مجله علوم پزشکی رازی
سال سیزدهم شماره 4 (پیاپی 53، زمستان 1385)

In childhood, dilated cardiomyopathy has a prevalence of 36 in 100000. Its prognosis is one of the most important matters. The chance of 5-year survival is reported to be around 50% and 10-year one around 25%. We aimed to study the prognosis, treatment, and mortality of dilated cardiomyopathy patients in Iran. Patients & In this descriptive study, the medical records of all infants and children with dilated cardiomyopathy hospitalized between 1990 and 2004 were reviewed. Among 115 patients, 67(58%) were boys and 48(42%) were girls, with a mean age of 8.4 years(ranging from 3 months to 16 years) and mean weight of 21.5 Kg. The most common clinical manifestation was respiratory distress in 71.3% and congestive heart failure(CHF) in 62% of the patients. Ninety-four(82%) were discharged after medical therapy with a combination of digitalis, furosemide and angiotensin-converting enzyme inhibitor(captopril). Twenty-one patients(18%) died in the picture of severe CHF and dysrhythmias during the first admission. A mean follow-up of 6 years(ranging from 0 to 13 years) revealed that 56% were still alive. The prognosis is still poor especially for those under 2 years of age or with CHF or dysrhythmias, but new attempts have been made to use different therapeutic modalities like L-carnitine, growth hormone, intravenous immunoglobulin, cardiac transplantation, and new surgical approaches in pediatric patients.

Peroneal reaction time measurement has been used to objectively evaluate functional instability of the ankle joint. The reliability of the method has been reported only in frontal plane, but it has not been proven in oblique plane. The purpose of this study was to determine the reliability of ankle musculature latency, peak and time of activation measurements on a tilting platform(APS=Ankle Perturbation System) in response to sudden external oblique perturbation under different conditions. Patients & The latency, peak and time of activation of 10 healthy and 10 unhealthy subjects with functional ankle instability(FAI) were examined in a methodological study. The latency, peak and time of activation after sudden inversion of the ankle were determined by APS and surface EMG(Electromyography). Relative reliability(1&1 model) and absolute reliability(Standard Error of Measurement) were used as statistical methods. The ranges of ICC(Intra-class Correlation Coefficient) values for latency of Peroneus Longus(0.97-0.99), Tibialis Anterior(0.92-0.99), Peroneus Brevis(0.96-0.99), and Soleus(0.98-0.99) for 10, 20, and 30 degrees of oblique Plane were obtained. These values for peak of activation of Peroneus Longus(0.92-0.99), Tibialis Anterior(0.97-0.99), Peroneus Brevis(0.95-0.99), Soleus(0.96-0.99) and for time of activation of Peroneus Longus(0.95-0.99), Tibialis Anterior(0.94-0.99), Peroneus Brevis(0.91-0.99), and Soleus(0.9-0.99) were calculated too. The ranges of SEM(Standard Error of Measurement) values for latency of Peroneus Longus(0.76-2.06), Tibialis Anterior(0.91-3.15), Peroneus Brevis(0.89-1.72), and Soleus(0.67-1.22) were also obtained. These values for peak of activation of Peroneus Longus(2.98-10.82), Tibialis Anterior(3.51-4.58), Peroneus Brevis(3.4-4.23), Soleus(4.27-10.05) and for time of activation of Peroneus Longus(2.4-6.81), Tibialis Anterior(2.66-9.19), Peroneus Brevis(3.87-14.75), and Soleus(4.25-17.67) were calculated as well. Determination of timing of muscle activity was proven as a reliable measurement technique.

