Acta Medica Iranica
Volume:39 Issue: 2, Feb Mar 2001

Abstract: The results of standard and augmented surgical treatment of partial accommodative esotropia have been compared in this study.In this sequential matched randomized double blind clinical trial, we studied 48 patients (96 eyes) with partial accommodative esotropia between the ages of 13 to to 144 months, referring to strabismus clinic of Farabi Eye Hospital between 1999-2000. These patients were grouped according to age degree of hyperopia and AC/A ratio and then were randomly divided in two standard and augmented groups (24 patients in each group). All patients were followed for at least 6 months after standard or augmented biomedial recession with or without inferior oblique weakening procedure. Post operative visual acuity, hyperopia, eye deviation, stereopsis, fusion and AC/A ratio were compared between the two groups Post operative acceptable deviation was observed in 37.5% and 87.5% at first week follow up P<0.001). 66.6% and 91.5% at 6 th week of follow up (P<0.05), 91.6% and 95% at 6 th month of follow up (not significant [N.S]) of patients in standard and augmented groups respectively.Other results of standard and augmented groups are as follow:-Improvement of visual acuity (at least one line) in 8.3% and 20.5% (N.S). -Improvement of fusion in 8 out of 13 patients (61.5%) and in 9 of 14 patients (64.3%) (N.S).-Reduction of post operative hyperopia in 3 Patients (12.5%) & 6 patients (25%) (N.S).-Reduction of AC/A ratio in all patients with high AC/A ratio, in both groups.-Improvement of stereopsis in 2 of 13 patients (15.4%) and in 3 of 13 patients (23%) (N.S).this study shows that augmented surgery improves longterm alignment, visual acuity, stereopsis and fusion greater than the standard group, but with statistically insigificant difference, which might be due to short duration of followr up and the small number of cases in each group.

Abstract: To determine quality of life and various factors affecting it, we conducted a cross-sectional survery among 103 hemodialysis patients in four teaching hospitals of Tehran University of Medical Sciences.A quality of life questionnaire (QLQ). Containing various items relating to physical, psychological and social aspects of life was filled by interviewing each patient and a total score ranging from 70 to 300 was assigned to denote overall life quality. We also determined the most common underlying renal diseases and comorbid conditions in these patients.The most common underlying renal diseases were found to be primary glomeruloarteriolar disease, interstitial disease, diabetes mellitus and essential hypertension. Common comorbid conditions in this study were musculoskeletal diseases (osteoarhritis), spinal disorders, gastrointestinal, cardjovascular and endocrine problems. Moreover, restricted social life, financial difficulties, loss of independence and family/marital strain emerged as major psychosocial problems affecting the lives of our patients.The percentage of patients who had reached a satisfactory level of adaptation with dialysis therapy (46%) was distinctly lower than that reported from the United States. Advanced age and the presence of comorbid diseases were found to have a negative impact on the patients’ life quality, while a psositive association was recorded between quality of life and longer duration of dialysis treatment.Overall, these findings indicate a significant degree of psychosocial impairment in our patients and emphasize the importance of providing effective counseling and rehabiliation services to hemodialysis patients

Abstract: The major objective of the present study was to characterize the effects of oxidants generated b xanthine (X) plus xanthine oxidase (XO) on isolated rat ileum motility. The effects of three concentrations of X/XO on the basal tone of the rat ileum preparation were studied for 20 minutes. Developed tensions were measured in mg/mg tissues and then expressed as percentage of baseline tension. Also the effects of 2X concentration of X/XO in the presence and absence of superoxide dismutase, catalase, mannital, histidine, and deferoxamine were evaluate. The results were expressed as mean ± SE. Xanthine puls xanthine exidase produced relaxation of ileum. Superoxide dismutase (a superoxide anion metabolizer) and catalase (a hydrogen peroxide scavenger) did not protect ileum from effects of X/XO suggesting that neither superoxide anion nor hydrogen peroxide involse in X/Xo- induced relaxation of ileum. The results of this study suggest that hydrogen peroxide formed extracelluarly by X/XO may enter the cells and interact with intracellular iron of form a highly reactive oxidant. Hydroxyl radical. The finding that two powerful hydroxyl radical scavengers, dimethylthiourea (DMTU) and mannitol offered protection against X/XO-induced relaxation of ileum suggest formation of hydroxyl radical withing the cells. Pretreatment with deferoxamin, a potents iron chelator, reduced the relaxation of ileum, indicating that hydroxyl radical plays an important role in mediating the X/XO –induced relaxation of ileum. In addition.The ability of exogenously administered histidine to reduce relaxation suggests that singlet oxyen is another oxygen derivative which is responsible for relaxation of ileum-induced by X/XO.

Abstract: Anotomical boundary of atrioventricular node reentrant tachycardia (AVNRT) is composed of fast and slow pathways right atrium in upper turnaround and common distal pathway in lower turnaround. We performed electophsiologic study (EPS) in 152 patients and could show the existence of distal common pathway with decremental conduction properties in approximately 40 patients.

