مجله علوم پزشکی رازی
سال چهاردهم شماره 4 (پیاپی 57، زمستان 1386)

Gallstone disease or cholelithiasis is the most prevalent disorder of the biliary system and a major costly health problem throughout the world. Over the past two decades, a great deal has been learned about the epidemiology of and risk factors for gallstones and ultrasonography has played a major role in this process. However, the prevalence and epidemiologic features of gallstone disease has changed due to revolutionized life styles. Therefore, this study was performed to determine the prevalence and epidemiologic features of gallstone disease among hospitalized patients in Rasool-Akram hospital. Patients and This cross-sectional study was performed on 1312 hospitalized patients in Rasool-Akram hospital from 2000 to 2004 who had undergone gallbladder and biliary duct ultrasonography. 420 patients had gallstone which were evaluated for demographic variables, symptoms and laboratory findings. The data were collected, described and analyzed using SPSS v.13 software. Chi Square was performed during analysis. The prevalence of gallstone in this study was 32%(420 of 1312). Among these 420 patients, 316(75.2%) were females and 104(24.8%) were males with the mean age of 58.21yr.(SD=14.3). The most common symptoms were abdominal pain in right upper quadrant (RUQ) in 67.9%, nausea and vomiting in 59.8%. There was a significant association between age group of the patients and both site of gallstone and pain in RUQ (P=0.001 and P=0.000, respectively). The results of our study showed the higher prevalence of gallstone disease in women and ages between 55-74 years. Also there was relation between site of stone with RUQ abdominal pain and patients age. In addition, the site of gallstone was mostly in gallbladder among younger patients whereas, it changed to biliary duct in older individuals.

Levels of lactic dehydrogenase(LDH) in the cerebrospinal Fluid(CSF) have been used to evaluate a variety of neurologic disorders. However, few studies have been performed on neonates. The aim of this study was to detect levels of this enzyme in normal neonates. Patients and In this descriptive study, CSF samples were collected from 94 febrile infants 46 aged 0-4 weeks and 48 aged 5-8 weeks. These LDH levels were compared to those of 45 febrile infants with mean age of 10±6/2 months who were suspected of nervous system infection and normal CSF findings. Mean total LDH activity in the CSF was significantly higher in the first month of life than in the second month of life as compared with the control group(p<0.001). We propose evaluation of total LDH activity in CSF of normal neonates according to age.

Rhabdomyosarcoma is the most frequent soft tissue tumor in children with prevalence of 5-8% among childhood cancers. The survival of patients are related to some factors such as primary site of tumor, histology, stage of disease, early diagnosis and treatment. The survival rate of these patients has significantly increased since the 1970s. Considering the variety of reports and studies in this regard, we evaluated the 5-10yr. survival rate in this group of patients. Patients and This is a retrospective cross sectional survival analysis study that has been carried out on 77 children up to 15 years of age with Rhabdomyosarcoma who were admitted in the hematology and oncology wards of AliAsghar children Hospital from 1993-2003 and were evaluated in regard to age at time of admission, pathology, stage of disease, primary site, type of treatment received and it's relation to survival rate. For analysis SPSS version 11.5 software was used. For determination of survival rate Kaplan Meire method and for evaluation of factors affecting it cox regression was used. P value<0.05 was considered statistically significant. The mean age of cases was 6.58 years with SD=4.02, males 60%, females 40% and mean survival time of cases was 8 years(95% CI: 8-9). The 5 year survival in stage I was 85.82%, stage II 86.88%, stage III 64.68% and stage IV 20%. The survival rate in tumor histology was embryonal 86.7%, and alveolar 48%. In regard to primary site of tumor orbit 94%, genitourinary tract 85.71%, parameningeal 57% and in extremity was 58%. Overall 5 and 10 year survival rates were 79.54% and 77.92% respectively. Like other studies, children with lower stages of rhabdomyosarcoma, embryonal histology, orbital and genitourinary as primary sites had better survival. Poor prognosis was associated with metastatic disease at the time of presentation, alveolar histology and tumors of extremity. Children who survived the first 5 years after diagnosis had relatively longer survival and better prognosis 5 and 10yr. survival rates were 79.54% and 77.92% respectively.

Osteoarthritis is the most common joint disease among all the joints. It is one of the major agents of physical disabilities. Degenerative changes of the joints begin from second decade of life. Ninety percent of people have degenerative changes at 40 years of age in weight bearing joints. Osteoarthritis is common in spinal joints especially cervical spine, because of its high mobility. The aim of this study was to determine the effects of sustained mechanical traction in patients with mild and moderate cervical osteoarthritis and compare the results with a control group. Patients and A clinical trial study was conducted in the physiotherapy clinic of faculty of rehabilitation sciences. Patients with mild and moderate cervical osteoathritis were randomly assigned in control and experimental groups. Patients in control group received a routine physical therapy protocol for cervical osteoarthritis, that included superficial heat (hot pack), conventional TENS, exercise for neck and shoulder girdle muscles. Patients in experimental group received a routine physical therapy protocol plus sustained traction. Each participant was evaluated four times: immediately before the 1 st treatment session, at the 5 th treatment session, the last treatment session and 2 weeks after treatment. Intensity of the neck pain, range of the neck motions, sleep disorders and rate of medicine taking were main variables of this study. Cervical pain and mobility improved in both groups(P<0.0001). There was a significant statistical difference in improvement of cervical pain and mobility between control and experimental groups patients in experimental group showed greater improvement. There was a significant statistical difference in pain reduction between two groups in fourth evaluation(P<0.004). Based on the results it can be concluded that application of the mechanical traction in patients with mild and moderate cervical osteoarthritis is useful. It helps in the improvement of cervical pain and mobility and decreases the need of patients to take medicine(NSAID).

