مجله علوم پزشکی رازی
سال دوازدهم شماره 4 (پیاپی 49، زمستان 1384)

Polyhydramniosus is a pathological condition characterized by excessive accumulation of amniotic fluid, usually more than 2100ml. It is associated with numerous fetal anomalies and causes maternal complications due to overdistension of the uterus. An AFI(Amniotic Fluid Index) exceeding 24cm constitutes the diagnosis of severe polyhydramniosus. Case Report: The patient was a 25-year-old woman G3P1D1Ab1 referred at 28 weeks of gestational age with chief complaint of respiratory distress due to severe polyhydramniosus. Amniotic Fluid Index(AFI) had been reported to be 35cm from 24 weeks of gestational age. The patient was admitted into the hospital and amniocentesis was done nine times. About eight liters of amniotic fluid was evacuated. Her chief complaint decreased gradually and at last she delivered a baby boy at 32 weeks of gestational age due to preterm labor. The apgar score was 8-10 and no abnormality was observed. Doing amniocentesis, we postponed the delivery for about 5 weeks so that we could achieve fetal lung maturity.

Ostoid osteoma is a benign bone tumor characterized by pain especially at night, which is relieved with aspirin. Hand is an uncommon site of this tumor. Here a case of ostoid osteoma in middle phalanx is reported.Case Report: The patient of the present case study was a 26-year-old woman referred due to a pain in her left ring finger. The diagnosis was made pre-operatively through clinical observation and examination, x-ray, bone scintigraphy, and CT scan. After excision of the lesion, diagnosis was confirmed by histology examination. The diagnosis of such lesions is difficult, so accurate clinical history and high index of suspicion are required in the evaluation. The diagnosis and pre-operative planning are facilitated by isotope bone scan and CT scan. This patient had en block excision of the lesion and the defect was filled with bone graft. After surgery, her symptoms were obviated.

Osteoporosis is a significant problem in patients with advanced COPD(chronic obstructive pulmonary disease). It is followed by fractures which make life conditions worse for these patients. Several studies demonstrated the relationship between osteoporosis and COPD. This study was designed to determine the prevalence of osteoporosis in male patients with COPD. Patients & This descriptive cross-sectional study was carried out on 30 men whose COPD had been proved by spirometry test and were admitted to the hospital within six months. The variables in this study were age, smoking, activity levels, use of oral and inhaled glucocorticoid, and BMI(Body Mass Index). We also measured BMD(Bone Mass Densitometry) at lumbar spine and the neck of femur through Dexa(Dual energy X-ray absorptiometry) method. The study involved 30 men with COPD with a mean age of 66.02 years. The prevalence of osteoporosis was obtained 83.3% and we could demonstrate the relationship between osteoporosis at the neck of femur and use of oral glucocorticoid. We also observed the correlation between osteoporosis at lumbar spine and BMI. Patients with COPD are high risk groups for osteoporosis, so it is necessary to evaluate them by bone densitometry screening even if they are not treated with glucocorticoid.

Ectopic pregnancy is still considered one of the major diagnostic and therapeutic problems in obstetrics and gynecology which may result in mortality and infertility in some cases. The aim of the present study was to evaluate benefits such as maintenance of fertility and risks such as obligation of laparatomy resulted by laparascopic surgery that is quite new in our country. Patients & In this historical cohort survey, 101 ectopic pregnancy patients admitted to gynecologic endoscopy ward of Rasoul-e-Akram Hospital from 1995-2003 were studied. Data collection was performed by checklists prepared through patients’ medical records. Involved tube was saved in 88 cases and salpingectomy was performed on 13 cases.There were 2 cases of postoperative bleeding that needed second laparascopy and one case needed laparatomy. Postoperative infection caused laparatomy in one more case. Two more cases underwent laparatomy in another center. There was one case of β-hCG rise after surgery that underwent chemotherapy. The rate of pregnancy after laparascopy was 58% in 37 patients with desire for childbearing, and the rate of recurrent EP in the involved and contralateral tube was 7% in total. Ectopic pregnancy is one of the most common emergencies in obstetrics and gynecology which should be considered as one of the differential diagnoses of acute abdomen in women of fertility age. The kind of treatment depends not only on the age and desire of the patient for more pregnancies but also on the gestational age and other findings during laparascopy. It is obvious that in older patients with no intention for pregnancy, the preferable method is simple salpingectomy by cautery, laser or 3-loop method. Conservative surgery for ectopic pregnancy carries the risk of recurrence, so the patient and her family should be aware and sign the consent form. 14 of the 101 patients had positive history of tubal surgery due to ectopic pregnancy(table 1) and new EP happened in the same or the other tube. Although some studies deny this risk, recurrence is a fact that depends to some extent on the method and kind of surgery.

