فهرست مطالب

Archives of Iranian Medicine
Volume:10 Issue: 3, Jul 2007

  • تاریخ انتشار: 1386/07/11
  • تعداد عناوین: 31
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  • M. Nouraie, H. Razjouyan, M. Assady, R. Malekzadeh, S. Nasseri, Moghaddam Page 289
    Background
    The prevalence of gastroesophageal reflux disease (GERD) in Asian populations is reported to be lower than that in the West. Population-based data on the prevalence and symptom profile of GERD in developing Caucasian countries is lacking. Our objective was to determine the prevalence of gastrointestinal symptoms and clinical spectrum of GERD in Tehran, northern Iran and their association with patient characteristics.
    Methods
    One thousand seven hundred telephone numbers were randomly selected from Tehran telephone directory using a simple random method. A two-step screening telephone survey was then performed. In each answered call a second rapid survey was done to select a subject 18 – 65 years old from that household. A validated questionnaire was then filled out for that individual. Patient characteristics (age, education, and gender) and history of acid regurgitation and heartburn during the last week, as well as the previous three months were inquired about.
    Results
    Of the 1,700 selected numbers, 278 either did not answer or did not have an eligible case; 220 refused to participate. A total of 1,202 subjects (42% males, mean age: 36 years, range: 18 – 65 yr) were surveyed. The prevalence of heartburn occurring monthly, weekly, and daily was 4.7% (CI95%: 3.5 – 6.0%), 1.6% (CI95%: 1.0 – 2.5%), and 0.6% (CI95%: 0.3 – 1.3%), respectively. The corresponding figures for acid regurgitation were 15.6% (CI95%: 13.6 – 17.7%), 5.7% (CI95%: 4.4 –7.1%) and 1.5% (CI95%: 0.9 – 2.4%), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced daily, weekly and monthly was 1.9% (CI95%: 1.2 – 2.9%), 6.8% (CI95%: 5.4 – 8.3%), and 18.4% (CI95%: 16.2 – 20.6%). There was no relationship between the prevalence of GERD and either gender, age, or education.
    Conclusion
    Monthly GERD symptoms occur in 18.4% of the general population in Tehran. Acid regurgitation is more common (4 – 5 times) than heartburn. Gender, age, and level of education do not affect the prevalence of GERD symptoms in the community studied.
  • A. S. Fourozan, M. Dejman, M. Baradaran, Eftekhari, A. Bagheri, Yazdi Page 295
    Background
    Domestic violence is exceedingly prevalent and is recognized as a health priority by World Health Organization. The prevalence of domestic violence against women has been the topic of a number of previous studies, very few of which have looked into direct and/or indirect costs it imposes on the victim and the state. The current study seeks to determine the direct costs looking into the wife abuse files in Legal Medicine Centers of Tehran.
    Methods
    This was a descriptive cross sectional study. Based on Legal Medicine Organization''s report on the number of annual visits and proportion of spouse abuse cases in the five centers of Tehran, a sample size of 225 was calculated. A questionnaire was developed to gather information, which was then utilized to estimate the direct costs that domestic violence (against women) imposed on the victims. The figure would mirror all expenses on medical services, legal-judiciary follow up, commuting, and any sundry charges.
    Results
    The subjects had spent, on average, $66.82 for healthcare services (including $12.8 for visits, $12.02 for prescribed drugs, $16.5 for radiologic studies, and $25.5 for laboratory tests). Given the estimated number of 9,050 female victims attending Legal Medicine Organization (during the study period, the total medical service expenses approach $142210.6. In 2002, related legal services expenses (as charged by the police force) were $741996.3. In the same year, the sundry charges were $163052.1. The estimated total costs sums up as high as $1047259.
    Conclusion
    The calculated figure only reflects expenses of first-time visits and what was spent before attending Legal Medicine Centers. Were additional visits and related expenses taken into account, a more precise estimate would have been produced. Nonetheless, the current figure well indicates high expenses of domestic violence on the state and the nation.
  • A. Motlagh, P. Azadeh, A. Fazlalizadeh, B. Shahrad, B. Shafaghi, M. Fudazi Page 301
    Background
    Expression of epidermal growth factor receptor is observed in 50 – 70% of colorectal carcinomas and is associated with poor prognosis. The objective of this study was to analyze whether epidermal growth factor receptor expression predicts tumor response and sphincter preserving in patients treated with preoperative chemoradiation therapy.
    Methods
    This study was conducted on 34 patients with locally-advanced rectal adeno­carcino­ma who were treated with preoperative chemoradiation therapy. The patients had histologically-proven adenocarcinoma of the rectum with the inferior margin of the tumor located no farther than 6 cm from the anal verge. Preoperative radiotherapy was delivered to the pelvis with 60CO to 50.4 Gy. All patients received simultaneous chemotherapy with 5-fluorouracil, 300 mg/m2 IV infused over 24 hr during radiotherapy on days 1 – 5 every week; 28 patients received oxaliplatin 50 – 60 mg/m2 weekly during radiotherapy. The patients were restaged by physical examination and pelvic CT, between four and six weeks later. Then, they were referred to a surgeon who was expert in gastrointestinal cancer surgery. Subsequently, postsurgical specimen was histopathologically examined and graded according to the Mandard criteria for assessment of pathologic response after neo-adjuvant chemoradiation. Immunohistochemistry for epidermal growth factor receptor was determined at the preradiation biopsy and was evaluated according to the extension and staining intensity.
