Acta Medica Iranica
Volume:41 Issue: 2, Feb-Mar 2003

Less than 5% of prenatal thymoctes express HLA-DR before week 12 of gestation. However, the number of HLA-DR- positive cells increases during the late second and third trimesters of development. To determine the role of alpha-smooth muscle actin in fetal thymic HLA-DR signaling in different stages of development we examined and compared the immunohistochemical expression of alpha-smooth muscle actin in the myoid cells of the thymic medulla stroma in the 2 nd, and 3rd trimesters of gestation respectively, over the equivalent expression of the protein in the 1 st trimester, in relation with the appearance of HLA-DR-positive thymocytes. Our results demonstrated a quantitative difference in the second and third trimesters of development concerning the expression of alpha-smooth muscle actin in the stromal myoid cells of the thymic medulla over the equivalent expression of the protein in the first (P<0.0001, t-test). Similar changes in the above period wee found concerning the expression of HLA-DR over the first (P<0.0001, test), suggesting a direct involvement of alpha-smooth muscel acting in the sustainence of HLA-DR reactivity. Our data provide evidence that a contractile microfilament alpha-smooth muscle actin plays a pivotal role in HLA-DR expression, through interaction between medullary stromal cells and thymoctes.

Opportunistic fungal infections including candidiasis have increased dramatically in recent years. Most medically important fungi are Candida species. Rapid identification od Candida isolates to the species level in the clinical laboratory is necessary for more rapid and effective antifungal therapy and to facilitate hospital infection control measures. Conventional morphological methods for identification of candida species are often difficult and time consuming. Molecular DNA-based techniques provide useful alternative methods. In this study using universal primers, ITS1-ITS4 region of the fungal rRNA genes were amplified. Digestion by the restriction enzyme Mspl allowed us to identify of C. albicans, C. glabrata, C. krusei, C. tropicali, and C. guilliermondii. C. guilliermondii produces 3 bands whereas the others gave two distinctive bands after digestion. This panel of PCR-restriction enzyme could be rapid, simple and useful in diagnostic studies of candida and candidiasis.

The aim of this study was to compare the effectiveness of Fenugreek (Trigonella foenum-graecum) with that of lovastatin in restoration of endothelia function in the aorta taken form aged N-Mair rats. For this purpose, 4 groups of old N-Mari rats were used (n=6), normal saline treated control group, lovastatin (10 mg/kg, orally) and fengreek seed powder in normal saline suspension (100 or 500 mg/kg) were administered orally daily for 8 weeks. The rate of relaxation of ephedrine- precontracted aorta to acetycholine, the lipid profiles, and histological examinations of the aorta were compared between these two groups and with a control non-treated normal saline treated group. The results showed that treatment with lovastatin and fenugreek produced significant reduction in IDL, VLDL triglyceride and total cholesterol, while HDL was increased as compared to control non-treated group. Lovastatin induced an increase in contraction/mg tissue weight. However, improvement in endothelial function was significantly increased in all treatment groups. The histological findings showed significant reduction in thickness and lipid deposits in the aorta in all treatment groups. The improvement in the epithelial function was correlated with LDL-cholesterol lowering and partly with the reduction in the thickness of the aortic intimal layer. This study demonstrated that fenugreek is as effective as lovastatin in reducing the features associated with atherosclerosis.

To evaluate the maternal serum dehydroepiandrosterone sulfate level as a factor associated with the outcome of labor induction. Venous blood was collected from 45 women at the initiation of labor induction. Pregnancies complicated by maternal corticosteriod use, anterpartum chorioamnionitis, or cesarean delivery for indications other than arrest disorders, were excluded from analysis. In 42 women meeting inclusion criteria, induction followed established protocol. Serum dehydroepiandrosterone sulfate levels were measured by radioimmunoassay and correlated with the outcome of each induction attempt. A successful result was defined as progression to active labor. The welch approximate t-test, Mann-Whitney test, Fisher exact test, simple regression, and multiple regression were used for statistical analysis, with P<0.05 considered to be significant. The mean (±standard error) dehydroepiandrosterone sulfate level was higher in women who progressed to active labor (n=25) than in those with unsuccessful attempts (n=17), (48,63±6.53 µg/dl versus 26.86±5.17 mg/dl, respectively; p= 0.03). Compared with women with dehydroepiandrosterone sulfate levels above 60 µg/dl, women with lower levels had an unsuccessful induction odds ratio (OR) of 6.92 (95% confidence interval 1.74, 32.52, p= 0.01). The OR increased as dehydroepiandrosterone sulfate levels decreased. Dehydroepiandrosterone sulfate may be an important factor in successful labor induction.

