Iranian Journal of Medical Sciences
Volume:33 Issue: 4, Dec 2008

Percutaneous coronary intervention in the setting of coronary bifurcation lesions is associated with increased risk for complications. The goal of this manuscript is to review the currently available classifications for coronary artery bifurcation lesions with a guide to the use of specific coronary bifurcation techniques based on lesion characteristics.

Ocular involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. Lymphoma manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis, or herpetic retinitis. Accurate diagnosis depends on a high index of suspicion and frequently requires histopathological analysis of specimens, particularly vitreous biopsy, subretinal aspiration, or retinal biopsy with flow cytometry, polymerase chain reaction, or immunohistochemistry methods. Most of ocular lymphomas are of B lineage. Diagnosis is often complex and needs use of paraclinical evaluations. Treatment mainly consists of chemotherapy. It is important to review the ocular manifestations of lymphoma to assist ophthalmologists in prompt diagnosis of ocular lymphoma. And it also helps oncologists to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up, and management of patients with lymphoma.

Neutropenia can be associated with life-threatening infections. Gram negative and staphylococcal infections are the most common pathogens. The spectrum of bacterial isolates has changed considerably over the past four decades. The objective of the present study was to evaluate the pattern of bacterial and fungal infections in neutropenic pediatric patients. A non-randomized descriptive and cross-sectional study involving 100 hospitalized children was carried out at the emergency and pediatric hematology and oncology units of hospitals affiliated to Mashhad University of Medical Sciences from September 2004 to September 2005. Neutropenic children younger than 12 years old with clinical signs of infection and/or fever were enrolled in the study. The study comprised of 100 febrile and/or infected neutropenic episodes occurring in 57 male and 43 female children younger than 12 years old with a mean age of 4.55±3.33 years. A total of 87 pathogens were cultured: 37 (42.5%) from urinary tract and 50 (57.5%) from other sites; 54 (62.1%) were gram-negative bacteria, 21 (24.1%) were gram-positive bacteria, and 12 (13.8%) were fungus. Pseudomonas aeruginosa and staphylococcus aureus were the most frequent gram-negative and gram-positive isolates respectively. Candida spp. was the only isolated fungus. Acute lymphoblastic leukemia was the most common disease encompassing 33% of all cases. As the patterns of isolates in neutropenic patients are not the same in different parts of the world and gram-negative organisms were still the most common pathogens isolated in our study population, therapeutic adjustments for empirical antibiotic therapy are likely to be focused on gram-negative pathogens.

It has been argued that unprecedented degree of human leukocyte antigen (HLA) loci polymorphism within a population is required to avoid the devastating effects of infectious diseases. The present study was conducted to determine the associations between some of HLA class I genes and the outcome of hepatitis B virus (HBV) infection. Using sequential sampling method, 64 individuals were selected and categorized into two groups according to their clinical and serological profiles. The patients in the case group were 27 patients with chronic HBV infection and the controls were 37 individuals considered as HBV natural convalescent who recovered from HBV infection. Antibodies against HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc) were assessed to exclude primary HBV infection. Individuals with viral clearance were positive for anti-HBs and anti-HBc without the presence of HBsAg at two time points. HLA typing was performed by serological method. Collected data were analyzed by SPSS software version 13. The most frequent HLA antigens among the studied subjects were B51 (40. 1%), B27 (14.1%), B8 (12.5%), and B7 (10.9%). A significant correlation was found between HBV persistence and HLA-B27 (P<0.05). The association between other HLAs (HLA 7, 8, 57) with HBV clearance was not significant. The two studied groups were statistically different in sex but not in age. Findings of the present study demonstrated an association between HLA class I and outcome of HBV infection where HLA B27 was linked to an increase in HBV persistence. These findings support the hypothesis that HLA class I-restricted cytotoxic T cells play an important role in HBV chronicity.

