Iranian Journal of Medical Sciences
Volume:33 Issue: 2, Jun 2008

Clinical information about stroke in the vertebrobasilar territory has lagged behind that for anterior circulation syndrome. This is the first report from posterior circulation syndrome registry in Iran. Consecutive patients with brain infarction in vertebrobasilar territory admitted to Ghaem hospital, Mashhad were enrolled in a prospective study during 2006-2007. Diagnosis of ischemic stroke in the posterior circulation was made by a stroke neurologist based on the clinical manifestations and neuroimaging. Vertebrobasilar territory infarcts were classified into five groups according to the location involved: brainstem, thalamus, cerebellum, posterior cerebral artery, and mixed categories. All of the stroke patients underwent a standard battery of diagnostic investigations and the etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. The 72-hour stroke course determined as regressive, stable, and deteriorative. Total of 302 patients (147 females, 155 males) with mean age 62.5 years (±17.2) were investigated. Posterior cerebral artery, thalamus, brain stem, cerebellum, and mixed categories consisted 31.3%, 4.3%, 32.8%, 17.9%, and 13.9% of the stroke topographies respectively. Atherosclerosis consisted 50.6% of etiologies in our patients followed by uncertain (25.5%), cardioembolism (12.5%), both atherosclerosis and cardioembolism (6.3%), and miscellaneous causes (4.6%). Rheumatic mitral stenosis was the cause in 34.2% of our patients with cardiac emboly. The distribution of stroke etiologies based on its localization was not significantly different (df=16, and P=0.421). Stable status was the most common early stroke course (57.7%) followed by deteriorative (22.1%), and regressive (20.2%). A significant association between stroke localization in the vertebrobasilar territory and its course was not found (df=8, and P=0.901). Atherosclerosis is the most common cause of posterior circulation syndrome in Iranian patients. The cause of stroke in the posterior circulation could not reliably be derived from infarct topography.

There is inconsistent information about the role of psychological factors in the incidence of reflex sympathetic dystrophy (RSD) in patients with distal radius fractures. The present study was thus undertaken to evaluate the relationship between some of these factors and the occurrence of reflex sympathetic dystrophy in patients with distal radius fracture. One hundred and twenty patients with distal radius fracture who met the criteria to enter the study and admitted to the orthopedic department of Imam Reza hospital in Mashhad were evaluated. Spielberger anxiety questionnaire, Beck depression questionnaire, and personality type questionnaires as well as the information about the patients'' demography were recorded after the treatment. The patients were followed for two months based on clinical evidence of RSD and the results of specific examinations. In our study, Veldman''s criteria were used to set the diagnosis of RSD. Finally, the psychological status of the patients with or without RSD was evaluated using Chi square and t tests. Of the 88 patients completed the study, 13 were affected by RSD. There was no significant relationship between depression and anxiety of the patients with occurrence of RSD (P>0.05). The presence of type A personality characters had a significant positive relationship (P=0.000) and the presence of type B personality had a significant negative relationship (P=0.004) with the incidence of RSD after 2 months. Personal characteristics of patients with distal radius fracture play a role in the incidence of RSD.

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients (less than three months of age) suffering from biliary atresia from 1999 to 2005. The patients in group I (G I) were managed peri-operatively by high-dose methylprednisolone while the other group (G II) received low dose methylprednisolone only post-operatively (2mg/k/day for 1 month). Infants in GI (n=30) received methylprednisolone for 3 successive days before operation (10-8-6mg/kg/day), and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated (39 girls and 33 boys). Twenty-six of the 30 patients (86%) in G I became jaundice-free within 90 days after portoenterostomy while only seven (15%) of the 42 patients in G II had normal bilirubin (P<0.0001). Episodes of postoperative cholangitis in G I were 20% (6 of 30), and 53% (24 of 42) in G II (P<0.005). The difference in 3-year survival rate between the two groups is also remarkable: Eighty seven percent (26 of 30) in GI versus 29% (13 of 45) in G II (P<0.005). Death related to biliary atresia occurred in 1 (3.3%) patient in GI compared with 12 (29%) patients in G II (p<0.005). These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival.

