Acta Medica Iranica
Volume:44 Issue: 3, May-June 2006

Helicobacter Pylori infection leads to different clinical and pathological outcomes in humans, including chronic gastritis and gastric neoplasia. It has been demonstrated that oxidative stress associated with inflammation plays an important role in gastric carcinogenesis. To evaluate the oxidative stress in H. Pylori infection we studied the gastric juice levels of nitric oxide and the activities of superoxide dismutase and glutathione peroxidase. A total of 43 patients suffering from H. Pylori infection were selected and 43 non-infected individuals were chosen as control group. Compared to control group, significant reduction in the mean levels of nitric oxide in the gastric juice of the patients was noticed (P = 0.0001). In the patients activities of superoxide dismutase and glutathione peroxidase in gastric juice were markedly higher than those of control group (P = 0.0001 and P = 0.0001, respectively). A reverse and meaningful relationship was observed between the levels of nitric oxide and the activities of superoxide dismutase in the gastric juice of patients (r = -0.35, P = 0.023). The results of this study confirm that H. Pylori has developed various mechanisms to escape the effect of immune system. H. Pylori have also developed strategies for defense against oxidative stress.

Rate of in vitro maturation of oocytes is one of the challenges of assisted reproductive techniques. In this study we investigated the effects of supplementation of cysteamine on the rate of in vitro maturation of oocytes in two different media. Germinal vesicle oocytes were collected from mouse ovary and cultured in two media (TCM199 and MEME) with 0, 50, 100, 200, 500 µM/ml cysteamine. Number of germinal vesicle breakdowns and metaphase II oocytes were recorded. The results showed that the rate of in vitro maturation in 100 µM/ml cysteamine was significantly higher compared to control (P < 0.05). Evaluation of two media in this study showed that TCM199 improved the rate of in vitro maturation and oocyte maturation better than MEME; however, this difference was not statistically significant. These findings indicate that TCM199 as compared to MEME was better in rate of in vitro maturation of oocytes.

Rate of in vitro maturation of oocytes is one of the challenges of assisted reproductive techniques. In this study we investigated the effects of supplementation of cysteamine on the rate of in vitro maturation of oocytes in two different media. Germinal vesicle oocytes were collected from mouse ovary and cultured in two media (TCM199 and MEME) with 0, 50, 100, 200, 500 µM/ml cysteamine. Number of germinal vesicle breakdowns and metaphase II oocytes were recorded. The results showed that the rate of in vitro maturation in 100 µM/ml cysteamine was significantly higher compared to control (P < 0.05). Evaluation of two media in this study showed that TCM199 improved the rate of in vitro maturation and oocyte maturation better than MEME; however, this difference was not statistically significant. These findings indicate that TCM199 as compared to MEME was better in rate of in vitro maturation of oocytes.

The central cholinergic system has been associated with cognitive function and memory and acetylcholine plays an important role during the early stages of memory consolidation. In this study, after training mice were tested with one way active avoidance procedure and retention were tested at 4, 8, 12, 16 and 24 hours of training and compared with non-shocked mice, in which it took 24 hours, a suitable time for retention test. Low dose administration of arecoline and physostigmine pre-training, immediate post-training and before retrieval showed that muscarinic agonist arecoline can potentiated memory in post trained and retrieval phases and reversible cholinesterase inhibitor physostigmine potentiated memory only in retrieval phase. Scopolamine disrupted acetylcholine potentiation only in retrieval phase. In the second part of this study, the effect of dopaminergic system was investigated. Low dose of apomorphine and D2 agonist bromocriptine potentiated memory when administered immediately post-training, and D2 antagonist sulpiride impaired memory. When the cholinergic system was blocked by scopolamine immediately post-training, apomorphine and bromocriptine potentiated memory and sulpiride impaired it. In conclusion, these results suggest that, cholinergic system in retrieval phase is very critical and there was no interaction between the two systems in the post-training phase.

Patients afflicted with chronic pain have both physical and psychological problems. This research investigated the impact of the psychological factors in the treatment results of transcutaneous electrical nerve stimulation (TENS) in the patients afflicted with chronic diseases. The subjects were 37 individuals (20 males and 17 females) with the mean age of 46 who had referred to two centers of physiotherapy treatment to receive TENS treatment process. Subjects were suffering from chronic pain in upper part of their body, hands and legs. The subjects were tested and screened psychologically by PDQ4+, MPQ, MPI, and BDI questionnaires. On the basis of the personality disorder and the intensity of the depression, they were divided into two groups: 1) patients with psychological symptoms (n = 14); and 2) patients without psychological symptoms (n = 23). In order to study the rate of the pain intensity reduction in both groups, the MPQ questionnaire was used in three stages (before beginning, in the middle and at the end of the treatment). Also, the MPI questionnaire was used in order to review the inter-personal problems, the interference of the pain in life, daily performance and the rate of social support. Results showed that in each group, the pain intensity had significantly reduced as a result of the impact of TENS treatment and the psychological factors did not have meaningful impacts. Also there was statistically significant correlation between the rate of social support of the family members and the reduction of pain intensity.