Ramadan fasting is one of the most important religious duties of Muslims, that its effect on the heart has not been determined yet. Our objective was to evaluate the effect of Ramadan fasting on ventricular repolarization as assessed by QT interval, corrected QT interval, QT dispersion or corrected QT dispersion. Sixthy healthy subjects aged 20 to 35 years were dispersion included in this study. QT interval, corrected QT interval (QTc) QT dispersion QTc dispersion, RR interval and QRS axis were measured in 12-lead surface electrocardiogram, once during fasting (10 to 11.5 hours of absolute fasting from food and liquid) and another time, 15 tp 60 minutes after eating food at sunset, All of the subjects had been fasting 11 to 12 hours each day at least for 25 days during Ramadan. The study was performed at Amir Alam hospital in the year 2000. Maximal QT interval, mean QT interval and RR-interval, were longer during fasting (P<0.05), and both QT dispersion and QTc dispersion were increased (P<0.05). (QT dispersion: mean ±SD= 57.2±20.1 ms during fasting Vs 41.6±15.1 ms after meal, QTc dispersion=75.4±24.6 ms during fasting Vs 64.1±22.8 ms after meal). But mean QTc interval maximal QTc interval and QRS axis showed no significant difference. Prolongation of QT interval and RR interval during fasting, instead of no significant changes in corrected QT interval may primarily suggest that prolongation of RR-interval causes QTc interval not to have significant difference. But increases of QT dispersion and corrected QT dispersion (QTc dispersion) during fasting -that are more reliable indicators of ventricular repolarization-support the idea that ventricular repolarization may be changed during Ramadan fasting. QT dispersion in cardiac patients is showed to increase from normal values of 30-40 to 64-138 ms, but in our study their increases did not reach critical value.

This cross sectional study was carried out between 1993 to 1998 at Razi Skin Hospital, the affiliated Dermatology Department of Tehran University of Medical Sciences. Eight hundred patients receiving etretinate for various skin diseases took part in this study. Among them, 457 patients with first admission to dermatologic clinic who had at least four regular sequential visits and responding to our questionnaire were selected to enter the study for evaluating acute toxicity of etretinate. Cheilitis with a frequency of 88 percent was the most frequent side effect. Hair loss (22.97%), dry mouth with thirst (15.09%), dryness of mucous membranes (13.12%), xerosis with pruritus (11.15%), nose bleeding (8.31%), paronychia (5.47%), facial dermatitis (3.06%), conjunctivitis (2.84%) and in addition to mucocutaneous ones, chills (2.63%), headache (2.19%), mental depression (2.19%), urinary frequency (1.53%) and papilledema (0.44%) were among the other observed toxicities, The relationship between mucocutaneous side effect with dosage of etretinate, sex and, age of the patients was evaluated. The association between mucoctaneous toxicities and sex was significant, sex and, age of the patients was evaluated. The association between mucocutaneous toxicities and sex was significant (P<0.05). We observed four rare side effect in the patients including hair color lightening appering as whitening or blondness, hair waving, dyspareunia and gynecomastia. In conclusion, females were more to acute mucocutaneous toxicities of etretinate.

This study was designed to assess the role of first-line chemotherapy with 5-FU and platinum in the treatment of advanced or recurrent cervical cancer, ten patients with advanced or recurrent cancer of the cervix, with no prior chemotherapy were entered in phase II trial, from Oct. 2000 to Nov. 2001. Eight patients were treated with cis-platinum (50 mg/m2 over 60 minutes in first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) and two patients with impaired renal function were treated with carboplatin (300 mg/m2 over 15 minutes in first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) every three weeks, until progression of disease or prohibitive toxicity had been observed. Median age was 52 years (range: 28-70 years). Ten patients received a total of 42 cycles of chemotherapy. The mean number of chemotherapy cycles was 4.2 (median 4, range: 3-7). Three patients had partial response (30%, CI, 1.7%-58.5%). Mean response duration was 198 days (range: 122-273 days). Four patients required red blood cell transfusions; three of them had grade II and one of them grade III nausea and vomiting Two had fever and neutropenia (one developed acute renal insufficiency), and there wee no treatment related mortalities. First-line chemotherapy with platinum and 5-FU for advanced recurrent cervical cancer is promising and deserves consideration for large phase III trials.

Present paper reports a case of breast actinomycosis due to Actinomyces israelii in a 31-year-ol female nurse from Shahrekord, in Iran. Diagnosis was based on the observation of short and very fine gram-positive filaments in direct examination of aspirates from fistulas, as well as isolation of organism in sodium thioglycolate and brain heart infusion blood agar (BHIB) culture media, under anaerobic conditions and complementary phyiologic tests.

