Acta Medica Iranica
Volume:43 Issue: 3, May June 2005

Alzheimer’s disease (AD) is a uniquely human disorder. Although the pathogenesis of AD is not fully understood, growing evidence indicates that the deposition of beta-amyloid (Aβ) and the local reactions of various cell types to this protein play major roles in the development of the disease. In the present study transgenic mice expressing mutant amyloid precursor protein (APP) has been used. These mice exhibit selective neuronal death in the brain regions that are most affected in AD, suggesting that amyloid plaque formation is directly involved in AD neurons loss. Brains from 12 transgenic animals and 12 age-matched non transgenic littermate controls (1 and 2 years old) were examined histopathologically. One year old transgenic animals (n=6) exhibit deposits of human Aβ in the hippocampus, corpus callosum and cerebral cortex. By 2 years of age, a great number of diffuse and mature plaques were present in the cortex and hippocampus, and subcortical regions like thalamus and striatum. Another major finding was reduction of cholinergic cells in the medial septum, striatum and diagonal band of Broca. The present data are consistent with the hypothesis that the neuropathology begins in the cerebral cortex and hippocampus before spreading in a retrograde fashion to subcortical regions.

Cystoscopy and urinary cytology are currently the basis for diagnosis and ‎follow-up of bladder tumors. Research to find a sensitive and specific tumor ‎marker for diagnosis of bladder tumor is actively underway, however, due to low sensitivity ‎and high cost of cytology. This cross-sectional study was performed in 65 patients to evaluate whether urinary bladder ‎cancer (UBC) antigen level can predict the presence of active bladder tumor. In patients with ‎inactive tumor, UBC antigen level was determined in addition to standard cystoscopy ‎and cytology for follow-up. Patients with active tumor were ‎subjected to standard treatment and UBC antigen level determination. UBC antigen levels were measured by ELISA, using monoclonal antibodies ‎specific for UBC antigen. As a control group, UBC antigen level ‎was also determined in 65 persons who had been referred for urinalysis for other reasons. ‎UBC antigen level more than 1 μg/L which was regarded as ‎positive was found in 49.4% of the patients. In control group, 96.9% had UBC antigen < 1μg/L‎. Mean UBC antigen level in patients was ‎3.77 μg/L while it was 0.508 μg/L in controls (P < 0.0001). Sensitivity of ‎UBC antigen was 53.3% and its specificity was 40%. Sensitivity and specificity of urinary cytology was 17.3% and 88.2%, respectively. This difference was statistically ‎significant (P < 0.001). UBC antigen is more sensitive than urinary cytology, although cytology still ‎retains its priority in specificity. It is not yet recommended to replace UBC antigen for ‎cytology due to its low specificity and not favorable sensitivity.

Vaccination against mumps is included in world Health Organization (WHO) program of global immunization. Safety and efficacy of vaccines must be confirmed by control units in charge of public health. In Iran, the secondary control on potency of vaccine has not been set up yet. We decided to overcome this problem by developing WHO and NIBSC methods in Food and Drug Control Lab. ‎Nine dilutions of vaccine from 10-1 to 10-5 in ‎0.5log10 steps were mixed with Vero cell suspension. In WHO method, the cell suspension was seeded in octaplicate (8 wells of each dilution) in 24-well plate and incubated at 36°C for 10 days, during which the cells were checked for cytopathic changes everyday and positive wells were recorded. We used 5% serum and 1 × 105 cells for the assays. The test was repeated with six different vaccines produced in one batch. The mean potency was 10 4.475±0.134 CCID50/vial for each ten-dose vial. For NIBSC method the dilutions of vaccine were added to hexaplicate (6 well per dilution) in 24-wells plate. After 3 hours, the medium was removed and overlay was added. Then the plates were incubated at 35°C for 10 days. After incubation period, the plaques were stained with methyl violet and counted. This assay was repeated three times and the mean of results was 5.93 log10 PFU/dose. Results indicate that the potency of the vaccine is in acceptable range in either method. WHO method is simple and less time consuming compared to NIBSC method.