Possibility to trace-label albumin with isotopes results in information concerning its synthesis, breakdown, and distribution in the intra and extra cellular spaces. The iodination of albumin is a widespread procedure used in scientific studies. Bromine not only is more reactive and less expensive than iodine, but bonds more easily with many elements. Therefore, it could be a suitable tracer in labeling procedures. The present study was designed to represent a method for labeling human serum albumin (HSA) with stable isotope of bromine. In the present study, the labeling of HSA by use of stable isotope of bromine (79Br) has been sought through a series of preliminary experiments including iodination of bovine serum albumin (BSA) and iodination and bromination of BSA. The experiments were basically designed according to that of Mc Conahey and Dixon in 1966. All measurements have been obtained by inductive coupled plasma mass spectrometry (ICP/MS). Twenty protein solutions, each having 50 mg HSA dissolved in 10 ml of 0.05 M buffer (pH 7.0) were prepared. A series of calculated amounts of pure bromine was added directly to each sample. Each sample was placed in a crystallizing dish containing crushed ice to keep the reactants cold. After dialysis and final preparation of the samples, the intensities of bromine in the samples were measured. Data indicated the maximum presence of bromine in HSA samples in a ratio of 40 atoms of bromine to each mole of HSA. After dialysis, sample analysis showed that on average, about 65% of the bromine was really bound to the HSA molecules. This finding indicates that about 26 atoms of bromine were bound to each HSA molecule. Data analyzed by simple linear regression method. Results showed that each µg increase in dose leads to 0.002 unit increase in the mean of mole ratio of pure bromine (Br2)/HSA (P=0.001). The present study has unique specifications in that almost all of the labeling procedures of plasma proteins have used other elements rather than bromine and mostly radioactive isotopes instead of stable isotopes. The present paper showed a method for about minimum as well as maximum bromination of HSA (0.05 atoms- 26 atoms), within certain limits of experimental conditions. By this method, one can exactly determine how much bromine should be used to obtain a certain desired mole ratio of Br2/HSA with no, or at least minimal, alteration of protein behavior.

Geographical Information System is a new tool in environmental epidemiology that makes the opportunity of visualization and analysis of spatial data. The aim of this study was to determine the geographic variation of low birth weight using geographic information system in order to evaluate the efficacy of primary health care and health information system. Low birth weight records in rural areas of Rasht district (north of Iran) were collected from the records of health care centers and health houses. Electronic map of the Rasht district was collected from National Cartographic Center. Health information was collected from health surveillance data in each village. The three layers of data were analyzed using ArcView program. The prevalence of low birth weight was 0.049. Using kernel smoothing method, three major and two minor hot spots were identified within Rasht district, mostly in northern part. Existence of health houses was found to be statistically significant in explaining low birth weight risk. This research examined geographic variation of LBW in Rasht district and found hot spot places. Existing of health house was associated with higher risk of low birth weight.

Vulvovaginal candidiasis is one of the most common infections in gynecologic filed, and non–albicans Candida species are emerging causative microorganisms. This species shows resistance to routine treatments. One of the suggested treatments is administration of vaginal suppositories of boric acid. The aim of the present study was to compare boric acid with clotrimazole in the treatment of recurrent or resistant vulvovaginitis. In a double-blind, randomized clinical trial, 90 non-pregnant women were enrolled. The patients were divided into two groups to receive; boric acid (300 mg twice a day for 2 weeks) or clotrimazole (100 mg once a day for 2 weeks) intra-vaginally. Treatment responses were monitored by laboratory and clinical data. Treatment responses were significantly different in laboratory results for boric acid and clotrimazole groups (86.7% v 60%, P= 0.004). Clinical responses (improved signs and symptoms) showed no significant differences (8.2. v 6.5, P= 0.02). Drug side effects were not different in boric acid and clotrimazole groups (13.3% v 11.1%, P= 0.75). Intra-vaginal administration of boric acid is more effective than clotrimazole in vaginal candidiasis caused by non-albicans species.

Pre-eclampsia along with its complications seems to be one of the major causes of maternal morbidity and mortality. Despite numerous studies, the etiology of pre-eclampsia has not yet been fully elucidated. According to recent studies changes in the level of blood trace elements can be an adverse event in human and animal pregnancy. The present study determines whether maternal serum levels of calcium, magnesium, copper, and zinc in patients with pre-eclampsia are lower than matched control subjects. Serum calcium, magnesium, copper, and zinc levels were measured in 52 women with pre-eclampsia in thir third trimester of pregnancy as patients group, and in 52 healthy normotensive pregnant women as control group with similar maternal and gestational ages. All women were primigravida with singleton pregnancy. Data on body mass index (BMI), maternal and gestational ages, serum calcium, magnesium, copper, and zinc levels were collected and compared between the two groups. There were no significant differences between the two groups in body mass index and maternal and gestational ages. Serum calcium, magnesium, copper, and zinc levels were 8.97±0.49, versus 8.70±0.58 (P=0.27), 1.90±0.24 versus 1.90±0.26 (P=0.75), 21±2.60 versus 21±2.32 (P=0.47), and 13.07±3.20 versus 12.91±3.01 (P=0.78) for control and patients groups respectively. The mean serum levels of calcium, magnesium, copper and zinc between the two groups were not significantly different. It seems that these trace elements are not involved in the pathogenesis of pre-eclampsia.