Labor pain is a cause of stress and suffering; for which many women seek methods to relieve this pain. The aim of this study was to determine the effect of relaxation techniques on pain relief during labor. This study was carried out on 62 pregnant women referred to Fatemieh hospital (Hamadan, Iran) during their labor. They were selected using convenience sampling and were divided randomly in two groups. The first group (control) received routine way of ward during their labor and the second group (test) went through the relaxation technique after training. The intensity of pain was determined using a standard pain number rating scale, and the behavioral reactions were recorded using an observational checklist. The statistical analysis of data showed significant difference in intensity of pain between the two groups (P = 0.0001). Also there was a significant difference in behavioral reactions between the two groups (P < 0.0001). Since the relaxation technique is easy to perform and without any risk and also has low expenses it is recommended for pain relief during labor.

Patients with Turner’s syndrome (TS) are at an increased risk of developing autoimmune thyroid disease (ATD). The aim of this study was to determine the frequency of anti-thyroid peroxidase (anti-Tpo) antibodies and ATD in children and adolescent girls with TS. It also assessed the influence of karyotype on the development of thyroid disease. Sixty eight patients with TS were compared with 68 age matched healthy unrelated girls in this study. They were screened for anti-Tpo antibodies, free T4 and TSH levels. Sign and symptoms of hypothyroidism and hyperthyroidism and the presence of goiter were also investigated. Anti-Tpo antibodies were found in 18 (26.4%) TS patients and 1 (1.4%) patient in the control group (P < 0.001), evenly distributed between the karyotypes 45X, 46X, isoXq and mosaicism. Out of 68 TS patients, 8 (11.7%) had visible goiter. Subclinical hypothyroidism and hypothyroidism both occurred in 2 patients (5.9%). These patients were characterized by higher levels of anti-Tpo antibodies. Visible goiter was found in 3 (4.4%) subjects of the control group, but all of them were euthyroid. We found that younger patients were more likely to be anti-Tpo negative (P < 0.001). Our data demonstrated a high frequency of ATD in a representative sample of Iranian girls with TS which is in accordance with previous observations. Regular follow up assessment of thyroid autoantibodies and thyroid function in patients with TS is recommended for timely diagnosis of thyroid dysfunction and treatment.

Children who are operated for biliary atresia by the Kasai procedure have approximately 30% chance of survival for 5 years. In an attempt to define the role of this operation for biliary atresia, the surgery records of the past 15 years were reviewed. The aim of this study was to assess the benefits achieved from this operation in infants with biliary atresia. This study was conducted in the department of pediatric surgery Taleghanei Medical Center from 1986 to 2000. A total of 36 cases, 15 boys and 21 girls were reviewed retrospectively. All the operations were performed uniformly by Kasai procedure by three investigators. Data regarding patient history, clinical presentation, laboratory and radiological features, operative finding, complication and mortality were collected and retrospectively studied. In these series 36 cases were classified as three groups. Group A, represented the successful category after the Kasai operation (11 patients, 30.5%) characterized by survival of more than 3 years and no jaundice. Group B (2 patients, 5.5%) was defined as survival of more than 3 years, but with jaundice, and group C (23 patients 63.8%) was defined by survival of less than 3 years (this group was further divided to subgroups). It seems that jaundice is the main prognostic factor after operation.

Totally implantable venous access devices (TIVAD) or implantable catheter ports are devices which can be implanted subcutaneously. They enable prolonged and repeated access to the vascular system, into the peritoneal cavity or intravertebral space. This device is particularly useful for repeated medical injection, for blood sampling or transfusion of blood and blood derivatives and for total parenteral nutrition (TPN). Although many patients benefit from the insertion of TIVAD without any secondary effects, any surgical implantation can nevertheless lead to complications. ‎In this study, we investigated the advantages and disadvantages of TIVAD catheter in pediatric age group. A total of 94 cases, 2 to 14 years old, were included in our study. We implanted TIVAD in these patients for chemotherapy in 83 cases (88.29%), for prolonged TPN in 6 cases (6.38%), for corticosteroid and antibiotic therapy after ‎Kasai operation in 2 cases (2.12%), for intermittent IV therapy in 2 cases (2.12%) and for need to partial parenteral nutrition in 1 case (1.06%). Out of 94 cases, 14 cases (15%) had some kind of complications and 80 cases (85%) had no complication. There was no mortality. Most patients and their parents (82 cases, 87.23%) were satisfied from TIVAD. ‎It seems that TIVAD can be a useful device for many chronic patients who need an IV access for multiple injections.