Tolerance to the semi-allogenic fetal graft by the maternal immune system is a medical enigma that has stimulated investigations for a half of century. Several hypotheses have been proposed to explain the tolerance of mother to the fetus. The successful pregnancy is proposed and proved by many scientists to be a Th2 dominant phenomenon. This hypothesis is proved in most aspects of feto-maternal interface, but systemic effects of pregnancy on immune system, are controversial. Dendritic cells (DCs) are the most potent activators of naïve T lymphocytes capable of tolerance induction as well as immunity. These cells can influence Th cell differentiation, by inducing Th1 or Th2 responses as well. Therefore DCs are one of the probable candidates which mediate immune regulation during pregnancy. The aim of this study was to determine if pregnant mouse serum has any effect on DCs’ functional capacity to stimulate antigen specific proliferation of T lymphocytes and their cytokine profile. In this experimental study, mid-gestational sera were obtained from allogenic pregnant Balb/c mice (Balb/c C57BL/6) on days 9-11 of gestation. DCs were purified from Balb/c mice spleens through a three steps method including collagenase digestion of spleen tissues, selection of low-density cells by Nycodenz density gradient medium and plastic adherence. The purity of DCs was determined by flowcytometry, using anti CD11c antibody. DCs were pulsed with Conalbumin as a foreign antigen during overnight culture. In some cultures pregnant mouse sera were added at 2.5% final concentration. Two other groups of DCs were treated with normal mice sera and FBS, respectively. Antigen pulsed DCs were injected in to mice palms. Draining lymph node cells of immunized mice were cultured in presence of Conalbumin after 5 days and their proliferation was measured by 3H-thymidin incorporation method. IFN- and IL-10 production by stimulated T cells was also measured in their culture supernatant using sandwich ELISA. The results were analyzed using non-parametric Mann-Whitney test. Our results showed that normal serum-treated, antigen-pulsed DCs induced a strong proliferative response of T cells and high levels of IFN- and IL-10 production. However, treatment of DCs with pregnant mouse serum markedly blocked their ability to induce antigen-specific lymphocyte proliferation. IFN- and IL-10 productions were also decreased by lymph node cells of mice injected with pregnant serum treated DCs. Our results demonstrate that pregnant mouse serum has suppressive effect on DCs capacity to induce antigen specific proliferation and cytokine secretion by T cells. The suppressive effects of pregnant serum can be induced through HLA-G, IL-10, PGE2, progesterone and several other factors, existing mostly at the feto-maternal interface but because of their overflow can be found in the serum as well. However, determination of the exact mechanism underlying this phenomenon needs more investigation.

Propofol is one of the sedative hypnotic drugs used for anesthetizing patients undergoing surgery. This drug is lipid based and therefore long-term infusion of it during prolonged surgeries and in intensive care units has the risk of hyperlipidemia. The aim of the study was to investigate the concentrations of triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein during administration of propofol and comparing it with that of isoflurane in patients undergoing surgeries in operation rooms of Rasool Akram Hospital. Patients and The study was an interventional clinical trial all patients undergoing surgeries in Rasool Akram hospital during the years 2004-5 were enrolled into our study. The patients were randomly allocated to two groups first group taking propofol and second taking isoflurane as anesthetic agent. Lipid profile(triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein) and CRP were checked before, immediately after, and the day after drug administration. For statistical analysis, repeated measurement of ANOVA, Chi square, Paired T-test and Square T-test were used. A total of 97 patients were enrolled into our study, 49 of which took propofol and 48 took isoflurane. The mean operation time was 2.24±0.89 and the mean age of the patients was 38.14±18.99yr. Triglyceride and very low density lipoprotein(VLDL) were the two factors with statistically significant rise after infusion of propofol(P<0.000). Such a change was not detected in isoflurane group this increase was associated with a compensatory decrease the day after operation. Propofol infusion can induce dramatic rises in Triglyceride and VLDL even after short term infusions and therefore special attention must be paid to patients prone to hyper-triglyceridemia and pancreatitis.