Considering the role of cellular immunity in prognosis of malignant tumors of the head and neck, especially SCCs(Squamous Cell Carcinoma), we intended to investigate cellular immune system activity in patients with head and neck tumors, whether malignant or benign, and then compare it with the kind, severity and prognosis of tumoral involvement. Patients & This is a cross-sectional study performed on 40 head and neck tumor patients in Hazrat-e-Rasoul and Firouzgar hospitals from November 2003 to June 2005. After skin testing with DNCB(Dinithrochlorobanzen) and grading skin reactions, blood sampling was performed within 3 weeks and after isolating, culturing, and stimulating the lymphocytes with PHA(phytohemaggulotini) stimulant, the amount of cytokine production was measured using ELISA(Enzyme Linked Immunosorbent Assay) method. Then the results were compared with the information pertained to pathologic diagnosis, the stage of the disease, and also the results of clinical follow-up. Patients with more advanced malignant tumors(stages 3&4) had weaker skin reactions compared with the early stages of the disease(10.5% contre 87.5% p<0.001). Also in epithelial malignant tumors, skin reactions were weaker than non-epithelial and benign tumors(40% contre 90%). With increasing stages of the malignant disease(up to stage 3), IL-2(Interlukin-2) production also increased but in the fourth stage there was a significant reduction in IL-2 production(P<0.01). Similar findings were also noted about IL-12 and INF-G (Interferon-gama) but they were not statistically significant. In this study there was not a significant relationship between the grade of skin reaction and cytokine production. The follow-up revealed that 3 out of 4 expired patients had weak skin reactions and very low levels of IL-2. This study showed a significant relationship between the grade of skin reaction and pathologic diagnosis and the stage of the disease. Also, levels of IL-2 production decrease significantly in the late stages of the malignant disease. Significant relationship between cellular immune system activity and the kind and severity of tumoral involvement can influence our decision on the choice of treatment and also help us predict the prognosis of the tumoral disease.

Diabetes mellitus is one of the commonest chronic diseases in community which induces immunodeficiency and infection through multiple mechanisms. In addition, infections can also bring about hyperglycemia and ketoacidosis. In this study, we have tried to evaluate the frequency of diabetes and the factors related to its outcome in patients with sepsis. Patients & This is a descriptive cross-sectional study which involves 300 randomly sampled cases who had been admitted to Rasoul-e-Akram Hospital and diagnosed with sepsis between 2001 and 2003. The data was analyzed by SPSS version 11.5. The mean age of the patients was 52.7 years(SD=28.4). 158(52.7%) out of 300 patients had diabetes. The most common sites of infection were respiratory tract and then urinary tract. Evaluation of the outcome of the patients in two diabetic and non-diabetic groups demonstrated a statistical difference(P.value=0.001). Mortality rate increased with aging and delay in beginning the treatment(P.value=0.001). With respect to 4 signs of SIRS, 88 cases revealed 2, 156 had 3, and 56 presented with all signs at the time of admission. 16(18.2%) of the first group, 116(74.4%) of the second group, and 47(84%) of the third group expired, though(P.value=0.001). Of 158 patients with diabetes, 67 cases of whom 97% expired had average blood glucose more than 250mg/dl, 55 ones of whom 84% expired had average blood glucose between 180-250 mg/dl, and 36 patients of whom 42% expired had average blood glucose less than 180 mg/dl. These 3 groups, however, demonstrated statistical differences(P.value=0.001). This study demonstrates that aging can increase the rate of sepsis and its mortality in both diabetic and non-diabetic groups. Also, mortality of sepsis in diabetics is more than non-diabetics and quick treatment of it can decrease this mortality. In addition, mortality increases with an increase in the severity of the disease, i.e. more SIRS criteria, and strict control of blood glucose can result in a better prognosis.

Malignant tumors of larynx, mostly seen in males, are usually observed during the fifth and sixth decades of life. These tumors are usually associated with tobacco and alcohol usage. The symptoms of these tumors are hoarseness, dysphagia and a chronic sore throat. A rare form of laryngeal malignancy is adenoid cystic carcinoma as a malignant minor salivary gland tumor. Case Report: In this article, we report a rare case of laryngeal adenoid cystic carcinoma(ACC) in subglottic area in a 22-year-old female without any risk factors. The patient was referred suffering from pain, hoarseness and exertional dyspnea. After performing a biopsy on the subglottic mass and confirming the pathologic diagnosis of adenoid cystic carcinoma, the patient underwent total laryngectomy. During a period of 2.5-year follow-up, no sign of recurrence or distant metastasis was reported. The presence of upper airway symptoms needs to be evaluated. If there is no improvement in the symptoms using medical treatment, the patient should be evaluated by imaging techniques or direct or indirect diagnostic laryngoscopy. In order to prevent late diagnosis and disease progression, there should be a suspicion of malignant lesions in laryngeal tumors even at young ages.

