Rα was measured with ELISA method. The mean concentration of serum IL-2Rα was 1909.2 pg/ml in leukemic patients and comparable with the healthy subjects (P<0.0001). It was 273pg/ml in control group.In addition the serum IL-2Rα in ALL and AML patients were 2478.6pg/ml and 1339.7pg/ml respectively. This difference was significant (P<0.04).There is a significant difference for IL-2Rα between patients with complete remission (889.5 pg/ml) and patients that had recurrence (2900 pg/m) or expired (2407.8 pg/ml) (P<0.002). That seems to be an important pattern.So, quantitative measurement of serum IL-2Rα level is a remarkable parameter for prognosis in acute leukemia that also determines the course of the disease.As the higher concentration of this membrane protein might be due to the higher expression on leukemic cell surfaces. Therefore monoclonal antibodies against IL-2Rα (Anti CD 25) may prevent leukemic clones progression.

Cutaneous Leishmaniasis (CL) is an endemic disease of the country since old days. Clinically it has two types: dry form or Antroponotic (ACL) and wet form or zoonotic (ZCL), which both of them exist in Mashhad city. Under permoission of Mashhad University of Medical Sciences & Head Quarter of Education Department of Khorasan, this study took place in 51 secondry schools with 23568 students (boys & girls) during accademic year in different parts of the city, to evaluate the prevalence and determine the main foci of infection, using direct Giamsa stained smears for diagnosis.In this survey, only 577 students had active lesions or scars, 2.45% Most cases were from schools in south-western part of the city. So, it is obtainable that the infection has a low prevalence and the main foci of it, is in south-western part of Mashhad.

Prevention of type I diabetes mellitus is appreciated recently. Multiple immunological markers were used for diagnosis and prediction of diabetes mellitus (Type I). Among them, islet cell antibodies (ICA) in the circulation are the most important. During 2 years newly diagnosed type I diabetes mellitus (group A) who adminted to the endocrine department or private clinics reruited in the study. Serum ICA were measured in this patients and their siblings (group B) and normal persons (group C) using immumo fluorescent assay (IFA). Group A was included 54 patients (24 male, 30 female and median age 15.9±8.2 year). Group B was included 79 persons (38 male and 41 female, median age 14±7 year) and control group was included 42 persons (22 male, 20 female and median age 19±6 year). Prevalence of ICA (Titer > 1/16) was 74.1%, 16.4% and 0% in groups A, B, C, respectively.Sensitivity and specificity of IFA method for ICA detection was 68.8% are 100% respectively. Predictive value of ICA for identification of high risk (ICA first - degree relative 100M patients is significant).

Pityriasis Versicolor (PV) is a superficial mycotic infection caused by a lipophilic fungus "Malassezia furfur". The disease is seen mostly in young age groups (20-40 years old). It is an endemic skin disease in many parts of the world and also is seen in many states of Iran including Khorasan. In order to investigate. the realtion between blood serum Cholestrol (CH), Triglycerid (TG) levels in men this study was undertaken over an eleven months period in the departments of Parasitology-Mycology & Biochemistry Emam Reza Hospital.Four groups of volunteers were selected as follows.Group 1: Had confirmed PV lesions. Group 2: Patients with high CH & TG.Group 3: Patients with normal CH & TG.Group 4: The control group without any fungal lesion on their skin.All cases were tested by direct fresh smear (with KOH 15%) & wood light for diagnosis of PV. Examinations showed: The level of CH in PV patients was higher than control group (P=0.01).The rate of PV was high in patients with hypertriglyceridemia more than 141.6 mg/dl (P=0.05).It is concluded that hyperlipidemia is a risk factor for PV, and the patients suffering from PV usually have hyperlipidemia.

The cervical cancer is still one of the most common malignancies of female low genital tract and is the second most common neoplasm among women, in the world. The annual mortality rate is 4500 in U.S.A. cervical cancer can be prevented because there is along period before invasion.Background: By screening program of routine pap smear and colposcopy and confirmation by biopsy, the disease is recognized in early stages and morbidity and mortality is reduced. Objective: This study was undertaken to compare the value of routine Pap smear, colposcopy and cervical biopsy for cervical cancer screening.Methods: In the study we evaluated 132 unselected women in out patient's clinic, Zynab Women University Hospital. For all of them we did rutine pap smear, colposcopy and cervical biopsy. This study was taken one year (1988).Results: 1) Sensitivity of pap smear was 33.3% and sensitivity of colposcopy was 80%.2) Specificy of pap smear was 96.9% and specificy of colposcopy was 100%.3) False positive of pap smear was 3.42% and false positive was 0%.4) False nagative of pap smear was 66.6% and false negative of colposcopy was 20%.Conclusions: We concluded that in early processes of cervical cancer, the colposcopy is better method of diagnosis than routine pap smear and if is used for screening of cervical cancer, routinlY, 1 and as first step. The disease will be recognized in early stages and prognosis will be better.

