Acta Medica Iranica
Volume:42 Issue: 2, Feb Mar 2004

In the present study, the effect of apamin (potassium channel blocker) on tolerance to cocaine-induced locomotor activity in mice has been investigated. Locomotor activity was measured by locomotor activity meter, Animax, type S (LKB, Farrad). Intraperitoneal (IP) injection of different doses of cocaine (2.5, 5, 10 and 15 mg/kg) produced dose-dependent locomotor activity in mice.Animals were treated with a dose of cocaine (60 mg/kg, IP) once daily, for 2, 3 or 4 days in order to produce tolerance to cocaine-induced locomotion. Twenty-four hours after the last dose of cocaine, locomotor activity induced by a test dose of cocaine (10 mg/kg) was assessed. Animals pretreated with apamin (0.1 mg/kg) 30 min before the test dose of cocaine had a decreased cocaine response. However, daily treatment of animals with apamin (0.1 mg/kg), 30 min after cocaine (60 mg/kg) for 3 days (during development of tolerance to cocaine-induced locomotion), did not alter the cocaine effect. Single administration of apamin to mice did not cause any response. It is concluded that, apamin as a potassium channels blocker may decrease tolerance to cocaine-induced locomotion due to blockade of potassium channels

Lead is an ubiquitous environmental toxin that induces a broad range of physiological biochemical, and behavioral dysfunctions. In this study, we examined the pathologic effects of lead acetate in NMRI mouse ovarian tissue and the protective role of antioxidant L-cysteine, against the induced damage. We used lead acetate at a dose of 10 mg/kg, and L-cysteine at a dose of 200 mg/kg. Both drugs were administered intraperitoneally according to 2 protocols: intraperitoneal injection of lead acetate 10 mg/kg/day for 15 days or 10 mg/kg/week for 15 weeks. Ovaries were examined histologically and changes in the number of graafian, growing, atretic, and primordial follicles, thickness of granolusa of theca layers, relative ovary weight (ROW) and animal weights, were determined. Significantly increased numbers of atretic follicles and thickness of the theca layer, and a decrease in other parameters were observed after treatment with lead acetate (P< 0.05). No changes were observed after treatment with a combination of L-cysteine. Also, more oocytes had resumed meiosis in the follicles exposed to lead acetate. The results suggest that lead acetate at a dose of 10 mg/kg has a toxic effect on ovarian tissue, and antioxidants such as L-cysteine have a protective role against the induced damage.

An investigation was carried out on permethrin-susceptible and resistant strain of malaria vector, An.stephensi. Efficacy of several pyrethroids such as permetrhrin, deltamethrin, lambdacyhalothrin, cypermethrin and cyfluthrin against this species showed that those with an α-cyano group and dibromo substitutions were more toxic to sensitive strains than the other classes like permethrin. The ranking order of toxicity of pyrethroids was different for resistant strains. Evidence of enhanced mono-oxygenase activity and the synergism shown by piperonyl butoxide suggests that each resistant strain possesses a mono-oxygenasemediated resistance mechanism responsible, at least in part, for pyrethroid resistance.

Brucellosis is an infectious disease and it seems that it affects human immune system and can cause acute, subacute and chronic clinical features. Forty patients suffering from chronic brucellosis were studied for CD3+, CD4+,CD8+, CD19+, cells and CD4+/CD8+ ratio by flow cytometry before and after treatment with antibiotics and immunopotentiators. The results were compared with 15 healthy controls. The patients were divided into three groups: 1) antibiotic, 2) levomisol + antibiotic, and 3)treated with cimetidine + antibiotic. The results showed a significant decrease of B cells (CD19+), CD4+ T cells and CD4+/CD8+ ratio in comparison with normal subjects before treatment. In the first group, significant decrease of CD4 T cells and CD4/CD8 ratio inversion were seen after immunotherapy. The 3rd group showed the best correction of phenotype quantity. In other words, significant increase of CD4+ T cells, CD19+ B cells, CD4+/CD8+ratio and decrease of CD8+ T cells were seen with cimetidine immunotherapy.

The purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program Ib-IIa, bulky and suspicious IIb by radical surgery in patients with stage Ib-IIb cervical cancer. From September 1999 to April 2002, 30 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy of 45 Gy in 5 weeks. Patients received concurrent continuous infusion of cisplatin 50 mg/m2 for one day in week during 5 weeks of radiation. Radical surgery was performed 4-6 weeks after completion of the preoperative treatment. Toxicity with chemoradiation was usually mild. Two patients developed vesicovaginal fistula, and four developed long-term hydronephrosis that needed ureteral stenting. Clinical response was observed in 100% of the patients (23.7% complete response). The analysis of the surgical specimens revealed complete pathological response in 43.3% of the cases and partial pathological response in 56.7%. The degree of pathological response was not predictable by the degree of clinical response. Thirty months disease-free survival and overall survival were 66.3% and 77.31%, respectively. Patients with complete and partial pathological response were not significantly different in terms of disease-free survival (p= 0.08) and overall survival (p= 0.3). Cisplatin in preoperative chemoradiation is effective and usually welltolerated in bulky cervical cancer and parametrial invasion, inducing a high rate of clinical and pathological complete responses. When this therapy is followed by radical surgery, disease-free and overall survival rates are higher. The latter may be possible only through extensive surgical resection with a parallel increase in complication rates.