Hyalane membrane disease(HMD) is considered as one of the common causes of mortality among premature neonates and exogenous surfactant is used as a vital treatment. The aim of the present study was to evaluate the frequency of different complications that followed prescription of exogenous surfactant in neonates of Ali Asghar Hospital from 2001 - 2003. Patients & In a cross-sectional study, all neonates with HMD who had been admitted to the NICU of Hazrat Ali Asghar Hospital and treated with exogenous surfactant underwent evaluation. 39 cases included 47.2% male and 52.8% female. The mean of age and weight was 32.12±2.89 weeks and 1725±601.8grs respectively. Lung hemorrhage which was seen in 14% of the cases including 2 males and 3 females led to their death. Decrease in blood oxygen content was noticed in 10 cases(27.7%), 6 boys and 4 girls. Hypotension occurred in 13 cases(36%), 9 boys and 4 girls. Total frequency rate of complications was significantly related to decrease in gestational age and birth weight. Mortality was statistically higher in pulmonary hemorrhage. Based on the results of this study and comparing them with the findings of other studies, we can conclude that the rate of pulmonary hemorrhage and the resulting death after exogenous surfactant therapy in this study is higher than others, which needs to be investigated by future studies. However, surveys of this kind have hardly been carried out in our country and this makes our study quite exclusive.

Regarding the high incidence of upper GI(gastrointestinal) inflammatory diseases and the clear role of helicobacter pylori in their pathogenesis, this study was designed to evaluate the ability of different staining methods in detection of this bacterium. In an analytical cross-sectional study, 50 patients suffering from upper GI symptoms who were referred to the clinics of Iran University of Medical Sciences were selected and endoscopy was done for them. Obtained gastric mucosal biopsies were stained by three different staining methods including Hematoxylin & Eosin(H&E), Giemsa and Hematoxylin & Eosin stain with prolonged hematoxylin time, and the abilities of these methods for detection of helicobacter pylori were compared to each other by using McNemar test. In Giemsa and H&E method with prolonged hematoxylin time, H.pylori was detected in 27 patients(54%) but in H&E stain, H.pylori was detected in 21 patients(42%). Concordance between Giemsa and H&E with prolonged hematoxylin was 100% and between H&E and two other methods was 88%, showing 77% sensitivity. H&E with prolonged hematoxylin time has comparable sensitivity with Giemsa method and because it is feasible and does not require other additional staining methods — to diagnose other pathological changes — is a good alternative to replace H&E and Giemsa methods.

The importance of exact diagnosis of diseases and prevention of complications caused by them is evident to everyone. One of the preventive methods is early detection of diseases. Cytologic examination is a useful and effective method among all. Recognition of early changes of cell morphology could perhaps help us diagnose diseases and manage them before clinical manifestations appear. The present study compared the results of cytology with cell block findings to distinguish if cell block findings could complement cytologic results. 300 patients referred to the hospital in 2003 underwent aspiration and lavage. Cytologic and cell block slides were obtained from specimens. Thereafter, specimens were divided into 5 categories: 1- inflammatory 2- malignant 3- suspicious 4- negative for malignancy 5- lymphocytic rich. The results of cytology and cell block were compared. Among obtained fluids, pleural and peritoneal specimens were the most frequent, and bronchoalveolar lavage and thyroid aspiration were next. Regarding findings, 53% of cytologic results and 54.2% of cell back ones were negative for malignancy. Chronic inflammation was found to be 31.9% and 21.5% in cytology and cell block respectively. The percentage of suspicious specimens was 3% for cytology and 2% for cell block. Malignancy constituted 4% of all both in cytology and cell block. Other specimens including bloody, unsatisfactory and insufficient were excluded from the report. In addition, malignant samples were documented by biopsy which was considered as gold standard pathway showing 54.5% sensitivity and 98.5% specificity in cytology(P=0.000) and 70% sensitivity and 97.8% specificity in cell block. PPV(Positive Predictive Value) and NPV(Negative Predictive Value) were 60% and 98.1% for cytology respectively, and cell block showed PPV of 99% and NPV of 98.9%. Comparing cytology and cell block with biopsy specimens, the following results were obtained. Concerning pleural effusion, specificity and sensitivity of cytology were 99% and 33.3% respectively(P=0.000). In cell block, sensitivity and specificity were 100%(P=0.002). Positive predictive value(PPV) and negative predictive value(NPV) in cytology of pleural effusion were 50% and 98% and in cell block 40% and 100% respectively. With regard to peritoneal fluid, the results of biopsy specimens were compared with those of cytology and cell block. In cytology, sensitivity and specificity were 71.4% and 98.9% respectively(P=0.000). Positive predictive value(PPV) and negative predictive value(NPV) in cytology were 83.3% and 97.9%, and in cell block 83.3% and 97.9% respectively. Ultimately, to find out correspondence between cell block and cytology, we used test of agreement. Kappa was 0.977, which showed desirable conformity. Acceptable correspondence was found between cytology and cell block. However, specificity was higher than sensitivity in malignant reports in cytology. This could mean that positive results in cytology can be confirmed by biopsy. But low sensitivity indicates that some malignant cases may be ignored in cytology. Therefore, because of high rates of false negative in cases of malignancy, we can make use of complementary techniques such as cell block.

