Medical Journal Of the Islamic Republic of Iran
Volume:14 Issue: 3, Autumn 2000

In order to assess the efficacy of hysteroscopic endometrial ablation and factors which are important in it's success, a prospective, randomized study was performed in Shiraz university hospitals between Sep. 1995 to Feb. 1998. 50 patients with chief complaints of menorrhagia that were in reproductive age (25- 50 years) and had shown no response to medication and D;C underwent endometrial ablation. Thirty-seven patients received pre-op medication and thirteen patients did not. All patients had undergone pre-operative endometrial sampling that had demonstrated benign histology. Eleven patients had submucosal myomas or pedunculated polyps that were resected at the time of hysteroscopic ablation. The minimum follow-up period was 1 year. Amenorrhea developed in 14% of patients, 50% of patients became hypomenorrheic and 30% eumenorrheic. Menorrhagia did not respond in 3 patients (6%). Hypermenorrhea was detected more commonly in younger patients. Type of endometrium, depth of the uterine cavity, presence of polyp or myoma and receiving pre-op medication were not important and did not affect patient response. Overall, the results of this study clearly indicate that endometrial ablation is a simple, effective and acceptable procedure for the management of intractable menorrhagia. The only factor which was important concerning the efficacy of endometrial ablation was patient age.

Various dimensions of the human vestibular aqueduct were evaluated in two groups, patient and control, and these measurements were compared. Both groups were examined clinically, followed by audiometric evaluation and temporal bone high resolution CT scan. It was found that in approximately one third of the patient group (with idiopathic SNHL), the vestibular aqueduct was 1.5 mm or larger. Also, the midpoint diameter of the distal limb was larger than in the control group (p<0.01). But there was no relation between the various dimensions of the vestibular aqueduct and mastoid pneumatization.

Recently, using polymerase chain reaction (PCR) technique, the DNA of cytomegalovirus was detected from depigmented white patches in patients with vitiligo. The reactivation of infection and occasional anti-CMV IgM circulating among patients infected by cytomegalovirus has been reported for years. We have studied 26 patients with clinical signs and symptoms of vitiligo, some of whom had a history of disease for years. Of these patients, 7 cases (26.92%) showed positive for anti-CMV IgM, indicating the presence of cytomegalovirus infection among vitiligo patients which differed significantly from control subjects (p<O.OOOI). Of these 7 patients positive for anti-CMV IgM, 6 cases (85.71 %) were also positive for antinuclear antibody (ANA). On the other hand, from among the 19 cases negative for anti-CMV IgM, 7 cases (36.84%) were positive for antinuclear antibody (ANA), so the difference was statistically significant (p<O.05). The prevalence of anti-CMV IgM was higher among the active vitiligo patients than those with stable vitiligo (p<0.02).

To investigate the patterns of DNA ploidy and proliferating activity in breast cancer and relate them to other prognostic factors, paraffin blocks of 53 cases of breast carcinoma were studied. Cancer cells obtained by mechanical tissue disaggregation were examined for DNA content, ploidy and S-phase fraction. DNA assay was done using a CAS interactive image analyzing system. All of the cases showed high degrees of proliferation. The rate of aneuploidy was 77% in invasive breast carcinomas. S-phase fractions were correlated with the grades of the tumors (p<O.05). There was no statistically significant correlation between S-phase fractions and other prognostic factors this was also true about the pattern of ploidy and other prognostic factors.

Postdate pregnancy is estimated to occur in 3% to 12% of all gestations. Morbidity and mortality rates associated with this common obstetric problem are higher than those with term gestation. The incidence of fetal distress, birth injury, meconium aspiration, congenital malformations, macrosomia, and oligohydramnios is also greater in postdate pregnancies. We prospectively evaluated breast self-stimulation to determine its effect on the incidence of postdate pregnancy. One-hundred uncomplicated patients at 40 weeks gestation were randomly assigned to either a control group or a breast-stimulation group. Results showed that breast stimulation reduced the number of pregnancies managed as postdates from 22 per 100 (22%) to zero per 100 (p= 0.002). It is concluded that breast stimulation in postdate pregnancies can decrease significantly the number of patients that must be monitored by biochemical or biophysical means.

