مجله علوم پزشکی رازی
سال دوازدهم شماره 2 (پیاپی 46، تابستان 1384)

Febrile convulsion is the most common disorder in childhood with good prognosis. There are different hypotheses about neurotransmitters and trace element changes (such as Zn) in CSF and serum which can have a role in pathogenesis of febrile convulsion. The aim of the present prospective analytical cross-sectional study was to determine whether there was any change in serum zinc level in children with febrile convulsion during seizure. A total number of 92 children were divided into three groups: group A: 34 children with febrile convulsion (aged 6 months to 5 years), group B: 40 children having fever without convulsion (aged 6 months to 5 years) and group C: 18 children with febrile convulsion (aged 6 months to 5 years). Serum zinc levels for three groups were estimated by atomic absorption spectrophotometry (AAS) and later compared. Serum Zn levels of groups A, B, C had a mean of 76.82 ± 24.36mg/l, 90.12 ±14.63mg/l and 94.53±17.39, respectively. Serum zinc level of group A was lower than those of the other two groups (P=0.006). It was also lower in group B than that of group C (P<0.006). These findings suggest that serum zinc level decreased during infection and that decrease was more significant in patients with FC.

Trichomoniasis with the cause of trichomonas vaginalis(T.V) and bacterial vaginosis(B.V) are well recognized as sexual transmitted diseases(STD) affecting prematuration and low weight birth. The present cross-sectional study was undertaken to investigate the prevalence of T.V and B.V, their coincidences, their effects on women sterilities, prematuration and low weight birth in pregnant women referred to Shahid Akbarabadi Maternity Hospital. During one year study(started from June 2002), 368 pregnant women voluntarily enrolled for regular checking and parturition in the above-mentioned maternity hospital. After private interviewing, filling the questionnaires, doing clinical observations and recording the results, vaginal and posterior fornix samples were collected and labled. In hospital’s laboratory, the vaginal samples were checked macroscopically, pH was determined, Whiff Test was carried out for odour concentration, and finally gram staining was used for detecting clue cells and consequently finding B.V infection. In order to find T.V, direct smears and culture methods on Dorse Media were utilized. In this study, of 20(5.5%) infected women, 11(2.9%), 8(2.2%) and one(0.3%) were infected with T.V, B.V and fungi respectively. In none of the patients, conincidence of T.V and B.V was observed. Although the highest age of pregnancy was 25 or below, there was not any statistically significant relationship between infection and pregnant women’s age, number of parturitions, age of pregnancy abortions and clinical symptoms. Only one case(0.3%) of T.V infected woman was observed for prematuration with a low weight birth. The present study indicated that the poor level of T.V and B.V infection in pregnant women, as compared with those of free sexual relationship countries is essentially due to their culture, family etics and constitutional beliefs. This study also showed that since the vaginal cavity is an eco-type and natural biological living orifice therefore, the only physical presence of T.V and B.V can not cause sterility in women unless under non optimum or non physiologic condition. According to this survey, the precise clinical and laboratory examination of the pregnant women and their vaginal discharges are important since they may be wrongly identified as vaginal secretion or semen liquid with pathogenic materials, particulary by an inexperienced gynecologist.

Although leukemia is the most common malignancy in childhood, congenital leukemia which manifests itself within the first 4 weeks of life is rare and accounts for less than 1% of all leukemias in childhood. Congenital leukemia should be differentiated from transient myeloproliferative disorder(TMD) which is noted in Down Syndrome. Among the reported patients, acute myeloid leukemia(AML) was more frequent(64%) than acute lymphoblastic leukemia(ALL 21%). Cytogenetic abnormality was found in 72%, 42% of which was 11q23 abnormality. The survival of AML patients was better than ALL. Until now, 18 cases of congenital leukemia showing spontaneous remission have been described and all of them were AML(FAB M5, M4). Clinical characteristics of congenital leukemia differ from those of leukemia in older children, the outcome is poor, and its chemotherapy needs improvement to increase the remission rate. In the present article, we report an 18-day-old female with congenital leukemia who had blueish infiltrative lesion at different parts of skin, jaundice, hepatosplenomegaly, anemia, and thrombocytopenia hyperleukocytosis from the birth. Peripheral blood smear and bone marrow aspiration showed ALL L1. Immunophenotype evaluation showed undifferentiated leukemia, and skin biopsy revealed infiltration of leukemia(leukemia cutis).