The most important physical quantity of irradiation to predict and evaluate the response of biological samples to irradiation is absorbed dose. Recently, according to ICRU(International Commission on Radiation Units and Measurements) reports, determination of absorbed dose with 3.5% accuracy is recommended. Dose distribution is usually estimated in homogeneous mass by unit density, while irradiated volume consists of different layers such as fat, bones, etc that cause changes in dose distribution. Absorbed dose determination with maximum accuracy is essential for crucial tissues when they are located in body cavities, encircled with heterogeneities(doubted charged particle equilibrium) and when the low quality beams are used in radiobiological studies. The goal of this study is to determine absorbed dose in such situations — rat’s spinal cord. In order to investigate the effect of heterogeneity on the received dose of orthovoltage x-rays in the cervical spinal cord region of rat, a homogeneous phantom of polyethylene, a frozen sample of the animal using liquid nitrogen, and a jig for the reproducibility of the sample were designed and made. The used dosimeter in the project was rod shaped TLD(Thermduminscence Dosimetry) chips, TLD-100. The x-ray generating device was a radiotherapeutic x-ray in potential of 200 Kv(HVL: Half Value Layer=1.5mmCu). The reader device used was Hardshaw TLD reader model 3500 with the heating accuracy of ±1˚C. We took advantage of various dosimetry protocols including American association of physical medicine(AAPM) report TG-61, 2001, dosimetry protocol in radiobiology by Zoteliefe et al, 2001, NSC-report 3, TR-IAEA, 277 protocol and also reports by ICRU-23, 24, 30, 48. Statistical calculations using SPSS for running t-test on the resulting doses within the recommended limit of 3.5%(P<0.001) showed no significant difference between the two groups. Thus, in usual fields in radiobiological studies and within the spectrum of orthovoltage energies used for rats and smaller animals, normal accuracy in calculations could be accepted. However, in the regions where there is no equilibrium in the charged particle and where microdosimetry is concerned the results are not to be crucially applied.

Tumour angiogenesis is essential for tumour growth and appears to play an important role both in invasive growth and metastasis. Basal cell carcinomas(BCCs) and squamous cell carcinomas(SCCs) of the skin are derived from a similar cell type but differ in the invasive and metastatic potential. This study investigates whether the behaviour of these tumours could be explained by differences in their angiogenesis patterns. Vessel counts were made of blood vessels in the stroma and the body of 32 BCCs, 15 SCCs, and 4 normal skin samples, both after H&E(Hematoxylin and Eosin) and immunohistochemical staining using CD31 monoclonal antibody. The stromal(P<0.0001) and body(P<0.0001) counts for SCCs differed significantly from the counts for BCCs. There was a correlation between the vascular density and degree of differentiation in SCC samples(P=0.002). The stromal(P<0.0001) and body(P<0.0001) counts for BCCs differed significantly in invasive and non-invasive groups. The microvascular density is correlated with invasive growth pattern and metastasis of skin SCCs and BCCs. It seems that the vessels in the tumour body play a more important role.