Acute appendicitis is one of the most common etiologies of attending of patients with abdominal pain to Emergency Department. In order to diagnose, it, it is necessary to obtain patient's history, and perform physical examination and paraclinical tests that would waste time. Therefore because of the severe abdominal pain in these patients and the fear of some surgeons in giving narcotics (because of missed diagnosis in examination), this research was done to prove the fact that early administration of morphine reduces pain and discomfort of the patients without any disturbance in time and accuracy of diagnosis. Patients and This randomized controlled clinical trial was done on patients who came to emergency department of Hazrat Rasool Akram hospital because of abdominal pain and whose alvarado scores were above 6 and were operated with diagnosis of acute appendicitis. They were divided to 2 groups: double blind group that received 4 mg morphine and placebo group. The time of intervention and diagnosis was noted. Biopsy samples were sent to pathologist for reports. Results were analyzed by parametric tests(t-test and Chi Square) via SPSS software. Overall 200 patients were enrolled in research and divided into two groups who received placebo & morphine. There is no difference inregard to mean of age and distribution of gender between two groups(p>0.05). There is no difference between two groups inregard to percentage of pathology findings(p>0.05). Also the mean duration from our intervention to time of diagnosis of surgery team was not significantly different between two groups(P>0.05). Our research shows that use of morphine does not affect the accuracy and time of surgical diagnosis. Thus it seems that we can use opiate analgesics in patients with abdominal pain, suspected of appendicitis.

Diabetes mellitus accompanies disturbances in learning, memory, and cognitive skills in the human society and experimental animals. There is some evidence for anti-diabetic activity of Vaccinium myrtillus(VM) and the beneficial effect of its fruit on learning and memory in normal animals. Therefore, this research study was conducted to evaluate the effect of chronic oral administration of VM on learning and memory in diabetic rats. In this experimental study, female Wistar rats(n=36) were divided randomly into four: control, VM-treated control, diabetic, and VM-treated diabetic groups. Treatment groups received rat chow containing 6.25% VM with no restriction for 4 weeks. For induction of diabetes, streptozotocin was injected i.p. at a single dose of 60 mg/kg. For evaluation of learning and memory, initial(IL) and step-through latencies(STL) were determined at the end of study using passive avoidance test and alternation behavior percentage was obtained using Y maze. For statistical analysis, one-way ANOVA and repeated measure ANOVA were used for weight and glucose data and Kruskal-Wallis test was used for behavioral parameters. There was a significant increase in IL in diabetic and VM-treated diabetic groups after 4 weeks as compared to control group(P<0.05). Meanwhile, STL significantly decreased(P<0.05) in diabetic group and significantly increased(P<0.05) in VM-treated diabetic group. In addition, STL did significantly change in VM-treated control group in comparison with control group(P<0.05). Alternation percentage was significantly lower in diabetic group relative to control(P<0.05), treated diabetic group did not show a significant difference in comparison with diabetic group, and VM treatment in control group also did not produce a significant difference as compared to control. VM treatment could enhance the capability of consolidation and recall in diabetic animals.

Renal transplantation has established itself as the treatment of choice for the majority of patients with End stage renal failure(ESRF). Arterial stenosis is the most common vascular complication after kidney transplantation, occurring in approximately 4%-25% of transplant recipients. Case Report: The patient is a 68 year old man with ESRF due to Poly cystic kidney disease(PCKD) that was treated by renal transplantation from a living donor. Vascular anastomosis was end to end from renal artery to right internal iliac artery. After 1.5 month from transplantation, serum creatinine(Cr) raised to 3.1. In color duplex ultrasound Resistance index(RI) in intra renal arteries and spectral wave form in intratenal, renal and internal iliac arteries indicated severe stenosis in internal iliac artery proximal to anastomosis. Magnetic resonance angiography(MRA) shows stenosis of about 80%-90% in internal iliac artery proximal to anastomosis. Radionuclide scan with TC-DTPA suggests mild hydronephrosis & renal dysfunction, so for this patient PTA was performed. 24 hours after stent placement, serum Cr decreased to 2.1. In color Doppler ultrasound, 48 hours after stent placement, wavefrom, time and resistance indices are in normal range. Radionuclide scan 3 days after angioplasty demonstrated normal renal function. Important notes about this case were, short time(1.5 month) from transplant to presentation of symptoms of arterial stenosis, arterial stenosis proximal to anastomosis in internal iliac artery, and stenosis following transplantation from a living donor. Because of successful PTA in this case, stent placement is suggested as an effective and useful treatment for arterial stenosis after renal transplantation.

Postop shivering is a common complication that needs attention and treatment. Mepridine is an effective drug in treatment of shivering but it has important side effects such as respiratory depression. It is also contraindicated in some patients. The aim of this survey was to compare effects of mepredine and tramadol in treatment of postop shivering in order to find a good substitution for mepridine. Patients and Ninety women undergoing elective cesarean section under general anesthesia, in ASA class I and II, were enrolled in this double-blind clinical trial. They were randomly divided in three equal groups(n=30 in each group) 1st group received mepredine 0.5 mg/kg, 2nd group received tramadol 0.5mg/kg and 3rd group received tramadol 1mg/kg for treatment of shivering. Data of patients during shivering, time interval between injection of drug and cessation of shivering, incidence of respiratory depression, nausea and vomiting were registered and statistical analysis was done by chi-square test. Shivering ceased in 1st group after 3.9±1.6min, in 2nd group after 4.8±2.6 min and in 3rd group after 2.6±1.1 min(p<0.05). Incidence of respiratory depression in 1st group was %6.66, in 2nd and 3rd groups it was zero(p<0.05). Incidence of nausea and vomiting in 1st group was %13.3, in 2nd group %10 and in 3rd group it was %16.6(P<0.05). According to these findings, tramadol can be substituted with mepredine in treatment of postop shivering and dose of 1mg/kg of tramadol is suggested.