Rotavirus is a major cause of acute diarrhea in children worldwide. It is an important cause of death among young children in developing countries. The aim of this study was to evaluate the prevalence of rotavirus infection in children less than five years old hospitalized for gastroenteritis in Jahrom. One hundred and two stool samples were collected from children less than 5 years old hospitalized for acute diarrhea during October 2006-February 2007 in Motahary hospital, Jahrom, south of Iran. All samples were tested for rotavirus antigen by commercial enzyme linked immunoassays (ELISA) and latex agglutination test. Sixty nine stool samples (67.6%) were positive for both ELISA and latex agglutination. The mean age of the patients was 14.38 months (range 2-60 months). There was no significant difference between the patients with positive and those with negative tests for rotavirus in duration of admission, fever, vomiting, gender, and stool examination. Thirty-three percent of the patients had abnormal increased blood urea nitrogen that was normalized after hydration. Rotavirus was an important cause of acute gastroenteritis in young children less than 5 years old in our hospital. Dehydration, azotemia, and electrolyte disturbances were the major problems in those patients.

Presence of antisperm antibodies (ASAs) in infertility and their adverse effects on fertility is a matter of controversy. The aims of this study were to determine the percentage of antibody positive sperms and rate of ASA positive sera in both fertile and infertile men and women, and to find the association between these antibodies and infertility. This study consisted of 29 fertile and 60 infertile men and women. The serum immu-noglobulin (Ig) M, G, and A antisperm antibodies were evaluated after incubation of the sera with normal and high-quality fresh sperm from healthy donors. The percentage of spermatozoa positive for IgM, IgG, and IgA antibodies and the rate of antisperm antibody positive sera in fertile and infertile groups were measured by flow cytometry. Mean percentage of antibody positive sperms in fertile and infertile groups showed no significant differences (all P>0.05). The rate of ASA positive sera in fertile and infertile individuals showed no significant differences (all P>0.05). There were no significant differences between the mean percentage of antibody positive sperms and the rate of ASA positive sera in fertile and infertile men and women (all P>0.05). Presence of ASAs in the serum may not be associated with infertility. Although antisperm antibodies may interfere with fertility, not all types of ASAs can associate with infertility. Current tests cannot differentiate the ASAs that interfere with infertility from those that do not, because the antigenic specificities of these ASAs are not known. The antigens of the infertility-related ASAs must be characterized to allow an accurate detection for individuals with ASAs.

To improve the athletic ability and muscle mass, anabolic androgenic steroids are abused by athletes. Little is known about how these compounds affect the fine structures of the testis. This study aimed to identify the changes in the fine structure of testis following administration of nandrolone decanoate. Twenty five Sprague-Dawley rats were randomly divided into two experimental, two vehicle, and one control groups. Experimental groups were treated by 3 or 10 mg/kg/wk intramuscular injection of nandrolone decanoate. The vehicle groups were treated by the same amount of peanut oil, for 14 weeks. One week after the last injection, the rats were sacrificed and their testes were prepared for transmission electron microscopy study. The cells in the interstitial space of the experimental rats were considerably degenerated. The basement membrane was thick and the diameter of seminiferous tubule was reduced. Several degenerated Sertoli cells and apoptotic germ cells were considerably observed in the experimental rats. The results of this study show that fine structure of the testis is affected by nandrolone decanoate.

Chronic diarrhea is a common problem in patients with symptoms related to gastro-intestinal tract. Some of these patients present with chronic non-bloody, watery diarrhea and no specific clinical, laboratory, or endoscopic findings. The aim of the present study was to investigate the value of histological findings in patients with chronic diarrhea who have normal or non-specific endoscopic findings. We also determined the frequency and distribution of histological changes related to different anatomical sites in the colon. This study was performed in Kerman city on 90 patients with chronic watery diarrhea whose diseases had not been exactly diagnosed after extensive clinical, laboratory, and endoscopic studies. Laboratory tests including complete blood count, erythrocyte sedimentation rate, C-reactive protein, stool examination, thyroid and liver function tests, and serologic study for celiac disease were all normal in this group of patients. Colonoscopy was performed and mucosal biopsies were taken from recto-sigmoid, descending, and transverse colon. The histologic findings were as follows: 39 (43.3%) patients showed normal histology, 25 (27.8%) patients showed microscopic colitis, not otherwise specified form. Ten (11.1%) patients had classic lymphocytic colitis, and 15 (16.7%) patients had paucicellular lymphocytic colitis. One (1.1%) patient showed focal active colitis. None of them had collagenous colitis. Diagnostic histological findings were seen in 28.9% of biopsy samples in patients with chronic diarrhea and normal or near normal endoscopic findings. We recommend multiple punch biopsy sampling in such patients from different sites of the colon to avoid missing some cases of microscopic colitis.