Beta-thalassemia major is a severe and lethal hemolytic anemia. Regular transfusion is necessary for avoidance of its complications but it may end to cardiac involvement secondary to iron overload. Angiotensin converting enzyme inhibitors (ACEIs) are useful medications even in early stages of heart failure. We studied the effects of two common ACEIs on improvement of heart function in asymptomatic patients with beta thalassemia. Of 300 patients over 10 years old with beta-thalassemia, 62 asymptomatic patients were divided into two groups. Captopril (1mg/kg/d in 2-3 divided doses) was started for patients in group one and enalapril (0.1 mg/kg once daily) was started for patients in group two. Six months later, systolic and diastolic parameters were assessed and compared with those before treatment with ACEIs in each group and after treatment between the two groups. In group one, left myocardial performance index, ejection fraction and fractional shortening were improved significantly (P<0.001). Decrease in peak atrial velocity and increase in early maximum filling velocity/atrial velocity (E/A) ratio of mitral valve were also significant (P=0.04 and P=0.01 respectively). In group two, a significant improvement in myocardial performance index, ejection fraction, and fractional shortening was seen compared with before treatment (P<0.001). Also peak early maximum filling velocity of mitral valve and peak atrial velocity of tricuspid valve were improved. Comparison of the two groups after treatment with ACEIs did not show any difference, although both of them showed significant improvement. In patient with beta-thalassemia major early administration of ACEIs is recommended. Since the difference between the efficacy of captopril and enalapril was not significant, both drugs seem to be suitable in these patients.

Fat embolism syndrome refers to a constellation of symptoms secondary to the presence of fat globules in the lung parenchyma and/or peripheral blood circulation. The syndrome is most often seen in association with long bone or pelvic fractures and can cause significant morbidity and mortality. The present randomized double blind placebo-controlled trial was conducted to evaluate the efficacy of prophylactic corticosteroids in the prevention of fat embolism syndrome and arterial hypoxia in patients with long bone fractures. Ninety-one patients with long bone fractures were randomized to case and control groups; 38 and 53 individuals, respectively. The patients in the case group received a single dose of 10 mg/kg intravenous methylprednisolone succinate upon presentation to the emergency room. The control group received placebo (normal saline). The primary endpoints evaluated were the presence of fat embolism syndrome, based on the Gurd criteria. Total two patients with fat embolism syndrome were observed in the corticosteroid-treated group (5/2%) compared with five patients in the control (9.4%; P=0.4). Arterial hypoxemia was observed in one patient in the corticosteroid-treated group (2/6%) versus eight patients in the control group (17/0%; P= 0.07). Mean arterial oxygen was not significantly different between the two groups (P=0.07). It seems that single dose methylprednisolone succinate (10 mg/kg intravenously) is not effective as prophylaxis for fat embolism syndrome and arterial hypoxemia.

Abdominal aortic coarctation is an extremely rare vascular pathology. Its etiology can be congenital or acquired. Here we present a case of acquired infrarenal abdominal coarctation in a 66-year-old woman who complained of low back and legs pain. She had no signs of resting lower limb ischemia, with diminished distal pulses and normal blood pressure in upper and lower extremities. Magnetic resonance angiography of abdominal aorta, iliac and femoral arteries revealed local stenosis of abdominal aorta below the renal arteries (80% of luminal diameter). The length of coarctation was 3 cm. The patient was scheduled for percutaneous aortoplasty and stent implantation. Nintinol self-expandable stent was implanted. At 9 months clinical follow up no signs or symptoms of stenosis or diminished blood flow in lower extremities were found. Self-expandable stent is effective, easy to implant, and has good adaptation to the wall of aorta and can be considered in such cases successfully.

Visceral artery aneurysms are rarely reported. They can occur in the context of a variety of underlying diseases. These aneurysms may coexist with non-visceral arterial aneurysms.Here we describe an 80-year-old man with concomitant superior mesenteric, celiac, renal, and aorto-bi-iliac aneurysms. The patient was a hypertensive and hyperlipidemic old man with history of transient ischemic attack and atherosclerotic carotid plaques who developed multiple aneurysms most likely due to degenerative atherosclerotic vascular involvement. To the best of our knowledge, this constellation of aneurysms has not yet been reported.

A 25-year-old woman (gravida 2, abortion 1) was admitted to Ghaem Hospital affiliated to Mashhad University of Medical Sciences at 24th week of gestation. Her chief complaint was bloody show. She had a history of incompetent cervix, with premature labor at 22nd week of gestation. She was hospitalized with 4 cm dilatation and 50% effacement of cervix at 24th week of gestation. Following bed rest and prescribing heparin for prophylaxis against thromboembolism, she delivered at 39th week of gestation with good maternal and neonatal outcome. Expectant management with complete bed rest along with anticoagulant therapy is considered to be a safe method for management of cervical incompetence.