مجله دانشگاه علوم پزشکی اردبیل
پیاپی 32 (تابستان1388)

Henoch-Schonlein Purpura (HSP), also known as anaphylactoid purpura is a common vasculitis of small vessels with cutaneous and systemic complications. Henoch-Schonlein Purpura is often associated with an infection, and a wide variety of noninfectious agents have been implicated in its pathogenesis. However, its association with entamoeba histolytica has once been reported. We report the case of a 7-year-old boy with HSP, diagnosed by HSP criteria and observation of numerous cysts and trophozoites of E. histolytica on stool smear. The patient was treated with steroid unsuccessfully but following anti amebic therapy signs and symptoms of disease were disappeared and the patient discharged from the hospital

Mastalgia is a common breast disorder affecting lots of women during reproductive ages and leads to cancer phobia in some women. It increase clinical referring and disturb the social activities and familial communities. The aim of this study was to determine the clinical, sonogarphical and mammographic findings in patient with mastalgia. This cross-sectional study was done on 160 patients with mastalgia who referred to gynecologic clinic, Yahyanejad hospital, Babol University of medical sciences. They were examined by gynecologist, then in patients under 35 years sonography and older than 35 years mammography was done. Other information including age, menarche age, age of first pregnancy, number of delivery, history of oral contraceptive usage or hormone replacement therapy, family history of cancer, knowledge of diet recommendation for mastalgia and correlation of mastalgia with menstrual cycle were recorded for all patients. Data were analyzed using SPSS10. The mean age of patients was 34.8±9.9. Tenderness was observed in 122 (76.3%) patients. Fibrocystic disease was seen in 42 (53.2%) patients in mammography and 50 (40.3%) in sonography. There were normal findings in 29 patients (36.7%) in mammography and 60 patients (48.4%) in sonography. In the majority of women with mastalgia, sonography and mammography showed normal or fibrocystic changes. A comprehensive history and breast exam is essential to make decision.

Ticks play an important role in different diseases of human and animals in Iran. With respects to the reports on the occurrence of Borreliasis and CCHF in Ardabil province, an attempt was made to study fauna and geographical distribution of two families of ticks, Ixodidae and Argasidae in different parts of the province. Within the scope of present study, several villages were randomly selected. From the study area during four different seasons, the total number of 2080 ticks were collected and identified according to the national systematic keys. The collected ticks were categorized in 10 species from two families, and 3 genera. They were as follow: hard ticks from Ixodidae families, Hyalomma, Rhipicephalus and Heamaphysalis were found in 65.5%, 34.3% and 0.2% respectively. In Argasidae family, Ornithodoros comprise (97.2%) and Argas (2.8%). In Hyalomma genus, Hy. marginatum (16.9%) and Hy. aegyptium (%0.3) had the most and least density, respectively. Among soft ticks, Ornithodoros lahorensis (97.2%) had the highest number during autumn and winter. The main important hosts were; sheep, cow, poultry, goat, buffalo and camel. Cypermethrin was evaluated against Argas persicus and O. lahorensis and results compared to that of Kordistan, Lorestan and West Azerbaijan strains. Results showed that Meshkinshar strain exhibits 1.7 fold susceptible to this insecticide than other strains at the LD50 level. Results of this study is useful for study on the biodiversity of ticks and their frequency. It is medically important for controlling disease and may result in reduction of disease transmission.

Lymphadenopathy refers to the disease of lymphatic nodes. Any immune response against foreign antigens is often associated with lymph node enlargement (lymphadenopathy) and lymphadenitis. Most pathologic studies of neck lymph nodes indicated TB as the most common cause of cervical lymphadenopathy. Approach to a neck lymphadenopathy as the main complaint of the patients or the only clinical finding is usual events which physicians encounters frequently during their practice. Management of these patients depends on the physician experience and knowledge. This study aimed to investigate etiology of cervical lymphadenopathies in admitted patients. In this cross-sectional study, one hundred patients with cervical lymphadenopathy who referred to Fatemi hospital from 2002-2006 and underwent excisional biopsy with pathologic results were included. Demographic data ' age and sex', and pathologic findings were obtained using the patient's file. FNA results and non lymphoid samples were excluded. All findings were analyzed by SPSS. A total number of 100 subjects were studied of whom, 52 (52%) were male and 48 (48%) were female. On the basis of pathologic findings, tuberculosis was the most common cause of lymphadenopathy (36%). Reactive changes including follicular hyperplasia, sinus histiocytosis and other forms of lymphadenitis, metastatic carcinoma, Hodgkin and non Hodgkin lymphoma were found in 34%, 13%, 9% and 8% respectively. In patients aged under 15, reactive changes were seen in 11cases (57%), and in age group of 16- 55 years tuberculosis was found in 31 cases (44.2%), and metastatic carcinoma was diagnosed in subjects aged over 55 years with 5 cases (45.4%). In our study tuberculosis is the most common cause for cervical lymphadenopathies in both sexes (especially between 15 to 55 years). This findings emphasis about the TB prevalence in Ardabil. Under the 15 years old reactive change of lymph nodes and over the 55 years metastatic carcinoma were the most common causes.