Microcystic adnexal tumor is a rare sclerosing variant of ductal carcinoma of eccrine sweat gland which is deeply invasive. This tumor which is said to have high recurrence rate is often misdiagnosed as other benign or malignant skin lesions and improper treatment is administered. Case Report: We report herein a 59-year-old man who underwent incisional biopsy for a congenital lesion on posterior neck which had grown recently. Microscopic examination exhibited an infiltrative tumor constituted by small cord-like and angulated tubules with tadpole or comma-like shapes, individually set in abundant fibrous stroma in dermis. So the diagnosis was syringoma. In the next step, the lesion underwent excisional biopsy. Histologic examination noted a tumor in dermis with extension to subcutis which contained basaloid keratinocytes with occasional horn cysts and abortive hair follicles. In other areas, ducts and gland-like structures lined by two-cell layers predominated. The tumor had extended to skeletal muscle and perineurial structures, but no significant atypia or mitosis was identified. Eventually, with respect to the above-mentioned features, the diagnosis was microcystic adnexal tumor. It seems useful to report this case since correct diagnosis of this rare invasive skin tumor and proper use of Mohs’ surgery lead to a significant decrease in recurrence rate. In this reported case, the noticeable point was that this tumor was set in a congenital lesion.

Tonsillectomy is the most common head and neck surgery in Iran. Considering that any operation involves three specimens and this can cause a considerable waste of time and cost, we intended to conduct a survey. The aim of designing and performing this research was to evaluate the value of histopathology done on all obtained specimens of adenotonsilectomy. Patients & This retrospective study included 313 patients who had undergone adenotonsilectomy in Rasoul-e-Akram Hospital between 2000 and 2003. Fisher test was applied to analyze the information. The age of the subjects ranged from 1 to 78 with an average age of 10.8. Only 3 cases(0.9%) who were above 50 years old yielded positive results. Considering p<0.01, there is a meaningful relationship between age and positive histological result. Also, a significant relationship was seen between malignancy and a change of voice in 60 cases(P=0.4), dysphagia in 26 cases(P=0.2, R=20%), unexplained weight loss in 1 case, asymmetric tonsils in 29 cases, neck mass in 34 cases(P=0.8), and infected tonsils in 15 cases(P=0.12). Therefore, the above-mentioned signs and symptoms can be considered as malignancy factors. Regarding the results of the study, there is no need to send tonsilectomy specimens to laboratory for histopathological evaluation, especially in children and patients without risk factors and clinical suspicions.

The patients suspected of appendicitis are evaluated by history, physical examinations and laboratory results. The aim of this study was to assess the diagnostic value of C-reactive protein in patients with suspected acute appendicitis. Patients & In a prospective study, 299 patients with acute abdominal pain who had been admitted to hospital for observation were enrolled. Serum CRP measurements were performed and the results were compared with the final results of histopathology or follow-up results. The results were analyzed using Chi-square test and their accuracy, sensitivity, specificity, and positive and negative predictive values were determined. The findings showed that the accuracy of CRP test in diagnosing appendicitis was 70%(CI=Confidence Interval 95% from 65% to 74.4%), the sensitivity was 80.7%(CI95% from 71.2% to 87.6%), the specificity was 65.4%(CI95% from 58.8% to 71.5%), and the positive and negative predictive values were 49.3%(CI95% from 41.3% to 57.4%) and 89.0%(CI95% from 83.2% to 93.0%) respectively. The odds ratio was 8(CI95% from 4.3 to 14.4). The results of CRP test can help a surgeon rule out or confirm the diagnosis of appendicitis in suspicious cases.

Paracetamol is a non-opioid and non-NSAID(non non-steroidal anti-inflammatory drug) analgesic with central function. Analgesic effect of paracetamol is similar to opioids and NSAIDs but different from them in terms of side effects. Remifentanil is a short-acting opioid. In our study, we assess the effect of these two drugs on the depth of anesthesia using BIS monitoring. BIS(Bispectral) index is a complex EEG(Electroencephalograph) parameter. Bispectral index values of 0 represent an isoelectric EEG, where values of 100 represent awareness. Patients & This study was done on 100 ASA-1(American Society of Anesthesiologists) patients who were candidates for endoscopic sinus surgery. Patients who were out of the age range of 15-45 years were excluded. Then the patients were randomly divided into two groups of 50. The first group included patients using paracetamol and the other group used remifentanil. Both groups received 1μg/kg of fentanil as premedication. Induction of anesthesia in the first group was started by using propofol 2.5mg/kg and then cysatracurium 0.15mg/kg. Propofol 100μg/kg/min+N2O 50%,O2 50%(equal minute volume)+paracetamol 1gr/Q4h were administered for maintenance. In the other group the induction was similar to the first group, but for maintenance propofol 100μg/kg/min+N2O 50%, O2 50%(equal minute volume)+remifentanil 1μg/kg/min were administered. For each group, depth of anesthesia was measured during laryngoscopy, intubation and incision. Blood pressure and heart rate were recorded on collecting data sheets too. Data was analyzed using independent sample t-test and PV<0.05 was statistically significant. The analysis of data showed no significant difference between the two groups(PV>0.05). As a result, there is no difference between the effect of paracetamol and remifentanil on the depth of anesthesia. These findings suggest that infusion of paracetamol replace remifentanil in order to observe hemodynamic stability during the surgery.