Interleukin-10 (IL-10) is a potent immunosuppressor which inhibits alloantigenic T cell response. IL-10 is also an anti-inflammatory endogenous cytokine. To investigate the predictive significance of endogenous IL-10 for acute graft versus host disease (GVHD) following allogeneic bone marrow transplantation (BMT), we performed a prospective study on spontaneous IL-10 production in the serum of 96 patients admitted for allogeneic BMT. High spontaneous IL-10 production at the time of admission and prior to any preparative treatment correlates with a subsequent low incidence of GVHD as compared to patients with low IL-10 production. Our data demonstrate the predictive significance of increased IL-10 production in BMT patients and suggest a role for it in maintaining immunobalance in the setting of allogenic BMT.

Neonatal hypoglycemia is common and its prompt ‎management is important to reduce neurological sequelae. To determine the effect of two different glucose concentrations of intravenous (IV) fluid ‎therapy in the incidence of hypoglycemia in sick premature infants, 200 preterm infants ‎weighing 1500-2500 g were selected and randomly assigned into two groups. ‎Group 1 received 10% dextrose in water (DW) and for group 2 ‎we used 12.5% DW with recommended fluid volume according to the infant’s condition. ‎First blood glucose sample ‎was obtained during 2-3 hours of life before starting IV therapy and the two others were ‎measured between 4-24 hours of life after starting IV fluid therapy. Plasma glucose < 36 mg/dl during 2-3 hours of life and level below ‎45 mg/dl between 4-24 hours of life were considered as hypoglycemia. ‎Birth weight, gestational age and type of diseases in two groups were matched. Although ‎there was no difference between volume of fluid, statistical differences were found to ‎be significant between amounts of calories (P = 0.000) and dextrose (P = 0.000) received ‎in two groups. We detected 15 and 30 cases of hypoglycemia in group 1 and 2, ‎respectively. After starting IV fluid therapy, the incidence of hypoglycemia decreased especially in ‎group 2 and comparison of cases with two consecutive low plasma glucose in two ‎groups showed significant difference (P= 0.024, relative risk= 2.67). ‎We recommend 12.5% DW when initiation of peripheral IV therapy is indicated in sick ‎preterm infants weighing 1500-2500 g, especially when restriction of fluid is mandated.

There are currently ‎many different protocols in use for controlled ovarian hyperstimulation (COH), but the optimal method has ‎not yet been determined. To compare the outcome of COH using ‎clomiphene citrate (CC) versus CC plus human menopausal gonadotropin (hMG) in conjunction with intrauterine insemination (IUI), we studied 117 infertile couples‎. IUI with CC was used in 92 cycles ‎(group A) and IUI with CC plus hMG was used in 66 cycles (group B). ‎Data analysis demonstrated no significant difference between the two ‎groups with respect to patients’ age, duration and type of infertility, prior COH and endometrial thickness and pattern. Group A had a little ‎longer follicular phase length than group B. ‎Pregnancy rate for group A and B were 6.52% and 12.12%, respectively (P= 0.22). ‎Endometrial pattern and thickness had no impact on pregnancy rate. ‎There were no multiple gestation and obvious hyperstimulation syndrome. ‎For patients undergoing controlled ovarian hyperstimulation with IUI, ‎CC plus hMG protocol yields higher pregnancy rate than one using CC, although this ‎difference was not statistically significant because of limitation of number of ‎cycles.

Familial defective apolipoprotein (apo) B 100 (FDB) causes early-onset coronary heart diseases (CHD). It is produced by R3500Q mutation of the apoB gene resulting in decreased binding of LDL to LDL receptor. We screened the apo B gene for R3500Q mutation in 130 hypercholesterolemic patients, among whom 30 patients met criteria of familial hypercholesterolemia (FH). The prevalence of R3500Q allele in this patient population was 0%. To obtain better estimation of mutation frequency, a broad survey is needed.

