MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:45 | Issue:77|Papers Count:25

HTLV1 associated Myelopathy/Tropical spastic Paraparesis (HAM/TSP) is Characterized by chronic spastic tetra paresis, hyperreflexia, Babinski sign, mild sensory loss, painful paresthesisa and bladder dysfunction.Here, we report the results of clinical and preclinical evaluation of 100 patients with HAM/TSP conducted in Mashhad Ghaem Hospital between 1999 - 2001.The results of this study are as follow: The incidence of HTLV1 associated Myelopathy/Tropical spastic Para paresis was 24/4 percent (one Hundred from 410-tetraparetic patient). The age range was 8 to 74 years and peak of age was 40 years. Disease was more prevalent in female than male. CSF findings consisted with increased protein and IgG but normal cytology and suger. Cerebrospinal anti HTLV1 antibody detected in 92 patient by Elisa and western blot assays.Eight patients who were not searching with poly merase chain reaction (PCR) were positive. Magnetic Resonance Imaging performed in 100 patient. Only three patients had periventricular plaques. The latter was different from multiple sclerosis plaques.

Osteoporosis is common in rheumatoid arthritis. Corticoesteroids act as an independent risk factor for osteoporosis. We have evaluated the effect of glucocorticoids on bone density of patients with rheumatoid arthritis.In this study bone mass density of spine and neck of femur in 52 patients with rheumatoid arthritis who had been taking glucocorticoids for at least 6 months were compared with 17 control patients that not used glucocorticoids. Dual energy X-ray absorbiometry was used.Bone mass density was lower in spine and neck of femur in esteroid receiving patients in both sexes. This difference was statically significant only in femur of male patients. Decreased bone density was more significant in spine. There was no correlation between density of spine and femur.All patients with rheumatoid arthritis who were taking esteroid have more chance of osteoporosis and should be evaluated and followed by bone densitometry.

Impotence is an important complication of diabetes that has not been considered much in our society. In this study we have evaluated 250 married male diabetic of 25-60 years old referring to Mashhad University endocrine clinics for evidence of impotence and response to intracavernosal papaverin injection.We used protocol of Sexual Health Inventory for Men (SHIM) to evaluate our patients. There are five basic questions and each has maximum of five marks (total of 25),21 mark or less is considered impotence. From 250 male diabetics 134 had impotence according to SHIM protocol (less than 21 mark with highest of 25), 12 cases were found to have another reason for impotence and were omitted from the study and 238 patients were followed, 24 patients had type. One (10.08%) and 214 patients had type II diabetes (89.92%). We injected 30-mg papaverin hydrochloride into carpous cavernous in each patient.Mean age of patients was 45.05 years and mean duration of erectile dysfunction was 3.45 years. Total incidence of impotence was 51.26% (122 .patients ). Incidence of erectile dysfunction in seven patients with type I diabetes cases was 29.16% and in 115 patients with type II diabetes was 53.74%. Total response rate to papaverin injection was 46.72%. Response rate was 85.71% in type I, 44.35% in type II diabetes. The most common side effect was periapism, which occurred in one patient and responded to treatment.Erectile dysfunction is an important complication of diabetes and should be evaluated in our patients. Papaverin injection although is not the first choice but can be considered as a rather safe and cheap way to manage the impotency.

Blood is valuable and expensive because of the cost paid for preparation and preservation and because of its value. Hence it is obvious that carrect preservation and use of blood is very important.We use a questionnaire for all elective surgical patients in whom blood was reserved for six months period. In this questionnaire we record demographic data, kind of surgical procedure, units of blood reserved and units of blood used, Hct one day before surgery and Hct one day after surgery.In this study 658 patients that have undergone 20 kind of routine surgical procedures studied. In the five operations transfusion is not need. In another operations the minimum of blood use was in nephrectomy (C/T ratio = 18) and maximum of blood use was in mastectomy (C/T ratio =2.75). This study suggests that the medium of C/T ratio was seven. With regard to calculated C/T ratio in different operations it is clear that only in mastectomy the C/T ratio is compatible with universal standard of C/T ratio and in another 19 operations the reserved blood was more than acceptable rate. With regard to average of blood use for different surgical patients the MSBOS determined.

