Acta Medica Iranica
Volume:43 Issue: 1, Jan-Feb 2005

The development of culture media able to mimic the preovulatory stage of follicular environment and support nuclear and cytoplasmic maturation of oocyte is important for in-vitro fertilization (IVF) programs. It seems that the best culture media for embryonic development and cell cleavage is the natural composition which surrounds the oocyte which has been used occasionally in human IVF programs. For further investigation of effects of natural media composition of human follicular fluid (HFF) on embryo development, we compared the biochemical constituents of HFF with synthetic serum substitute (3S) and their effects on embryo development and cell cleavage. From a total of 40 women with unexplained infertility, who attended for intracytoplasmic sperm injection (ICSI) in IVF center of Mirzakoochak Khan Hospital, we collected the HFF during oocyte pick-up in operation room. The chemical composition of HFF was compared to 3S medium culture to identify which natural components of follicular fluid might enhance embryo maturation in vitro. The results of comparison between HFF and 3S culture media indicated significant differences in biochemical component except for Na and bilirubin concentration and pH level (P<0.05) and significant differences between the rates of cell cleavage in 3S compared to HFF media (P<0.05). Furthermore the rate of embryo cell cleavage related to HFF is faster than 3S medium. There was no significant difference between the development of embryos in 3S and HFF media culture. Our data confirm the benefit of the use of HFF as a culture medium.

Glial cell line-derived neurotrophic factor (GDNF) plays important roles not only for the differentiation of neurons during normal development but also for the survival and recovery of many populations of mature neurons. The effect of traumatic brain injury (TBI) on the expression of GDNF is currently unknown. To determine if there is alteration in GDNF after TBI we examined the effect of controlled cortical impact (CCI) injury on GDNF protein levels at 6 hours, 1 day, 1 week, and 4 weeks following injury by utilizing a commercially available antibody specific to GDNF. Rats were anesthetized and surgically prepared for CCI injury (4 m/sec, 2.7 mm) and sham surgery. Injured and sham animals (n=6 per group) were sacrificed at 6 hours, 1 day, 1 week, and 4 weeks and perfused with 4% paraformaldehyde. Coronal sections (35 mm thick) were cut through the hippocampus. An increased expression of GDNF protein was observed by immunohistochemistry in the dentate gyrus of hippocampus and the cortex in injured rats compared to sham controls. The increased expression of GDNF was more evidently observed in the ipsilateral dentate gyrus and the area around the contusion in the cortex. In the cortex, GDNF immunoreactivity appeared greatest in cells with glial morphology but in the hippocampus, GDNF immunoreactivity was greatest in neuronal-like cells. These changes were observed at 1 day, 1 and 4 weeks postinjury. We speculate that the up-regulation of the GDNF protein may reflect its neurotrophic and neuroprotective effect on dopaminergic system responding to the TBI insult.

There is an impression that basal cell carcinomas (BCC) occurring in younger population may be of more invasive behavior in comparison to those arising in older patients. The purpose of this study was to investigate this hypothesis by comparing the histological types of BCC in a large cohort of young and old patients. A total of 287 histological reports and clinical records were evaluated. A consecutive series of 95 patients less than 45 years old were compared with a consecutive series of 192 patients over 45 years of age. Tumors were classified according to the accepted definition of aggressive (morpheic, infiltrative and micronodular) and less aggressive (nodular and superficial) histological growth patterns. Aggressive growth types were found in 32% of patients over 45 and 29% of patients under 45, a difference which was not significant. There was a higher rate of incomplete excision in younger patients and this was highly significant (17% compared to 5%, P < 0.01). This study found that BCCs arising in young patients are not histologically different from those found in the older population. Clinically observed aggressive behavior of BCC in young patients may result from inadequate surgical excision due to cosmetics and diagnostic doubt.

