Acta Medica Iranica
Volume:41 Issue: 3, May -June 2003

There is just one study about the effects of 830 nm low power laser (LPL) on conduction velocity of sural nerve in human. Considering the fact that the sural nerve is a pure sensory nerve, therefore, for determining the effect of LPL on electrophysiological parameters of the nerve in human, this study was carried out as a base for further basic and clinical researches. Thirty eight normal volunteer men participated (20–35 yr.) in this study. LPL (670 and 780 nm) was applied on left and right sural nerves. Electrophysiological parameters such as Onset Latency (OL), Peak Latency (PL), Negative Peak Amplitude (NPA), Peak to Peak Amplitude (PPA) and Duration were measured before and after the application of various doses (0.5, 1.5 and 2.5 J/cm²(of LPL. This study showed that both wavelengths of LPL increase the latencies and therefore reduce the nerve conduction velocity (NCV). In addition, LPL application decreased the nerve amplitudes. Among the various intensities, the application of 2.5 J/cm² was the most effective (P< 0.001). On the other hand, 670 nm wavelength and 2.5 J/cm² had the greatest effects on OL in comparison with 780 nm (P< 0.04). However, there was no significant difference between the effects of 670 and 780 nm on the other electrophysiological parameters of sural nerve.

Acquired color deficiency in the tritan axis in Parkinson’s disease has already been reported, manifesting itself as impaired performance in various visual tasks. However, its clinical significance has always been controversial. In this study we evaluated the performance of Parkinson s disease patients in Lanthony 15-desaturated clinical test and for the first time, compared it with the standard Farnsworth-Munsell 15-dichotomous test, in order to determine the clinical value of the color vision deficiency in these shorter tests and their relationship with other factors such as age, duration and severity of the disease, and the presence of signs and symptoms of depression and hallucinations. This blind case-control study was performed on 39 definitely diagnosed patients (of which 14 patients were excluded because of confounding variables) and 25 sex and age-adjusted controls in a neurologic referral center. The subjects were selected by consecutive sampling. Eleven patients in Farnsworth-Munsell and 3 patients in Lanthony showed normal function, however, overall patients had significantly weaker performance than controls (P-value=0.003 and 0.000 for FM and Lanthony respectively). The pattern of responses in Lanthony was consistent with a mild tritanomalia and had a significant correlation with the severity of motor signs and symptoms (Spearman coefficient=0.44, P-value=0.027). The weaker correlation of color deficiency with age in patients (Spearman coefficient=0.42) in comparison with controls (Spearman coefficient=0.60) also signifies the role of the pathophysiology of the disease. We concluded that color deficiency is a clinically significant visual dysfunction in patients with Parkinson s disease.

The Robert/SC (pseudothalidomide) syndrome is a rare autosomal recessive disorder, associated with phocomelia and craniofacial abnormalities. An anomalous fetus with lower limb phocomelia and micromelia, lumbar myeloschisis, upper limb and ribs defects and craniofacial abnormalities is reported whose diabetic mother took mebendazole and glibenclamide in early pregnancy. Ultrasonographic findings of syndromes with phocomelia are discussed as well as Robert/SC syndrome which is the most probable diagnosis. Robert/SC phocomelia syndrome is a rare autosomal recessive condition characterized by severe pre and postnatal growth deficiency, symmetric limb reductions of variable severity and craniofacial anomalies including hypertelorism, hypoplastic nasal alae, cleft lip and palate. About half of the reported cases presented chromosomal abnormalities. We think that findings in our case are consistent with Robert/SC syndrome with additional abnormalities.