ABO Hemolytic disease of the newborn is the most common cause of Hemolytic jaundice in newborns. In a prospective study during] 997, we determined the clinical course and incidence of hemolytic disease of newborn due to ABO blood group incompatibility in Ghaem Hospital.In the present study from a sample of 128 blood group (O) mothers, 50 term neonate, had blood group A & B as case group, and 50 neonates without incompatibility considered as control group these infants were compared for hyperbilirubinemia in first 3 days of life.Skin Bilirubin index, measured daily in both groups of newborns byjaundicemeter instrument. In babies with critical index (skin Bilirubin> 17) serum bilirubin and other Hematological values were determined.In this study, six newborns had significant jaundice (Bilirubin>15mg/dl) in incompatible group but in control group only 2 infant had hyperbilirubinemia in first three day of life.Taking into account that in Mashhad their frequency & blood 0 is nearly 60%, it was concluded that in general population of pregnant mothers 24%, Present feto- maternal ABO incompatibility.This figure is less than value that reported by others, therefore, incidence of ABO- Hemolytic disease in all of newborns is 2/9 percent (%24).

In order to assess the effect of zinc supplement in increasing the height in children we studied 60 boys (5-13 years of age) in two villages Toos area (Mashhad). We divided them in two groups: 1) Group one, received zinc sulfates 7.5 mg daily.2) Group two, received placebo.We followed their height & weight and armspan bimonthly up to six months. The height of zinc increased 4.2 cm while placebo group gained 3.36 cm (Pvalue=0.04), armspan increased 3.42 cm versus 2.20 cm (P=0.03).Weight did not change differently. We conclude that zinc supplement in these two villages has good effect on growth velocity in boys.

Learning disorders of various types are relatively common. Prevalence of them is between one to 6 percent. It is consider that epilepsy is more frequent in children with learning disorders. To evaluate prevalence of epilepsy in children and adolescents with learning problems a cross sectional study was designed. Psychiatrist evaluated 148 patients with learning problems. All of them were students. Range of their ages was between 6 to 17 years old and mean of age was 10.8±3.1 (mean±SD). 96 cases were male and 52 were female, 45 patients had epilepsy (30.4%). There was no significant difference between epileptic and non-epileptic groups about sex, family history, educational status and number of family. But there was significantly lower mean of age in epileptic patients (t= -2.922, df=145, P=0.004).Our finding suggests that epilepsy is the most frequent cause of learning problem in children and adolescents. It is considering consultation between psychiatrist, psychologist and neurologist ought to do for patient with learning problem.

pityrosporosis is one of the most common superficial fungal infections among young people, which is distributed all around the world. The etiologic agent is lipophilic yeast called Pityrosporum ovale (Malassezia furfur) which naturally exists as a skin flora, and can be the cause of several superficial infection derma toses under percipitating circumstances.Attempts to find & prepare the effective drugs for treatment of these infections have been made in recent years.In order to study the prevalence of Pityrosporosis among the students of Birjand Medical Sciences University, to compare the efficacy of two different shampoos (Selenium sulphide & Prition zinc) for the treatment of Malassezia infection, this study was undertaken.The relation between Pityrosporosis and age, sex, bathing, exercise, etc. was also studied. The results showed that Pityrosporosis is common among the students (female 55.3 percentage & male 35.5%) & hairloss was the most common clinical symptom (69%).Among patients received Medicine, 73.6% obtained successful result. Selenium sulphide & Pirition zinc were effective on 83.3% & 65.5% of the patients respectively. It is concluded that Pityrosporosis is a common fungal infection among the young age group & it is related to oily skin, sex, bathing, etc.However there was no significant statistical difference between efficacy of selenium sulphide & prition zinc but, selenium sulphide is recommanded for its relative efficacy on pityrosporosis. 

