Acta Medica Iranica
Volume:39 Issue: 1, Jan Feb 2001

Abstract: Craniospinal irradiation plus posterior fossa boost (CS1) is the standard modality of post-operative treatment of patient with medulloblastoma, but considering the technical difficulties and limited facilities, often whole- brain irradiation plus posterior fossa boost (WBI) had been used in our institution until 1991. Tust a retrospective study was undertaken to compare the patients treated by By WBI and CSI for recurrences and disease-free survival (DFS). Files of all medullobalstoma patients treated post-operatively in our department in the 10 – year period of 1986-1996 were reviewed. To obtain the best possible follow- up, a formal inquiry letter was mailed to all patients’ addresses.Total of 72 patients had been treated, with a mean age of 14.7 years and male-to-female ratio of 1.5:1 Thirty –seven patients had been treated by WBI and 35 by CS. A simple wooden device designed and made in our department was used for CSI patients’ set-up and immobilization. Mean radiation dose to posterior fossa was 4, 765 cGy in WBT and 5, 071 cGY in CSI (180-200 cGy fractions). Sixty-two patients (85%) came back for follow-up, with 24 recurrences. Only 24% of CSI patients had recurrences, versus 51% in WBI Nearly all Wbi recurrences versus half of the CSI recurrences were spinal. DFS was 39 months in CSI and 26 months in WBI (P<0.001). in multi-factorial analysis, only the extent of radiation (CSI versus WBI, P<0.001) was statistically significant. Mean age in our patients was higher than what is commonly reported in literature. The immobilization device introduce was a simple and useful accessory to CSI. Considering DFS, CSI in our department was acceptabley comparable to literature results and significantly superior to WBI. With regard to relatively high spinal recurrence rate even in CSI, the importance of suitable spinal cytological and imaging evaluation is again emphasized.

Abstract: The disease of thalassemia major requires mangement by repeated transfusions of packed cell and iron chelators such as deferoxamine. Today, serum ferritin is used for estimation of adequacy of the management. As the most morbidities and mortalities of the disease are the consequences of cardiac complications. Echocardiography is periodically periodically performed along with the management. In this case-control study, our object was to appoint if we can use “left ventricular mass” to evaluate the quality of past longterm managements for the patients.The variables of wieth, height, body suface area, total amounts of transfusion of packed all can deferoxamine during 5 years ago, crude left ventricular mass, indexed left ventricular mass (left ventricular mass/ obdy suface area 123), ejection fraction, and shortening fraction, were measured in 34 thalassemia major patients of 16 to 18 years of age who had no sings or symptoms of any organ failure, particulary cardiac failure and had received repeated transfusions of paced cell and dederoxamine. In the control group, these variables (except amounts of transfusions of packed cell and deferoxamine) were measured in 34 normal subjects of 16 to 18 years of age too. The variables of left ventricular mass, ejection fraction and shortening. Fraction were recorded on the echocardiographic paper. Then, the group of thalassemic patients were sectioned into two subgroups of ordered (well managed) and non-ordered (bodly managed) patients on the basis of 5 scales. Since, on the basis of international scates, absolute majority of the patients were set in the non- ordered group, the international scales were moderated and comparisons wee done.Only the means of variables of weight, height had body surface area were tooless and of indexed left ventricular mass was too more in thalassemics than normal subjects (P.value= 0.0001). Almost no significant difference was seen between two ordered and non- ordered subgroups. On the baiss of any scale (P.value>0.05).By increase the cases and extension of the research the study can be done to reach the oetter results of more confidence.

Abstract: Asthma is one of the most common chronic illnesses in childhood with an increased rate of hospitalization. In order to detemine the considerable factors for hospitalization of asthmatic children in our patients, we carried out a retrospective study of children with asthma who were admitted to children Medical center affiliated to Tehran University of Medical Sciences over a 3 year period (1993-1995). In this study 100 admitted asthmatic children were evaluated including 58 males and 42 females. The mean age of patients at the time of study was 19 months (6 months- 12 years). Fifty – three out of 100 patients (53%) were admitted in intensive care unit (ICU). 26 out of 53 patients admitted to ICU, required tracheal intubation and mechanical ventilation. Among the 100 admitted patients, 78 patients had respiratory infection before hospitalization, 60 had history of emergency room visit for asthma in 48 hours prior to hospitalization and 23 patients were steroid dependent. Family of 90 patients had little formal education about asthma. We conclude that most asthma exacerbations are provoked by respiratory infections, and proper family education is essential for improving outcome of asthma management