Hereditary hearing loss(HHL) affects one in 1000-2000 newborns and more than 50% of these cases have a genetic base. About 70% of HHL are nonsyndromic with autosomal recessive forms accounting for 85% of the genetic load. Different genes have been reported to be involved, but mutations in GJB2 gene at DFNB1 locus have been established as the basis of autosomal recessive nonsyndromic hearing loss. In addition to GJB2 mutations, the deletion of ∆(GJB6-D13S1830) involving GJB6 gene (also localizes to DFNB1 interval) has been detected in many patients heterozygous for one mutation in GJB2 gene. The aim of this project was to study the prevalence of GJB2 mutations in Turk deaf population living in East and West Azarbaijan provinces of Iran. Mutation screening began by Amplification Refractory Mutation System(ARMS) - PCR for the detection of 35delG then, we analyzed all samples excluding 35delG homozygotes by DHPLC and Direct Sequencing for other GJB2 mutations. We screened 276 chromosomes (138 probands) for GJB2 mutations. Seventy - five chromosomes (27%) carried GJB2 mutations including 35delG, delE120,-3170G>A, W24X, 363delC, E129k, Q80L, and Y155X. Among them, 35delG had the highest frequency, and Q80L and 363delC were novel mutations which have not been reported in any other populations. Thirty-five patients(25.3%) had biallelic GJB2 mutations and five probands had monoallelic GJB2 mutations. The ∆(GJB6-D13S1830) mutation was not found in heterozygous patients. Polymorphisms found were V1531 and V271. Regarding high prevalence of DFNB1-related hearing loss in the north east of Iran, screening this population for this locus is recommended. Also, in comparison with other countries, our results suggest that other loci and genes can be responsible for nonsyndromic deafness in this population.

Correction of pure, severe symptomatic geno-varum in young adults is mandatory. High(proximal) tibial osteotomy(HTO) is an accepted procedure for surgical correction of these deformities. In this retrospective survey, the long-term results of 27 osteotomies with a unique method of surgery are presented. Patients & From 1981 to 2001, 27 valgus-producing high tibial osteotomies were performed on twenty patients with symptomatic geno-varum. Osteotomies were done by using modified Maquet’s barrel-vault dome shape method and stabilized by an external fixation device. The mean age of the patients at the time of surgery was 24 (18-30) years and the mean duration of follow-up was 6.7 (2-12) years. Clinical and radiological evaluation was done pre- and post-operatively for all patients and Knee Society Score(KSS) method was applied to evaluate pain relief and functional outcome of knees. Fourteen patients with 21 osteotomies were followed and evaluated for results. During the follow-up, various clinical(recurrence, control of pain) and radiographical(valgus degrees) factors related to the outcome of the knees were assessed. According to Knee Society Score(KSS), there were obvious improvements of scores in patients from 20 preoperatively to 45 in the follow-up period. Varus to valgus angle corrections measured pre- and post-operatively on average changed from 17.5 to 5.5 degrees. Surgical correction of symptomatic geno-varum in young adults without any other knee problems can relieve pain and prevent the phenomenon of progression towards osteoarthritis. Dome shape HTO together with compressive external fixation are very useful methods. The device is not expensive and a good range of the motion of the knee can be achieved sooner.

Bennett’s fracture-dislocation is an intraarticular injury of the first metacorpal, usually treated by closed(non-surgical) methods. Fractures of the trapezium are among the rare wrist injuries. Simultaneous occurrence of these two injuries is a very rare entity. Case Report: A young man who had fallen down a motorcycle was referred with right Bennett’s fracture -dislocation and comminuted trapezium fracture. Closed methods were applied with relative success. Open surgery seems to be a more appropriate choice for trapezium fractures.