Toxoplasmosis is caused by a protozoan parasite called toxoplasma gondii. SAG1 is an antigen which only exists in tachyzoite stage. This antigen which has two glycoforms is a conformational antigen. The aim of this research is to study cloning of SAG1 gene in PTZ57R and transformation of recombinant plasmid in E.coli(TG1 & DH5a). Tachyzoites of T.gondii are able to multiplicate in mouse macrophages. SAG1(30 KDa) is one of the three surface antigens and a main candidate for DNA vaccine. Also, SAG1 is the most immunogenic antigen of toxoplasmosis and a major surface antigen of the proliferative tachyzoite form of T.gondii. SAG1 genome with a 960 bp band is single copy. In this study, the DNA of toxoplasma gondii was extracted and SAG1 genome was amplified. Then PCR(Polymrase Chain Reaction) product was purified and cloned in PTZ57R and finally transformed into two strains of E.coli(TG1 & DH5α). The DNA of toxoplasma gondii was extracted and SAG1 gene was amplified. The PCR product was seen as a 960 bp band in 1% agarose gel. After cloning and transformation, to recognize the E.coli recombinant plasmid, the bacteria were cultured in LB with ampicilin, X-Gal and IPTG. The mean and standard deviation of colonies that grew in LB were measured. To confirm the data, the plasmids were extracted and the DNA of SAG1 was amplified and digested by BamH I enzyme. The recombinant plasmid was restricted by enzyme and two 2982 and 864 bp bands were obtained. It was noticed that as for transformation of plasmid with the DNA of SAG1, TG1 is more suitable than DH5α. This method is useful for cloning and storing the important genome of toxoplasma gondii, SAG1.

Intense and long-standing problems in burn centers in Tehran have led nurses to burnout. This phenomenon has provoked serious responses and has put the nurses, patients and the organization under pressure. The challenge for managers and nursing executives is to understand the factors which would reduce or increase the nurses’ responses to burnout and develop delivery systems that promote positive adaptation and facilitate the quality of care. This study, as a part of an extensive research, aims to explore and describe the nurses’ perceptions of the factors affecting their responses to burnout. Patients & This qualitative study made use of grounded theory as a research method. Thirty-eight participants were recruited through purposeful and theoretical sampling. Data was collected by unstructured interviews and 21 sessions of participant observation during all working shifts. The interviews were tape recorded and transcribed by computer and observations were documented as field notes on special forms. Constant comparison was used for data analysis. Open, axial, and selective coding were done and then core category, sub-categories and their attributes emerged. The results revealed that nurses’ and patients’ personal characteristics and social support influenced nurses’ responses to burnout. Personal characteristics of the nurses and patients, especially when interacting, had a more powerful effect. They altered emotional, attitudinal, behavioral and organizational responses to burnout and determined the kind of caring behavior. Social support had a palliative effect and altered emotional responses and some aspects of attitudinal ones. The powerful effect of positive personal characteristics and their sensitivity to long-standing and intense organizational pressures suggests new approaches to executing stress reduction programs and refreshing the nurses’ morale by attaching more importance to ethical aspects of caring. Moreover, regarding palliative effect of social support and its importance for nurses’ well-being, nursing executives are responsible for providing a working environment that supports nurses and motivates them.

Closed kinetic chain exercises are the most popular methods of lower limb muscles strengthening both in physical therapy and sports. One of these exercises is squatting. Despite the common idea about the activation of many muscular groups during this exercise, there is little research work on the activation pattern of muscles while squatting. In this regard, some researchers propose that there be different activation patterns while squatting in different hip positions. The purpose of this study was to show whether hip position can alter electromyographic(EMG) activity of vastus medialis, vastus lateralis, adductor magnus, and biceps femoris muscles. Patients & Twenty non-athletic healthy females participated in this experimental descriptive study. They were asked to make parallel squat moves in three different positions namely abduction, adduction, and neutral. While exercising, EMG signals associated with the above-mentioned muscles were recorded and parameters of normalized EMG were analyzed using ANOVA(repeated measure). The findings showed that there was no significant difference between EMG patterns recorded in different positions of squatting. It is concluded that in strengthening programs for rehabilitation purposes, hip position has no specific effect on any of different muscles tested in this study and all are strengthened equally.