There are many different doses and protocols of heparin injection for treatment or prevention of many thrombotic diseases. The present interventional experimental(Clinical trial) study was conducted to compare the effect of continuous and intermittent injection of heparin on APTT at different times. 423 patients were randomly selected by simple sampling and their APTT was measured by a standard and unique kit at predetermined time after injection. The only time in the intermittent method when APTT was in its therapeutic range was 60 to 40 minutes after primary bolus injection. Before that, there were higher and after that lower levels of desired ones whereas in the continuous method there was a near constant level of APTT. The goal of practitioners is to find a drug which is in constant therapeutic range and safe from pharmacokinetic point of view therefore, according to the results of this study, the continuous method of heparin administration is strongly recommended in order to decrease the rate of thrombosis recurrence and complications such as hemorrhage.

Hepatitis B virus(HBV) is the cause of hepatitis and hepatic cancer. Each year more than 800 thousands die from HBV infection and its complication in the world. More than 350 million people are the career of this virus in the world and careers are the main source of this disease in community. Approximately 3% of Iranians are virus career, but in USA and Western European countries this rate is 0.5-0.1% and in Eastern Asian countries and tropical regions it is 5-20%. There is little information about hepatitis and its transmission and prevention routes in community, so training all community, specially, the high-risk groups has a very important role in the control of this disease. This cross-sectional study was undertaken in 2003-2004 to determine Meshkindasht high school students’ awareness level about transmission and prevention ways of hepatitis B. Data was collected by using a questionnaire including 24 questions about hepatitis B disease. Sampling was done randomly and in several stages. Of 300 responders, 153(51%) were boys and 147(49%) were girls. The maximum score of the questionnaire was 48. The mean score of total awareness was 30.67. Information about the ways of transmission and prevention was 15.13 and 15.63 respectively. Total mean of awareness was 5.24 in girls which was more than the boys(P=0.0005). Students’ level of awareness increased with education and this increase was statistically significant(P=0.0005). Level of awareness in mathematic students was the highest. Natural sciences and human sciences students came second and third respectively and this increase was statistically significant(P=0.0005). Level of awareness is not related to the level of education in students’ parents(P=0.0005). Level of information in girls was higher but was just 70% of total questionnaire score and this showed that people who will be in risk in the near future, don’t have enough information about this disease. Therefore, there is a serious need for educating and training the students on hepatitis B disease.

Fibro-Osseous lesions are numerous and heterogeneous group of tumors of the jaws which pose difficulties on classification, diagnosis and treatment. The present study was undertaken to evaluate fibrous dysplasia and the diagnostic value of histologic examination for its workup. Fifteen patients with cranio-facial bone lesion, who had previous pathologic diagnosis of fibrous dysplasia, were evaluated during 4 years (1998-2002) in Hazrat Fatemeh Hospital. Male-female ratio was 9/6 and patients’ range of age was between 16-38 years with mean age of 20 years. There were 12 patients with monostotic and 3 patients with multiple lesions of both jaws and skull. The maxilla bone was the most frequent site of the lesion. Clinicopathologic diagnostic correlation was 46.6%. There was one patient with malignant transformation of the lesion to osteogenic sarcoma. In microscopic view, 10 cases were classic fibrous dysplasia with evenly distributed islands of woven bone without osteoblastic rimming in a fibroblastic stroma, 5 cases showed variation in histologic pattern, 3 cases had focal or diffused osteoblastic rimming(ossifying fibroma) and 2 cases had rounded bodies regarded as a form of cementum both contained cellular stroma exhibiting mitotic activity named as cemento-ossifying fibroma. These two lesions showed more local aggressiveness and bone deformity in clinical and radiologic study than in classic fibrous dysplasia.