Genitalia system cancers are the third most common cancers. In females, surgery and/or radiotherapy±chemotherapy are treatments of choice for cervical, endometrial or vaginal cancers. Brachytherapy is a complementary part of External Beam Radiotherapy(EBRT). MDR(Medium Dose Rate) brachytherapy in female genitalia cancers is founded on two bases: high and appropriate dose distribution in tumor area as well as dose reduction beyond tumor area especially in sensitive organs such as rectum and bladder. Use of treatment-planning system is a contemporary part of treatment in brachytherapy. This presentation introduces a quality control way for dose distribution in normal adjustment tissues (rectum/bladder) by TLD(Thermoilluminecent Dosimeter) in-vivo dosimetry. Patients & In the present study, 33 patients with cervical and endometrial cancers staged 1-3 were evaluated for rectal dose specifications as per ICRU-38(International Committee of Radiological Protection and Unit) recommendations. Each TLD was placed in one sheet and each sheet was separated 1 centimeter from the other and fixed on rectal applicator and named as R3,R1,R2,R4. Then, the applicator was totally inserted in the rectum of the patients who were candidates for brachytherapy and fixed. The TLDs were read out at the end of the treatment course by using calibration and correction factor. Rectal doses from R1 to R4 (in-vivo doses) were evaluated by TLD reading and compared with treatment–planning doses calculated at the same points. This descriptive study involved statistical methods including regression, t-test, X2,and paired t-test. Mean TLD reading was 579.8 cGy(SD=213.7) and mean planning dose was 654cGy(SD=245), suggesting that the difference between these two was meaningful and planning dose on average was 75.4cGy more than the dose of TLDs(P-value<0.001,CI=50.5-100.2). According to the obtained results within the studied range of 300-1200cGy, the real dose received by rectal area can be calculated by the following formula: Y=0.7X + 118.5 (R2=66%)(X=planning dose). Parameters such as mean rectal points distances (LR=Length from Reference point), age, dose rate, total dose, anterior-posterior diameter of the patient, and stage had no effect on the model of correlation between TLD mean dose and planning dose. Only applicator type (cylinder) affected this model and had positive effect on formula confidence(P-value<0.002,R2=0.99).

Diabetes is one of the risk factors for coronary artery diseases. Pathologic changes in the vasculature that occur in DM(Diabetes Mellitus) lead to coronary artery diseases. There are some reports that these groups of patients have longer ICU staying than non-diabetics. This descriptive cross-sectional study was undertaken to evaluate the effect of diabetes on pump time and ICU staying in CABG patients. During 2001 and 2002, 122 diabetic and non-diabetic patients who came to Namazi Hospital for coronary artery bypass grafting entered our study and their pump time and ICU staying were determined and analyzed statistically by Mann-whitney U test. There was no difference between diabetics and non-diabetics regarding pump time and ICU staying. But the association between the number of coronary grafts and pump time and also pump time and ICU staying was significant. The results showed no significant difference between diabetics and non-diabetics in the length of ICU staying and pump time, but there was a linear relation between the pump time and ICU staying. The extensiveness of the coronary artery disease is the major determinant of the pump time and ICU staying after CABG(Coronary Artery Bypass Grafting).

Duchenne muscular dystrophy(DMD) which is caused due to the absence of cytoskeletal protein of dystrophin is the second most common, lethal genetic disorder in humans. The gene which is responsible for DMD is localized in the XP21 of human genum. Although genetic pattern and biochemistry of DMD have been recognized, pathophysiology that leads to disabling patients is not known. Patients & On the other hand, there are not any scientific criteria for classification of DMD patients. Since muscle biopsy is the most important diagnostic method in this disease, we have tried to evaluate the intensity of the disease through clinical signs and histopathological findings and determine the most important variables involved in the progression of the disease. This research was done on 51 DMD patients. Clinical signs and morphological findings on muscle biopsies were investigated. According to the clinical signs, the patients were classified into two groups: mild and severe. Doing different stainings on paraffin blocks of muscle specimens, we searched for some variables such as degenerating fibers, regenerating fibers, central nuclei, fibrosis, etc. The control group consisted of six orthopedic patients without any neuromuscular disorders who underwent internal fixation surgery due to traumatic fractures. Chi-square statistical method revealed a meaningful relation between disease intensity and pathological signs. Therefore, it can be concluded that the presence of some variables such as degenerating fibers, central nuclei, fibrosis, infiltration of fat and inflammatory cells can account for the progression of the disease and histopathological changes may be directly related to the intensity of clinical signs.