We wished to assess the frequency of EEG positivity with our available EEG technology to compare with those elsewhere. Between April 1996 to February 1997, of patients referred to the Pediatric Neurology Out-patient Clinic for assessment of seizure disorders, 202 randomly selected patients aged 16 months to 17 years (mean 8.96 years) underwent a 10-minute inter-ictal EEG recording using a standard lO-channel paper EEG, with various activation techniques performed. Of these, 142 (70.3%) were clinically diagnosed as having some type of seizure disorder, while the rest (60, 29.7%) had EEG performed for other reasons. Of 142 cases with seizure disorder, 65 (45.8%) had definitely abnormal, 15 (10.5%) suspicious, and 62 (43.7%) had normal EEG's. In the 60 "other" patients, 22 (36.7%) had abnormal, 2 (3.3%) suspicious, and 36 (60%) normaI EEG's. In 202 patients as a whole, 87 EEG's (43.06%) were abnormal, 17 (8.41 %) suspicious, and 98 (48.51 %) normal. In conclusion, although of lower than standard technology compared to those taken in developed countries, EEG's taken in our laboratory could help us substantiate our clinical impression of seizure disorders in children. The result could be further improved by more appropriate selection of cases and further refining the procedure, using the same instrument.

HLA-DRB1 allele frequencies of 28 myasthenia gravis (MG) patients, residents of southern Iranian provinces, were studied using PCR-SSP method. The control group consisted of 100 healthy individuals of the same ethnic group. The allele HLA-DRB1 * 16 (RR= 2.04, p= 0.028) was found to be significantly increased in MG patients compared to the control group, whereas HLADRB1 * 15(RR= 0.17 p= 0.043) and HLA-DRB1 *07 (p= 0.036) were found to be significantly increased in the control group compared to the patients, and seem to be negatively associated with the disease.

The purpose of this study was to determine whether sectioning the cervical septum is associated with intraoperative bleeding, incompetent cervix, and secondary infertility. In this prospective observational study, fourteen women with complete septate uterus who had a history of repeated pregnancy loss and infertility were treated hysteroscopically. Preoperative history included 35 pregnancies of which abortion rate was 62.8% and premature delivery 37.2%. Three infants (8.5%) survived. The cerivcal portion of the septum was incised with Metzenbaum scissors and the corporeal portion with micro scissors under hysteroscopic guidance. Eleven patients achieved pregnancy (78.5%). There were ten term pregnancies (91 %). Mean±SD of operating time was 31.1±9.74 minutes with a mean±SD distending media deficit of 472±186 mL. No significant bleeding was encountered. At follow up hysterosalpingography, all cervices were competent. In conclusion, section of the cervical septum with scissors is simple, rapid and safe, facilitates corporeal hysteroscopic metroplasty, and may be considered a valid procedure to correct a complete septate uterus.

Using a cluster sampling method, a group of menopausal women from three geographic areas in Tehran were asked to participate in the study. Demographic data was obtained using a questionnaire. Subjects were than referred to perform bone mass densitometry (BMD). The relationship between various variables (i.e. age of menarche, number of years of endogenous estrogen exposure, ... ) with mineral density of the lumbar spine and femur were sought. Results showed that the incidence of bone loss during menopause was high among these women. Earlier age of menarche and longer reproductive years, higher BMI, previous usage of OCP and HRT are likely to increase BM. Being active at home and doing household chores can greatly influence the BMD of the femur. Poor dietary calcium intake may be the main reason for low BMD among the studied subjects.