Infertility is a relatively common problem, the prevalence of which is reported to be one in six couples. Among female factors, ovarian and tubal factors which are treatable are the most important ones. Laparascopy is the golden test for evaluation of fallopian tubes but because of its expensiveness, the necessity of general anesthesia and other problems, hysterosalpingography has been suggested as the screening test. The aim of the study was to assess the prevalence of fallopian tube abnormality in patients with primary and secondary infertility using hysterosalpingography. Patients & In this case-control study 50 subjects were randomly selected from groups of primary and secondary infertility patients who were referred to the radiology department of Ghods Hospital for hysterosalpingography. After excluding pregnancy and genital infection, the patients underwent hysterosalpingography between the sixth and eleventh days of the menstrual cycle and the results were registered in proper forms. Uterin abnormality was found in 10 patients(20%) with primary infertility, 7 of whom(14%) were related to fallopian tubes. 22 patients(44%) with secondary infertility were seen to have fallopian tube pathology. Acquired results were analysed. Using SPSS software(version 10) and t-test, a statistically significant difference in the prevalence of fallopian tube pathology was observed between the two groups(P<0.001). Fallopian tube abnormalities are more common in patients with secondary infertility. Considering the fact that pelvic inflammatory disease is the most common predisposing factor, on time diagnosis of genital infections, health care improvement and increasing the knowledge of society seem to be necessary.

Alveolar soft part sarcoma is a malignant soft tissue tumor whose metastasis to other organs like lung and brain as a primary presented symptom is not unusual. In the literature there are many reports of metastasis to different parts of brain, but cerebellar metastasis has not been reported yet. In this case study, we discuss a rare occurrence of simultaneous metastasis to brain and cerebellum as a primary presented symptom. Case Report: An 18-year-old woman who was referred due to nausea, vertigo, a severe headache, and blurred vision underwent craniotomy for the resection of brain tumor. Pathologic diagnosis was alveolar soft part sarcoma with metastasis to brain and cerebellum. However, metastasis of this type of sarcoma to cerebellum is considered rare and has not been reported yet.

Postoperative nausea and vomiting(PONV) is a common problem after surgery. Apart from increased patient dissatisfaction, PONV may lead to serious complications including disruption of surgical incisions and anastomosis, electrolyte imbalance, and delay in postoperative rehabilitation. The purpose of this study was to evaluate acupressure as a nonpharmacological alternative for the prevention of PONV in patients undergoing adenotonsilectomy. Patients & We conducted a prospective, randomized, clinical trial to assess the efficacy of acupressure band in prevention of PONV after adenotonsilectomy. The band was placed on patients’ wrists after establishing invasive monitoring and before induction of anesthesia. In the band group, spherical beads of the acupressure band were in contact with the P6 point, which is located on the anterior surface of the forearm, 2 inches proximal to the distal wrist crease between the tendons of flexor carpi radialis and palmaris longus muscles. In the control group, an identical band with a head was placed in the opposite position. Patients with a previous history of congenital heart disease, severe pulmonary dysfunction, prolonged duration of operation due to the complication of anesthesia or surgery, and vomiting during operation were excluded from the study. A standard track for adenotonsilectomy anesthesia was employed. Postoperative pain relief was achieved with acetaminophen and standard pharmacological treatment of nausea and vomiting was applied. Data collection was performed within 6 hours after surgery. 177 children ranging 5 to 10 years were studied in two groups(case-control). 22(24.7%) out of 89 patients in the case group presented with PONV, while 49(55.7%) out of 88 patients in the control group did so. There was no difference between the two groups with respect to demographic data, surgical characteristics, and analgesic requirements. Numerical and categorical data were analyzed by comparing two proportions(z-test) between two independent populations. Data was recorded as number of patients in percent. A Pvalue of less than 0.05 was considered statistically significant. Acupressure is a simple, noninvasive and cost-effective method in prevention of PONV and has been used successfully in different patient populations. Although in one study on the effects of acupressure on PONV in 100 patients undergoing adenotonsilectomy there was no significant difference between the case and control group, we found out that inter-group difference with respect to PONV was approximately 30%, which is suggestive of statistical significance(Pvalue<0.001). In conclusion, we recommend that acupressure be applied to decrease PONV after adenotonsilectomy.