Osteoporosis is one of the most common diseases among elderly adults and old people, being associated with some risk factors. Osteoporosis is expensive, costly and infirmer disease that is accompanied by mortality and morbidity. Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs in many regions of the world. The aim of this study is to determine the osteoporosis risk factors among women. Patients and This case-control study was carried out on 100 women with normal bone mineral density settled in control group and 100 persons with low bone mineral density of the same center settled in case group. Data inregard to risk factors including age, BMI, underlying disorders(diabetes mellitus, hyper/hypothyroidism, renal stone, arthritic pain, hernial disk pain, joint pain), family history, history of fracture, tobacco consumption, physical activity, ocp use, estrogen and progestrone consumption, menopause, history of surgery(oopherectomy or hysterectomy), use of dairy products and drug consumption(calcium and corticosteroids) were collected by referring to medical files and recorded in data forms. For data analysis spss software, chi-square and fisher's tests were used. Odds Ratio(OR) and CI 95% were also colculated. Results showed that age>50(P<0.001, OR=5.86), arthritic pain(P<0.001, OR=4.22), menopause(P<0.001, OR= 29.6), use of dairy products(P<0.001, OR=34.02), underlying disorders(P=0.019, OR=2.85), history of fracture(P=0.03, OR=2.37), family history(P=0.021, OR=4.88) and physical activity(P<0.001, OR=0.097) were related to osteoporosis there were no other significant relationships with other factors. Also significant relationship was observed between age>50(P=0.038, OR=2.47), joint pain(P<0.001, OR= 5.43), family history(P=0.002, OR= 7.07), physical activity(P<0.001, OR= 0.14), menopause(P= 0.038, OR= 2.47) and use of dairy products(P< 0.001, OR= 27.44) with osteopenia there were no other significant relation with other factors. This study has been conducted for prevention of osteoprosis. Based on the results, public education in regard to physical activity and dietary intake of calcium is mandatory for prevention of osteoporosis.

Water birth is a non-medical intervention, which has been used throughout the world for many years. It can be considered as a new approach for enjoyable birth in Iran. The aim of this study was to determine the impact of water birth on labor pain during active phase of labor. Patients and The study was a controlled clinical trial in which 114 full term pregnant women gravida 1 st to 3 rd participated. We performed voluntary sampling for experimental group(n=52) and conventional sampling for control group(n=62). Women of both groups, entered the study after having 4-5cm of dilatation(begining of active phase of labor) and all contributors received special individual care whereas the experimental group was put in a warm water pool of temperature between 36.8˚c to 39˚c at least for one hour at the beginning of trial, and during the second stage of labor. A 10 point ruler was used to measure labor pain in different stages of labor. We used paired sample t-test in order to compare pain change scores within each group. Chi-square test, Mann-Whitney test and independent sample t-test were used to compare the pain mean scores between two groups. P value<0.05 was considered as statistically significant level. Our finding showed that, in the first 15 minutes the intensity of pain was stabilized in the experimental group, but was increased in control group(P=0.009). In the second stage of labor, the pain was significantly more severe in control than experimental group(P<0.0001). Overall, patients in the experimental group suffered less pain than the controls. With the exception of the above mentioned points, the differences were not statistically significant. Warm water pool can be an effective way to decrease labor pain and alleviating her suffering especially during first and second stages of labor. Although there were not much significant statistical differences between the two groups, experimental group suffered less pain which could be of clinical importance. Even though the pain of labor is lessened to a small extent, it could be a pleasant experience for the mothers and probably an effective step in decreasing the number of selective cesearen sections, which are performed mainly because of fear of labor pain.

The immune system is quite capable to combat tumors and many immunological parameters including cytokines such as IL-12 & IFN-γ play major roles in this regard. IL-12 is also the major cytokine responsible for the differentiation of TH1 cells, which are potent producers of IFN-γ, IFN-γ in turn has a powerful enhancing effect on the ability of phagocytes to produce IL-12 as well as having an important role in cellular immune response. In this study the serum concentration of IL-12 & IFN-γ and percentage of IFN-γ producing cells(CD4+, CD8+, NK cells) in metastatic & nonmetastatic breast cancer patients and healthy adults was evaluated, with the aim of finding out the possible correlation between cytokine levels with disease stage and progression. Since cytokines are produced by all of these cells, cell enumeration may help to find out whether changes in cytokine levels is due to change in the cell number or their function has been altered during disease progression. Patients and Whole blood samples were taken from 50 breast cancer patients prior to therapeutic manipulation who were admitted to Dr. Shariaty & Day general hospitals. Also 26 healthy people were selected as control and blood was taken similarly. According to disease stage patients were classified into non-metastatic(stage I, II) and metastatic(stage III, IV) groups. 30 patients were non metastatic and 20 patients were in metastatic stages respectively. Serum cytokines level(IFN-γ, IL-12) was measured by ELISA. Lymphocyte subpopulation percentage was measured by flow-cytometry using bichromatic specific antibodies(anti-CD4+/CD8+, anti-CD3/CD16+CD56). The research protocol is designed as a descriptive, comparative cross sectional study. The parametric findings were analysed by one way Anova test and the nonparametric data were analysed using Mann whitney and Kruskal Wallis statistical tests. IL-12 level was increased significantly in metastatic group compared to controls(P=0.017), while IFN-γ levels were in the same range as controls. CD4+ lymphocyte percentage in nonmetastatic(P=0.022) and metastatic groups(P=0.037) was decreased significantly compared to control, but there was no significant difference in CD8+ and NK cell numbers. Despite the decrease in percentage of CD4+ lymphocytes in patients(due to activation of compensative hemostatic system and increase in IL-12), there was no change in IFN- level. It seems that increase in serum IL-12 levels correlates with disease progression. However serum IFN-γ level has no effect on disease progression and as a whole no prominent failure was recorded in the cellular immune response of brease cancer patients as compared to normal individuals.