Bladder cancer is one of the most common diseases treated by urologists. Epidemiologic and experimental lines of evidence favor a strong role for chemical carcinogens in the etiology f bladder cancer.This study is a prospective research has done on 200 Patients with definitive diagnosis of bladder cancer.Bladder cancer is more common in male than female and in this study it is four times more common among men than women. The most common prevalence of age is 60-69 and the mean is 60.9±12.7 (mean± SD). 44.5% of them were smokers, 1.5% was addict to opium and 8% had both habit. The ones with addiction to cigarette, opium or both had higher grade and stage of disease when were diagnosed. Also duration of abuse had a linear association. More than halves of bladder cancer is diagnosed in stage T1 and before that. 95.5% of the tumors were T.C.C. There is no meaningful relation between the kind of tumor and addiction to cigarette or opium.Probably not only cigarette but also opium have effective role in etiology of bladder cancer and change the progress of disease.

chronic urticaria is a common disease that is always a challenge to the dermatologist due to its etiology. In this prospective study, 100 patients with chronic urticaria (mean duration 27.1 months) attending Allergy Clinic of Mashhad were selected. They were educated about a diary form. Routine tests and ELISA test for anti H.pylori IgA & IgG were requested. At the third visit, antibiotic therapy (triple regimen) for seropositive patients was commenced.27 patients (16 females, 11 males) with a mean age of 31.6 years (range 17 to 55 years) had positive test for IgA.Disappearance (40.7%) or improvement (22.2%) occurred in most antimicrobially treated patients. In conclusion, in clinical and paraclinical approach to chronic urticaria, H. pylori infection should be considered as an etiologic factor.

Citicoline (CDP-Choline) is an essential intermediate in the biosynthetic pathway of Phosphatidy1choline, and the later is a main component of neuronal membranes. Many experimental and few clinical studies showed the beneficial effect of citicoline in cerebrovascular diseases, memory disturbances and cognitive disorders.The current trial was a case - control study in 60 (40 patients as the cases and 20 patients as controls) nondiabetic, 50-70 years old patients who had an ischemic stroke in the MCA territory for the first time. Citicoline (500 mg/day/IV or IM) was administered in the first 24h of stroke and continued for 4 weeks. Barthel Index measured the neurologic function of the patients in the first day, 4th week and eighth week.After 4 weeks patients in citicoline group had significantly greater improvement of neurologic function (p=0/01). Patients with more severe disability (BI<45) had more improvement at the end of 4th and 8th week. (59,5 for citicoline and 39,6 for control group (p=0.001). The percent of patients who had a full recovery (95) were greatly higher in citicoline group at eighth week.This study suggests that citicoline was effective in enhancing neuroligic recovery in stroke patients especially in a subgroup of patients who had more disability at the beginning.

human brain organizes sensory stimulus by perception, but sometimes perception is not correspond with the outside world and there are some types of errors in brain findings. One of the famous visual illusions is the Muller-Lyer illusion in which the line outward arrow ahead appears longer than the inward arrow ahead. The aim of this study is the comparison of the effects of experience and knowledge on visual illusions.Experience is one of the key factors to reduce visual illusions but not meaningful (p= 0.0768). On the other hand the education and knowledge are more important and have significant effect on reducing the illusion (p= 0.0000).Education and having moved knowledge can be more effective than experience to correct our cognition of around world.

Diastematomyelia which is defined as "two hemicord each within a separate Dural tube separated by a dural sheated rigid osseocartilagenous (bony) median septum" that tethers cord and prevents cephalic migration of the spinal cord. Leading to various neurologic, coetaneous and orthopedic signs and symptoms is briefly reviewed. The aim of this presentation is to define the signs and symptoms and to prevent late complications.A retrospective study was done on ten cases of diastematomyelia that were treated by the authors during 15 years (1986-2001) in the university and the private hospitals.Sex ratio of male to female was 5: 1. 80% of cases were in pediatric, 10% in juvenile and 10% in adult age groups. 40% of cases had motor sign, 40% had sensory symptoms and 20% of cases had mixed motor & sensory findings. Sphincteric disturbances used to occur in later ages.

A 23-year-old man was admitted to the hospital because of fever, headache, nausea and weight loss. The patient has been well until a month ago, while fever and nightsweat developed. It was a persistent fever associated with nausea and headache.The patient was a native of Afghanistan living in a city at the south of Khorasan province. He was not married and there was not history of tuberculosis, exposure to i1lpersons, no history of a1cohol, tobacco and drug abuse and no history of coughing, hemoptysis, dyspenea and predisposing factors for HIV infection.His temperature was 39.1 C on admission, heartbeat 84, and respiration rate 17 with blood pressure 115/70. There were no receptions and lymphadenopathy, chin-to-chest exam was doubtful, no splenomegaly and no hepatomegaly and fundoscopy was normal. Hematologic lab and blood chemical values on admission were; WBC 8500 (mm3), Neut 71%, Lymph 20%, Mono 8%, Eo 1%, platelets 320000 (mm3), glucose 150, HDL 50, LDL 130, Na 122, K 3.5, UA was normal.On CX Ray, ca1cified lymphnodes were present on the both of hilar regions the heart appeared normal CT Scan of skull without contrast material on administration was performed and showed scalloping of inner table of skull looking like arachnoid granulation.A lumbar puncture was done. CSF colour was cloudy containing 250 WBC per mm3, 75% Neut, 25% lymphocytes, glucose level 40 mg/dl and protein level was 275 mg/dl. Bacteriolobic exam of CSF revealed no acid-fast bacilli and no other organism. The results of CSF culture and other tests were pending.