Tuberculosis has been one of the most important problems for a long time. This disease can involve different organs among which lung is the most common one. Chest X-ray is the oldest and the most practical diagnostic method for pulmonary tuberculosis. Using chest X-ray can cause difficulties for the students of medicine and young physicians because of the different patterns of lung involvement during the disease therefore, familiarity with them is important. The present research was an observational study done in periodic cross-sectional way on patients with TB in Rasoul-e-Akram and Firoozgar Hospitals. Data collection was done via kind of form designed like a checklist. The aim of this study was to determine the frequency of parenchymal consolidation atelectasis and lymphadenopathy, pleural effusion and other abnormal findings in chest X-ray of 400 patients with pulmonary TB. 203 of patients were women (50.7%) and 197 of them were men(49.3%) with mean age of 56.01+18.47 years. The youngest was 10 years old and the oldest was 90. The location of infection was in the right lung in 66.6% of patients(265 ones), in the left lung in 15%(60 ones), in both sides in 18.3%(75 ones), in 61.8% of patients in upper lobe of the lung, 24.3% of patients(97 ones) in lower lobe and in 14% middle lobe was involved. The most common finding in chest X-ray was parenchymal consolidation(53.7%) and after that mixed pattern(18.7%). The finding of this study showed that chest X-ray is an important tool in the diagnosis of tuberculosis and parenchymal consolidation is the most common radiologic finding. The chronicity of symptoms(fever,cough), positivity of PPD and failure to respond to antibiotics in CAP are key points to differentiate TB from bacterial pneumonia.

Opium consists of a mixture of different chemical compounds extracting from Papaver Somniferum plant seed. The major effect of opium arises from its morphine content. In smoked opium use, the vapor of morphine enters the blood stream rapidly through lung and reaches brain within a few seconds. One of the complications arisen from long-period consumption of smoked opium use is affliction with chronic obstructive pulmonary diseases(COPD) and sometimes cor pulmonale which is considered independent of tobacco consumption. The present cross-sectional study was conducted on 22 patients who referred to respiratory clinics of Hazrat Rasoul-e-Akram and Abooreyhan Hospitals. Those who smoked only cigarette and meanwhile had no underlying or predisposing occupational factor regarding development of chronic obstructive pulmonary diseases were excluded from the study. Those whose COPD was confirmed by measuring lung dynamic volumes were assessed and data were analyzed by SPSS 11.5 software. Of a total number of 22 patients with mean age of 54.8(SD=16.31) years, 17 patients(77.3%) complained from cough 8(36.4%) from dyspnea 7(31.8%) from wheezing and 5(22.7%) from sputum production. In these patients the ratio of average FVC percent value to the predicted value was estimated 78.7%(SD=14.86%), the ratio of average FEV1 percent to the predicted value was 75.96%(SD=17.59%), and the average of FEV1/FVC value was determined 71.2%(SD=12.36%). Of 22 understudied patients, 4(18.2%) had spirometry with normal results, 16(72.7%), obstructive profile, and 2 individuals (9.1%) showed restrictive profile. Accordingly, because of obstructive profile frequency in our patients and limited reports about COPD in opium smoker addicts, it can be suggested that opium smoking addiction may have significant role in COPD incidence.