The purpose of this study was to compare the efficacy of retinoic acid 0.05% with triamcinolone acetonide 0.1%, both in an oral base, in the treatment of atrophic and erosive oral lichen planus. Thirty patients with clinically proven oral lichen planus were asked to participate in the study. The severity of lesions was scored from 0 (no lesion) to 5 (large erosion), and symptoms were scored ranging from 100 (asymptomatic) to 0 (impossible to live with symptoms). Patients were randomly assigned to receive either triamcinolone acetonide or retinoic acid. They were instructed to apply the medication on dried lesions four times a day. The signs and symptoms were evaluated after 1, 2, 3 and 4 weeks of treatment. The scores were analyzed by the Wilcoxon rank sum test. The stage of lesions in patients receiving topical triamcinolone acetonide (n=18) improved from an average score of 3.22 to 1.05 after 4 weeks of treatment, whereas patients receiving topical retinoic acid (n=12) showed nonsignificant improvement (average score 3.41 improved to 3.25). The keratotic areas in 4 patients (22.2%) receiving triamcinolone acetonide and one patient (8.3%) in the retinoic acid group were completely resolved. After 4 weeks of treatment all patients in triamcinolone acetonide group, and 50% of retinoic acid group were asymptomatic. Improvement in symptoms and signs was significantly different in the two groups (p≤ 0.003, p≤ 0.0001 respectively). The results suggest that in non-keratotic and even keratotic oral lichen planus, topical triamcinolone acetonide 0.1% in oral base reduces the severity of atrophic and erosive oral lesions more effectively than topical retionoic acid 0.05% in oral base.

The purpose of this study was to compare the anatomic and visual outcome of primary vitrectomy with scleral buckling in patients with retinal detachment following cataract surgery. Fifty-six consecutive patients with retinal detachment after cataract surgery were randomly assigned to two treatment groups: standard scleral buckling and standard three-port deep vitrectomy. Successful treatment was defined as improvement in vision (minimum of 2 lines in Snellen chart), anatomic reattachment and prevention of post-operative proliferative vitreo-retinopathy (PVR). The prognostic role of pre-operative and intra-operative conditions of the affected eye was also evaluated. Twenty-six of fifty-six eligible patients underwent scleral buckling and thirty had deep vitrectomy. Anatomic reattachment was achieved in 18 (69.2%) cases in scleral buckling group and 19 (63%) cases in vitrectomy group. Improvement in visual acuity was achieved in 76.9% and 83.3% and PVR occurred post-operatively in 23.1% and 16.7%, respectively. The differences were not statistically significant, and pre- and intra-operative ocular conditions did not prove to be prognostic factors, either. Scleral buckling and primary deep vitrectomy seem to have comparable outcomes in terms of anatomic reattachment and visual improvement in patients with pseudophakic and aphakic retinal detachment. Failure to achieve anatomic reattachment and visual improvement or PVR occurred in about one third and one fifth of the cases respectively, irrespective of the technique used. This warrants further research to improve treatment results

Diagnostic peritoneal lavage (DPL) is considered by many as the most important investigation for the early detection of intraperitoneal injury. The aim of this study is to assess the accuracy of DPL as a diagnostic method in evaluating abdominal trauma. A prospectively maintained database of all DPLs performed in the past 36 months at Sina Hospital was analyzed. Information relative to the type of injury, indication for DPL, DPL and laparatomy results were analyzed in order to evaluate the accuracy, sensitivity and specificity of DPL. Over a 36-month period, 111 (13.9%) DPLs were performed for 800 patients with abdominal trauma at Sina Hospital. Fifty-five (49.5%) patients had negative and 56 (50.5%) patients had positive DPL. Among negative results, laparatomies were performed for 5 (9.1%) patients. Among positive results, 47 patients had organ injuries at laparatomy and 6 (11.3%) did not have any organ injuries (false positive). The overall accuracy, sensitivity and specificity of DPL were 87%, 90% and 85%, respectively, that were comparable to the other reports (p<0.05). DPL correctly identified the presence or absence of organ injuries in 87% of the patients (positive predictive value =84%, negative predictive value=91%).

Stressful life events may play an important role in coronary heart disease and sudden cardiac death. This study was performed to compare the frequency of stressful events and mental strain in patients with acute myocardial infarction (MI) and normal population. A case-control study was performed on 50 survivors of MI and 50 controls with no evidence of cardiovascular disease, matched by age, gender, education, race, and number of family members. A questionnaire was used to determine the number of stressful life events. Mental strain was measured by two different scoring selfestimated mental strain, and inferred mental strain. Patients with MI had more stressful life events in contrast to controls but this was not statistically significant (p = 0.08). Self- estimated and inferred mental strain during the two preceding years were significantly greater in patients with MI (p<0.01, p<0.05, respectively). We conclude that emotional strain due to a stressful life event may complicate coronary heart disease and thus result in MI.

Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP) and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases) using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group). We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.

The objectives of this study were to define the clinical risk factors, microbiological spectrum, and visual outcome of bacterial keratitis at Shahid Sadoughi Hospital (Yazd, Iran). A crosssectional prospective study, identified 80 cases of microbial keratitis from March 1999 to March 2001. Inclusion criteria were presence of corneal stromal infiltrate in slit lamp examination, and microbiologic evaluation of corneal scrapings. Clinical features, risk factors, VA were analyzed. The mean (±SD) age of patients was 45.3 years (±18.50) with a range of 3 to 79 years. Forty-six (57.5%) patients were male and (42.5%) female. The predominant predisposing factors were corneal trauma (39%), ocular diseases (34.1%), previous ocular surgery (10%) and use of contact lens (9.8%). Forty percent of cases were culture- positive. Staphylococcus epidermis (21.9%), Staphylococcus aureus (18.8%) and Streptococcus pneumonia (15.6%) were the most common isolates. Fungi were isolated in five eyes. Twenty-nine patients (36.2%) achieved VA of 20/120 or better at the final follow-up. Fourteen eyes (17.5%) required surgery and 4 eyes (5%) eventually needed evisceration. Microbial keratitis resulting in loss of the eye occurred typically in elderly patients, with pre-existing poor VA and delayed treatment. This study illustrated that the epidemiology of corneal ulcer in this area is different from what is observed in other parts of the world.

Diabetes mellitus (DM) type 2 is one of the most common endocrine disorders affecting more than 135 million people in the world. The etiology of the disease is not fully understood, but recently subclinical hemochromatosis has been considered as one of the probable causes of DM. This study was carried out to examine the relationship between serum ferritin as a marker of iron overload with DM and HbA1c. This study was conducted on 97 patients with type 2 DM who were referred to Zanjan Diabetes Clinic. Ninety-four normal age-matched individuals were included in the study as the control group. Ferritin, hemoglobin, HbA1c, and fasting blood sugar were measured in blood samples. Exclusion criteria included anemia, or any other disease or drug that could affect ferritin levels. Results were analyzed statistically by Chi-square test, t-test and Pearson regression coefficient test. One hundred ninety-one cases including 97 diabetics (37 males and 60 females) and 94 normal individuals were studied. There were no significant differences between the two groups regarding age, hemoglobin and body mass index. Mean serum ferritin was significantly higher in diabetics than in the control group (101±73 mg/ml vs. 43.5+42 mg/ml, p<0.001). There was no correlation between serum ferritin and HbA1c in diabetic patients of either sex. Ferritin levels in patients with DM is high, but not related to levels of HbA1c and blood glucose control.

Kindler''s syndrome is a rare entity of unknown cause characterized by acral blisters early in life followed by progressive diffuse poikiloderma and cutaneous atrophy. The inheritance pattern of this syndrome is not clear. We report four Iranian siblings (three boys and one girl) with this syndrome, who were the result of a consanguineous marriage. In addition to the usual manifestations of the syndrome, corneal epithelial punctate defects were detected in all four, and segmental chorioretinal atrophy in one case. This is the first report of the affliction of four siblings, and also the first report of the association of the above ophthalmologic findings with Kindler''s syndrome.

Mucoepidermoid carcinoma is a neoplasm of salivary gland origin, and its laryngeal occurrence is extremely rare. This malignant tumor is composed of two distinct cell types, the epidermoid and mucus cells. Prognosis is largely dependent on the histologic pattern. In this report, an extremely rare laryngeal cancer and its clinicopathologic features are described.

Hydrogen peroxide, an oxidizing agent used in surgery for its antiseptic properties, has been associated with life-threatening complications. We report a case of suspected gas embolism following irrigation of a tibial bone cyst with hydrogen peroxide in a five year-old boy under general anesthesia, who died despite resuscitative measures and a long stay in the intensive care unit.

Histiocytosis of Langerhans cells (class 1 histiocytosis) consists of a range of clinical manifestations, including bone eosinophilic granuloma, Hand-Schüller-Christian syndrome, and Letterer-Siwe disease. These syndromes represent a spectrum of severity and prognosis of an underlying disorder which is usually sporadic. This report describes three cases in one family, who developed the disease a few years after their brother was discovered to have histiocytosis. All three patients had the same clinical manifestations. They had hyperthermia, eczematic rash, swelling in skull, hand and foot. Radiological data included lytic areas in the skull and fourth metacarpal. Serology for Epstein-Barr infection was negative. Infiltration of abnormal Langerhans cell histiocytes was demonstrated upon bone biopsy. Chemotherapy was administered. One case (male) died after a year of chemotherapy. In another case (female) chemotherapy was unsuccessful, but T-cell suppressor (cyclosporin) induced remission. In the third case (female), chemotherapy was successful.