Osteosarcoma is a primary malignant tumor of bone, which can involve jaws. This article reviews osteosarcoma of the jaws referred to the Department of oral pathology, dental faculty of Tehran University of Medical Sicences and Pathology Department of Cancer Institiute in Imam Khomeini Hospital during 30 years from 1349 to 1378 and also reviews jaw Osteosarcoma in English literature. The purpose of this review is comparing the clinical behaviour of jaw tumors with Osteosarcoma from elsewhere in the body and reporting the observations of clinical, histological and diagnostic findings. For this retrospective review the clinical, radiographic and histopathologic records of 42 patients were obtained, furthermore follow up results were also obtained from patients records. The mean age of patients was 35 years (range 9 to 61 years) with slight male predilection. The most common presenting features were swelling, pain and ulcer. Histologically, the lesions ranged from well-differentiated tumors with prominent osteoid formation to poorly differentiated tumors, which had bizarre cells and numerous mitosis especially atypical ones. Most of the lesions had areas of chondroid formation, but all of tumors showed neoplastic osteiod, of course in different degrees. The most important problem after treatment was local recurrence. Primary osteosarcomas of the jaws are a group of lesions, which are biologically distinct from long bones osteosarcoma and have better behaviour than them. More accurate determination of their clinical behaviour and their management will depend on complete follow up of patients and actual records of patients’ data.

A 32-year-old end stage renal disease (ESRD) woman was scheduled for transplantation. Also, she has had fever of unknown origin (FUO), rise of ESR and PPD>22 mm. Therefore treatment with isoniazid and rifampin was started three months prior to transplantation. She developed allograft dysfunction on week after transplantation. She received a few course pulse therapy (methyl prednisolone), antilymphocyte globulin (ALG), hemodialysis and because of low blood level of cyclosporine, isoniazid and rifampin were stopped. She was seen because of unilateral decreased vision, fever, cough and in physical examination, chorioretinitis and bilateral infiltration in both lungs were seen three weeks later. Severe cytomegalovirus (CMV) antigenemia was detected and she responded rapidly to gancyclovir. One month later, she complained of fever and productive cough again. In chest X-ray (CXR), cavitary lesions were shown and with transthoracic biopsy, invasive aspergillosis was detected. In spite of amphotericin B therapy, she developed CNs involvement. Unfortunately she expired six months post transplantation. This is an interesting case of aspergillosis following CMV infection most likely because of an excess of immunosuppression.

At present, many drugs are used for inhibition of uterine contractions, but the proportions of preterm labors are increasing. Although magnesium sulfate is the most commonly prescribed parenteral tocolytic agent, but it’s optimal use has yet to be delineated. In this study a high-dose protocol for magnesium sulfate tocolytic therapy was compared with a low-dose regimen. One hundred patients admitted to labor unit of Imam Reza''s Hospital with preterm labor were enrolled in the trial. The median times to successful tocolysis were 8 hours in the low-dose group and 4 hours in the high-dose group (P<0.001). Patients treated with higher doses were also more likely to spend significantly less time in the labor and delivery unit (P<0.001). The median gestational age at delivery was 33 weeks in the low-dose group and 36 weeks in the high-dose group (P=0.001). There were not any statistically significant differences between two groups with respect to pre and post of magnesium infusion side effects. These results suggest that in the high-dose group, tocoysis was achieved more rapidly and patients required shorter admissions to the labor and delivery unit without increased maternal morbidity.

Clinical cases of Histoplasmosis have been reported from many parts of the world principally from the USA and to a lesser extent from central and South America. Sporadic cases are recorded in medical literature from Europe, Africa and Asia. Histoplasma capsulatum, the etiologic agen of histoplasmosis is a cosmopolitan geophilic fungus associated with avian and chiroptera. The association of bats with cases of histoplasmosis in man and the isolation of Histoplasma caplulatum from organs and feces fo naturally infected bats suggest that certain species of chiroptera may play a role in the epidemiology of histoplasmosi. For this purpose during 12 months between 1994 and 1995 a total of 800 bats representing 3 genous include Myotic, Rhinolophus and Sherbersi were examined from 2 caves in the North and West in Iran. The methods were based on direct examination, culture and inoculation to animals and Histoplasma capsulatum was not isolated.

It has been sugeested since long that peripheral nerves possess opiod receptors and this has tempted clinicans in adding narcotics to local anesthetics to prolong the analgesic effects of these solutions. In this regard, we studied 45 patients undergoing surgical procedures on upper extremities. The patients scheduled for surgery were divided in to three groups, each comprising of 15 patients and all the patients underwent supraclavicular block. In goup A, we used 5 mg/kg of 1.5 percent lidocaine, in group B the same dose of lidocaine along with 1 mcg/kg of fentanyl solution was use. Lidocaine in the above dosage and pethidine 1mg/kg were injected to the patients in group C to facilitate supraclavicular block. The average length of analgesia was 180 minutes in group A, 300 minutes in group B and 406 minutes in group C. In Adding pethidine or fentanyl to local anesthetics can increase the analgesia period 2-3 times. Although pethidine implies longer effect than fentanyl, but this difference is not significant (P>0.05).