Paraoxonase can hydrolyse organophosphate esters and paraxon is its most important substrate in laboratory studies. This enzyme circulates in blood with HDL. It seems that reduced paraoxonase activity in human may increase risk of coronary artery disease. Genetic variations in two autosomal genes may reduce its activity. These variations produce three phenotypes: A, AB and B. B phenotype activity is higher than A and AB. With regard to high prevalence of CAD in Iranian people and paraoxonase effect in process of CAD, paraoxonase activity, phenotypes and lipid parameters were determined. In this study serum paraoxonase phenotypes in Iranian subjects were determined and the association between paraoxonase activity and its phenotypes with coronary artery disease risk factors were estimated. Patients with more than 50% angiographically confirmed stenosis were studied and compared with healthy subjects at Tehran Rajaii Heart Center. Serum paraoxonase activity with and without NaCl, and arylesterase activity were estimated. Paraoxonase/ Arylesterase activity ratio was used for phenotype determination. In patients, paraoxonase activities with and without NaCl were much lower than healthy subjects (P=0.01 and P=0.00 respectively), but arylesterase activity was not significantly different. Paraoxonase/ arylesterase activity ratio was also reduced in patients (P=0.02). Frequency distributions of three paraoxonase phenotypes in patients and healthy groups were not significantly different. Triglyceride and VLDL-C in patients were higher than healthy subjects (P=0.00), but HDL-C and apo AI were lower in patients (P=0.01 and P=0.00 respectively). No significant variations in total cholesterol, LDL-C and apo B was found in patients compared with healthy group. Due to significant fall in paraoxonase acitivity and no significant difference in frequency distributions of the enzyme phenotypes, it seems that paraoxonase activity measurement in serum is a better marker than determination of the enzyme phenotypes to discriminate patients from healthy subjects.

The purpose of the present study was to determine the effect of Benson relaxation and premedication on systolic, diastolic, LV & aorta pressure in patients under coronary angiography hospitalized in heart and post angio unit of Shahid Beheshti Center of heart in Zanjan during 2003. In this quasi-experimental study, 40 patients under coronary angiography were selected with random allocation technique(relaxation and premedication group). Data collection tools included two forms which were applied to record blood pressure 8-12 hour and 0.5 hour after, during and before angiography and a questionnaire to record demographic data. Benson relaxation was practiced in relaxation group one day before angiography, then patients were requested to carry it out 2-3 times before coronary angiography. In premedication group, patients took drugs including diazepam, chlorpheniramine, metochloropramid and hydrocortisone. Patients in the control group only took routine nursing care. In two groups hemodynamic parameters were measured 8-12 hour and 0.5 hour after, during and before angiography. Results obtained via independent t-test indicated that there was not a significant difference between relaxation and premedication in parameter hemodynamic variables(systolic and diastolic blood pressure, LV pressure, end diastolic pressure, systolic and diastolic aorta pressure) (P>0.05). This study indicated that both relaxation and premedication methods changed the pressure equally. However, Benson relaxation method is preferred to premedication before massive procedure due to its safety and easy application.

Foreign body aspiration to airways occurs in children under the age of 15 and the maximum incidence is in the 1-3 age range. Using general anesthesia or sedation would enable us to remove the foreign body in the operation room. Here is a case report of a 4-year-old child in whom a retained broken suture needle was found by radiography in the parapharyngeal area after tonsillectomy and adenoeedectomy. Using general anesthesia, the needle was removed under fluoroscopy after 4.5 hours.

In a cross-sectional retrospective study, management of patients with febrile seizure admitted to pediatric ward of Hazrat Rasoul Hospital was evaluated over 1.5 years (Dec. 2002 and Jun. 2004). The objective of this study was to determine whether practice parameters recommended by American Academy of Pediatrics(AAP) have been applied to the management of patients with febrile seizure. The files of 83 patients aged between 6 months and 5 years were reviewed. There were 16(19.2%) patients with complex febrile seizure and 67(80.7%) with simple febrile seizure. Complete blood count(CBC), blood glucose, serum calcium and serum electrolytes were performed for all patients. Lumbar puncture was done in 85%, electroencephalography(EEG) in 33% and CT-scan in 22% of patients. The average length of stay was 3 days. The present study showed that the use of unnecessary investigations such as laboratory & radiologic tests is common, causes significant expense and has little diagnostic value. As a result, investigation should be performed only where there is specific indication regarding patient’s condition and medical history based on practice guidelines suggested by AAP.