Early or late introduction of complementary feeding is one of the important reasons of infants’ growth faltering and malnutrition which can lead to irreversible economical complications. The aim of this study was to determine the relation between onset time of complementary feeding and introduction of each complementary food with the growth of children aged less than 2 yrs, in the Health centers in West of Tehran. Patients and In a historical – cohort study and using health files, 359 infants under 2 years of age(183 boys and 176 girls) were included in study by clustering sampling. All infants were term, with normal birth weight, complete vaccination, healthy mother and were exclusively fed by mother's milk. Growth indices were expressed as standard deviation scores(SDS) of height and weight according to National Health Center Statistics(NCHS) references. Data were analyzed in SPSS version 11 software by ANOVA. A total of 183 boys and 176 girls were studied. There was "increase growth trend" in first month and then "growth faltering" till 1 years of age"growth acceleration" occurred after 1st year. Early onset of complementary feeding(before 6 months) as compared to late onset(after 6 months) leads to lower growth indices although not much significant. Introducing fruit juice at 4-6 months of age(sooner than normal time) leads to significant growth faltering. On time introducion of egg yolk i.e, 6-8 months, leads to better height (but not weight) as compared to late onset group. Introducing meat at 4-6 months of age(sooner than normal time) as compared to late onset group led to faltering in growth indices, although not much significant. Onset time of complementary feeding and also beginning time of introducing each type of complementary food / can influence infants’ growth. Cohort studies are strongly suggested.

Retinoblastoma is the most frequent intra-ocular tumor in childhood. The tumor has both endophytic and exophytic patterns of growth. After enucleation, the pathologist is called on to evaluate risk of further growth for prophylactic therapy. Invasion of the choroid or optic nerve are risk factors for developing metastases, but occasionally, metastatic or locally invasive tumors occur in the absence of these risk factors. In this study, correlation of vascular density using CD31 with vascular endothelial growth factor(VEGF) and also both of these markers with local invasive growth of retinoblastoma were assessed. Patients and The study was analytical cross-sectional and performed on sections of paraffin-embedded blocks of 37 enucleated eyes due to retinoblastoma, at Ophthalmology Department of Hazrat Rasool Akram Hospital in years 2000-2006. Hematoxylin and Eosin stained slides were reviwed for evaluation of local invasive growth of tumor. Vascular density by CD31 and VEGF was assessed by immunohistochemical staining(IHC), using an Strept avidin-Biotin Immunoperoxidase technique. For data analysis, T test, Chi 2 test, Phi test and ROC curve were used. A CD31 number equal or greater than 62/10 HPF with 78.9% sensitivity and 66.7% specificity was considered as the most efficient cutt-off point and with VEGF as a qualitative test, were assumed as predictors for local invasion. Significant correlation was noted between VEGF and CD31. There was no correlation between CD31 and VEGF with uni or bilaterality, age, size and growth type. Assessment of vascular density with the use of CD31 and vascular endothelial growth factor(VEGF) can be useful method for prevention of local invasive growth of tumor and determining the need for prophylactic therapy in patients with advanced ocular retinoblastoma.

Toxoplasmosis is a common disease between human and animal with an extensive distribution. It is caused by the parasitical protozoan Toxoplasma gondii. Most clinical laboratories have problems with the diagnosis of toxoplasmosis. The aim of this study is the comparison of sensitivity and specificity of conventional and unconventional methods in the diagnosis of Toxoplasmosis based on the measurement of IgM and IgG and introduction of the best method. Patients and In this comparative analytical study, from 100 people that physicians suspected of having the Toxoplasmosis symptoms and had been introduced to two laboratories in Tehran and Karaj for toxoplasmosis testing. Serum specimens were prepared and tested with Enzyme-linked immunoadsorbent assay(ELISA), Indirect fluorescent assay(IFA), Chemiluminescence(CLIA) and Enzyme linked fluorescent assay(ELFA). Data was analyzed via Chi-Square. In comparison with the IgG ELFA method, the IgG CLIA has the most sensitivity, specificity, positive and negative predictive values(100%). In comparision with IgM ELFA, IgM CLIA and IgM ELISA had the same sensitivity(92%), but IgM ELISA had more specificity(100%) than IgM CLIA(97.3%). In IgM ELISA positive and negative predictive values were 100% and 97.4% respectively and in IgM CLIA they were 96% and 98% respectively. Although results of the comparative methods are near to each other, the automatic methods(CLIA, ELFA) are preferred because of a high reproducibility, reduced personnel expenses, time saving, etc. Therefore we suggest using these methods for diagnosing Toxoplasmosis. Also it is suggrsted that for measuring IgM, the mentioned methods are the most suitable of diagnostic methods.