The first upper limb transplant with acceptable function was reported in 1963. Afterwards with progress in microvascular surgery, outcomes improved. A brief report of experience concerning transplantation in the United States, China and Switzerland published in 1981 revealed that 1/3 of the patients had excellent, 1/3 good, and 1/3 had poor results. Regarding shoulder transplant, all results were poor and the rate of success with sharp cut lesions was higher than avulsion types. Case Report: An 11-year-old boy was taken to the emergency room while he was conscious but in a state of pain shock. Being restless, he had blood pressure of 80/50mmHg and heart rate of 120 per minute. His left upper limb was totally avulled from the middle third of the arm. The stump was so dirty and bleeding continuously. The amputated limb was in a dirty plastic bag with some ice chips on it. The patient was referred to the operation room and transplant was done. Then he was followed up monthly. Transplantation in shoulder area is hardly ever followed by excellent or satisfactory outcomes. The rate of success, acceptable function, in transplantation of different parts of the arm is as following: 0-40% above the elbow, 0-70% in proximal forearm, 50-83% in distal forearm, 80% in the wrist, 25-70% in the palm, 32-90% in the thumb, 70% in proximal PIP(Proximal Interphalangeal) in fingers, and 100% in distal PIP. Sharp cut traumas have better results than crushing ones, but avulsion types are the worst. However, vascular transplant was successfully performed on the above-mentioned case, and he was referred to a well equipped center for neural transplant.

Coarctation accounts for about 5-9% of congenital heart diseases and is the fifth common congenital heart disorder in children. Approximately 90% of untreated patients die before the age of 50 and about half of deaths occur before the age of 10 due to heart failure. The main goal of this study is assessing the frequency of reccurent coarctation after repair and determining the results and complications after subclavian flap aortoplasty. Patients & In this retrospective study, the results of surgical repairs for coarctation of aorta in 188 patients under 14 who had been treated at the Rajaee Heart Center were evaluated. The average age of patients was 5.5 years. 72.3% of cases were male and 27.7% were female, including 61 pure coarctation patients. The frequency of associated heart malformations was PDA(Patent Ductus Arteriosus)(67.6%), VSD(Ventricular Septal Defect)(21.8%), AS(Aortic Stenosis)(20%), Bicuspid Aortic Valve(15.4%), MS(Mitral Stenosis)(6.4%), Shone Complex(4.8%), and ASD(Atrial Septal Defect)(3.2%). The proportion of stenosis was 78% for discrete and 22% for long segment. The most common methods of surgical treatment included patch-graft aortoplasty(59%), resection with end-to-end anastomosis(20.7%), and SCFA(16.5%). None of them experienced paraplegia. The patients were followed for 1-126 months with a mean of 41.6 months. In postoperative echocardiography, 29% of cases showed PG(Peak Gradian)≥25mmHg of whom 10% had undoubted recoarctation according to angiography. Later, these patients underwent Balloon Angioplasty. The highest incidence rate of recoarctation was found in patch-graft aortoplasty method(12.7%) and the lowest in SCFA(3.2%). The rate was 10.3% in end-to-end anastomosis. No case experienced acute ischemia, gangrene or left hand dysfunction in SCFA method during follow-up. The incidence of recoarctation in long segment stenosis was significantly more than discrete one(30% versus 4%, P=0.001). In patients younger than 1 year, the incidence of recoarctation was lower than those older than 1 year and those above 5 years(4% versus 15% and 10%). In conclusion, we believe that surgical repair for neonatal and infantile coarctation gives no rise to incidence of recoarctation and decreases postoperation complications such as HTN(Hypertension). Therefore, it should be done as soon as possible. Regarding fewer complications in SCFA method, it provides an excellent method of surgical repair especially in young age.

NO(Nitric Oxide) is a lipophilic molecule which acts as a cytotoxic and mediator in the body. Also, NO has a role in cellular defense and its high concentration causes inhibition of growth and death of microorganisms such as fungi. This experimental study was designed to search the antidermatophilic effects of NO donors and their probable interactions with terbinafin. The method used in this study was determination of MIC(Minimum Inhibitory Concentration) in microdilution broth as per NCCLS(National Committee for Clinical Laboratory Standards) recommendations. The results showed that inhibitory and cidal effects of NO donor complex on dermatophytes are significant. In comparison with terbinafin, its potency is very low and fungicidal effects of both are dependent on their concentration. The zoophilic and geophilic species are more sensitive to either terbinafin or DETA/NO(Diethylen triamine nitrite) than antropophilic ones. The interaction between DETA/NO and terbinafin for microsporom canis, microsporom gypseum, and trichophyton mentagropytes(non-antropophilic species) is because 14 is antagonist. As a result of short half-life of DEA/NO(Diethyl amine nitrite), no effects were observable in this study. Considering the obtained results and the literature, it seems that topical usage of NO donor complexes can be a useful treatment for dermatophitic infections.