Helicobacter pylori is often found under the mucosa (over the gastric mucosa) and between mucosal layer and apical surface of mucosal epithelium. It produces urease enzyme which produces ammonium and carbon dioxide to cause reduction in pH of stomach, which has some effects on bacterial colonization and chemotaxis of neutrophils, monocytes and platelet activator factors and it starts an inflammatory reaction. Secreted proteases and phospholipases of this bacillus cause endodermal ulcer without any evident reason. On the basis of hypothesis, there is a probable association between helicobacter pylori and epithelial lesions of gastrointestinal tract such as appendicitis and anal fissure which both have an inflammatory process. The present cross-sectional study, which aimed to assess this association, was conducted on 98 patients with anal fissure admitted to surgery ward of Rasoul-e-Akram Hospital during 2003. Patients’ mean age was 38.14(SD=13.92) years. A blood sample was taken from patients before surgery for serology test and a biopsy sample from anal fissure for histopathologic assessment during surgery. Data were analyzed by SPSS 11.5 software. Results of serologic tests for anti helicobacter pylori antibody were negative in 42.9% while it was positive in 57.1%. All the biopsies were negative for the presence of helicobacter pylori. There was a significant difference(P=0.012) between recurrence rates in seropositive cases with (0.5 times SD=0.5) and seronegative cases(0.33 times with SD=0.75). In this study, helicobacter pylori was not detected in any of specimens therefore, it is thought that helicobacter pylori does not have any direct role in the pathogenesis of anal fissure.

Surgical wound infection is the second most common cause of nosocomial infection which leads to mortality and extra expenses due to prolonged stay in the hospital. The aim of the present study was to survey surgical wound infection in different wards of Iran University Hospitals and investigate the predisposing and risk factors. Investigation was done on 960 patients who underwent surgery in general surgery, gynecology, orthopedic, ENT and neurosurgery wards. For each patient a questionnaire was filled by residents. Patients were categorized into two groups: those with infection and those without evidence of infection. Data were collected by EPI6 and the results were analyzed by t-test, chi-square and odds ratio tests. The results showed that malnutrition, infection in other body sites, obesity and smoking are among the predisposing factors which carry high probabilities of infection. Other factors had low probability. Technical factors pertinent to the type of operation, the site and the organ, prophylactic antibiotic treatment were also studied. Surgical wound infection rate in this study was estimated as 8.5% which is equal to international reports(5-34%). The importance of each predisposing factor was also emphasized in this study.

Contralateral breast dose from primary breast irradiation has been implicated in the risk of second breast malignancies. In the radiotherapy departments of Iran, based on oncologist’s and physicist’s viewpoint, a special technique and set-up may be used for treatment of chest wall in mastectomized patient. The present study compared three different breast treatment techniques and set-up used in three different hospitals H1, H2 and H3 in Tehran by measuring radiation dose to the contralateral breast. In this study, total number of 69 patients with ages ranged from 25 to 75 years were investigated. Dose measurements were made using thermoluminescent dosimeters(TLD) chips. The technique used in the hospitals showed the highest contralateral breast dose in H2 and the lowest in H3. In all techniques, contralateral breast dose showed a direct relationship with A-P and lateral chest wall diameters as well as target volume. Also, with normalization of dose to target volume and entrance dose, H2 has the highest and H3 the lowest contralateral breast dose. This study showed that the patient set-up is the most important factor in increasing contralateral breast dose in these three hospitals. Therefore, patient set-up used in H3 is suggested as a better method.