Asthma is the most common chronic disease of childhood. Exposure to allergens plays an important role in asthma. Recently, cockroach has attracted attentions as an important allergen. This study was performed to evaluate cockroach allergy in Iranian children with asthma. One hundred children with definite diagnosis of asthma were selected. After obtaining primary information, the severity of their disease was determined according to their history, physical exam and measurement of PEFR (Peak Expiratory Flow Rate) with a mini peakflowmeter. Also, serum total IgE and blood eosinophil count were measured. The patients were skin prick tested with cockroach (Blattella germanica), trees, weeds, grasses, cats, mite, feather and common food allergens. According to cockroach skin prick test (SPT) results, the patients were divided into two groups (sensitive and non‑sensitive) and compared. Positive SPT for cockroach was detected in 29% of patients. Cockroach sensitive group had a more severe asthma than non-sensitives (P<0.02). Also, asthmatic patients with cockroach allergy had perennial symptoms (P<0.05). A remarkable number of sensitive patients were born in winter (P<0.05). Eosinophilia was more common in sensitive group (P<0.02) and they had a higher level of serum total lgE (P<0.04). Prevalence of cockroach allergy was near to other common aeroallergens. Cockroach sensitive group had perennial symptoms, which is compatible with other indoor allergens. Cockroach allergy was more prevalent in children born in winter. Maybe these children are kept at home during their first months of life and are more exposed to cockroaches. The higher prevalence of eosinophilia and higher lgE level in sensitive group may be the reasons of more severe asthma in this group.

This study was carried out to analyze certain epidemiological variations in Iranian patients with colorectal cancer. (CRC): From March 1981 up to March 1993, 103 patients were analyzed retrospectively for age, gender, marital state, job, nutritional habits, presenting symptoms and histopathological features. Most of the patients with colorectal cancer were male, age range 20-75 (mean 56), 25.4 percent were long-term smokers and bleeding was the most common symptom. The rectum was the most common site and moderately differentiated carcinoma was considered as the main common histopathological variety. In conclusion, increasing incidence of colorectal cancer in younger Iranian population, below 30 and late admission and diagnosis were the main findings in the present study necessitating screening programs with annual fecal occult blood tests in high risk families.

Recognition of typhoid hepatitis is important since it has to be differentiated from other common ailments in our country such as viral, malarial or amoebic hepatitis. Early institution of specific therapy in cases of typhoid hepatitis carries a good prognosis. In our study, 107 patients with positive blood or bone marrow cultures for Salmonella typhi, were evaluated for hepatomegaly and abnormal serum liver enzymes, PT and alkaline phosphatase. The clinical features of typhoid fever with hepatic involvement include: fever 100%, hepatomegaly 52.3%, clinical jaundice 1.8%, rising in ALT 71.1%, AST 24.2%, Alkaline phosphatase 23.3% and abnormal PT 63.5%. Both clinical and biochemical abnormalities were seen in 22.4% of our patients. In patients with fever and jaundice with or without abnormality in liver enzymes, we must keep typhoid hepatitis in mind.

This study was designed to determine the frequency of Y chromosome AZF (Azoospermia Factor) subregions, microdeletions in patients with idiopathic nonobstructive azoospermia and severe oligozoospermia. Subjects included 40 men who had been referred to infertility clinics for assisted reproduction, 37 were azoospermic and 3 had severe oligospermia. Medical history and physical exam revealed no evidence of infection, obstruction of seminal tract, endocrine failure or chromosomal anomalies. Hormonal study was performed for all patients. Twenty six men had biopsies of the testes including 11 patients with hypospermatogenesis, 9 patients with maturation arrest, 4 patients with sertoli cell only syndrome and 2 patients with tubular sclerosis. In 14 men who did not have a testicular biopsy multiple, epididymal and testicular sperm aspirations under anesthesia failed and testicular sperm extraction was subsequently performed for ICSI. DNA was isolated from blood samples. Polymerase chain reaction (PCR) amplification of 11 loci spanning the AZFa, AZFb and AZFc subregions of the Y chromosome using sY81, sY83, sY127, sY130, sY131, sY147, sY149, sY157, sY158, sY254 and sY276 was performed. Microdeletions of the Y chromosome were found in two of the patients (5%), who had azoospermia. Deletions were restricted to DAZ (deleted in azoospermia) locus in AZFc subregion. One of the patients had a history of cryptorchidism and the second had undergone a left side varicocelectomy. Testicular pathology showed sertoli cell only syndrome in both of them. Our experience adds to the current logic that men with azoospermia or severe oligospermia should be evaluated for Yq11 microdeletions before deciding to operate varicoceles or else scheduling them for assisted reproductive techniques. PREVALENCE OF Y CHROMOSOME MICRODELETIONS IN IRANIAN INFERTILE MEN Author(s): F. Akbari Asbagh, A. Sina, H. Najmabadi, M. T. Akbari, A. Tabarrokiand and Gh. Pourmand Source:, 2003;41(3):164-170. Abstract: This study was designed to determine the frequency of Y chromosome AZF (Azoospermia Factor) subregions, microdeletions in patients with idiopathic nonobstructive azoospermia and severe oligozoospermia. Subjects included 40 men who had been referred to infertility clinics for assisted reproduction, 37 were azoospermic and 3 had severe oligospermia. Medical history and physical exam revealed no evidence of infection, obstruction of seminal tract, endocrine failure or chromosomal anomalies. Hormonal study was performed for all patients. Twenty six men had biopsies of the testes including 11 patients with hypospermatogenesis, 9 patients with maturation arrest, 4 patients with sertoli cell only syndrome and 2 patients with tubular sclerosis. In 14 men who did not have a testicular biopsy multiple, epididymal and testicular sperm aspirations under anesthesia failed and testicular sperm extraction was subsequently performed for ICSI. DNA was isolated from blood samples. Polymerase chain reaction (PCR) amplification of 11 loci spanning the AZFa, AZFb and AZFc subregions of the Y chromosome using sY81, sY83, sY127, sY130, sY131, sY147, sY149, sY157, sY158, sY254 and sY276 was performed. Microdeletions of the Y chromosome were found in two of the patients (5%), who had azoospermia. Deletions were restricted to DAZ (deleted in azoospermia) locus in AZFc subregion. One of the patients had a history of cryptorchidism and the second had undergone a left side varicocelectomy. Testicular pathology showed sertoli cell only syndrome in both of them. Our experience adds to the current logic that men with azoospermia or severe oligospermia should be evaluated for Yq11 microdeletions before deciding to operate varicoceles or else scheduling them for assisted reproductive techniques.