Anterior transposition of the ulnar nerve is widely implemented for treatment of cubital tunnel ‎syndrome. However, preservation of the extrinsic blood supply of the ‎ulnar nerve may result in better clinical outcomes. Fourteen patients with cubital tunnel ‎syndrome, 11 ‎men and 3 women, were treated by anterior subcutaneous transposition of the ulnar nerve. The extrinsic blood supply of the ulnar nerve was ‎preserved. The average age at the time of operation was 33 years. The average follow-up period was 44 months. Post-operative outcome assessment by an independent examiner was based on the modified Bishop rating system. Nine patients had excellent or good outcomes. Five patients had a fair outcome. There ‎were no complications or recurrence of symptoms. Anterior subcutaneous ‎transposition of the vascularized ulnar nerve is an effective method of surgical ‎treatment for patients with cubital tunnel syndrome.

In upper brachial plexus (C5-C6 or C5-C6-C7 roots) injuries, restoration of elbow flexion is the first aim. Several methods have been used to achieve this goal. Among these procedures, Oberlin’s method (transfer of part of ulnar nerve to the nerve to biceps muscle) is the newest one. From April 2002 to March 2003 we used this method in 9 cases, 8 males and 1 female, of upper brachial plexus injury with impaired active elbow flexion and intact ulnar nerve. Patients’ age ranged from 9 to 53 years. In 6 acute cases only Oberlin’s method was used and in 3 old cases this technique was combined with gracilis free muscle transfer. The minimum follow up period was 6 months. Six cases gained effective elbow flexion and 3 cases showed fair or poor results. No permanent impairment of ulnar nerve function was observed. We found Oberlin’s method to be a safe, simple and effective way to achieve elbow flexion in patients with upper brachial plexus injury.

Schistosomiasis is the second most common parasitic cause of death, after malaria. Biomphalaria glabrata is a fresh water snail with medical importance since it is the intermediate host of Schistosoma mansoni, an agent of schistosomiasis. The internal defense system of B. glabrata snails is mostly represented by circulating elements of the hemolymph, hemocytes, which are important factors in fighting against infections in snails. The purpose of this study was morphological study of B. glabrata hemocytes and their interaction with miracidia of Schistosoma mansoni. B. glabrata hemolymph was collected by heart puncture and a differential count of hemocytes was done in dyed preparations. Dyeing with Giemsa revealed two cell types: type 1, hemocytes with basophilic nucleus, little cytoplasm and sub-spherical shape and type 2, nucleated hemocytes, uniformly basophilic and spherical shape. Hemocytes showed cytoadherence and encapsulation after 1 h of miracidium-hemocyte incubation. These results could be of concern in the control programs of schistosomiasis.

Determination of F-wave latency is a simple and valuable method in evaluating proximal part of peripheral nerves. The aim of this study was to determine the mean minimal peroneal F wave (F min) in healthy individuals. A total of 282 individuals were studied. The mean age was 45.6 years. The F min (± SD) for 564 peroneal nerves was 47.09 ± 4.51 ms. The F min for the age group of 20-45 and height group of 160-180 cm were 47.63 ± 4.50 and 49.77 ± 3.76, respectively. This study demonstrates that the mean F min of our samples was not significantly different from other important similar studies. Age and particularly height had a major role in determination of F min value and these two parameters must be considered in clinical evaluation of patients.