Below knee amputation, which is noticed as one of the most common lower extremity amputations, is caused as a result of various factors like trauma, disease, or congenital limb deficiencies. In order to take these amputees back to daily life, below knee prostheses are used as an alternate to original limb. Comfort and patients’ satisfaction with prostheses are directly related to each prosthesis socket, and socket composing design itself is associted with various casting techniques. The main objective of this study was to compare the patients’ satisfaction with sockets made by three casting techniques including weight-bearing, air-pressure, and elastic stockinet casting techniques. Other aims of this study were to detect the relationship between dimensional measures of three made sockets and patients’ satisfaction, to find out the effect of various casting techniques and socket dimensional changes on patients’ satisfaction and, finally, to offer correct techniques for optimizing the prosthesis making process. Ten, over 20-year-old below knee amputees with unilateral amputation who referred to technical orthopedic clinic at least one year after their amputation were selected in a nonrandom manner. Subsequently, casting was performed through three different techniques and positive casts were provided. Sockets made by lamination technique were then connected to other components made below knee prostheses by the help of which patients walked with and declared their level of satisfaction. In addition, positive casts were measured in order to be compared with each other. In descriptive statistics, including comparison between average dimensional casts measures and levels of satisfaction, variables showed significant differences. However, in analytical statistics, data were analysized via Pierson correlative statistical test. The relationship between distal anterior-posterior socket diameter and the level of patient satisfaction in weight-bearing casting technique was 0.58 which was so closed to 0.60 (the significant base of chart), but they had a converse relationship. Relation between socket volume and the level of satisfaction in weight-bearing technique, with 0.70, was conversely significant, and also in air-pressure technique, with 0.66, was directly significant. The relationship between socket height and level of satisfaction in air-pressure casting, with 0.69, was significant and direct. Despite low differences between levels of satisfaction in various casting techniques, air-pressure casting technique had higher level of satisfaction than the other two techniques. Based on the obtained hypotheses, patients were more satisfied with more voluminous and higher sockets.

Propofol’s unique pharmacokinetic profile offers advantages for rapid emergence in patients after coronary artery bypass graft surgery. However, concern for negative inotropic properties potentially limits its usage in these patients. The present study was undertaken to compare the hemodynamic effects of anesthesia, with propofol base versus morphine base, on usage of inotrope during weaning off cardiopulmonary bypass. This study was conducted on 60 patients with A.S.A II, III, EF>35% without history of recent myocardial infarction. We randomized 60 patients undergoing CABG surgery to receive either a propofol-based (propofol 50 μ g/kg/min+ fentanyl 0.1 μ g/kg/min as infusion) or morphine-based (morphine 0.3-0.4 mg/kg+Midazolam 0.1-0.15 mg/kg as bolus) anesthesia during pump. Either group underwent general anesthesia similarly (midazolam 0.1-0.15 mg/kg, Morphine 0.3-0.4 mg/kg, thiopental 3-4 mg/kg and pancuronium bromide 0.15 mg/kg) and it was maintained with halothane 0.5% O2+N2O (50%/50%). The requirement to inotrope was assessed by mean arterial blood pressure(BP) and central venous pressure(CVP). If CVP was more than 14 mmHg and mean BP was less than 80 mmHg we started infusion of epinephrine 0.02 μ g/kg/min that was increased to 0.5 μ g/kg/min. Thirty-seven of the patients required inotrope, out of whom, 24 patients received morphine-based anesthesia and 13 patients received propofol anesthesia(P<0.05). The result of this trial suggests that a morphine-based anesthesia requires additional inotrope support during weaning off CPB in contrast to a propofol-based anesthesia.

Trauma is the fourth cause of death at all age groups with socio-economic costs which caused more than 6 million deaths in the world in 2000. Despite promising trend in improving many aspects of health case and treatment in the last decade in our country, little attention has been paid to the subject of registering trauma on an international standard. Effective practical research specially in quality improvement of treatment, defined causes of trauma, control, prevention and evaluation of effectiveness of programs, would materialize when the national trauma registry system is established and its data is collected and completed on time. Considering the absence of an appropriate national trauma registry system in Iran, and the necessity to create an appropriate model, conducting this research was urgently felt. This comparative cross-sectional study was conducted to evaluate the developed national trauma registry systems in the world and to suggest an appropriate model for Iran national trauma registry system in the years 2002-3. In this study, national trauma registry systems in the world were evaluated via library resources, web sites and e-mail communication with internal and external specialists. Iran national trauma registry system axes was presented based on economical,cultural and geographical situations. This model was evaluated by Delphi technique at 3 stages. At the first and the second stages, semi-structured interviews were used. The validity of the questionnaires and data collection was evaluated. At the third stage, specialists were invited to discuss suggested model completely. After data analysis, the final model was presented. A model suggested for Iran national trauma registry system was in seven main axes. The results showed that in order to optimize the infrastructure of Iran trauma registry system, structure, data elements, information gathering process, main goals, registration criteria, classification system and quality control mechanism of the current national trauma registry system should be re-evaluated. According to international trauma research institute’s suggestions, increase in registry and quality control mechanism, could be considered as advantages of the suggested model in comparison with the present system in the country.