Lymphoma particularly Non-Hodjkin Lymphoma (NHL) in head and neck have different manifestations and in many times may be misleading. We present a patient, which initially hqve operated with a diagnosis of chronic dacryocystitis. (Dacroyocystectomy), and then cervical lymphadenopathy and facial subcutaneous nodules appeared and fistulae. We have considered other clinical diagnosis such as T.B, mycosis and bacterial infections. Thus many clinical investigation have been performed, that these leading to the final diagnosis of lymphoma.

Primary leiomyosarcoma of the skin is a rare tumor. It is more prevalent in men, and always is seen in the extremity extensor surface especially the thighs and around knee and head and neck region, with greater incidence in fifth to seventh decades of life.Leiomyosarcoma is localized to the skin in two sites: cutaneous and subcutaneous. Subcutaneous leiomyosarcoma with vessel wall's smooth muscle origin has a distinctive pattern, so may be misdiagnosed as a vascular tumor. Light and electron microscopy and immunohistochemistry can easily do diagnosis. Prognosis of cutaneous leiomyosarcoma is much better than the subcutaneous type, which has 30-60% rate of metastasis that can be determined by flowcytometric methods.In this case, we report an 80-year-old woman with a cutaneous nodular lesion on the right thigh. On macroscopic examination, the tumor had 1.8-centimeter diameter and 1.5cm depth, and in microscopy, cutaneous leiomyosarcoma with prominent cellular atypia was diagnosed. Specific staining confirmed the diagnosis. The tumor was excised widely, to prevent of recurrence.

Parry-Romberg disease is a relatively rare syndrome, which its neurological aspects are not fully known. Localized sclerodermia or morphea (En coup de sabre) is one of the most important causes, which results in coetaneous, subcutaneous and sometimes bone tissue maldevelopment.The patient that is presented is a 33 years old female who was referred to this center because of progressive wasting in the left side of the face, tongue, soft palate and left eye enophthalmus. There wasn't any abnormal finding in neurological examination, and neuroimaging eiectrodiagnostic smdies and EEG were normal too.Skin biopsy revealed pathological finding of morphea.

on chest X-ray there are calcified lesions on hilar regions of both lungs; lesions that inalicates the presence of old heald granulomatous disease.The patient has immigrated from Afghanistan, where tuberculosis is a common problem of people, the patient has hyponatremia a finding more common in T.B. meningitis so another L.P was performed and CSF was sent for Stewart, PCR assay and culture for tuberculosis in the second CSF exam. The level of protein had increased (350 mg/dl) while CSF glucose decreased and a shifting CSF, PMN to lymphocyte were reported.Anti tuberculosis drugs were initiated (INH, RMP, PZP, ETB) and blood gasometric test, PPd and B.A. lavage for B.K performed, in the third hospital day, febrile agglutination tests, L.F.T, kidney function tests were performed and dark field illumination test of centrifuged CSF was done and it was negative. Cold agglutination assay and standard tube test for brucella, both of them were negative too. Headache in-patients thought to have tuberculosis should always raise the possibility of T.B meningitis. In the early stage of disease headache and fever may be the only symptoms. Analysis of CSF usually shows lymphocytic pleocytosis.Hypoglycorochia is present in approxinately 70% of cases. Smears of CSF are rarely positive in TB meningitis. CSF, PCR assay for BK was positive, but blood cultures sputum culture and CSF culture were all negative. After starting anti TB drugs additional treatment with dexamethasori and pyridoxine, the situation of patient gradually because better and after 4 weeks hospitalization he was discharged and ased him to come back to outpatient clinic for control of treatment of T.B.