Precocious Pubarche (PP) is most often a benign condition secondary to the early appearance of adrenarche. However, PP may be a manifestation of mild errors of steroidogenesis in particular non classic 21 hydroxylase deficiency (NC210HD). The incidence of NC210HD in patients with PP ranges from about 0-30% of cases in various reports. Controversy exists as to whether all children with PP should undergo an ACTH test. This study was designed in order to determine 1) the frequency of NC210HD in children with isolated PP 2) to determine whether basal 17 hydroxyprogestrone (17OHP) values could help distinguish patients who are at risk for having NC210HD and thus should have an ACTH test. We studied 54 subjects (38 girls and 16 boys) aged 6.5±1.4 yr with isolated PP. Twenty five normal subjects (10 age matched and 15 pubertal) were studied as controls. Blood samples were drawn at baseline for dehydro-epiandrosterone (DHEA), androstendione (A), and 17α-hydroxy progesterone (17OHP). An ACTH stimulation test (synacthen 0.25 mg IV bolus) was performed and 1 hr post injection 17OHP was evaluated. Bone age was determined in all subjects. Using published normogram standards for the serum 17OHP response to ACTH, 3 patients (5.5%) were diagnosed as having NC210HD. In all patients diagnosed as having NC210HD, basal 170HP level was higher than pubertal value. Thus, from a clinical point of view, the ACTH test in patients with typical pubarche must be reserved for subjects with high basal 170HP levels. Our experience adds to the current logic that men with azoospermia or severe oligospermia should be evaluated for Yq11 microdeletions before deciding to operate varicoceles or else scheduling them for assisted reproductive techniques.

Premature rupture of membranes (PROM) is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91%) cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86%) of neonates was less than 37 completed weeks. Thirty five infants (21.47%) had respiratory distress syndrome and 33 (20.245%) had clinical sepsis. Pneumonia in 6 (3.7%) and skeletal deformity in 7 (4.294%) were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6%) of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours) showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p<0.05). The risks of pneumonia and mortality were much higher in group with >24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11%) of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane were higher than previous studies.

The goal of this study was to define the normal range of diameter in the deep vein of the lower limb and to compare this range with diameter of the veins with acute thrombosis and of veins with chronic thrombosis by using color doppler sonography. The study was cross sectional. The vein diameter and vein to artery ratio in different levels were measured and the following results were obtained. In patients with acute thrombosis the vein diameter and vein to artery ratio were more than normal range and this difference had statistical significance so we can reliably predict acute thrombosis if the vein diameter is upper than a suggested level. In chronic thrombosis, however, the vein diameter is not a good diagnostic factor and so we can not rely on it.

