Iranian Journal of Medical Sciences
Volume:32 Issue: 2, Jun 2007

Abstract More than 45,000 of 100,000 exposed patients are suffering from late effects of sulfur mustard (SM) after almost 20 years post-exposure. Respiratory complications of SM exacerbate over time and are the greatest cause of long-term disability in exposed patients. A triad of cough, expectoration and dyspnea has been found to be the main symptoms among patients. Even those who had not developed acute symptoms may suffer from late respiratory complications. Pulmonary function test studies have revealed more obstructive patterns than restriction. High-resolution computed tomography (HRCT) is supposed to be the diagnostic imaging tool of choice in patients with history of SM exposure while chest x-ray may not be helpful. In contrary to earlier reports of interstitial pulmonary fibrosis in these patients, HRCT and pathological studies revealed the diagnosis of bronchiolitis obliterans. Bronchodi-lators and corticosteroids are widely used to resolve respiratory symptoms of mustard lung. Macrolides and antioxidants may improve respiratory symptoms and pulmonary function. Interferon gamma could improve pulmonary function of SM exposed patients with bronchiolitis.

Abstract This is a case series of 76 knees of 62 patients who underwent upper tibial valgus osteotomy for treatment of medial compartment osteoarthritis during a 20-year period and who were followed for a mean of 7.6 years. The patients were evaluated by validated outcome assessment systems of general health status short form (SF-36), the Western Ontario McMaster osteoarthritis index (WOMAC), McMaster Toronto arthritis patient preference questionnaire (MACTAR) and also knee society clinical rating system (KSS). Two control groups—one consisting of 60 patients with similar age with osteoarthritis who had not received any surgical treatment and another 60 patients who had received knee replacement for osteoarthritis—were also studied. The results were compared among these three groups. Results/ Tibial osteotomy caused improvement in SF-36 and WOMAC scores compared to the non-operated control group, but it did not do so when it was compared with knee arthroplasty. The mean±SD KSS was 103.37±12.19 with a failure rate (defined as candidacy for knee arthroplasty) of 28.94%. Improvement in patients’ pain level, social activity, housework activities and self-esteem was observed. Stair navigation, surface walking, getting on and off a car were not significantly better than the non-operated group.

Abstract In this study, we compared the efficacy and safety of propofol and midazolam in treatment of children’s refractory status epilepticus. We recruited 32 patients with refractory status epilepticus. Of those, 16 were treated primarily with midazolam and 16 received propofol. We achieved complete seizure control in 6 (38%) patients treated by midazolam, and in 10 (63%) of 16 patients receiving propofol. After drug withdrawal, seizure recurred in 2 of 6 children who had complete seizure control with midazolam and in 2 of 10 patients who were successfully treated with propofol. Overall treatment with propofol failed in 4 (25%) patients, while in the midazolam group, the failure was 50%. Complications in the midazolam group consisted of bra-dycardia which led to cardiac arrest in one patient who fortunately recovered following cardiopulmonary resuscitation, and rise in serum creatine phosphokinase in another. Untoward reactions seen in the propofol group included elevated serum creatine phosphokinase in 5 patients and dyslipidemia in another 5. Untoward reactions in children who received propofol consisted of rise in serum creatine phosphokinase in 5 and increase in serum triglyceride and cholesterol in 5 patients. No significant change was observed in the frequencies of apnea, hypotension, sepsis, electrolyte imbalance and median duration of stay in intensive care unit between the two treatment groups. Propofol, if used appropriately, can quickly and effectively terminate episodes of refractory status epilepticus in children.

Use of botulinum toxin is becoming a popular way in treatment of some forms of strabismus.To evaluate the morphological changes in the orbital surface layer muscles of the rabbit eye following a single injection of botulinum toxin. 10 white Dutch rabbits weighing 2–3 kg received either 10 units (group 1; n=5) or 20 units (group 2; n=5) of botulinum toxin into the superior rectus muscle of right eye. The superior rectus muscle of the left eye in each rabbit was considered as control. The diameter of at least 20 muscle fibers of the orbital layer of the superior rectus muscle was measured with an ocular micrometer on histological sections after extirpation 2 and 10 days, and 4, 8 and 12 weeks after the injection. Marked decrease in size of muscle fibers was observed, especially on 2 and 10 days post-injection. It was more sever in animals which received 20 units of the toxin. In both groups, between 4 and 12 weeks after injection, the size of some fibers returned back to normal; rarely, the fibers became hypertrophic while atrophic changes were still present. Hypertrophy of neuromuscular end-plate was seen accompanied with atrophic changes. Fibrosis around the muscle fibers was rarely seen. Injection of botulinum toxin into extraocular muscles causes atrophic changes which seems to be more severe with higher doses. The effect of botulinum toxin has been persisted up to 8 weeks.