Hexokinase type I is the most predominant form of the enzyme in brain. It binds reversibly to the outer mitochondria membrane. In normal condition the major part of the enzyme binds to the membrane. Membrane bound form of the enzyme is more active than the soluble form, so this is more a control mechanism of the enzyme activity. Those metabolites that affect the binding or releasing of the enzyme from the mitochondria have regulatory effect on glucose consumption of the cell. Since an increase in phenylalanine and its metabolites causes mental retardation in patients with phenylketonuria, we have studied the effects of these metabolites on the activity, binding and releasing of the enzyme to determine the destructive effect of these metabolites in relation to glucose metabolism in brain. This investigation was an experimental study in which hexokinase activity was determined spectrophotometrically by using G6PD(Glucose-6-Phosphate Dehydrogenase) coupled assay. The results show that phenylpyruvic acid decreases the enzyme activity in bound and soluble forms and increases the release of the enzyme from mitochondria whereas phenylalanine and phenyllactic acid have no effect on the enzyme activity, release and rebinding. It is possible that phenylpyruvic acid causes the reduction of glucose consumption by decreasing hexokinase activity. Therefore, ATP(Adenosine Triphosphate) production declines in brain cells.

Myelolipoma is one of the rare benign nonfunctioning tumors of adrenal gland that is often diagnosed incidentally or during autopsy. This tumor is usually small, unilateral and causes no clinical disorders but there have been some cases coexisting with endocrine disorders. Case Report: The present study reports two patients who underwent adrenalectomy with the clinical impression of incidentaloma in Hashemi-Nejad Hospital. Microscopic evaluation of both specimens revealed mature fat tissue admixed with islands of hematopoietic cells, which was diagnosed as myelolipoma.

Diabetic neuropathy occurs in approximately 50% of individuals with long-standing type I and type II DM(Diabetes Mellitus). The pathology of diabetic neuropathy involves oxidative stress, advanced glycation end products, polyol pathway flux, and protein kinase C activation.The purpose of this study was screening for diabetic neuropathy and analysing the relation between HbA1C and diabetic neuropathy. This descriptive-analytical study was carried out by means of interview, questionnaire, HbA1C testing, neurologic physical exams, and EMG(Electromyography) in Imam Reza Hospital in Urmia. 30 diabetic patients aged between 40 and 65 took part in the study. We investigated the effects of DM on peripheral nerves. 20% of the patients had HbA1C less than 7.5%, 14% between 7.5% and 9.5%, and 66% more than 9.5%. 23% of the whole study group were asymptomatic, with no complaints of paresthesia. Among these patients 57% were in the group of good control of DM with HbA1C less than 7.5% and 43% were in the group of intermediate control of DM with HbA1C between 7.5% and 9.5%. The rest of the patients(77%) were symptomatic and included 8% with HbA1C less than 7.5%, 18% with HbA1C between 7.5% and 9.5%, and the rest of them(74%) were in the group of poor control of DM with HbA1C more than 9.5%. Electroneurophysiologic exam that was performed on the whole study group revealed that 43.5% of the patients had sensory polyneuropathy and 36.5% suffered from sensory-motor polyneuropathy. All the patients with sensory-motor polyneuropathy were in the group of poor control of DM with HbA1C more than 9.5%. Considering the findings, control of blood glucose level near the normal range with acceptable amounts of HbA1C will reduce the intensity of diabetes - related neuropathy.

Epidemics of measles are still continuing in developing countries especially Iran. For this reason, ministry of health provided mass vaccination for all persons between the ages of 5 and 25 in 2004. The aim of this study is to determine the prevalence of antimeasles antibody in military students after vaccination. Patients & This cross-sectional study was carried out, one month after mass vaccination, on 865 military students who had vaccination cards in the capital city of Tehran in 2004. Demographic information included age, history of measles vaccination and past history of measles or close contact. Blood samples(5 cc) were taken from each student and were assayed for antimeasles antibody by ELISA kits manufactured by Enzygnost Behring of Germany. Qualitative level of antibody was determined by cut off OD and quantitative level by MIU/ml as per WHO orders and kit formula. SPSS software was used to analyze the data. All participants of the study were men with a mean age of 19±1.1 SD. More than 586(67.7%) of students had been vaccinated in their childhoods, 34(3.9%) had close contact with measles cases and 27(2.7%) had positive history of measles. Antimeasles antibody was positive for IgG in 97.8% and for IgM in 0.8% of the cases. Only 19(2.2%) of students were negative for IgG and IgM. It was noticed that 2.2% of the students did not have any antimeasles antibody, which puzzled us why some students suffered from lack of the synthesis of antibody. Therefore, further evaluation of this issue is recommended.