The most important cause of mortality in developing countries is coronary artery diseases(CAD). From ethiological point of view, CAD is multifactorial. In this study, some involved important factors were evaluated. Patients and In this cross-sectional study, 94 normal controls and 106 cases with 50% angiographically proved coronary stenosis who had referred to Tehran Shahid Rajaii Heart Hospital were selected and investigated inregard to levels of TG, HDL-C, VLDL-C, Apo A1, Apo B100, ACE activity and BMI in the both groups. The results showed significant changes in the serum ACE activity, HDL-C, TG, VLDL-C, APO A1 and BMI compared with control group. Furthermore, multiple linear regression analysis showed odds ratios for ACE activity, cholesterol, HDL-C and VLDL-C as 1.08, 1.24, 1.05 and 0.68 respectively. However, the ACE activity had no correlation with the other studied factors. Increase of serum ACE may be an independent factor in the incidence of CAD and its inhibition may delay the atherosclerosis process.

Succinylcholine has obvious advantages for facilitating endotracheal intubation in the ambulatory setting patients(eg: low cost, fast onset and no need for reversal of neuromuscular relaxant). Unfortunately postoperative myalgia(POM) may frequently occur after the use of succinylcholine and this myalgia may be particularly troublesome in outpatients. This study was conducted to evaluate the efficacy of Atracurium or Lidocaine alone or together for prevention of succinylcholine – induced fasciculation and postoperative myalgia in patients undergoing small or ambulatory surgery. Patients and This study was prospective and clinical trial and conducted on 80 ASA physical status I, II patients aged between 30-50 years that were scheduled for elective and ambulatory or small surgeries under general anesthesia in Uromieh Imam Khomeini hospital. Patients were randomly assigned to one of the four groups(n= 20 for each group) group 1: without pretreatment, group 2: 3mg atracurium, group 3: 1mg/kg lidocaine, group 4: 3mg atracurium and 1mg/kg lidocaine together, before 1.5mg/kg succinylcholine was administered. During induction of anesthesia incidence of fasciculation was assessed and four point rating scale was used for its severity assessment. In addition, severity of myalgia was assessed by a four point rating scale at 4, 12, and 24 hours postoperatively. For each of patients data collected included demographic variables(eg: age, sex, duration of operation), presence or absence of fasciculation, myalgia, severity of myalgia, severity of fasciculation and time of onset of myalgia. Correlations between fasciculation and myalgia, limitation in ambulation, and need for excessive analgesics in postoperative phase were assessed and then differences analyzed via Fishers-Exact test and Chi-Square test. P value<0.05 was considered significant. Non of the patients complained of any side effects after administration of the study drugs. Severity and rate of fasciculation was observed less frequently in groups 1, 3 (30%,50%) as compared with groups 2,4(10%,10%). This difference was significant between groups 1 and 2(pv=0.014) and between groups 1 and 4(pv=0.014). Meanwhile this comparison was not significant between other groups. Inother words decrease in incidence of fasiculation is more pronounced with use of atracurium alone or atracurium with lidocaine than use of succinylcholine without any pretreatment. Seventy percent of fasciculated patients had myalgia in the remaining 30% postop myalgia did not occur. Incidence of myalgia was more frequent in groups 1,3(40%, 25%) as compared with group 2(5%) and this difference was significant between groups 1,2(pv=0.021). However it was not statistically significant between groups 1 and 3(Pv=0.5). However none of the patients in group 4 reported myalgia. Severity of myalgia in groups 1 and 3 was mild and moderate but this severity in group 2 was only mild. Severe myalgia was not reported in any of the cases. This study suggests that use of succinylcholine in conjuction with atracurium(3mg) or lidocaine(1mg/kg) as pretreatment resulted in reduction of fasciculation and postoperative myalgia, (although atracurium was more effective than lidocaine).This study demonstrated that pretreatment with atracurium combined with lidocaine was more effective in reducing Succinylcholine-induced fasciculation and postoperative myalgia, in comparison to using each alone.

Objective assessment of nasal airway is helpful in understanding nasal breathing function. Acoustic rhinometry is one of the most commonly used objective measurements of nasal airway. This test has the ability to measure cross-sectional areas of the nose in different distances and volume and also determines the site of minimal cross-sectional area. These variables are different in various areas. Defining these normal values in adult Iranian population, as a criteria for diagnosis and treatment of nasal diseases, can be very helpful. Patients and A number(180) of adult Iranian population(age:18-60 years) without nasal breathing complaints underwent acoustic rhinometry. The mean volume and minimal cross-sectional area of nose and also correlation of these variables with age, sex, height, smoking habitus, and topical nasal decongestant were assessed. This study is cross sectional and the statistical tests were descriptive statistics, T test and correlation test in SPSS software. In this population total nasal volume is 8.12±0.94cm3 and total minimal cross-sectional area is 0.9±0.17 cm2 before decongestion. There was no correlation between those values and age, sex, height, weight and smoking habitus. There was a significant increase in volume and minimal cross-sectional area after decongestion. Due to volume and minimal cross-sectional area differences in various races, measurement of these values in Iranian population is a proper way for diagnosis of rhinological diseases and treatment(medical or surgical) planning and also helpful for comparison of pre and post operative results after nasal surgeries.