Abstract Some patients with respiratory failure who are in need of mechanical ventilation require sedation to tolerate the inserted endotracheal tube (ETT) and other unpleasant stimuli. While a light sedation is satisfactory, deep sedation can interfere with the weaning process of patient from me-chanical ventilator. Nevertheless, so far, the ideal regimen for sedatives and analgesics has not been found. We evaluate the effect of intratracheal administration of lidocaine for sedation of patients under mechanical ventilation. In a double-blind randomized clinical trial, 50 patients aged 33–65 years who had no obvious brain injury, in need of mechanical ventilation were enrolled into this study. They were randomized into two groups; the treatment group received 2.5 mL of 2% lidocaine, and the control group received 2.5 mL of normal saline via ETT each two hours for 12 h under sterile conditions. The baseline sedation was maintained with morphine, midazolam, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout the entire study. During 12 h of the study, the mean±SD total morphine and midazolam requirements were 7.13±0.96 and 4.65±1.15 mg, respectively, in the treatment group, and 11.08±0.77 and 6.37±1.17 mg, respectively, in the control group. There was a significant (P<0.05) reduction in the requirements for both drugs during the study in the treatment group as compared to the control group. Intratracheal administration of lidocaine significantly reduces sedative requirements in intubated patients during 12 h. In the short-term, no side effects or complications were observed.

Abstract The electrical dose selected for electroconvulsive therapy (ECT) must have an acceptable efficacy and no or minimal cognitive side-effects. We evaluated the clinical efficacy and cognitive side-effects of ECT in relation to the stimulus dose administered. This study assessed 71 depressed patients who were treated with bilateral ECT. For evaluation of depressive and cognitive states the mini-mental state examination (MMSE) and Hamilton scale for depression (HAM-D) were used before starting ECT and after the fourth and last sessions. The baseline mean MMSE was significantly (p=0.005) different with that evaluated after the fourth (p=0.005) and the final (p=0.002) sessions among the four groups receiving various doses of ECT. The mean Hamilton score did not change significantly over the study. No decrease in cognition was observed with employing higher doses (224–345.6 mc) of ECT compared to lower doses. The rate of improvement did not change significantly among the studied groups. Cognitive function does not decreased with higher doses of ECT (224–345.6 mc) as compared to the other groups. The rate of improvement does not differ with the stimulus dose administered.

Abstract Anabolic-androgenic steroids are used at high doses by athletes for improving athletic ability, physical appearance and muscle mass. Therefore, the abuse of these steroids has been significantly increased. Many undesirable side effects of these steroids on the male reproductive function have been reported, however, little is known about their effects on sexual behavior and tissues of the reproductive system. The aim of this study is to identify the effects of anabolic-androgenic steroids on the body, testis and epididymis weight, as well as semen parameters. Five groups of Sprague-Dawley adult male rats (n=72) were used. Two experimental groups were medicated with intramuscular injection of 3 and 10 mg/kg body wt/wk of nandrolone decanoate and two vehicle groups with same doses of sweet almond and olive oils, respectively, for 14 weeks. The control group received no injection. One week after the last injection, rats were sacrificed and the weights of the body, testis and epididymis and also semen parameters were assessed. The weights of testis and epididymis, as well as, sperm count and motility rate were significantly decreased in experimental groups than in the vehicle and control groups. Morphologically abnormal sperms were observed. We found that anabolic-androgenic steroids affect fertility parameters and cause testis atrophy.

Abstract Rotavirus is a major cause of morbidity and mortality among children with gastroenteritis. Since the discovery of rotaviruses, several techniques have been used for their laboratory diagnosis; those included Electron Microscopy (EM) and enzyme immunoassay. These methods, however, are expensive and not readily available everywhere. We have developed a technique which can be used for routine diagnosis of rotavirus gastroenteritis. Purified simian rotavirus, SA11, was injected into rabbits and the γ-globulin fraction of antisera was purified and used for coating of latex beads. The prepared sensitizied latex was then used for agglutination test on fecal samples. 94 stool samples from infants with acute gastroenteritis were tested by (EM), enzyme immunoassay and Latex Agglutination (LA) method. The sensitivity of enzyme immune assay and (LA) were 92.5% and 90%, respectively; the specificity of both tests was 98.1% as compared with (EM). Latex Agglutination Test (LAT) is a simple and relatively inexpensive test which can be used for diagnosis of rotavirus gastroenteritis in diagnostic laboratories and health centers.