Pregnancy termination in cases with unripe cervix is a problem for obstetricians and finding a way to ripen the cervix in order to get a better response to the induction of labor is ideal. The aim of the present study is to make a comparison between extra-amniotic normal saline solution infusion per se and combined with dexamethasone for cervical ripening and labor induction. Patients & A double-blind randomized clinical trial was performed in Akbarabadi Hospital in Tehran between March 2002 and 2003. The subjects were 84 pregnant women with gestational age of 40 weeks or more, Bishop score≤5, single cephalic presentation, and intact membrane who had been admitted for termination of pregnancy. They were randomly assigned to two groups. 41 cases received dexamethasone(20 mg) plus extra-amniotic saline solution infusion(EASI) and for 43 patients EASI alone was prescribed. 6 hours after EASI, labor induction was started by oxytocin. Then the progress of labor was followed and compared in both groups. There was no statistically significant difference between the groups according to age, parity, gravidity, and primary Bishop score. From 84 patients, 75 cases entered the active phase of labor. They included 38 patients(88.37%) in EASI group and 37 patients(90.25%) in combined group but the difference was not significant. The duration between oxytocin infusion and delivery time was 7.25±2.86 hours and 9.76±3.91 hours in combined and EASI groups respectively, which showed a statistically significant difference(P=0.002). There was also no significant difference between the two groups according to cesarean section rate, meconium passage by fetus, neonatal Apgar score, birth weight, and need for NICU(Neonatal Intensive Care Unit). However, there was a statistically significant negative relation between gravidity and the interval between oxytocin induction and delivery(P=0.001, r=-0.474). Extra-amniotic saline solution infusion is a suitable and inexpensive method for cervical ripening and labor induction and adding dexamethasone to it can shorten the duration of labor without any significant risk for mother or her fetus.

Iron deficiency anemia(IDA) is the most prevalent nutritional problem in the world, particularly among children and females of reproductive age in developing countries. IDA alters brain biochemistry and function with possible irreversible damage at the cellular and neuronal levels. On the other hand, the effects of iron deficiency may vary depending on age and as a result different neural responses can be received. The objective of this study was to investigate the effect of iron therapy on cognitive function in women with IDA who were referred to educational clinical centers of Iran University of Medical Sciences in 2003. Patients & In this clinical before-after treatment trial, 42 women aged 18 to 49, who were known as cases of IDA according to WHO criteria(Hb<12g/dl, Hct<36%, MCV<82 fl, MCH<26pg, and MCHC<32g/l), were selected. The effect of iron therapy was assessed by hematological, biochemical(serum iron and ferritin, TIBC=Total Iron Binding Capacity, and TS=Transferin Saturation) and cognitive tests which were done before treatment started and repeated after the intervention. We used four tests of so called Wechsler Memory Scale-Revised as assessment of cognitive function. The dietary iron intake was evaluated before and in the fourth and eighth weeks after iron therapy using a 24-hour food recall. The data were analyzed using Nutritionist IV and SPSS software. Post intervention hematological and biochemical measures of iron status improved noticeably(P<0.001). Dietary iron intake was 28.8 mg/d, which did not change considerably before, during and after iron therapy. Figural memory, Digits Span, Verbal Paired Associate, and Visual Reproduction scores (34.5%, 43.3%, 43.7% and 27.2% respectively) increased significantly after intervention(P<0.001). There were positive correlations between an increase in Hb and figural memory(P<0.05, r=0.31), Hct and figural memory(P<0.05, r=o.32), and MCH and Digits Span(P<0.05, r=0.33). These findings show that iron therapy in iron deficient women improves their memory, but further studies are required to assess physiological and psychological causes.

Neuroendocrine carcinoma is one of the neoplasms of neuroendocrine system which involves organs sparing of APUD cells. The most common sites of this carcinoma are gastrointestinal and pulmonary system. From a histologic standpoint, these tumors are reactive to silver stains and specific markers like NSE(Neuron Specific Enolase), synaptophysin, and chromogranin A. Case Report: A 74-year-old woman with a complaint of 6-month nasal stuffiness, epistaxis, anosmia, and hearing loss was referred to the hospital. In her nasal examination, a vascular polypoid mass in nasopharynx was noticed. CT-scan showed a homogeneous, isodense mass in nasopharynx without bony erosion. After confirming the diagnosis of carcinoid tumor using specific markers and special stains, there are some factors to predict its malignancy. Systemic chemotherapy(esp. cisplatin & etuposide) is effective to treat malignant neuroendocrine tumors especially aggressive variants. Radiotherapy has palliative effect.