Many factors influence the tensile strength of the tendon in a tendon-bone tunnel complex. The purpose of this study is to determine the influence of tendon length & time of implantation of the tendon in the bone tunnel on the tensile strength of the tendon in a rabbit model. In this prospective study fourteen adult(age 6 months) White New Zealand rabbits(weight: 2.5-3 kg) underwent bilateral hindlimb(n=24) surgery in which the Extensor digitorum longus tendon was implanted into the tibial metaphyseal extra-articular bone tunnel. Based on the length of bone tunnel(1 or 2 cm) and duration of implantation(6 or 12 wks), the rabbits were divided into 4 groups. Seven rabbits were sacrificed after 6 weeks(groups 1 and 2) and 7 others were sacrificed after 12 weeks(groups 3 and 4) for tendon tensile loading test to determine ulitimate pull-out strenght. In group one(1 cm, 6wks) one tendon was ruptured and four were pulled out, in group two(2 cm, 6 wks) one tendon ruptured and six pulled-out, in group three(1cm, 12wks) one tendon was pulled out and five ruptured and in group four(2 cm, 12 wks) five tendons ruptured and one was pulled-out. The mean failure force after 6 wks. was 4.98N for group one and 9.37N for group two. After 12 wks. it was 6.36N for group three and 10.81N for group four. Failure force difference was significant between 1 and 2 cm tendon lengths after 12 wks. Tendon rupture site was significantly different after 6 & 12 wks. This study demonstrated that the tendon length within a bone tunnel influences tendon tensile strength after 12 weeks. In other words, increase in tendon length within the bone tunnel, increases it's resistance against tensile strenght with the passage of time. Time of implantation has an additive effect to tendon length on the tendon tensile strength of the tendon-bone tunnel complex.

Diabetes mellitus is one the most prevalent chronic diseases in Iran which has a considerable burden on health system. In addition, hyperglycemia is a well-established independent risk factor for ischemic stroke and the development of microvascular and macrovascular diseases in patients with diabetes. On the other hand, middle cerebral artery is one the most important cerebral arteries which may role in up to 85% of cerebral blood flow. Therefore, this study was performed to determine blood flow velocity of middle cerebral artery (MCA) by means of transcranial doppler (TCD) in diabetic patients. Patients and This cross-sectional study was conducted on 81 diabetic patients who had referred to Firoozgar hospital in Tehran, Iran in years 2004-2005. All the patients were supposed to be free of previous myocardial infarction (MI) or cerebrovascular accident (CVA) and also had the appropriate criteria for undergoing Transcranial Doppler ultrasonography (TCD). For each patient, demographic data (age and sex), level of hemoglobin A1c, CRP, HDL, LDL, clinical features and TCD findings were recorded. Data were analyzed using SPSS v.13. The mean age of the patients was 55.91(SD=11.05) years. The mean blood flow velocities of right and left MCA were 50.74(SD=15.65) cm/sec and 48.87(SD=15.96) cm/sec, respectively. In addition, the mean end-diastolic blood flow velocities of right and left MCA were 34.82(SD=12.80) cm/sec and 33.60(SD=13.58) cm/sec, respectively. Significant statistical correlations were found between duration of diabetes and end-diastolic blood flow velocity of right MCA (P=0.025, r Pearson = -0.218). As cerebrovascular diseases are preventable, it seems that TCD study may play an important role in decreasing such complications in diabetic patients. Our results showed the inverse relation between duration of diabetes mellitus and blood flow velocity of middle cerbral artery. It also demonstrates the effects of vascular changes in diabetic patients on causing stroke. In addition the improtance of anticoagulants in prevention of cerebrovascular accident has been highlighted.

Hemolytic uremic syndrome(HUS) is the most common cause of renal failure in children. Hemolytic microangiopathic anemia, thrombocytopenia and renal failure are diagnostic triads of the disease. The aim of the preset study is determining histopathological findings of renal biopsy and their correlation with early outcome of the patients. Patients and In this cross-sectional retrospective study a total number of 28(20 males & 8 females) cases of HUS with mean age of 6 years(± 4.6) who were admitted in Ali-Asghar children hospital from 1994 to 2004 were evaluated. Light microscopic findings of glomeruli(sclerosis, necrosis, capillary loop thickening, crescent, …), arterioles (hyperplastic thickening, thrombi, necrosis, …), arterial(thrombi, necrosis, intimal lipid, …) interstitial(inflammation, fibrosis, edema), medullary vessels and tubules were scored without knowledge of clinical history. Short outcome was defined as appearing of initial improvement signs in less than 3 weeks. The data were analyzed via SPSS V.11.5 software statistical tests such as Pearson correlation and Linear regression. The most common lesions in glomeruli were capillary wall thickening and reduction in luminal size. In arterioles mild luminal stenosis, in arteries intimal thickening, in interstitium mild chronic inflammatory cell infiltration and interstitial edema, in vasa recta congestion and in tubules presence of casts were the most common findings. Arteriolar lesion(arteriolothrombosis) had significant correlation with the serum creatinin level at time of discharge. Vascular lesions(especially arteriolar) are the most important predictors of short outcome of children with HUS.