The review of literature shows that a strong relationship exists between the symptoms of otolaryngologic diseases and gastroesophageal reflux disease (GERD). It is commonly observed that an extended physical examination is needed to determine the occurrence of GERD. This non-randomized,prospective quasi-experimental study was performed to clinically verify the relationship between otolaryngologic symptoms and GERD and to show that a search for GERD is necessary under conditions that patients do not respond to initial routine treatment for otolaryngologic symptoms. Extended physical examination of patients who had been referred to an Ear, Nose and throat (ENT)hospital revealed that GERD-related laryngeal signs were present in 55 patients. Otolaryngologic symptoms detected in decreasing order of occurrence were posterior nasal drip, chronic pharyngitis, chronic cough, hoarseness, ear pain, chronic throat clearing and pruritus in the ear. Furthermore, 66% of the patients had gastrointestinal symptoms that included heartburn, dysphagia, odynophagia, aspiration, globus hystericus, dyspepsia and foreign body sensation. Signs observed during the physical examination were posterior pharyngitis, granular pharyngitis, inflamed arytenoids, contact granuloma, and pachyderma laryngitis. We administered proton pump inhibitor to all patients and recommended to change their life style. The follow up program was a 6-month period. Only 53 patients showed up for the follow up. The overall response rate to the therapeutic regimen was 83%. In treating otolaryngologic patients, especially those who are resistant to routine treatments, a careful extended physical examination including an indirect laryngoscopy for diagnosis of GERD is recommended.

Many investigators use bone matrix gelatin for bone induction but it is used rarely for repair of teeth defects. This study was designed to evaluate secondary dentin formation by endochondral bone matrix gelatin (E-BMG) in rabbit. E-BMG was prepared from tibia and femur of 4 Deutsche-Poland rabbits with average ages of 4-6 months. The prepared E-BMG was implanted in right incisor teeth pulps of 8 rabbits as experimental groups and left incisor teeth pulps selected as control groups. The light and scanning electron microscopic studies were performed on days 28 and 60 after operation. Also, new secreted matrix was analyzed on experimental, control and normal groups. The histological results showed secondary dentin and osteodentin formation in experimental group on day 28 after operation. The scanning electron microscopic observation on day 60 after operation in experimental group showed mineralized mass on site of E-BMG implantation. In contrast, in control group no mineralized mass was shown. Analyzing of new secreted matrix in experimental group showed the high deposition of calcium and phosphate on E-BMG implantation site. Results of present investigation indicate that implantation of E-BMG in pulp cavity could induce secondary dentin and osteodentin formation in rabbit. E-BMG could be a suitable biomaterial for secondary dentin formation in pulp cavity.

Current mainstay of treatment for human immunodeficiency virus (HIV)-infected patients is highly active antiretroviral therapy (HAART) but little is known about the long-term clinical outcome for HIV-infected patients who have received HAART. Determining factors associated with longterm survival in the course of treatment may allow modification to be made for patients who are at a greater risk of treatment failure. In this study patients who were under HAART from March 2002 to September 2003 were evaluated. They were visited from 2 to 5 times and clinical and lab findings and CD4 count on every visit were recorded. Rates of progression from the initiation of HAART to treatment failure, defined as constant decline of CD4 numbers, occurrence of AIDS criteria and death, were determined. Forty three patients, 31 male and 12 female, with an average age of 39.6 were selected. The most common finding on initiation of treatment in these patients was wasting syndrome (16.3%). Overall, treatment failure occurred in 37.2%. Mean time to treatment failure was 13.3 months. There was correlation between baseline CD4 and survival of patients with history of monotherapy (P<0.05). Initial CD4 as a prognostic factor was valuable only in patients with history of monotherapy, also low initial CD4 correlated to death. Initial CD4 may help clinician to predict patient''s response to HAART. A multicentric longterm follow-up of patients treated with HAART is imperative. Drug resistance is the major factor in treatment failure. It is also correlated to lack of drug diversity and virologic lab tools.

Recognized as a reliable tool for assessing the hypothalamus-pituitary-adrenal (HPA) axis, measurement of salivary cortisol plays an important role in both the clinical and research settings. To establish a normative data, which forms the basis for the usage of this valuable parameter, we gathered 8:00 h saliva samples from 94 healthy individuals aged 6-14 years. Cortisol levels were measured by radioimmunoassay technique, using Orion Diagnostica''s coated tube technology. Based on mean±2SD, we established a normal range for salivary cortisol concentrations in this age group: 1.69 - 12.81nmol/L. Considering a confidence interval for upper and lower limits, there was an upper limit equal to 11.42 -14.29 nmol/L and a lower limit of 1.21 - 2.25 nmol/L. Regarding the results of this study, cortisol levels were age dependent, and although with a low correlation coefficient, there was a positive correlation between cortisol levels and weight and height. There was no correlation with BMI and no sex difference was found.