Microembolic signals (MES) are frequently observed in transcranial ‎Doppler (TCD) recordings of patients with mechanical heart valve (MHV). If gaseous bubbles are the underlying cause, number of MES produced by MHV could be reduced with oxygen ‎inhalation. From September 2003 to September ‎2004, a consecutive series of 14 patients ‎with St Jude aortic valve visited in the cardiology clinic were referred to ‎neurosonology unit, Valie Asr Hospital, Khorasan. TCD monitoring of MES was performed with an ultrasound device and a 2 MHz probe. The MES counts were recorded during 30 ‎minutes breathing room air and thereafter 30 minutes breathing through a facial mask ‎with reservoir bag (6 liter O2 per minute). The criteria of MES detection were ‎characteristic chirping sound, unidirectional signal, random appearance within cardiac ‎cycle and intensity increase ≥ 3dB above background. The MES counts in two periods ‎of monitoring were compared with paired t test and significance was declared at P ‎< 0.05. Twelve patients (8 females and 4 males) were investigated. Oxygen ventilation ‎caused a significant decrease of MES counts in the patients in comparison to breathing ‎room air (P = 0.001). It seems that MES in patients with MHV are mainly gaseous bubbles ‎caused by blood agitation with MHV. The quantity of MES in patients with MHV is ‎not related to the risk of thromboembolic complications in these patients.

There is a misconception among our people that opioids may prevent or have ameliorating effects in the occurrence of cardiovascular diseases. In this study we evaluated 556 consecutive male patients hospitalized due to acute myocardial infarction (MI) in city of Yazd, from May 2000 to October 2001 and compared the characteristics of opium addicts to non opium users. Prevalence of opium addiction in MI patients was 19% in comparison with 2-2.8% in general population. There were not any differences in prevalence of traditional risk factors between opium users and non-users. Overall, in-hospital mortality was 18.6 percent among opium users and 6.2 percent among non-opium users (unadjusted odd ratio, 1.3; 95% confidence interval, 0.7 to 2.7, P = 0.2). After adjustment for the differences in the baseline features (age and other risk factors), odds ratio increased to 2.2 (95 percent confidence interval, 0.9 to 5.1). It seems that opium addiction may work as a risk factor in cardiovascular disease.

Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim of this study is to evaluate the frequency of common ‎etiologies of late adult onset epilepsies. All patients referred to Razi and Imam Khomeini Hospitals ‎in the year 2003 with at least two seizure attacks beginning after age of 50 were evaluated. In the majority of cases neuroimaging, electroencephalography and ‎echocardiography were done and risk factors for atherosclerosis and cerebrovascular ‎diseases were investigated. All medical records and previous medical histories ‎were reviewed. ‎A total of 97 patients were included. We found hemorrhagic stroke in 10 (10.3%), ‎ischemic stroke in 43 (44.3%) and space-occupying lesion (all of them were ‎tumors) in 19 patients (19.6%). In 24 (24.7%) cases we could not find a clear ‎cause for seizure attacks. ‎In conclusion, since seizures were associated with a central nervous system ‎disease in about 75% of the patients, careful investigation is necessary. We ‎also recommend better control of risk factors for cerebrovascular diseases in our country.

Sebaceous carcinoma is a relatively rare cutaneous tumor that is most commonly derived from the sebaceous glands located in periorbital area. The extraocular occurrence of this tumor is very rare. We report a case of an 85 years old woman who presented with a slowly enlarging mass on the right temporal region. Histological examination of the lesion revealed a malignant sebaceous carcinoma occurring in conjunction with nevus sebaceous. The lesion was surgically excised completely.

Benign fibrous histiocytoma is a rare tumor of nose and paranasal sinuses that originates from histiocytes. ‎‎The main symptoms of patients are nasal obstruction and nasal mass. ‎Our patient was presented with chief complaints of nasal obstruction and rhinorrhea non responsive to antibiotic treatment. In computed tomography scan a giant mass in left maxillary sinus and ipsilateral nasal cavity was seen. After en bloc resection of tumor by transnasal endoscopic approach all of patient’s symptoms were alleviated. The pathologic report was benign fibrous histiocytoma. ‎Because of excellent visualization, it seems that transnasal endoscopic approach is the method of choice for resection of these benign tumors.