Abstract: The absence of cerebrospinal fluid (CSF) pleocytosis in invasive meningococcal disease (IMD) has been associated with an increased risk of death. It is unknown whether patients who lack a cellular response to central nervous system (CNS) infection are at the same risk of adverse outcome as patiens without CNS infection. To determine the frequency of presentation and outcome of three groups of children with IMD, Group 1, children with CSF pleocytosis (cells ≥ 10 mm3) and negative or positive cultures, Group 2, children without CSF pleocytosis and with negative CSF pleocytosis but with positive CSF cultures (CNS infection without CSF pleocytosis), we reviewed the medical records of children with IMD. Clinical and laboratory indies and severe adverse outcomes (definded as death or limb loss due to gangrene) were compared in three groups. Multivariable bogistic regression analysis was performed.Of the 108 available patients, 75 (69%) had CSF pleocytosis, 24 (23%) had bacteremia alone and 18 (16/7%) had CNS infection without CNS plocylosis. Patients with CNS infection without CSF pleocytosis had significantly lower white blood cell and platelet counts and more coagulopathy than patients with bacteremia (P<0.05) of patients with CSF bleocytosis (P<0.01). The frequency of adverse outcome was 61% for patients with CNS infection without CSF pleocytosis compared with 41.6% for patients with bacteremia alone (P<0.001) and (26.4%) for patients with CSF pleocytosis was independently associated with adverse outcome by multivariable logistic regression analysis (P<0.03). Approximately 38.5% of all children with IMD presented without CSF pleocytosis. Of these patients those with CNS infection without CSF pleacytosis were at higher risk of adverse outcomes than either patients with CSF pleocytosis or patients with bacteremia alone.

Abstract: Distraction osteogenesis method (Do) in bone lengthening and rapid midpalatal expansion have shown the great ability of osteognic tissues for rapid bone formation under distraction force and special protocol with optimum rate of one millimeter per day. Periodontal membrane of teeth (PDM) is the extension of periostium in the alveolar socked. Orthodontic force distracts PDM fibers in the tension side and then bone formation will begin.Objects: Rapid retraction of canine tooth into extraction space of first premolar by DO protocol in order to show the ability of the PDM in rapid bone formation. The other objective was reducing total orthodontic treatment time of extraction cases.Patients and Tweleve maxillary canines in six patients were retracted rapidly in three weeks by a custom-made tooth-born appliance. Radiographic records were taken to evaluate the effects of heavy applied force on canine and anchorage teeth. Average retraction was 7.05 mm in three weeks (2.35 mm/week). Canines rotated distal- in by mean 3.5 degrees.Anchorage loss was from 0 to 0.8 mm with average of 0.3 mm.Root resorption of canines was negligible, and was not significant clinically. Periodontium was normal after rapid retraction. No hazard for pulp vitality was observed. PDM responded well to heavy distraction force by Do protocol. Rapid canine retraction seems to be a safe method and can considerabely reduce orthodontic time.

Abstract: ess the relationship between umbilical cord blood gases at birth and morphology of umbilical cord, in a prospective study of 200 consecutive term delivery, we investigated the relationship between umbilical cord morphology characteristics (umbilical crd length, number of vascular coil, coiling index) and color of amniotic fluid and umbilical vessel blood gases. Statistically significant linear correlation was found between umblicial venous PH and the umbilical cord length (r=0.39, 95% CI 0.25, 0.53, P<0.03), umber of vascular coils (r=0.45 95% CI 0.31-0.59 P<0.012), and coiling index (r=0.34, 95% CI 0.12-0.48, P<0.04), and also negative linear correlation was found between umbilical venous partial pressure of carbon dioxide & of coli (r=0.3, 95% CI –0.44, -0.16 P<0.03). No relation was found between umbilical cord indices and meconium staining of amniotic fluid.Placental weight also correlated with umbilical cord length (r=0.17, 95% CI 0.03-0.31, P<0.03), but not with umbilical cord coils or coiling index.Umbilical venous pH is related to umbilical cord morphology but umbilical venous PCO2 was only related to the number of coils and umbilicat artery pH wa only related to the number of coils and not related to length or coiling index of umbilical cord morphology. The morphology of umbilical cord can affect maternal-fetal gas exchange

Abstract: To delineate the incidence, epidemiology, etiology, and prognosis of acute renal failure (ARF) and to compaed the findings with international data, we prospectively studied 2360 patients, admitted at shariati hospital during a four months period ending on Jan, 6, 1996. One hundred and twenty-four (5.1%) patients meeting ARF crieteria were encountered. The most common cause of ARF was prerenal azotemia, nephrotoxins were the second common cause, and primary renal disease were the third.In-hospital mortality was 5.5% and 31% of this mortality was related to ARF. Poor prognostic factors were oliguria, maximum serum ceratinine (Cr) level, rise of Cr during admission, multiorgan failure,and sepsis.