Abstract: From 1986 to 1996, 1020 renal transplants were performed at our center. The purposes of this study were. 1) to evaluate the patient and graft survival rates and 2) to see if some donors and recipient characteristics such as age, sex and relationship had any effects on graft survivals. 571 transplants were from living related donors (LRD) and 446 from living unrelated donors (LUD). 65.9% of recipients wee males and 34.1% females, with the age range of 8-66 years. 72.5% of donors were males and 27.5% females with age range of 17-69 years. 91.3% of unrelated donors were males with a mean age of 28.8±5.6 years.From 1020 recipients 737 (72.2%) wee alive with a functioning groft. 211 (20.2%) were alive with a functioning groft. 211 (20.7%) had returned to dialysis and 72 (7.1%) had died with a functioning graft. 02 211 recipients who returned to dialysis, 171 were still alive and 40 had died. The overall patient survival was 98% and graft survival 72.7%. 726 patients who had transplant before October 1993 (at least 3 yars post transplant) were selected for this study. 388 transplant were from LRD and 338 and from LUD. In 388 LRD transplant patients, survival was 96.1%, and 95% and graft survival was 92.1% 87.6% and 811.9% in 1, 2 and 3 years respectively. Graft survivals in 1, 2 and 3 years were significantly better in LRD transplants as compared to LUD transplants (P<0.05, P<0.005, P<0.005) but there was no significant correlation in patient survivals. By performing log-rank test in Kaplan-Meier analysis there was also a significant correlation between graft suvival and patient age group (P<0.002) and donor recipient relation (P<0.02) but not with donor recipient sex. No correlation was also found when the graft survival of femae patients with history of pregnancy was compared with those who had to pregnancy.

Abstract: Metaplastic carcinoma is a rare form of breast cancer and is a generic term for breast carcinoma of ductal type in which the predominant component of the neoplasm has an appearance other than epithelial glandular structures.We report a case of this rare tumor in as 57-year-old psot- menopausal woman

Abstract: Bone matrix gelatin (BMG) has been used for bone induction intramuscularly and subcutaneously by many investigators since 1965. More recently, some of the researchers have used BMG particles for bone repair and reported various results. In present study for evaluation of bone induction and new bone formation in parital defects, BMG particles were used in five groups of rats. The BMG was prepared as previously described using urist method. The defects wee produced with 5 –mm diameter in pariteal bones and filled by BMG particles. No BMG was used in control group.For evaluation of new bone formation and repair, the specimens were harvested on days 7, 14, 21 and 28 after operation. The samples were processed histologically, stained by H& E, alizarin red S staining, and Alcian blue, and studied by a light microscope.The results are as follows:In control group: Twenty-eight days after operation a narrow rim of new bone was detectable attached to the edge of defect.In BMG groups: At day 7 after operation young chondroblast cells appeared in whole area of defect. At 14th day after operation hypertrophic chondrocytes showed by Alcian blue staining and calcified cartilage were detectable by Alizarin red S staining. The numerous trabeculae spicules, early adult osteocytes and highly proliferated red bone marrow well developed on dayd 21. finally typic bone trabeculae with regulated osteoblast cells and some osteoclast cells were detectable at day 28 after operation. In conclusion,BMG could stimulate bone induction and new bone formation in bony defects. So, it seems that BMG could be a godd biomaterial substance for new bone inducation in bone defects

Abstract: This is an observational case series study on penetrating trauma admissions in three teaching hospitals in Tehran from 1996 to 1997. in order to describe the epidemiology and determine the ways of improving treatment of penetrating injuries, we selected 410 patients with penetrating injuries and injury severity scores (ISS) of more than 7 (the maximum ISS is 75) out of 3580 trauma patients, hospitalized in the three hospitals (Sina, Shohada, Fayzbakhsh) since may 1 st 1996 during a period of approximately one year. These hospitals were among the ones with the highest load of trauma patients in Tehran. The in- hospital mortality rate was 2% and the rate of permanent disability was 6%. The most frequent injuries were in the extremities; while the most fatal ones occurred in the head and neck region.The mean ± SE injury severity score was 10.9±0.23. Cutting was the most prevalent mechanism of injury while gunshot was the ratest. The most fatal mechanism of injury was gunshot followed by stab can cutting injuries. Industrial workers comprised the population at the highest risk for other cutting injuries, which can be avoided by utilizting better protection facilities at work.Our findings show that the improvement of preventive measures in industrial occupations should be considered to be of utmost importance. It seems that faster and direct transporation of patients to appropriate and well- equipped centers, improvement of the technical skills of the emergency staff, appropriate tiage of trauma victims and decreasing the time spent in the emergency room can decrase the mortality rate substantially

Abstract: The aim of this study was to estimate the incidence of retinopathy of permaturity (ROP) and to evaluate possible neonatal risk factors for ROP. The main study was a cross-sectional study including 150 high-risk neonates born at teaching hospitals of Tehran universities referring to to Farabi Eye Hospital. The chossing critertia were birth weight less than 2500 g or gestational age younger than 37 weeks. ROP was present in 9(6%) newborns, all of whom aged less than 32 weeks a birth. There was also strong association between ROP and birth weight, oxygen administration, respiratory distress syndrome and intraventricular hemorrhage. There also seems to be a higher risk for developing ROP in female neoates, those who were born by multiple gestaional pregnancies or were treated by phototherapy or transfusion and those who had suffered from bronchopulmonary dysplasia or seiss.Prematurity per se remains the strongest risk factof for ROP. Suitable criteria for screening of ROP seems to be gestational age younger than 32 weeks or birth weight less than 1500 g