loss after spinal cord injury leads to increased fragility of bone and subsequent risk for low-trauma fractures in the sublesional parts of the body. Although in such injuries upper limbs are normally innervated, bone loss may occur in the upper extremities. The present study was designed to de-termine the systemic effects of spinal cord injury on the fracture healing of upper limbs in rabbits. Twenty nine skeletally mature New Zealand white rabbits received a transverse mid-humeral open osteotomy in the left upper limb with the use of a standardized technique and spinal cord injury was done using forceps model at T8 level. The animals were divided into three groups: experimental (laminectomy, spinal cord injury, and osteotomy), sham (laminectomy and osteotomy), and control (osteotomy alone). The bone healing score was calculated using modified Sandhu system by two independent pathologists. The mean (±SD) of healing scores in experimental, control, and sham groups were 7.22 (± 3.6), 8.6 (± 3.3), and 8.5 (± 4.3) respectively (P=0.68). The percentage of mesenchymal (20%) and cartilaginous tissue (35%) showed a slightly higher value in the experimental group compared with the sham group (15% and 20% respectively). A reverse pattern was seen concerning the percentage of trabecular bone, though as a whole there was no significant difference regarding the percentage of selected components of bone healing between the three trial groups. Fracture healing in innervated upper limbs is not influenced by the systemic effects of spinal cord injury.

Self-burning is the most devastating burn injury. It is a common social and medical problem in Iran. In a longitudinal prospective study, from April 2003 to March 2006, all burn patients admitted to Ghotb-eddin burn Hospital were enrolled in this study. Suicide attempts by burning accounted for 283 (21.9%) of all burn patients admitted to the hospital. Most (68.2%) of self-burning patients were female. Self-burn patients had significantly large burned body surface area (64.8±29%). Suicidal burns occurred predominantly in the age group 15-24 years (44.6%). The mortality rate for suicidal burns was (60.4%). Fars is a province composed of many different tribes and cultural minorities whereby major decisions are made by forums of clergymen. It is important to involve those clergymen in burn prevention programs to achieve a meaningful reduction in Self-burning prevalence.

Although chronic myelogenous leukemia in pregnancy is rare, its management and treatment is more difficult and complicated. Treatment of patients with chronic myelogenous leukemia includes bone marrow transplantation, however in less than 30% of patients the donor’s organ would be accepted. To this end, cytotoxic therapy is considered as an alternative therapeutic option. This option provides satisfactory hematologic and clinical response, while cytogenetic response is poor. Imatinib (Gleevec) is a new drug with highly specific efficacy in the treatment of chronic myelogenous leukemia. Prescription of this drug during pregnancy and lactation is not a classic approach and most physicians suggest that this drug should be discontinued during the pregnancy. Here we report the use of imatinib during the pregnancy in two women with chronic myelogenous leukemia.

Marjolin''s ulcer following frostbite is a rare occurrence. Our review of literature revealed that only 23 cases have been reported. In most instances heel is involved and the most common associated malignancy is squamous cell carcinoma. We present a 69-year-old male patient with squamous cell carcinoma arising over a frostbite scar in heel 45 years after cold injury. This case is unique with respect to the treatment modality performed: resection of tumor with free margins and reconstruction with pedicled reverse sural flap with good result and no evidence of recurrence during the follow up period.

Osteosarcoma of the foot is rare and, when presents, commonly observed in adults. We report a case of osteosarcoma of the calcaneus in an 11-year-old girl who was presented with a 4-month history of pain and swelling on her left ankle and inability to walk in her left lower extremity. On examination, there was a diffuse swelling involving her left ankle joint and foot. The radiograph showed soft tissue with calcification and ossification that involved the calcaneus with cortical bone destruction. Histologically, the tumor was consisted of variable foci of lacy osteoid formation and spindle pleomorphic stroma with typical osteoblasts. This rare location, histologic characteristics, and differential diagnostic points are discussed.

Abstract Creutzfeldt-Jacob disease is the most common form of prion diseases, which have become public health problems in the last two decades because of the high number of reported cases of mad cow disease in Great Britain and other countries. Creutzfeldt-Jacob disease is a fatal situation with known cardinal clinical features including progressive memory loss and myoclonic seizure disorder. In this report, we present a case of Creutzfeldt-Jacob disease with characteristic clinical signs such as progressive memory loss, myoclonic jerks, and focal and generalized seizures. We also discuss the pathologic findings of the brain autopsy confirmed by Gottingen center (Germany) for spongiform encephalopathy.