Objective: Video-Assisted Thoracoscopic Surgery (VATS) has recently been used for Patent Ductus Arteriosus (PDA) closure on a routine basis. Our entire experience with this technique is reviewed here supporting its efficacy and other advantages, without performing thoracotomy but with the same results.Methods: From june 1997 to october 2000, three-hundred patients (mean age: 6 years old) with P D A. recognized by echocardiography and/or cardiac catheterization, who underwent VATS were studied. With the patients under general anesthesia, three 5mm holes were made through the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected, and two titanium clips were applied for complete closure of the ductus. Exclusion criteria were: 1) Diameter of the ductus>9mm, 2) Complicated PDA such as: aneurysm formation, endocardiatis and calcification, 3) Pleural adhesion and/or left sided thoracic operation in the past.Results: All cases were re-assessed immediately after the procedure, and followed for more than 3 years by control echocardiography. No significant complication and residual shunt was recorded during the follow-up period. The procedure was changed to thoracotomy in three adult patients due to inappropriately dilated canal (>9mm), meanwhile, two additional patients developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was about 20+/-2 minutes. All patients were discharged shortly after the procedure (≈20 hours).Conclusion: Our results confirm that adventages of VATS technique for P D A closure is rapid, cost-effective, painless and of cosmotic benefits compared with the classical thoracotomy approach.

Setting: Clinical infertility practice of Mashhad University.Objectives: To determine whether the total motile functional sperm count and the other infertility factors can be predictive of IUI success.Design: evaluation and analyses of a large group (n=1017) undergoing 1258 cycles of therapeutic IUI with husband's sperm.Results: There was trend toword an increasing percentage of conception with increasing total motile functional sperm count. Significance was reached when the total motile functional sperm count. used for IUI exceeded 20x106. The overal pregnancy rate per cycle was 13.2% (167/1258) and the couple pregnancy rate was 16.4% (167/1017). Surprisingly the only intergroup difference detected in our study was duration of infertility (P<0.01).

Medullary Thyroid Carcinoma (MTC) refers to as a malignant neoplasm of the thyroid C cells. It occurs in a sporadic and an inherited form. MTC is the main part of the multiple endocrine neoplasia type 2 syndromes. MEN2A corresponds to an MTC associated with pheochromocytoma or hyperparathyroidism and MEN2B includes marfanoid habitus and ganglioneuromatosis in association with MTC. MTC without associated endocrinopathy may be hereditary (FMTC) or nonhereditary. The discovery of germline mutations in the RET proto-oncogene responsible for FMTC, MEN2A, and MEN2B associated with the presence of somatic mutations in RET codons in sporadic MTC, and in the several MTC from inherited disease has brought new perspectives.In the present retrospective study, ten cases of MTC out of ninety one thausands biopsies recieved in pathology department of Imam Reza Hospital Mashhad during past twenty years have been thoroughly surveyed.In this study, MTC consists 7.6% of all thyroid malignancies. Familial forms have been observed in two patients (20%) and sporadic MTC in the remaining cases (80%). Mean age is 48 years (27 to 60 years) in sporadic and 16 years (13 to 19 years) in familial cases. Male to female ratio (M/F) is 1/1.5. Neck lymphnode metastases have been observed in 30%, capsule in tumor periphery in one case (10%), amyloid at primary foci in 100% and at metastatic nodes in 67%. Several morphologic features of MTC such as angiosarcoma-like pattern and paraganglioma like pattern were at least focally observed. Papillary microcarcinoma was recovered as a concomitant finding with MTC in one patient. In ninety percent of cases, a positive immunostaining for chromogranin A and positive argyrophilic reaction were observed.

Peripheral vascular injury is very important in medical science, We collected and classifed Eighty of peripheral vascular injury admitted in Ghaem Hospital since 1982 to 1989.The Results of this evaluation about cause of trauma, type of injury and treatment were as follow:Bullet in 82.5%, gunshot in 12.5% cases and unknown cause.Lower extremities vascular injury in 62.5%, upper extremities vascular injury in 32.5% and neck vascular injury in 5% cases.False aneurysm in 45%, arteriovenous fistula in 12.5%, complete transection in 20% and concomitant A-V fitula with aneurysm in 21.5%. (1.25% no vascular injury).Skeletal injury and associated injury not evaluated in this study.

Cutaneous Leishmaniasis (CL.) is a common skin disease which is endemic in many parts of Iran, including Khorasan. In order to investigate the status of CL. during past 16 years, a study was undertaken over a 6 month period in department of parasitology, Imam Reza Hospital, Mashhad, Iran. Data recorded from all patients with CL. referred to parasitology laboratory during past 16 years were obtained and analysed. Investigations showed that among 5865 patients having suspected lesions on their body. 3252 (55.4%) patients confirmed by direct smear, of which 10.1% were Afghani people.More than 58% of the patients were male and less than 42% were female. The highest rate of infection among males and females were seen in the age groups of 20-24 and 5-9 years old, repectively.The lesions were mostly found on exposed part of the body, face (42.2%) and hands (36.9%) and few lesion were found on non-exposed parts (2%).More than 91% of the patients had only a single lesion. No significant change was observed in the rate of patients during different years of study, but the records showed a decrease from 1994 onwards.It is concluded that CL. is still an endemic skin disease in Khorasan and specially in North-east and south-west of Mashhad.