Inferior heel pain is a common complaint in patients referred to orthopedic clinics. Etiology of this pain is unknown, but one of the suggestible causes is heel spur. The present descriptive comparative cross-sectional study was undertaken to evaluate the prevalence of heel spur in patients with painful heels and compare it with general population in order to determine spur role in this pain. Patients & 625 lateral X-rays of heel including 427 X-rays of general population(age>40yrs) and 198 X-rays of patients with painful heels(age>40yrs) were evaluated. The prevalence of heel spur was 33.02% in general population and 79.79% in patients with painful heels, which was suggestive of a significant difference(P=0.000, X2=131.570). The prevalence of spur increased with age in the painless group but not in the painful group. Heel spur was significantly more common in women than men in the painless group(40.9% versus 22.8%, P=0.001). Mean spur length was 6.5536±2.3658mm in the painful group and 5.3672±2.5683mm in the painless group revealing a significant difference(P=0.004). No significant difference was found between two groups regarding spur angle. Based on the obtained results, it can be concluded that spur may not be considered as a causative factor of pain but it can be a predisposing factor for heel pain. Another conclusion would be that pain and spur could have common pathogenesis.

Amyloidosis is an idiopathic disorder characterized by amyloid deposition leading to tissue damage and disease. Laryngeal amyloidosis is usually a localized phenomenon that is rarely accompanied by systemic involvement. Hoarseness is its most common symptom and the clinical findings in laryngoscopy are variable, nonspecific and difficult to be distinguished from other laryngeal lesions. The diagnosis is made by pathological examination and the treatment consists traditionally of surgical excision to maintain a functional airway and optimize voice. Considering the rarity of systemic involvement with laryngeal amyloidosis, this article presents a case of systemic amyloidosis with primary manifestation in the larynx.Case Report: The case was a 45-year-old man referred to ENT ward of Firouzgar Hospital with primary chief complaint of dyspnea and hoarseness. Primary biopsy from endolarynx indicated an inflammatory process and two later biopsies revealed inflammation and submucosal hemangioma as well. Finally, in the last laryngoscopy and biopsy with Congo-red staining, amyloid deposits were observed and laryngeal amyloidosis was documented. Additional biopsies from gingival mucous and abdominal fat and the presence of amyloid deposits in these sites confirmed the diagnosis of systemic amyloidosis. Systemic amyloidosis with laryngeal involvement is a rare disorder which is currently treated by serial direct laryngoscopy and microsurgery. Research on its medical treatment is ongoing.

The most common surgically treatable causes of hearing loss are middle ear diseases among which the greatest effect is related to ossicular chain dysfunction. Successful ossicular chain reconstruction certainly improves air conduction thresholds and closes air-bone gap in audiograms, but the effect of this procedure on bone conduction thresholds has remained to be elucidated. Only few standard clinical trials have been done and most studies are retrospective with methodological faults. The aim of the present study was to determine the effect(s) of ossicular chain reconstruction on bone conduction thresholds. Patients & In a controlled clinical trial, pre-and post-operative bone conduction(BC) thresholds of speech frequencies were investigated in 68 patients. In order to evaluate the effect of ossicular chain reconstruction on bone conduction, the patients were divided into two groups including 34 cases each. One group received ossicular chain reconstruction during the middle ear surgery and the other one was to receive it later. In each group, mean preoperative bone conduction thresholds of any frequencies were compared with postoperative ones using paired t-test. In the reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds at 1000 and 2000 Hz with the largest mean improvement observed at 2000 Hz(about 9.7 db recovery). In the group without reconstruction, no significant changes were observed at any frequencies. The results indicated the remarkable effect of ossicular chain on bone conduction. This effect is eliminated in ossicular disruptions due to various middle ear diseases and is reproducible by successful reconstruction of the chain. The findings showed changes in bone conduction as a mechanical phenomenon affected by ossicular chain. In other words, BC thresholds are not exclusive indicators of chochlear function. We also observed that true sensorineural hearing loss is not a common major complication of middle ear surgery.