The objective of the present study was to compare the effect and complications of (oxytocin antagonist) and nifedipine(Ca channel blocker) for treatment of preterm labor. A randomized clinical trial study was performed on 80 pregnant women with preterm labor between 26-34 weeks of pregnancy in Shahid Akbar Abadi Hospital in Tehran. 40 women(atosiban group) were compared with 40 women(nifedipine group) for drugs’ safety and efficacy(delay of delivery for more than 48 hours for steroid therapy). Duration between drug administration and delivery was also compared. There was not any significant difference between two groups in treatment of preterm labor. Atosiban was effective in 82.5% of cases and nifedipine in 75%. Side effect in atosiban group was 17.5% and in nifedipine group 40%, which was a statistically significant difference(P=0.027). Duration between treatment and delivery was 29.03 ± 16.12 days in atosiban group and 22.85 ±13.9 days in nifedipine group without statistically significant difference. In conclusion, atosiban is an effective and safe drug for treatment of preterm labor with minimal side effects and can be an option in treatment of preterm labor specially in patients with heart disease and multifetal pregnancy.

The goals of the present study were to analyze the accuracy of cytological techniques for the intra-operative diagnosis of central nervous system tumors. In this study, 50 patients with brain or spinal tumor (according to the previous physical examination and imaging studies) were evaluated in the neurosurgery center of Hazrat Rasoul-e-Akram Hospital. Cytological methods including touch, scrape and squash were performed on the fresh tissue specimen received during neurosurgical procedure. Later, cytological diagnoses were compared with final histopathological diagnoses of the same specimens. This comparison revealed 94% correlation between cytological and histopathological diagnoses(including 73% complete, 21% partial and 6% no correlation). In this study the highest rate of correlation was in cases with meningiomas, glial tumors, pituitary adenomas, medulloblastomas and epidermoid cysts.

Treatment of patient with high anal fistulas has become complicated and post-operative complications are common. The aim of this study was to evaluate post-operative complications of primary sphincter’s repair technique in patients with high anal fistula. An interventional quasi-experimental study was conducted on 60 patients(42 male & 14 female) with high anal fistula. The most frequent age group was 4th decade in men and 3rd decade in women. Samples were collected in census manner. The method consisted of approach through intersphincteric space, cutting fistula tract. Later, there is an excision of internal opening by punch biopsy and internal sphincter repair. Finally, fistula tract is excised in external sphincter and repaired then. All patients were followed up for at least one month and their complications were evaluated by clinical examination. Relative gas incontinence in 4 patients(6.6%) was the most frequent complication. Recurrence in 2 patients (3.3%) and soiling in 2 patients(3.3%) were the followings. There was no case with complete incontinence. All cases with soiling and recurrence had trans-sphincteric fistula. In contrast to other studies, the frequency of post-operative complications was less. Probable differences would have occurred if the present research had used standard questionnaires or had followed up their patients longer than 1 month.

The amount of time women spend for occupational and leisure physical activities is varried, i.e. they spend less time for leisure physical activities and the related factors than for occupational physical activities. In order to determine the kind and time of occupational and leisure physical activities in employed women, a cross-sectional study was carried out and data was gathered through questionnaire. Selected through a stratified and random sampling method, 300 women were the contributers of this study whose height and weight were measured by the researcher. The findings indicated that the mean time of occupational physical activities during one week was 42.7 hours which had a significant relationship with age, marital status, education, body max index(BMI), income, kind of job and the type of occupational physical activities(P=0.000). This means that the mean time in women who are between 30-39 years old, educated, employed and are with BMI of 120-25 and low income was more than others. No significant relationship was found with factors such as, smoking and the age of the last child. Results also indicated that mean time for leisure activities during the week was 16.68 hours and women spent only 9.1 hours for leisure physical activities. The mean time of leisure physical activities had a significant relationship with income and age(P=0.000), i.e. the mean time was more in women with 30-39 years of age and good income. This study showed that mean leisure time was less than occupational time and also the leisure physical activities was very little.