Abstract: Fine- needle (FNA) cytology of ovary is a simple method for evaluation of ovarian masses. But there is controversy about its reliability in differentiating between benign and malignant neoplasms. To evaluate the efficiacy of FNA cytology in the distinction between benign and malignant masses of ovary, we examined 55 fine needle aspirations from 55 women 14-74 years of age. The aspirations were performed on fresh resected ovarian masses, which were sent to the pathology department for intraoperative consultation. All smears wee papanicolaou- stained and studied in two stages. In the first stage the smears were studied without any clinical and gross pathologic information and in the second stage clinical and gross pathologic information was available. In the first stage the results were classified as benign, malignant and inconclusive. In the second stage there was no inconclusive case so the results were divided into benign and malignant. By comparing the cytologic results with histologic diagnoses (gold standard), the sensitivity and specifity of FNA cytology was determine in the two stages. In the first stage, 11 cases were considered inconclusive and the sensitivity and specifity of the method was 87.5% and 8.33%, respectively. In the second stage the sensitivity and specifity was 78.7% and 92.7%, respectively with no inconclusive case.We conclude that FNA cytology of ovary is a reliable method for distinction between benign and malignant ovarian masses.

Abstract: Tinea capities is the commonest dermatophytosis in children with diverse clinical presentations. The causative fungi of Tinea capitis vary with geographic area and time.This study was aimed to identify the etiologic agents and determine the related factors of Tinea capitis in Tehran, Iran. From clinically suspected cases of Tinea capitis, microscopy and culture were performed. Of 58patients 96% were children below 12 years of age with the male/ female ratio of 21, the common clinical manifestation was gray patch, followed by kerion, favus (scutula), black dot not seborrehic dermatitis- liker lesion, thrychophyton violaceum was the most common etiologic agent, responsible for 53.4% of infection, followed by T. shoepnleini (24.1%) Microsporum canis (5.5%), T. mentagrophytes (3.4%), T. tonsurans (1.7%) and M. gypseum (1.7%). T. violaceum was the predominat pathogen causing Tinea capitis in this region and gave rise to a varied clinical picture

Abstract: Wegener’s Granulomatosis is a necrotizing granulomatous vasculitis involving small and medium sized vessels. The syndrome is classically defined as having involvement of kidney, lungs and upper respiratory tract (i.e. sinuses). Wegener’s Granulomatosis may be present in other autoimmune or inflammatory diseases, particulary systemic lupus erythematosis (SLE), but most frequently has been associated with polyarteritis and glumerulonephritis.We present a case of wegener’s Granulomatosis (WG) in a middle age lady with Rheumatiod Arthritis (RA); and discuss the implications of these two conditions co-existing in one patient. As for as we are aware, through medline and interent research, this is probably the fourth case with such as association of WG and RA and the fist one in Iran.Presentation of new uncontrollable sing and symptoms, in a previously well controlled RA patient, might suggest a new overlapping syndrome like Wegener’s Granulomatosis besides to flare up of previous disease as differential diagnosis

Abstract: Central nervous system ranks among the favorite sites to get involved by Nocardia astroides. This opportunistic organism complicates many disorders characterized by cellular or humoral immunity disturbances.A 36-year-old woman is being presented, known to have systemic lupus erythematosus (SLE) and having received a two year course of corticosteroid treatment. Cerebellar abscess was found on diagnostic imagings performed because of heddaches and dysequilibrium of two weeks duration.Craniectomy was performed and the abscess excised. Nocardia astroides grew in the pus culture. On switching the empirical therapy to a combination of trimethoprimsulfamethoxazole and vancomycin, the patient exhibited dramatic improvement in symptoms later on and postoperative imaging showed an absence of the lesion. We recommend a high index of clinical suspicion for nocardia abscess in patients suffering from SLE and presenting with neurological treatment presents the only plausible option

Abstract: Isolated scaphoid dislocation is a rare injury of the wrist. To our knowledger, only 22 cases of isolated scaphoid dislocation have been reported in Enghish-language literature and we could find only one case with pure radial dislocation. We present a 34-year-old man with isolated pure radial scaphoid dislocation that was treated by open reduction and repair of the scapholunate ligament and pin fixation. Because of the rarity of the injury and as few orthopedic surgeons seem to have encountered it, we present this case along with literature review stressing on treatment options and results.

Abstract: A 22 year-old woman presented with gradual visual loss in her right eye since 1990. Medical and family histories were unremarkable. Her visual acuity was 20/80 and 20/20 in right and left eyes respectively. Slit lamp examination was quite normal with no relative afferent papillary defect.Fundi of both eyes revealed subretinal lesion with optic nerve head involvement and subretinal fluid in papillomacular bundle with macular pucker in right eye. Whole body MRI revealed a large hemangioma in the spinal canal. In 1998 the patient ahsd significant visual loss at both eyes. This is the first report of Von hippel disease with bilateral optic nerve hemangioma in Iran.