In an attempt to determine the diagnostic value of FNA biopsy of head and neck masses, we reviewed FNAs performed on target lesions of the head and neck in1 59 patients who subsequently underwent surgery in Khalili hospital dur-. ing a 55 month period. Results ofFNAs were compared with postsurgical histologic diagnoses. These 159 cases were broken down into four categories: thyroid masses 34 , lymph nodes 3 6, salivary gland masses 58 , and masses not classified in the first three categories 31 . Values of specificity, sensitivity, positive predictive vlaue (in diagnosing malignancy) and negative predictive value (in diagnosis of benign disease) were calculated for each category and for all masses. Overall, we obtained a sensitivity of 77%, specificity of 94%, positive predictive value of 84% and negative predictive value of90% that was comparable with several other studies performed elsewhere, except that our elevated numbers of false negative in the salivary gland category lowered the sensitivity of FNA in this category to 57% and the overall sensitivity to 77%. The other disparity between our results and those of other studies I is our slightly elevated false negative rate (6.9%), overall sensitivity.

Twenty patients with bulky (>4 cm size) FIGO stage IB cervical cancer were treated with cisplatin 50 mg/m2 and vincristine 1 mg/m2, administered intravenously at 10-day intervals for a total of 3 courses before radical hysterectomy. A complete clinical response was noted in 1 patient (5%) and partial response in 5 (25%). Fourteen patients (70%) had stable disease. There was no grade 3 toxicity noted. Of the 20 patients who received chemotherapy (ChT), 3 patients had parametrial and para-aortic involvement in these cases, the operation was aborted and radiation therapy given. The remaining 17 patients underwent radical hysterectomy and pelvic lymphadenectomy 10-15 days following ChT. Five of these patients (29.4%) had pelvic node metastases. Three patients had positive margins. These 8 patients received postoperative radiotherapy. Twenty-four months later 15 patients were alive (87%) and 2 had died.

Twenty patients with intracranial hematoma (ICH or IVH) were treated with direct infusion of urokinase through a catheter. Reduction of hematoma volume was observed within a few days. Twelve patients showed good or excellent outcome. No infection or rebleeding was observed.

Forty patients with cataracts, as well as 40 patients with proven ocular toxoplasmosis were enrolled in this prospective clinical study. Serum IgG and aqueous IgG in both groups were measured by enzyme-linked immunosorbent assay (ELISA) and the corresponding ratios were calculated. Serum IgG/aqueous humor IgG ratio was less than 100 in the patient group and more than 100 in the control group. On the other hand in the chorioretinitis subgroup the ratio was less than 13, while in the group With uveitis, the ratio was more than 13 (p<0.05). The results revealed that calculating the ratio of Serum IgG (antitoxo) / Aqueous IgG (antitoxo) may be helpful as an adjunct to diagnosis in cases with clinically atypical ocular toxoplasmosis.

Man's instinct for exploring is the most natural way to enhance motivation and, consequently, cognition. In the research-centered teaching method, developed after many y ears of teaching experience, the principles mentioned in textbooks are not presented directly instead, the lecture begins by posing an initial question about how scientists have discovered a certain principle. Students are encouraged to explore a way to reach the answer and voluntarily suggest a proposal. The lecturer refines their views from scientific, methodological and ethical aspects, guides their thoughts towards a conclusion, and introduces their proposals' related references. The session then continues with customary lecturing. This investigation-which was carried out to evaluate the effects of the initial research-centered teaching stage in the beginning of every session-assessed the medical student's attitudes by using a questionnaire, and their knowledge by taking an examination including a test exam, research essay and class attentiveness from 1993-95. The results indicated that 84.3% of the 562 students obviously preferred the research-centered method to a customary way to lecturing. Statistical analyses were carried out on students' attitude variables in cognition, enthusiasm, anxiety, and not interested categories. It was concluded that cognition is in favour of the research-centered method which, by way of exploratory thinking is related to increased enthusiasm among the students (p= 0.001). Mean scores for research exam and class attentiveness were also higher in this group compared with those who chose only customary lecturing (p<0.05).