Totally implantable venous access devices (TIVAD) or implantable catheter ports are devices which can be implanted subcutaneously. They enable prolonged and repeated access to the vascular system, into the peritoneal cavity or intravertebral space. This device is particularly useful for repeated medical injection, for blood sampling or transfusion of blood and blood derivatives and for total parenteral nutrition (TPN). Although many patients benefit from the insertion of TIVAD without any secondary effects, any surgical implantation can nevertheless lead to complications. ‎In this study, we investigated the advantages and disadvantages of TIVAD catheter in pediatric age group. A total of 94 cases, 2 to 14 years old, were included in our study. We implanted TIVAD in these patients for chemotherapy in 83 cases (88.29%), for prolonged TPN in 6 cases (6.38%), for corticosteroid and antibiotic therapy after ‎Kasai operation in 2 cases (2.12%), for intermittent IV therapy in 2 cases (2.12%) and for need to partial parenteral nutrition in 1 case (1.06%). Out of 94 cases, 14 cases (15%) had some kind of complications and 80 cases (85%) had no complication. There was no mortality. Most patients and their parents (82 cases, 87.23%) were satisfied from TIVAD. ‎It seems that TIVAD can be a useful device for many chronic patients who need an IV access for multiple injections.

Bone marrow is infrequently implicated in early stages of Hodgkin’s disease. We studied the immunohistochemical bone marrow tissue of 7 out of 20 cases with early stage Hodgkin’s disease of the mixed cellularity variant, diagnosed by lymph node biopsy at initial presentation, not responding to radiotherapy alone, in order to examine possible marrow attack. A statistically significant prevalence of CD45, CD45RO, and CD4 positive infiltrates, to the advantage of unremitting hosts, was found. The predominance of CD4-positive cells in the bone marrow space might be suggestive of involvement in the process and could explain the abnormal cytokine production leading to reduced T-cell immunity and inefficient antitumor response despite the existence of a vast majority of reactive infiltrating immune cells.

Enterococci are normal inhabitants of gastrointestinal tract, being responsible for 5 to 18% of infective endocarditis and the incidence appears to be increasing. Eleven patients with enterococcal endocarditis were studied. In a case series group, 10 men (average 57 years) and one woman (37 years) were studied. Two patients had rheumatic heart disease, 5 patients arteriosclerotic disease and one patient chronic renal failure on hemodialysis. Ten patients were treated with ampicillin and gentamycin. Valve replacement was performed in 3 patients with aortic valve endocarditis, one on 8th day and two at the end of the treatment. Overall clinical cure was achieved in 9 patients. Two relapses occurred and 2 patients died as a result of refractory congestive heart failure and cerebral emboli. All of the enterococcal endocarditis cases were community acquired. In conclusion, infective endocarditis in patients with preexistent valvular heart disease, community acquisition and non specific symptoms with bacteriuria should be considered as enterococcal endocarditis.

Retained foreign body in the abdominal cavity following surgery is a continuing problem. We report a case of an 18 year old man who was referred with abdominal pain and cecal mass. Clinical exam, computed tomography scan and colonoscopy were suggestive of cecal tumor. Laparotomy confirmed a retained surgical sponge which had migrated from peritonel cavity into cecum.

Exudative retinal detachment (ERD) may be seen with many ocular pathologies including malignancies. Among malignant causes, metastases of breast and lung carcinoma are most common. A 50-year-old woman referred to our clinic with history of decreased visual acuity in her right eye since 3 months before referral. The visual acuity was counting fingers at 2 meters and 6/10 in the right and left eyes, respectively. On slit lamp examination, 2+ anterior chamber and vitreous reaction was detected. On funduscopy, advanced ERD of the right eye and multiple subretinal masses with ERD in the left eye were detected. On systemic work up, bilateral multiple breast masses were found on mammography. Her breast biopsy showed advanced invasive intraductal adenocarcinoma. Any patient with ERD with undetermined cause should undergo a thorough systemic work up. Prompt intervention is imperative and may be life saving.

While an important infectious disease in the United States and Eurasia, Lyme disease is rare in Iran. We present a 9-year old boy admitted in Children’s Medical Center in December 2001 with final diagnosis of Lyme disease. On admission he showed arthritis and a history of previous skin lesions. Serologic examination including enzyme–linked immunosorbent assay and Western blot was positive for Lyme borreliosis. Patient was treated with doxycycline for four weeks, with good results. Although it is difficult to confirm diagnosis of Lyme disease in our patients, we should be aware that Lyme borreliosis is also found in Iran.