Medical Journal Of the Islamic Republic of Iran
Volume:13 Issue: 3, Autumn 2019

The indications and results of cytogenetic analysis of 521 amniotic cell cultures performed at 13-16 weeks of gestation were evaluated in this study. 507 fetuses (97.3%) were cytogenetically normal, 14 (2.7%) had unbalanced karyotypes, and 2 fetuses were found to have major abnormalities, one with anencephaly detected by measurement of alpha -fetoprotein levels in amniotic fluid and ultrasonography, and the other with a full mutation at the FMRl locus detected by molecular techniques. The unbalanced karyotypes included 2 cases each of trisomy 21, trisomy 18, triple X, 47 XXY and mosaicisms and 4 cases of various chromosomal abnormalities. 225 tests were performed for women 35 years of age or over, 6 (2.4%) abnormal karyotypes were detected, showing a 6 - fold increase over the general population. This risk was even higher (2/23,8.7%) among those parous aged >35 y who had a previous history of offspring with chromosomal aberrations. 5 of 32 (15.65%) fetuses whose parent was a carrier of a balanced chromosomal translocation or a small chromosomal marker (in one case), had unbalanced chromosomal aberrations. There were 7 cases of spontaneous abortion within 4 weeks after amniocentesis, one of which was a case of 46 XY, t (1421), + 18. Excluding this case, the rate of abortion (6/521, 1.3%) was quite below the expected rate of 2.1 % for spontaneous abortion in the 2nd trimester of pregnancy. Our data indicates that amniocentesis performed at 13-16 weeks is a safe, reliable procedure for detection of fetal chromosomal abnormalities in Iran, and we strongly recommend it for those parous at risk.

The term mitral valve prolapse (MVP) is used for a particular subset of patients with hyperadrenergic dysautonomia. It occurs when part of a leaflet or both leaflets of the mitral valve extend above the plane of the atrioventricular junction during ventricular systole. The adenylate cyclase activity in MVP dys-autonomia was studied by extraction of enzyme from the erythrocytes from 62 normal subjects and 78 MVP patients. Adenylate cyclase activity in the MVP group was increased compared to that in controls [6.51 ±O.38 (mean±S.D., n= 78) vs. 2.76 ±O.12, n= 62, U activity/mg erythrocyte protein, p<O.05]. The determination of adenylate cyclase activity in combination with echocardiography allows a reliable diagnosis of MVP patients.

The acid-base status and arterial blood gas change with temperature variation. To determine the changes in arterial pH and pC02, arterial blood samples of 50 neonates with different clinical conditions were examined at temperatures of 35 to 42°C with an increment of 0.5° C, which resulted in two nonlinear equations with perfect fit on data. The temperature correction factors of these equations, unlike factors of the previously proposed linear equations, are not, themselves, functions of temperature. The arterial pH increases by 0.014 to 0.015 units, and peo2 decreases by 4.15-4.35%, with a 1ºC drop in body temperature.

The study included nineteen control subjects and fifty-nine diabetic patients. The diabetic patients were divided according to the treatment they received. Fasting blood glucose was markedly increased in all three groups, while low serum vitamin A, C and E levels were observed in diabetic patients as compared to control subjects.

The aims of surgical treatment for cholesteatoma include complete removal of disease and formation of a dry, self cleaning ear in addition to hearing reconstruction. This presentation concentrates on techniques of open mastoid surgery or modified radical mastoidectomy to achieve a well-constructed cavity. This study analyzes both primary and revision mastoid surgery referred to the author. All patients presented with otorrhea, and four patients presented with facial paralysis, two with labyrinthine and one with oval window fistula. Sclerotic mastoid with extensive cholesteatoma were indications for modified radical mastoidectomy as the treatment of choice. The main method of hearing reconstruction in an open cavity with a mobile stapes was type III tympanoplasty, leading to an improvement in the average air bone gap following surgery in both primary and revision groups. The major causes of failure that were found when revising mastoid cavities were incomplete removal of air cell tracts and inadequate mastoid cavity formation without a sufficient meatoplasty. The techniques of open mastoid or modified radical mastoidectomy that are required to avoid failure are discussed.

A perplexing issue in diagnosing the cause of renal allograft dysfunction is differentiation between rejection----the most common cause--and many other possibilities that have detrimental effects on graft function. This study was designed to determine whether technetium - 99m sulfur colloid (TSC) accumulation could predict graft rejection. We prospectively studied 54 episodes of allograft dysfunction in 53 kidney transplant recipients who had undergone TSC scintiscanning and graft biopsy, within one week of evidence of allograft dysfunction. Visual analysis of TSC uptake was done by comparing allograft uptake with that of the fifth lumbar vertebra (L5) marrow. A 3+ result meant that allograft uptake was greater than L5 marrow uptake 2+, allograft uptake was the same as L5 marrow uptake 1+, less than and 0, no allograft uptake. Transplant accumulation of 􀁀2+ was considered consistent with rejection (p=0.01). Allotransplant biopsies were interpreted based on the Banff Working Classification and rejection was noted in 45 of 54 renal biopsies. 42 of 45 biopsy -proven rejection episodes had ≥2+ graft uptake. This nuclear medicine technique has a sensitivity of 93.3%, specificity of 44.4%, a positive predictive value of 89.3%, a negative value of 57.1 % and an efficiency of 83.3% in the diagnosis of renal allograft rejection.