The effect of nerve growth factor (NGF) on regeneration of rat sciatic nerves in adult rat was studied. The sciatic nerve was cut out across a 6‑mm gap, then the proximal and distal stumps were inserted into the silicone tube chamber. 7s NGF was extracted from submaxillary gland and then was injected into the silicone in experimental group. After seven months nerve was transected and stained with toluidine blue. Semithin sections (1 µm from middle of silicone (control group, without NGF) showed that regenerated axons (mostly unmyelinated) were dispersed randomly, and they were not grouped into bundles. In this group some of the myelinated fibers were degenerated and macrophages or in other word, schwann cells contained a large amount of these degenerated sheaths. Semithin section of experimental group (with NGF) showed numerous regenerated axons (myelinated) that were grouped into small bundles. Schwann cells in experimental group were large and eucromatin and some of them were divided. These data indicate that NGF causes myelinated axons, regenerate and making new myelinated sheaths.

In patients requiring coronary artery bypass grafting (CABG), usually at least one of the internal mammary arteries is used. This study evaluates the degree of atherosclerotic involvement of the internal mammary artery (IMA) in patients undergoing CABG. During two months period, 79 patients (66 male and 13 female with a medium age of 58 years) undergoing myocardial revascularization had a biopsy of the distal left internal mammary artery. In our study atherosclerotic involvement of the IMA was assessed according to the scale of Kay. Using this index, grade 0 corresponds to a normal artery without atherosclerosis, grade 1 represents minimal disease, grade 2 a narrowing of less than 25% of the lumen, grade 3 narrowing between 25 and 50%, and grade 4 narrowing of 50% or greater of the lumen. Of the 79 IMAs examined, the arteries with degree 0, 1, 2, 3, and 4 were: 17 (21.5%), 36 (45.6%), 13 (16.5%), 10 (12.7%), and 3 (3.8%), respectively. Considering the arteries with severe atherosclerotic narrowing (3.8%), the IMA had a low but consistent incidence of atherosclerotic involvement. According to our investigation among risk factors only high blood pressure has some roles in inducing atherosclerotic changes (p=0.014). The other risk factors (i.e. diabetes mellitus, smoking, hyperlipidemia) had no correlation with the atherosclerotic changes in IMA. Preoperative angiography of the IMA is not necessary for all the patients that require CABG, but could be recommended in hypertensive patients.

Over the past decade, there have been several studies showing autobiographical memory retrieval and problem‑solving deficits in depressed population. The present study aimed to first to examine the roles of autobiographical memory specificity and problemsolving effectiveness in Iranian depressed people with or without suicide ideation and secondly, to test the correlations between autobiographical memory and problem-solving components. A group of depressed patients with suicide ideation (n=20, aged 18-45) and a matched control group (depressed without suicide ideation) were tested by a autobiographical memory test, a means-ends problem-solving task, Beck Depression Inventory (BDI), and Beck Hopelessness Scale (BHS). Both groups met DSM-IV criteria for major depression disorder without psychotic features. In line with hypotheses, the suicide ideators scored significantly higher on the hopelessness scale than the control group. The suicide ideators also provided significantly less effective problem-solving strategies and more over-general memories than the control group. A significant correlation was found between low effectiveness of problem-solving strategies and over-general memory retrieval. The present results suggest that access to non-specific memories in depressed people can lead probably to ineffective problem solutions and subsequently hopelessness and suicide.

Studies have shown that there are psychiatric patients who tend to aggressively mutilate themselves; they burn or in most cases attempt to burn themselves, attempt to severely damage their genital organs (especially amputate their penis), castrate themselves, axtract their own eyes, amputate their own hands, or commit suicide. This report introduces two psychiatric men, aged 40 and 47, who had undergone surgical operations in Urology Department of Imam-Khomeini Hospital, Tabriz, Iran, because of self-amputating their penis and, on discharge from Urology Ward, were referred to Razi Psychiatric Center for psychiatric consultation. Our assessment revealed that one of these patients was affected with psychotic-type major depressive disorder and the other with borderline personality disorder. Such cases of self-mutilating behavior emphasize the significance of recognizing the alarming signs of self-mutilation.