In the present study the effects of both CCK receptor agonists and antagonists on antinociception induced by morphine in the tail-flick test have been evaluated. M orphine induced dose-dependent antinociception in mice. The response of morphine was potentiated by sulfated cholecystokinin-8 (CCK-8S) but not by unsulfated cholecystokinin-8 (CCK-8U). The CCK receptor antagonists MK-329 and L-365, 260 decreased the potentiation of morphine antinociception induced by CCK-8S.•The antagonists even decreased the response induced by morphine in the pre5ence ofCCK-8U. High doses ofMK-329 and L-365, 260 also potentiated morphine's antinociception. Single administration of the CCK receptor agonists CCK-8 and CCK-8U or CCK receptor antagonists did not elicit any response in the tail-flick test. It is concluded that CCK receptor mechanisms are involved in the modulation of pain response and/or morphine antinociception.

We have developed a simple and precise paper chromatographic method for the determination of 4-hydroxy-3-methoxymandelic acid (VMA) in urine. Concentrations of VMA in patients with neuroblastoma were increased in comparison to controls. The linearity was excellent in the concentration range tested. The within-assay coefficient of variation for control and patient urine was less than 2.2%. The recovery was in the range of 97.9-99.4%. Results from testing urine samples of controls and patients with neuroblastoma suggest that this method is a reliable and convenient system for quantification of VMA in urine and can be used in the mass screening of neuroblastoma in infants. Sample preparation requires minimal time and the entire procedure is completed within 5 h.

Proteinase 3(PR3) is a human polymorphonuclear leukocyte serine proteinase and is the main target antigen for antineutrophil cytoplasmic antibodies (ANCA) found in Wegener's granulomatosis (WG). We developed a stable expression system for conformationally intact recombinant PR3 (rPR3) in Chinese hamster ovary cells (CHO-cells). The part of PR3 cDNA that encoded the active form of PR3 was selected by using appropriate primers, and a signal sequence was also added in front ofPR3 eDNA. The signal sequencePR3 (S-PR3) was cloned into the pME 18 expression vector and the result product was electroporated into E. coli (DH5 a strain). After isolation and purification, the presence of pMEI8-S-PR3 was confirmed by using appropriate restriction endonuclease and agarose gel electrophoresis. The pMEI8- S-PR3 was electroporated with CHO-cells and the presence of rPR3 was tested in culture medium after 10 days. There was 12 ng/mL rPR3 in culture medium that had activity and was recognized by ANCA in ELISA.

The use of bovine amnion in the urinary tract for reconstructive purposes following ablative surgery in cases of trauma, cancer or infection is now a common practice in urological surgery. To evaluate urinary bladder reconstruction with bovine amniotic membrane (BAM), ten healthy mongrel dogs of either sex weighing 10-40 kg were used. The animals were randomly divided into two groups of five animals each. A piece of the cranial wall of the bladder 5 cm in diameter was resected and replaced with fresh and formalin-preserved BAM respectively. The graft compatibility was evaluated on the basis of clinical, biochemical ultrasonographical, radiological and histopathological changes. Clinically all of the dogs were dull and depressed with blood tinged urine for the first few post-operative days. The biochemical parameters didn't show any significant changes in BUN and creatinine. Ultrasonographic findings consisted of floating masses in the bladder lumen (40%), chronic cystitis (10%), bladder adhesion with adjacent tissues (90%) and radiological findings were lack of normal distension of the graft site (100%) and filling defect (30%). No inflammatory responses and leakage were observed. The regeneration of uroepithelium, and proliferation of granulation tissue, infiltration of lymphoid cells, degenerative changes at the junction of the bladder and graft and heterotopic bone formation were observed. Keeping in view the compatibility of the fresh and preserved BAM, this study showed that it can act as a scaffold for repairing urinary bladder defects in dogs.

Administration of apomorphine and amphetamine induces climbing behavior in mice due to stimulation of brain dopamine receptors. In the present study, the effects of adrenoceptor agonists and antagonists on amphetamine-induced climbing have been investigated. Intraperitoneal (i.p.) injection of different doses of amphetamine (2,4 and 8 mglkg) induced climbing in mice (p<O.OOO 1). The u2- adrenoceptor agonist clonidine decreased the climbing induced by amphetamine (p<0.01). The adrenoceptor antagonists prazosin, yohimbine and propranolol did not alter amphetamine response. It may be concluded that α1- and α2-adrenoceptor stimulation decreases amphetamine- induced climbing behavior indirectly through changing dopamine levels.