Purpose: Long term success rate of trabeculectomy in control of IOP.Methods: Trabeculectomy performed on 37 patients that 18 cases of which were followed for more than 1 year and 19 cases for less than 1 year. All patients were operated by one surgeon and one distinct techinque.Results: No cases needed medication in first 2 weeks after operation, but medication was needed in 10% after 3 months, nearly 26% after one year and 40% after 3 years of operation. There was complete success in 60%, and relative success in 40%. IOP less than 10 mm Hg at first week after operation was a good pronostic factor in long term management of glaucoma.Conclusions: Trabeculectomy is strongly recommended as an appropriate tretment to control IOP especially in patients with poor medical complience. Postoperative regular follow up is essential because success rate of trabeculectomy is decreased during follow up.

Retinal agniomatosis presents as capillary hemangioma of retinal periphery or Optic disc and juxtapapillary. The early lesions are small and readily visible in clinical examination or earlier by flourescein angiography. About 20% of lesions are associated with cerebral tumors which are called Von-Hipple-Lindaue disease. Early diagnosis and appropriate treatment prevent visual deterioration. Treatment of lesions depends on size and location and includes laser photocoagulation or cryotherapy. In this case series study between 1991-1997, seventeen patients in whom clinical diagnosis was confirmed by t10urescein angiography were studied. The age ranged between 11-40 years with male predominance. Bilateral involvement occurred in 17.58% of cases. All patients complained of decreased vision Four patients had juxtapapillary angiomatosis and others showed peripheral retinal angiomatosis. Laser therapy resulted in good visual outcome and regression of peripheral lesions. One of bilateral ocular angiomatosis repeated brain CT scan showed posterior fossal involvement and patient died. Systemic work up is necessary for all patients with retinal angiomatosis.

Trauma is the most common causes of death in people younger than 45 and includes 78% of all death in ages between 15-24 annually. We want to determine the epidemiology of traumatic patients who referred from all of the cities in Khorasan to Mashhad Kamyab Hospital that is the main trauma center.In this study we evaluate 10000 patients in one year (1997) retrospectively from all patients who refer to this center (47448 patients) and we have analyzed them. 72.8% were male, 38% were younger than 15 years and 34% were between the ages of 16-30 years. In children younger than 16 the most common causes of trauma is falling down and vehicle motor accident in the second stage, but in children younger than 5 falling is the second cause. In adult vehicle motor accident, foreign body hit, working accident and falling were major causes. Head is the most common organ that involve in trauma (54.4%), limbs (37%), chest and abdomen (1.7%) and multiple organ involve in 4% of patients.

There are different theories about etiology of mycosis fungoides as one of cutaneous T-cell lymphomas. One of the important theories is relation between jobs and mycosis fungoides.In some studies we see this relation, although in others, there isn't any relation between mycosis fungoides and jobs.Below there is an explanation of our research about this relation.At first, we studied all biopsy files of dermatology department in Imam Reza Hospital and choose 15 files about mycosis fungoides, then took down all information about these patients includes: job, sex, age and stage of disease. The patients were workers, farmers, housekeepers, workmen and open jobs. When we studied and researched information and compared with controls very carefully, we found out there isn't any relation between mycosis fungoides and these occupations.

Timely diagnosis of APECED, of which only 140 cases have been reported in medical litrature, is particulary important. Clinical feature of this disorder is diverse and most patients are being treated as a single hormonal dysfunction, consequently some serious problems like acute adrenal crisis or hypocalcemic seizure may threaten patients life.Our patients had a combination of hypoparathyroidism, Addison's disease, mucocutaneous candidiasis, nail dystrophy, keratopathy and alopecia; and suffered from delayed diagnosis. The first patient had a combination of Addison's disease and nail and oral mucusal candidiasis.The second one had Addison's disease, hypoparathyroidism, oral mucusal candidiasis, keratopathy nail dystrophy and alopecia.The third patient was a case of hypoparathyroidism, oral mucusal candidiasis keratopathy and nail dystrophy and our fourth patient suffered from hypoparathyroidism, oral mucusal candidiasis and alopecia.

Reticulohistiocytoma, one of the non-x-Histiocytic proliferations is a rare lesion presenting as single or multiple cutaneous nodules with a self limiting course. Diagnosis is based on histopathology since clinicaly it is difficult to be diagnosed. It's importance is due to some clinicopathologic similarities to a few other potentially malignant neoplasms.We report a solitary reticulohistiocytoma in a young woman presenting as an unusual subungual nodule slowly producing nail bed dystrophy.