Adverse effects of antiepileptic drugs including cutaneous reactions may not only affect the result of treatment and quality of life, but can also be fatal if severe. Skin rash is more likely to occur during the first few months of treatment. The objective of this study was description of skin rashes in users of four antiepileptic drugs. We identified skin rashes of phenytoin, carbamazepine, sodium valproate and lamotrigine in a prospective descriptive cross sectional study in 1086 cases. Patients suffering from skin diseases, systemic illness with cutaneous presentations, radiation or drug–induced rash from non antiepileptic drugs and patients unwilling to be examined monthly were excluded. All the cases were followed for 6 months. Skin rashes occurred in 2.1% (23/1086) of patients. Twelve patients were male and the remaining 11 were female. The age of patients ranged from 8 to 71 (mean 24) years. Maculopapular rash and Stevens Johnson’s syndrome formed 56.5% (13/23) and 30.4% (7/23) of symptomatic cases, respectively. Toxic epidermal necrolysis, erythema multiform and psoriatic dermatitis each were detected in 4.3% (1/23) of patients. The interval between the beginning of antiepileptic as monotherapy or an add-on drug and skin rash presentation was from 3 to 45 (mean 13)days. Combination therapy was found to increase the incidence of rash, but dosage of drug did not show such effect. Special attention to skin rash in the first month of therapy and monotherapy instead of polytherapy is recommended.

It has been reported previously that modulatory effects of pleasant and unpleasant slides on the human acoustic reflex are observed only if startle probes are presented to the left ear or with binaural presentation. The present study examined the effects of the left and the right ear stimulation on modulated startle reflex (as indexed by eyeblink component, measured at the right eye) employing short (2-min) film-clips to elicit emotions. Sixteen right-handed subjects served as volunteers. The experiment included two consecutive sessions, on a single occasion. The acoustic stimuli were presented monaurally to one of the ears in each session, counterbalanced across order. The laterality phenomenon in startle modulation previously observed with affect-toned slides was not confirmed in this experiment. The probable discrepancy will be discussed methodologically.

Basal cell carcinoma (BCC) is the most common cancer of the skin. Definite diagnosis usually requires histological examination but recently it has been suggested that cytological examination of skin smear can be used as an alternative. To evaluate sensitivity and specificity of cytological examination, a total of 125 skin lesions, clinically suspected to be BCC were studied. Cytological samples were taken by scraping a scalpel blade over the lesion and smearing the cells on to a glass slide. The specimens were air- dried and stained with May-Grünwald-Giemsa. An incision biopsy was performed for histopathological study. The cytological results were compared with the histopathological results of the lesions. Histopathology revealed BCC in 102 lesions (81.6%), squamous cell carcinoma (SCC) in 11 lesions (8.8%), seborrheic keratosis in 6 lesions (4.8%), actinic keratosis in 5 lesions (4%) and keratoacanthoma in 1 lesion (0.8%). Cytological examination reported BCC in 90(72%), SCC in 13 (10.4%) and seborrheic keratosis in 6 lesions (4.8%) and was non-diagnostic in 16 lesions (12.8%). The sensitivity and specificity of the cytology in identifying all of the BCC types were 87.3% and 95.3%, respectively. In conclusion, cytological examination is easy to perform, saves time, requires a minimum of equipments and can be considered a reliable method in the diagnosis of suspected cutaneous BCC.

The ability of subminimum inhibitory concentrations (sub-MICs) of antibiotics to affect the virulence factors of bacteria may be an important criterion in selecting an antibiotic for therapy. Proteus mirabilis is one of the most frequently seen pathogens in urinary tract infections. The aim of this study was to analyze the effects of some antibiotics on two important virulence factors of P. mirabilis. In this study the effects of 1/2, 1/4 and 1/8 of the MIC of amoxicillin, gentamicin and nalidixic acid on adhesion and invasiveness of two clinical isolates of P. mirabilis were evaluated. Sub-MICs of ampicillin significantly reduced adhesion of P. mirabilis to uroepithelial cells and gentamicin exerted the same effect to lesser extent. Invasion of kidney epithelial cells by P. mirabilis in the presence of antibiotics was also evaluated. Ampicillin and nalidixic acid caused a reduction in the number of intracellular bacteria. Gentamicin showed the lowest inhibitory effect on cell invasion. The results indicate that the sub-MICs of antibiotics can affect virulence factors of P. mirabilis. The presence of sub-MIC effect of antibiotics may be an important factor in determining the dosing regimen for urinary tract infections.