Isolation of rat islets of Langerhans was carried out by using collagenase and the destruction of exocrine tissue was performed through the injection of Hanks' solution into the common bile duct. The identification of the islets was done by techniques including the use of a stereomicroscope against a black background. Vital staining was done by an injection of neutral red solution through the abdominal aorta to observe the red tinted islets. Immunofluorescent staining with anti-insulin was done to identify islets and nuclear staining was done with propidium iodide. The microorgans were detected by a confocal microscope equipped with a laser source. The secretory activities of the islets was investigated by in vitro measurement of insulin and the effects of various concentrations of glucose, potassium and calcium ions were studied. It was found that the insulin secretion by these agents obeyed a monophasic trend which points to the depolarization effect on cytoplasmic membrane induced by these agents.

In this study, twenty-five strains of Mycobacterium tuberculosis resistant to isoniazid (INH) were isolated from patients with tuberculosis (TB). Nine strains (36%) were found to be virulent in guinea-pigs [root index virulence (RIV» 1 ]. The remaining sixteen strains (64%) were non-virulent (RIV <1). Of the nine strains resistant to INH as well as virulent to guinea-pigs, eight of them were found to be catalase positive and only one strain was catalase negative, whereas the remaining sixteen INH resistant strains were catalase negative. A strong association was observed between INH resistance and catalase positivity and virulence (p<0.0001 chi-square test). This study supports the hypothesis that catalase has an important role in the virulence of INH-resistant strains of M tuberculosis.

Research has shown that exposure to lead may have adverse effects at different blood lead concentrations. Lead inhibits at least two enzymes that are essential for the formation of heme, and because of the interaction of lead with these enzymes, no iron is inserted into protoporphyrin. Therefore the concentration of protoporphyrin increases in erythrocytes. The concentration of lead was measured by atomic absorption at 217.0 nm. The erythrocyte protoporphyrin was determined following extraction into 90% ethanol. The concentration of protoporphyrin in the blood of the lead exposed rat group was increased compared to that in the control group [12.46 +/- 0.57 (mean +/- S.D., n= 72) vs. 3.89 +/- 0.42, n=68, µmollL, p<0.05]. The assay had excellent precision for both control and lead exposed groups (intra-assay and interassay coefficient of variation<5%). The method was linear from 0.0 to 12.46 µmollL of erythrocyte protoporphyrin. A good relationship was obtained between erythrocyte protoporphyrin value and blood lead concentration. The results suggest that the erythrocyte protoporphyrin value obtained by this method could be used as a screening test for lead poisoning

We report a case of a 40 year old man with portal hypertension caused by a splenic arteriovenous fistula that was diagnosed at laparotomy. He presented with bleeding esophageal varices and was initially treated by sclerotherapy. At laparotomy, portal pressure was 40 cmH20 but fell to 20 cm H20 after the fistula was treated with splenectomy. All symptoms disappeared shortly after operation and the patient has remained well for the past two years.

A case of acute extrapyramidal manifestations consisting of dystonia and akathisia following abrupt discontinuation of propranolol is reported. She responded well to oral propranolol and intramuscular diazepam. Extrapyramidal symptoms have commonly been associated with acute or chronic administration of neuroleptic drugs. There have been reports of a substantial number of cases with similar clinical characteristics associated with tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors. Although it is known that beta-adrenoceptor antagonists are effective in the treatment of extrapyramidal symptoms, especially akathisia, there has been no previous report of such symptoms induced by abrupt withdrawal of these drugs. Although she had been on low dose amitriptyline and had discontinued this medication long before, prolonged use of amitriptyline may have had a predisposing role in the development of these symptoms.