A simple, rapid and sensitive HPLC method for the determination of theophylline (T) in human serum has been developed. An isocratic system consisting of a /-l Bondapak C18 column, mobile phase of methanol, phosphate buffer (22:78, pH=4.5), and a flow rate of 1.4 mL/min was used. The eluent was detected by UV at 275 nm at room temperature. 8-Chlorotheophylline (8-CT) was used as an internal standard. The serum samples deproteinated by methanol containing 8-CT and the supernatant was injected into the HPLC system. The retention times of 5.7 and 8.1 min were found for T and 8-CT, respectively. The linearity was checked in the range of 0.2- 30 µg/mL. Relative standard deviation for both inter-day and intra-day precision analysis was less than 5%. No interference was observed from endogenous serum components. Specificity was shown against some commonly co-administered drugs. Simple and fast sample preparation, small sample volume (250 µL), precision, reproducibility, specificity, sensitivity and high percentage recovery (98 %) make the method to be practically useful for T monitoring in asthmatic patients.

Cortical control of the sensory output of muscle spindles was studied in thirteen anesthetized cats in the present experiment. Gamma motoneuron activity was monitored during electrical stimulation of the sensorimotor cortex while recording from single primary afferents from the tenuissimus muscle. Findings are as follows:1. The state of anesthesia is crucial in obtaining reproducible results and variation in the state of anesthesia can alter the fusimotor effect from static to dynamic or even from excitation to inhibition, a finding consistent with those of Vedel and Mouillac-Baudevin.30The anesthetic agent used was also important in determining the magnitude and types of responses to corticaI stimulation. the initial burst of the primary afferent in response to passive stretch was by far greater with chloralose than with barbiturate anesthesia in the tenuissimus muscle, suggesting that there may be a tonic low-level dynamic gamma excitation in chloralose anesthesia. 2. The state of the sensorimotor cortex is another determinant factor. Prevention of CO2 escape from the surface of the cortex in the present experiments, by covering the cortex with 1cm of mineral oil, is thought to be the sole factor which made these results different from those obtained by Gladden and McWilliam.ll•12 3. Different types of static gamma motoneurons could be recruited from the sensorimotor cortex independently. 4. The topographical mapping of the sensorimotor cortex in relation to the type of recruited gamma motoneurons, static or dynamic, was as follows: a) A"dynamic area" was identified from which dynamic effects were clearly elicited during stimulation. b) Static effects were elicited following stimulation of a much wider area across the sensorimotor cortex, the postcruciate dimple being almost at the center. 5. The sensorimotor cortex was not only capable of controlling static gamma motoneurons independently from dynamic ones, but also capable of simultaneously inhibiting static gamma motoneurons and exciting others, lending support to the idea put forward by others.6

Recent studies have established that sex hormones directly or indirectly affect T and B cells and macrophages by manipulating the production of cytokines. In this study the possibility of the effect of 5a-DHT on macrophage (MΦ) nitric oxide (NO) release via interleukin-l, 6 (lL-1β, IL-6) or tumor necrosis factor-a (TNFα) was investigated. The endogenous cytokines IL-1β, IL-6 and TNF-α were neutralized by hamster anti-mouse IL-1β, rat anti-mouse IL-6 or goat anti-mouse TNF-α monoclonal antibody, respectively. Blocking of IL-1β and TNF-α resulted in decrease in NO release. Neutralizing of IL-6 caused an increase in nitric oxide (NO) production. With regard to these findings, it can be concluded that 5αDHT may enhance NO production in peritoneal macrophages via modulation of cytokine secretion.

Resistance of the weanling rat to acetaminophen (AP AP)-induced hepatotoxicity is manifested with regard to a surge in APAP-glutathione (OSH) conjugate formation in the liver [Allameh et al. Mech Aging Dev 95(1997)71]. The present study was conducted to assess the role of this detoxification pathway in APAPinduced lipid per6xidationin the liver. Lipid peroxidation measured as thiobarbituric acid reactive substances (TBARS) in rat liver homogenate was observed to be increased due to a decrease in hepatic cellular GSH concentration. Cellular GSH content was relatively lower in growing liver and further decreased in rats treated with either GSH-depleting agents or APAP, whereas adult animals under APAP treatment suffered significantly less depletion of GSH. AP AP injection to weanling rats pre-treated with diethylmaleate (DEM) aggravated lipid peroxidation. Administration of a single large dose of APAP (500 mg/kg b. w.) to weanling rats, 3 h before sacrifice, which caused 46% GSH depletion, resulted in a 25% increase in lipid peroxidation. Pre-treatment of growing rats with DEM, 30 min before APAP, caused about 70% depletion in GSH content as a result of which there was a further increase (approx. 1.6 fold) in lipid peroxide formation (control: 37.40 experimental: 60.76 nmol malondialdehyde formation/g tissue). GSH S-transferase activity is not necessarily a determinant of APAP toxicity in adult animals. Unlike adults, in growing tissues the enzyme activity is indu.ced single overdose of APAP. When these data are discussed in relation to our earlier study, it could be concluded that APAP-dependent induction of GSHS-transferases is responsible for increased APAP-GSH conjugate formation which facilitates inactivation of NAPQI as well as other toxic metabolites of lipid peroxidation.