Abstract Dermatoglyphics are the dermal ridge configurations on the digits, palms and soles. Dermatoglyphic polymorphism results from the co-operation of genetic and environmental factors. The Dermatoglyphic analysis is a valuable completion of initial diagnosis of some syndromes genetically determined. Our objective was to assess dermatoglyphics study results against standard chromosomal analysis in Down and Klinefelter syndromes. In this study we applied clear plastic tape and graphite powder for finger and palm prints of 90 persons. Cytogenetic study was also performed for patients with Down (n=29) and Klinefelter (n=22) syndromes and 39 normal individuals who served as the control group. Dermatoglyphic investigations indicated that in Down syndrome, simian line, ulnar loops, whorl, t'', t'''' and t'' were significant, whereas arch and interdigital III pattern were more indicative for Klinefelter syndrome. Dermatoplyphic can be used both as an initial diagnostic step and for screening purposes.

Abstract Behçet’s disease is a vasculitis with multi-organ involvement. Our knowledge of the psychological aspects of Behçet’s disease is very limited. 40 women and 24 men who fulfilled the International Study Group (ISG) criteria of Behçet’s disease were selected from Behçet’s Disease Clinic of Nemazee Hospital Shiraz, South of Iran. Controls consisted of 65 healthy volunteers. Both patients and controls completed SCL-90R questionnaire. Scores of somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideations and psychoticism were compared between cases and controls. Patients with Behçet’s disease had significantly (P=0.04) higher global severity index of SCL-90R in comparison to controls. The patient group also had significantly higher scores for aggression (P=0.03), anxiety (P=0.04) and somatization (p=0.00) than controls. It is concluded that SCL-90R is a useful tool for evaluation of the psychiatric status of patients with Behçet’s disease.

Abstract Evaluation of trends in the rate of infectious diseases of blood donors is essential for monitoring safety of blood supply and effective screening of donors. Transfusion records of blood donors who attended the Center between 2002 and 2005 were reviewed for positive cases of HBS (by ELISA), HIV (by Western Blot) and HCV (by ELISA). During 2002–05, 507,531 persons donated blood. The prevalence rates of HIV in 2002, 2003, 2004 and 2005 were 0.019%, 0.008%, 0.007% and 0.009%, respectively; the respective values were 0.57%, 0.52%, 0.53% and 0.53%, for HBS; and, 0.19%, 0.13%, 0.09%, and 0.16%, for HCV. The prevalence of HIV was higher in 2002 (p≤0.05). Then, it decreased, but remained constant over the following years. The prevalence rates of HBS, HCV and HIV were significantly (P<0.05) higher in the first-time, male and married blood donors. The values did not correlated with age of blood donors. The prevalence of transfusion-transmissible viral infections in Shiraz blood donors is less than normal population and did not change over time. This might be due to effective donor selection and the lower prevalence rate of these infections in donor population.

Abstract Hydatid cysts are known to occur in most organs especially in the endemic areas. However, its occurrence in uterus is extremely rare and it mostly occurs as a secondary involvement. Herein we reported on a 25-year-old woman with primary involvement of the uterus and left fallopian tube. The patient presented with a colicky abdominal pattern and fever and was admitted to the Emergency Ward.

Abstract A 21-year-old woman presented with a painless growing mass in her right flank since 5 months before. With the probable diagnosis of a cold abscess, the patient was operated, but the wound was not cured. The patient was re-examined and a biopsy from the lesion was taken which revealed hydatid cyst. After nearly complete excision of the infected area and adjuvant chemotherapy with albendazole for 6 weeks, no recurrence was seen until 14 months after the operation.

Abstract Herein, we reported on a middle-aged woman presented with painless cervical lymphadenopathy. Past medical history was not significant. Pathologic examination of incisional biopsy show partial effacement of lymph node architecture with many reactive inflammatory cells admixed with Reed-Sternberg cells, many Charcot-Leyden crystals, and noncaseating granuloma. Immunohistochemical staining was positive for the classic Reed-Sternberg cells for CD15 and CD30 and was negative for CD45 and CD20. All these findings confirmed the diagnosis of Hodgkin''s lymphoma. Charcot-Leyden crystals, is considered a morphologic hallmark of eosinophil-related diseases. However, to the best of our knowledge, only one case of Hodgkin''s lymphoma has been reported in the world litera-ture who has had Charcot-Leyden crystals.

Abstract A 28-year-old man presented with a chest radiograph strongly suggestive for cardiomegaly. Although he did not consent any hemodynamic studies, cardiomegaly was ruled out on the basis of the clinical course. Computed tomography showed the existence of a large mass in both sides of the heart and in both lower hemithoraces. The tumor was resected by anterior mediastinotomy; it was weighted 2100 g and measured almost 35×25×6cm. Histopathologic examination revealed thymolipoma.