Abstract: To determine breath- holding spells (BHS) prevalence and risk factors in under 6- year- old children, we interviewed mothers of 400 children in a cross- sectional study in 5 health centers at south of Tehran in autumn 1999. 33 children (8.25%) had history of BHS (Male: 19, Female: 14 25 cases were between 2-4 years old (mean: 40±17 months). Seventy percent of cases (23) had onset of attacks after 6 months of age (mean: 10 monthis) and the commonest frequency was one spell per month (78.79%). Painful experience and falling and striking the head wee the common triggering factors (79% and 76% respectively) and there was significant association between BHS and history of fallin and severe striking of the head. There was no significant associations between BHS and sex, birth weight, birth order, delivery method, type of labor initiating and duration of labor.

Abstract: Hydrosalpins (dilatation of Fallpian tube that can be seen by hysterosalpingogeraphy. Laparoscocpy, and in severe cases by sonography) is one of the probable confounding factors of assited – reproduction therapy (ART) outcomes. This cohort study is conducted to determine the effects of hydrosalpins on IVF-ET outcomes. For this, of the total number of patients who had approached the infertility Department Mirza Koochak Khan Hospital in the period between ordibehcesht 1377 to Aban 1378 (April 1998 to November 1999), 392 patients had come for the IVF0 ET cysles and were selected for our study. In these patients the numbers of oocytes retrieved and fertilized, the number of embryos transferred to the uterine cavity and resulting clinical pregnancy rates were measured.51 patients who had hydrosalpins were studied in two separate comparisons. Initially with 50 patients who had tubal involvement other hydrosalpinx, but had other indications of IVF-ET. These groups had similar age distribution. The numbers of oocytes retrieved (in first comparison = 1.6 & 3.92 and in second comparison = 4.6 & 4.65) and the number of embryo comparison = 2.6& 2.47) didn’t have significant statistical differences, but despite the fact that the same number of embryos were transferred to the uterine cavity (in the first comparison = 2.53 & 2.14 and in the second comparison= 2.53 & 2.27), the clinical pregnancy rates in both comparisons were reduced by more than 50% in patients with hydrosaplins as comparison = 7.8% & 20% and in second comparison = 7.8% & 16.1%). we conclude that hydrosalpins didn’t result in impaired ovarian stimulation or decreased oocyte fertilization. It did however interfere with implantation and reduced to some degree the success of IVF in achieving a clinical pregnancy.

Abstract: Congenial cystic adenomatoid malformation of the lung (CCAML) is a rare lesion and is characterized by a multicystic mass of pulmonary tissue with an abnormal proliferation of bronchial structures. We report a case of CCAML type I presenting with heart displacement that was diagnosed prenatally.

Abstract: In Pott’s disease (tuberculous spondylitis), involvement of two separate levels of spine is rare. Attention to stability of spine prevents delayed progressive kyphosis. A 12-year-old girl presented with neck pain, tenderness and swelling Imaging showed Cl—C2 and T9-T10 and destruction. Mild spastic paraparesis was noticed. Preoperative diagnosis was metastasis. T9, T10 and T11 laminectomy and cervical operations were done in 2 sessions. Both pathologic examinations confirmed tuberculosis. Although antituberculous medications and casting were performed, kyhosis progressed and neurologic deficit restrated. Reportation was done for spinal cord decompression and stabilzation. Tuberculosis could involve multiple spinal levels. Laminectomy is not suggested in children. Bone fusion and serial observations are important. Keywords: Pott’s disease, Tuberculous spondylitis, Atlantoaxial dislocation, T9-T10 destruction, Laminectomy, Kyphosis, Child

Abstract: The mechanism by which lead may cause a perturbotion in the nevous system is through the nitric oxide synthase. In this study the effect of lead acetate on the hippocampal constitutive nitric oxide production was studied. The variation in the nitric oxide production may contribute to physiological lead neurotoxicity in vivo. Different concentrations of lead acetate (10-9 to 10-6 M), wre added to cultures of hippocampal pyramidal cell obtained from one-day newborn rats. Sodium acetate was used as control. In this range of stuy viability of cells did not alter when it was compared to control (P<0.05). In another part of study, cells were obtained from one day dams whose mothers were chronically intoxicated by lead acetate. The resuts showed that neither direct exposure of normal cells mor cells obtained from latter group could show andy increase in the amount of nitric oxide. Administration of lead to the cells 10 minute before measurement showed same results.These results showed that how concentration of lead acetate can not induce nitric oxide production in the pyramidal cells