Mice are ideal models for ICSI experiments because of the ease of culturing eggs/embryos in vitro and the availability of ample genetic information. Unfortunately, it has been extremely difficult. In this study we improved the mouse ICSI method by using a new holding pipette that was made of two pipettes such that one pipette was pulled and heat merged into the other one. The outer pipette had an outer diameter of 120 J..l. and an inner diameter of 80 J..l. to 85 J.1 (about mouse oocyte diameter). The inner pipette had an outer diameter of 80 µ to 85 µ. and an inner diameter of 55 µ to 60 µ. which was polished and narrowed to 20 J..l.on amicroforge. The distance between the tips of the two pipettes was adjusted to 120 µ. to 160 µ (1.5 to 2 fold longer than mouse oocyte diameter). Of 307 oocytes which were injected with a single spermatozoon, 206 (67.1 %) survived and 93 (45.1 %) of surviving oocytes showed normal fertilization (2 pronuclei and second polar body). Of 109 oocytes which were only sucked into the holding pipette (control group), 105 (96.3%) survived and only 4 (3.8%) of them became activated parthenogenically. U sing this new holding pipette, the oocyte is sucked into a glass tunnel and elongates to a reasonable length therefore the injection axis will be increased and piercing of the oolemma can be performed easily.

The purpose of this study was to investigate and compare whether the explant supernatants prepared from endometrial tissues during the proliferative phase, secretory phase and early pregnancy differ in immunosuppressive activity. Specimens of nonpregnant endometrium from hysterectomies and normal first trimester decidua following elective aspiration termination of pregnancy were obtained. Supernatants from culture of endometrium or decidual fragments were prepared after 24, 48 and 72 hours. The effect of the supernatants on mitogeninduced lymphoproliferation in vitro was assessed. The percentage of suppression was calculated and then data were evaluated using Student's t-test. The results confinned that endometrial immunosuppressive activity exists throughout the reproductive cycle and confirm that early pregnancy decidua is a source of immunoregulatory factors. Immunosuppressive activity was increased in early pregnancy decidua compared with secretory phase endometrium but the results did not reach statistical signifIcance. In contrast, the difference in immunosuppressive activity between proliferative endometrium and early pregnancy decidua was highly significant. In conclusion, the high frequency of early embryonic loss before implantation and the low success rate of in vitro fertilization (IVF), embryo transfer and pathological pregnancy in humans can be explained in part by lack of suppressor activity in the endometrium.

We describe a case of pulmonary blastoma, a rare primary lung malignancy which affects a younger population. This tumor contains both mesenchymal and epithelial elements. Pulmonary blastoma tends to relapse locally and metastasizes mainly in the first few years. It has a poor 5-year prognosis, and shows a potentid radio-chemosensitivity. Because these tumors are considered malignant, surgical excision is recommended. In this paper, we describe a case of pulmonary blastoma in a 3 year old boy with a brief review of literature.

Dopa responsive dystonia (DRD) is a dystonic syndrome of childhood, usually affecting gait and subsequently developing into parkinsonism with a dramatic therapeutic response to levodopa. At the best of our recollection this is the first case in Iranian medical literature of a 13 year old boy, affected by this interesting, rare and treatable disease which can be easily diagnosed if clinicians have a high index of suspicion. We also have a brief discussion on the pathophysiology of DRD.

Tracheobronchopathia osteochondroplastica (TO) is a rare and usually benign disorder affecting the trachea and occasionally the bronchi. A case of TO was diagnosed in a 61 year old male farmer presenting with pulmonary infections and prolonged productive cough. A bronchoscopy revealed multiple nodular excrescences aong the anterolateral wall of the trachea and main bronchi. CT scans showed moderate narrowing and distortion of the trachea. Biopsies revealed squamous metaplasia, and calcification and ossification in the epithelial surface. The literature on the subject is reviewed here. The severity of TO ranges from no symptoms to severe dyspnea, hemoptysis or pneumonitis. The etiology and pathogenesis is unknown. Treatment is seldom necessary. Awareness of the condition as a differential diagnosis to neoplasms is important to avoid unnecessary surgery or chemotherapy.