Gastrointestinal (GI) anthrax is a rare disease that occurs 2 to 5 days after the ingestion of undercooked meat contaminated with anthrax spores. The signs and symptoms of classic form include severe abdominal pain, hematemesis, melena, sudden and progressive ascites and severe diarrhea. The disease usually progresses to toxemia, shock, and eventually death in more than 50% of patients. Treatment-failure with penicillin is common. We report two cases of GI anthrax with review of literature. During 1988-1994 a total of 38 cases of human anthrax had been admitted in Sina hospital of Kermanshah (west of Iran). There were two cases of GI anthrax (5.3%) with positive culture of ascitic fluid. One of patients unexpectedly was diagnosed with vomiting and ascites and the other had only ascites. There were not any other signs and symptoms including abdominal pain or tenderness, diarrhea, hematemesis and melena. In contrast to available reports, these cases had atypical presentations. Both of them died although they had received sufficient dose of penicillin. We conclud that the GI anthrax is not as rare as reported but it may be misdiagnosed due to atypical presentation. Therefore, GI anthrax should be considered as a differential diagnosis in the case of progressive ascites and other GI presentations in endemic areas. This could help to diagnose more patients particularly in an early stage which may lead to better management of disease.

Esophageal carcinoma has more prevalency in northwest of Iran. Relapsing dysphagea after esophagectomy is one of the common delayed complication. It emerges due to technique of surgery. Reflux and or leakage in anastomotic area. The aim of this study is to evaluate the prevalence and etiologies of dysphagea after esophagectomy and postoperative endoscopic dilation results. This is a retrospective discreptive study, during 2000-2005 at Imam Khomeini hospital, all patients who had esophagectomy because of esophageal carcinomas entered this study. Data collected from medical records, Primary tumoral diagnosis, operation endoscopy, dysphagea, histopathological findings, Postoperative complications, especially dysphagia and it’s etiology, and different methods of therapy, reoperation and or endoscopic dilatation were studied. Among 324 patients 81 patients had esophagectomy for esophageal carcinomas. In eighteen patients (22.2%), dysphagea reappered after operation. Rate of dysphagea in patients with carcinoma of lower one third area was 5.3 times greater than middle third of the esophagus. Mean time between first hospitalization and second hospitalization due to relapsing dysphagea was 10.03 months. The main cause of relapsing dysphagia in 88.24%, was benign stricture in anastomotic area. 17 patients with endoscopic dilation and one patient with surgical stricturoplasty, were treated. Relapsing dysphagea after esophagectomy is common in our patients. This represents mostly benign strictures after esophagectomies for esophageal carcinoma. In benign anastomotic strictures, endoscopic dilation is an effective treatment and it is recommended.

This study aimed to compare the clinical efficacy of two-drug regimen of glucosamine and chloroquine with one-drug regimen of glucosamine in treatment of knee osteoarthritis. In this randomized clinical trial, 30 patients received glucosamine and chloroquine (trial group) and 25 cases underwent treatment by only glucosamine (control group) for 12 weeks. To evaluate pain and disability, WOMAC (Western Ontario and McMaster Universities) was used. Mean value of WOMAC index in the trial group was 3.51 at the beginning, 1.96 in week 6, and 1.84 in week 12. In the control group, this value was 3.15 at the beginning, 2.36 in week 6, and 2.35 in week 12. In week 12, mean value of WOMAC index was significantly lower in the trial group compared to the control group (P = 0.02). In females aged less than 65 years and with body mass index of equal or less than 30, a significant difference regarding mean value of WOMAC index was seen in week 12 between two groups (P < 0.05). Two-drug regimen of glucosamine and chloroquine in a 12-week period had a better clinical efficacy than one-drug regimen of glucosamine in lowering the pain and improving joint function of patients with knee osteoarthritis, especially in females with body mass index less than 30 and younger than 65 years of age.

Stem cells are characterized by the ability to renew themselves through mitotic cell division and differentiating into a diverse range of specific cell types. Wharton's jelly is the appropriate source of mesenchymal stem cells (MSCs) that have high differentiation competence. The aim of this study was differentiation of MSCs to lens fiber cells. In differentiation pathway of lens fiber cells, crystallins are expressed. Thus, crystallins can be used as differentiation marker of lens fiber cells. In the current study MSCs were isolated from the mouse umbilical cord. It was minced into 1-2 mm3 fragments and then were incubated with collagenase type IA following pipetting for mechanical isolation of cells. Cell suspension was plated in 25 cm2 culture flasks. Alkaline Phosphatase detection kit was used for staining of undifferentiated UC-MSCs from passage I. In the experimental group MSCs were plated in the maintenance medium supplemented with bovine vitreous body (1:3 v/v) for induction. Protein lysate were prepared from cells on days 10 of induction and were analyzed on polyacrylamide gels and transferred to nitrocellulose membranes. Rat lens extract was used as a positive control. Anti-alpha A, alpha B crystallin, secondary antibody, vectastain ABC- kit (standard) and vector blue alkaline phosphatase substrate kit III were used. Mouse umbilical cord MSCs had alkaline phosphatase activity. Morphological studies and separation of proteins in electrophoresis indicated that experimental group cells might probably differentiated into lens fiber cells. Mouse umbilical cord could be used as an appropriate source for MSCs. MSCs had fibroblast- like morph and experimental group indicated the presence of fiber-like cells that were long, thin, and parallel aligned. Electrophoresis and Western blot analysis showed there was a detectable expression of early developmental marker of lens fiber cells differentiation in experimental group.