Recurrent or chronic adenotonsillar infections mainly affect children. The prevalence of potential respiratory pathogens on the adenoid and tonsillar surfaces of children with moderate symptoms of recurrent tonsillopharyngitis and/or adeno tonsillar hypertrophy differs only slightly from that in children without symptoms of adenotonsillar disease. Chlamydia pneumoniae is a common respiratory pathogen which is often found in children. Little is known about the true colonization rate and the localization of the bacteria in the respiratory tract. The findings suggest that Chlamydia pneumoniae is a common pathogen in the adenoids of children undergoing adenoidectomy. The aim was to determine Chlamydia pneumoniae infection in adenoid tissue of adenoidectomized children by PCR and specific antibody in serum. Patients and In a descriptive cross sectional study during 2005-2006 in ENT department of Rasool Akram hospital, detection of Chlamydia DNA by PCR was performed on 44 adenoid tissue of adenoidectomized children. 168 ELISA tests (IgG&IgM for each sample) were performed. Samples were collected from 53 patients(63.1%) and 31 normal(36.9%) children. The data gathered were analyzed by SPSS 10.5 software. Age of children was between 3-14 years, range 11yr mean 7.95(SD=1.98years). Also there were 54.8% males and 45.2% females. Season of adenoidectomy was: 24% spring 18% summer 36% autumn and 22% in winter. Chlamydia-DNA by PCR was positive in 7(15.9%) of adenoid tissues. Positivity of PCR did not differ with age or sex. Acute chlamydial infection was seen in 3.7% previous immunity was seen in 12.3% of all children. By serology method in 51 patients, acute chlamydia infection was detected in 1(2%) and previous immunity in 6(11.8%). Acute and previous infections did not differ significantly between case and control group. The results suggest that Chlamydia pneumoniae(C. Pneumoniae)is a common finding in the adenoids of children undergoing adenoidectomy. The adenoid tissue, may act as a reservoir for bacteria causing sinusitis, lung and chronic ear infection. Whether or not C. pneumoniae plays a pathogenic role in this group of patients, could not be determined from the data obtained in this investigation. In cases of resistant adenoiditis to usual drugs, we recommend the use of specific antibiotics for Chlamydia(appropriate for age) including erythromycin, tetracycline or other new macrolids (e.g azithromycin, clarythromycin) before surgery.

The role of ryanodine receptor(RYR) on pacemaker activity of heart cells is controversial. Some investigators have suggested that it is obligatory, while others believe it is partial and not obligatory. The principle aim of this study was once more to characterize the role of ryanodine receptor(RyR) on the pacemaker activity of the sinoatrial node(SAN) and the atrioventricular node(AVN) in the mouse. In an experimental study the effect of ryanodine on the cycle length(CL) of action potential of the intact SAN and the AVN of the heart mouse was assessed. The recording of action potential was extra cellular and was done by 2 separated metal microelectrodes. Paired and independent t tests were carried on accordingly. If the P values were less than 0.05, the differences were considered significantly. Ryanodine with 0.2 and 2µM concentrations prolonged CL of action potential by 46.50±15.75% and 70±21% in SAN preparations while 163±72.25% and 241±91.25% in AVN preparations. During ryanodine use, the pacemaker activity was not stopped for all preparations. The effect of ryanodine on two nodes was significant with respect to control. On the basis of obtained result, it may be said that the ryanodine receptor current exists in SAN & VAN. AVN the pacemaker activity was functioning continuously in cardiac nodes when ryanodine was used, therefore, the role of RyR for pacemaker activity is not obligatory. The effect of ryanodine on AVN is significantly greater than SAN that is, the role of RyR in two nodes is not similar.

Pancreatitis is uncommon in children. The incidence is higher in chronic renal failure, hemodialysis, and chronic ambulatory peritoneal dialysis(CAPD) patients and accompanied with late complications including pancreatic necrosis, pseudocyst and abscess. Case Report: We report a 5 year old girl with end stage renal disease due to focal segmental glomerulosclerosis, being on CAPD for two years. She was admitted for intermittent severe epigastric pain of four months duration, hypotension, severe cachexia and cloudy drained dialysate with negative culture and mild increment serum amylase. On abdominal imaging a pancreatic cyst was reported which was an infected cyst on laparotomy. Despite drainage of suppurative fluid and antibiotic therapy, the patient expired with severe sepsis and multiorgan dysfunction two weeks after operation. The presence of poor weight gain, unexplained abdominal pain and cloudy drained dialysate in children on CAPD may suggest pancreatitis. Frequent evaluation of pancreatic function and sonography is recommended.