Adrenal cortical carcinoma is a rare malignant tumor which presents mainly in late adulthood with an equal age distribution. The tumor is usually functionally active. Case report: The present study reports two 11-month-old female infants with abdominal mass and virilysm who underwent radical nephrectomy. The final diagnosis was adrenal cortical carcinoma with regional lymph node metastasis which was confirmed by other paraclinical tests. Adrenal cortical carcinoma should be considered as a differential diagnosis in pediatric abdominal and renal mass. Ke

Cyclospora cayetanensis is a new-emerging pathogenic protozoan parasite. It is a rare coccidian associated with gastrointestinal disorders. Cyclosporiasis occurs in persons of all age groups and either in immunocompetent or immunocompromised hosts. The most characteristic feature of this infection is a syndrome of acute or chronic diarrhea. This parasite is worldwide in distribution. Cyclospora can be transmitted by ingestion of water or food contaminated with oocysts. The present study was undertaken to assess the prevalence of cyclospora cayetanensis in children with diarrhea. During twelve months(from June 2002 to June 2003) 420 stool samples from children under 10 years of age with diarrhea, admitted into Tehran Children Medical Center were screened. To detect and identify the organism, direct smear, formalin-ether concentration, and staining(modified acid fast) techniques were used. In this cross-sectional study, 31 out of 420 specimens(7.3%) showed parasite infection, but cyclospora cayetanensis was not detected in any of the stool samples. According to our study, it seems that cyclospora infection in Tehran is very rare and further studies with larger volume size of stool are necessary for cyclospora identification. We also suggest that medical practitioners and laboratories should be more aware of this infection and its diagnosis.

Zinc deficiency is a common worldwide nutritional disorder. Determination of reference normal values for biological levels of serum zinc in general population is necessary to indicate true variation of elemental concentrations arising from physiological and pathological influences, poisonings, and occupational exposures, but there are no previous studies on zinc status in healthy, adult Iranian population. The aim of this study was to obtain the levels of serum zinc in this population to determine the normal nutritional status of zinc and evaluate the influence of certain factors like age, sex, Body Mass Index(BMI) and smoking habits. In this cross-sectional study, serum samples from 102 randomly selected, healthy personnel of Firouzgar Hospital(mean age: 33.8 ± 10.7 years and mean BMI: 23.74 ± 3.73 kg/m2) were collected and zinc concentration was determined by Flame-Atomic Absorption Spectrometry(AAS). The results were analyzed using uni and multi-variate statistical techniques. The average concentration of zinc in serum was 75.36µg/dl(confidence interval: 95%, ranging 43.54-107.18 µg/dl). Women showed lower zinc levels but there was no statistically significant difference. Serum zinc concentrations were unrelated to age(r=0.073 p=0.466) and BMI(r=0.052 p=0.604). Also smoker men had no significant lower zinc concentrations. About 47.1% of our cases had serum zinc concentrations below the cut off value of 70 µg/dl in serum, which can be interpreted as marginal or mild zinc deficiency.

Gastrointestinal biopsies are common specimens evaluated in surgical pathology departments. Routinely, mucosal specimens are embedded randomly with respect to the side of the biopsy that faces microtome blade. However, sometimes initial histological sections of putative lesions — in spite of strong clinical suspicion — may lack any appreciable pathological findings. This study is designed for comparison between routine resectioning and new-emerging reorienting(or flipping) methods in providing diagnostic information in cases with no histopathological findings. In an analytical cross-sectional study, sixty-three gastrointestinal cases with different clinical impressions whose first slides were devoid of any specific findings were selected. Initially, another H&E(Hematoxylin and Eosin)-stained slide was prepared(labeled as “S” for resectioning). Then, paraffin-block was melted. Tissue was 180˚ reoriented and reembedded. Two other H&E(Hematoxylin and Eosin)-stained slides were prepared(labeled as “O1” and “O2” for reorienting). The section levels were sequentially arranged on slides and — in cases of changes — the first level on which the new findings were evident was recorded. Overall, 13 out of 63 cases(20.63%) revealed new histopathological changes, including 7 cases(11.1%) with essential changes and 6 cases(9.5%) with non-essential changes. Resectioning and reorienting methods displayed new findings in 8 cases(61.5% of all changed cases) and 7 cases(53.8% of all changed cases) respectively. Two cases(about 15.4%) were common in both groups. In cases of changes, all new findings developed in the fifth resectioning and/or the first reorienting level. Despite lack of significant statistical difference between two methods, emergence of additional diagnostic — and sometimes critical — information in each of the methods makes two-sided sectioning an essential approach in cases of discordance between clinical impressions and histological findings.