There are many tests for diagnosis of myasthenia gravis including Tensilon test and ice test.To compare the ice test with Tensilon test in sub jects with myasthenic and nonmyasthenic ptosis a process research study was designed. This study was performed in patients complaining of acquired ptosis in the neuro-ophthalmology center of Farabi Hospital. All 156 patients were tested with ice pack and edrophonium with an interval of 15 minutes. The patient was instructed to hold an ice filled plastic glove on the closed ptotic eyelid. Before and after 2 minutes of ice application on the ptotic eyelid, the distance between the upper and lower margin was measured by the neuro-ophthalmologist. An increase of 2 mm or hig her was considered a positive test result. Patients with positive Tensilon test were considered as control. In all 61 patients with positive Tensilon test the ice test was positive, and in none of the 95 patients with negative Tensilon test the ice test was positive. The ice test is a simple, fast, specific and sensitive test for the diagnosis of myasthenic ptosis.

Congenital radial club hand is an intercalary or terminal deficiency characterized by radial deviation of the hand, marked shortening of the forearm, and generalized underdevelopment of the extremity. We performed centralization of the ulna in 12 forearms of 10 patients with severe congenital radial club hands. The mean follow up was 42 months after operation (24 to 68 months). The mean age at the operation was 16.8 months (7 to 42 months). The mean angular deformity before operation was 100 degrees (75 to 135). The angular deformity was corrected in all patients initially, but in the latest follow up the mean residual angular deformity was 19.58 degrees (5 to 45). The mean correction of angular deformity was 79.57 degrees (55 to 120). Range of motion in the wrist increased significantly after operation in both flexion-extension range and radial-ulnar deviation range (P <0.05). Stability of the wrist was acceptable in the latest follow up in all patients. We recommend that correction of congenital radial club hand by centralization should be performed in three stages. The first is preoperative splinting and corrective casting, the second centralization of the ulna and correction of angular deformity, and the third which may be longer than previous stages is postoperative splinting and bracing. This stage of treatment should be continued till skeletal maturity.

Abdominal pregnancies are very uncommon and are misdiagnosed in half of the cases. We describe a case of abdominal pregnancy, which was misdiagnosed as pregnancy in a bicornuate uterus.The patient underwent operation urgently because of unstable hemodynamics. The spontaneously separated placenta and its bleeding site in the Douglas pouch were seen. We could not use sutures for hemostasis so, the place was managed by gauze packing and the minor postoperative complications were managed appropriately. It seems that packing with gauze is a good option for these cases.

n-hexane neuropathy has been described after glue sniffing and industrial exposure. Onset may be subacute and reminiscent of Guillain-Barre'' syndrome. Five patients (15-18 years old) presented with paresthesia, severe weakness of the extremities particularly lower extremities, as well as muscular atrophy, total areflexia and gait disturbances were admitted in hospital in March 2003. All of these boys were workers of a small footwear production unit. They worked as gluers of leather pieces. Nerve conduction velocity studies showed latency prolongation and cerebrospinal fluid (CSF) analysis showed normal protein. In the workplace assessment, it was found that hexacarbone-containing adhesives were used in an inappropriate ventilated place and without any personal protective devices. These patients were re-examined 8 months later. Sensory and autonomic symptoms were alleviated but two of them still had gait disturbance and decreased reflexes.

Intraepiphyseal location of an osteoid osteoma is extremely rare with few cases reported in the literature. They are often present with various atypical and nonspecific clinical features. Synovitis of adjacent joint is common and along with chronic inflammation could be misinterpreted as rheumatoid arthritis. Initial plain radiographs are often not diagnostic and further radiologic evaluation with CT scan is an essential part of diagnostic work-up. Repeated plain X-ray is very useful in making a correct diagnosis. Although the characteristic double density sign is usually absent in isotope scan in intra-articular osteoid osteoma, it plays an important role in localization of the nidus. We report a case with an intraepiphyseal osteoid osteoma without any signs of synovitis or growth disturbances. During the enbloc resection of nidus, we noticed no communication between the nidus and joint or physis in our cases. It seems that communication of nidus with joint space or growth plate is essential to allow mediators of inflammation pass to joint or growth plate and produce synovitis or growth disturbances, respectively.