Hydatid disease remains a health problem for Mediterranean and Far Eastern countries such as Iran. Living in rural or suburban areas is an important risk factor for the disease. These cysts are usually located in the liver, lung, and brain and mediastinal hydatid cysts are rarely found. The objective of this investigation was to present a very rare and nearly unique case of mediastinal hydatid cyst with invasion to right brachiocephalic vein. The patient underwent an operation successfully. Case Report: A 37-year-old female who was complaining of exertional dyspnea underwent an operation with the diagnosis of mediastinal hydatid cyst. Surgical approach was midsternotomy and because of the above-mentioned invasion, brachiocephalic vein was injured during dissection. However, the vein was repaired with a pericardial patch during the second operation and resulted SVC(superior vena cava) syndrome was resolved too. No recurrence was seen in a period of 6 month follow-up. Primary hydatid cysts of the mediastinum are distinct clinical entities that should be considered in a patient with a mediastinal mass who lives in endemic regions and because of surrounding vital structures, the cyst should be removed surgically without delay.

Maternal steroids modulate various functions in the brain. However, tamoxifen(TAM) treatment, as an estrogen antagonist, induces cell death in the hippocampus formation of a prenatal and postnatal rat. Estrogen influences cognitive functions, learning process, aging, vasodilation, angiogenesis, neurogenesis and neuroprotection. The present study deals with the effects of tamoxifen on ultrastructure and morphology of developing hippocampus in rats. In this experimental study, we examined twelve bands of rats in three groups of control, experimental and sham. In each group, there were four age ranges: full-term embryo(E22), one-day newborn(P1), seven-day newborn (P7), and three-week newborn(P21). Full-term animals received four doses of tamoxifen in propylene glycol and their brains were removed 6 hours after the last injection. We studied hippocampal regions such as CA1, CA3, D.G. and subiculum through light and electron microscopy. Statistical significance of the differences was assessed by ANOVA and t-test using SPSS program. A value of P<0.05 was considered significant. The obtained findings reveal a decrease in the density of cells in various regions such as CA1 and subiculum. Electron microscopy showed pyknosis, increased nucleus density, chromatin clumping, mitochondrial inflammation and changes in mitochondria crista, mostly in CA1 and subiculum. Maximum changes have been seen in E22 and P1 groups. Considering the effect of estrogen on neurogenesis, tamoxifen injection can bring about changes in hippocampal pyramidal cells. The novel finding of this study is the difference in the density of cells at various stages of development. Also, the results show that tamoxifen effects on full-term embryos and one-day newborns are significantly great.

Magnetic resonance imaging(MRI) in the coronal plane before and after contrast is currently considered to be the most specific and sensitive technique for imaging pituitary gland. However, because of the false negative results of this method in the detection of pituitary microadenomas and the importance of finding these microadenomas, infundibular deviation or tilt in MRI is used to support the existence of pituitary microadenomas. This study was performed to determine the frequency of this tilt as a normal variant in adult Iranian population with no pituitary disease and to establish a normal base to facilitate the assessment of pituitary gland in neuroendocrine diseases and the detection of microadenomas. This study was a cross-sectional observational prospective survey performed on coronal brain MRIs of 60 patients who had been examined for reasons other than pituitary disease in Hazrat – e – Rasoul Hospital from March until September 2004. The obtained data concerned sex, age, existence and type of infundibular tilt. 40% of the studied population had infundibular tilt of normal pituitary gland in MRI as a normal variation. This tilt was due to the lateral eccentricity of normal pituitary gland in relation to the midline of the brain in 26.7% of the above-mentioned cases and due to the eccentric insertion of pituitary stalk off the midline of the normal gland in the other 13.3%. There was no significant relationship between existence and type of infundibular tilt of normal pituitary gland in MRI and sex and age. There was no significant difference in the frequency of infundibular tilt between Iranian population with no pituitary disease and the American study group. Therefore, with respect to the high frequency of stalk deviation of normal pituitary gland in Iranian population, such displacement should not be used by itself to support the presence of pituitary microadenoma in MRI.