NO is a free radical that regulates a variety of developmental modulation processes. NO is synthesized by NOS and it acts as a neurotransmitter, neuromodulator or second messenger molecule in the central nervous system. Since NO production may be different before or after birth, the expression of neuronal nitric oxide synthase was examined and analysized during the development of rat optic vesicle from embryonic day E14 to E18 by histochemical procedures. The samples were frozen and cut on a cryostat and then studied by using the light microscope. Expression of nNOS was first seen on E14 in cells of Cajal-Retzius located in the marginal zone of optic vesicle. NADPH-d persisted in this layer throughout the embryonic period and began to decrease on E20. On E16, the optic vesicle had four NADPH-d positive layers. On E18,NADPH-d reactivity observed at low magnification was clearly defined in the fifth layer. In the late stages, the most notable feature was a decrease in histochemical reaction of the marginal zone, i.e. the fourth layer showed less staining than the rest of the cortical plate. The observations suggested that nitric oxide is synthesized during embryonic life processes and it changes with ageing in the rates of NOS-reactive cells in embryonic life and maturation processes. These results indicate that NOS makes different contributions in the optic vesicle NO production along with ageing.

Pregnancy and delivery are great experiences in a woman’s life. Many risk factors for fetus may harm mother and increase mothers’ mortality and morbidity. The most important factor related to neonatal mortality and morbidity is weight, therefore, there is no doubt over importance of recognizing fetal weight and its control during prenatal period. According to the studies and observations, there is an obvious and direct relationship between mothers’ fundal height, abdominal circumference, body mass index and infant weight. The present study was undertaken to determine the relationship between these three factors separately with infant weight and finally all three together. Also, the effect of age, occupation, mother’s previous gravidity, parity and abortions, gestational age, mother’s height and weight, mother’s weight and body mass index gain, presentation, infant’s sex, height, head and chest circumference, age and the weight of previous baby on these relationships were also evaluated. In this correlational study 1003 out of 1200 pregnant women who referred to delivery section of Be’sat and Shahid Fayazbakhsh Hospitals were selected and a checklist regarding pre and post-natal delivery was filled. The results indicated that there was a significant relationship between fundal height and infant weight with regression 0.723(t=33.133, P=0.000), abdominal circumference and infant weight with regression 0.530(t=19.770, P=0.000), body mass index and infant weight with regression 0.25(t=8.118, P=0.000) and between fundal height, abdominal circumference, body mass index and infant weight with regression 0.756(t1=23.94, P1=0.000), t2=10.58, P2=0.000), t3=-6.976, P3=0.000). Based on line equation, the relationship between mothers’ fundal height, abdominal circumference, body mass index and infant weight showed an error of less than 500 gr with 94.2% sensitivity, so this method can be used to estimate clincial fetal weight.

The present case report concerns a 64-year-old female who referred with an enlargement mass of right side of neck(submandibular angle) since 4 months ago. Mass resection specimen grossly revealed firm red-brown well-circumscribe mass. Cut sections showed nonhomogeneous tissue with multiple areas of hemorrhage associated with two regional lymph nodes. Microscopic examination mostly exhibited zell ballen pattern with pleomorphic oval to polyhedral tumoral cells which contained eosinophilic granular cytoplasm and hyperchromic nuclei surrounded by sustentacular cells. In subcapsular area of lymph node, a focus of metastatic tumoral cells was also seen. Ultimately, histopathologic diagnosis revealed a very rare malignant paraganglioma of carotid body.