    Results
    Fourteen (41%) out of 34 tumors were epidermal growth factor receptor positive. Twenty (59%) patients responded to pelvic preoperative chemoradiation. Sixteen (47%) patients achieved complete response with no residual tumor in the resected specimen; four (12%) were downstaged (partial response). Response to pelvic radiotherapy was observed in 80% of those negative for epidermal growth factor receptor and in 28% of those with positive epidermal growth factor receptor (P = 0.005). Only two of 14 positive epidermal growth factor receptor patients achieved a complete response, while 14 of 20 of the negative epidermal growth factor receptor patients developed complete response. In our study, the sphincter preservation rate was 43% in positive epidermal growth factor receptor patients and 80% in those who did not express epidermal growth factor receptor (P = 0.036).
    Conclusion
    Epidermal growth factor receptor expression in the diagnostic biopsy of locally-advanced rectal cancer treated with chemoradiation therapy may serve as an important predictor of complete response to preoperative treatment.
  • M. Nojomi, S. Agaee, S. Eslami Page 309
    Background
    Violence against women and threat of violence are some of the main barriers to women’s empowerment and equal participation in the society. However, they often go unnoticed and undocumented and therefore unresolved. For women, one of every five years of healthy life lost because of injury, disease, or premature death is attributable to violence.The aim of this study was to identify the prevalence of domestic violence in women attending three obstetric and gynecologic clinics in Tehran, and to determine the association between domestic violence and demographic factors.
    Methods
    One thousand women, 15 – 64 years old, attending three obstetric and gynecologic clinics affiliated to Iran University of Medical Sciences in Tehran were invited to participate in a cross-sectional survey with self-administered questionnaire. The association between demographic factors (age, level of education, religious believes, annual income, job, husband’s employment status, drug and alcohol abuse, previous custody of husbands) and domestic violence was assessed by questionnaire.
    Results
    Five hundred and ninety out of the 1000 women had experienced at least one form of violence (physical, mental, not sexual) from their husbands, 196 women had experienced some forms of controlling behavior and mental violence, and 361 women had been physically threatened. Low level of education in women, nongovernmental job, previous custody, psychiatric disorders of men, and coercive marriage for women were associated with an increased risk of domestic violence.
    Conclusion
    With the high prevalence of domestic violence, health workers should not ignore the seriousness of domestic violence. Health and social personnel should be appropriately trained before “asking all cases” becomes a policy within health and social services.
  • A. Dabbagh, M. Dahi, Taleghani, H. Elyasi, M. Vosoughian, B. Malek, S. Rajaei, H. Maftuh Page 316
    Background
    It has been demonstrated that chronic opium abusers have lower thresholds for pain. Spinal anesthesia is a common procedure in anesthesia, which is performed through administration of drugs (usually local anesthetics) in the intrathecal space, to produce temporary pain relief. The aim of this study was to determine whether chronic opium abuse could have any possible effect on the duration of spinal block by bupivacaine.
    Methods
    In a case-control study, 50 opium abusers and 50 nonabusers undergoing lower extremity orthopedic operations were selected from the patients admitted in Taleghani Hospital in Tehran for elective surgery. The study parameters were assimilated as much as possible, including the method of anesthesia.
    Results
    No statistically significant difference was noted between the two groups regarding the age, sex, and duration of surgery; while, the duration of sensory block was much shorter in the opium abusers (86.6 ± 15.7 minutes) compared with the nonabusers (162 ± 22.1 minutes) (P < 0.0001).
    Conclusion
    The study suggests a shortened duration of spinal block with bupivacaine in opium abusers. The results can propose a number of possible mechanisms including cross-tolerance mechanisms between local anesthetics and opioid compounds at the level of spinal neurons. Further molecular studies at the level of spine are suggested.
  • A. Saadat, Niaki, D. Abtahi Page 321
    Background
    The ability to identify critically ill patients who will not survive until hospital discharge may yield substantial cost savings. The aim of this study was to validate the mortality prediction model II (MPM II) in in-hospital mortality of critically ill patients for quality management and risk-adjusted monitoring.
    Methods
    The data were collected prospectively from consecutive admissions to the Intensive Care Unit of Imam Hossein Medical Center in Tehran. A total of 274 admissions were analyzed using tests of discrimination and calibration of the logistic regression equation for mortality prediction model II at admission (MPM0 II) and at 24th hour (MPM24 II).
    Results
    The mortality prediction model II exhibited excellent discrimination (receiver operating characteristic curve area). Calibration curves and Hosmer-Lemeshow statistics demonstrated good calibration of both models on outcome.
    Conclusion
    We recommend using mortality prediction model II in Iranian ICUs for routine audit requirements. Mortality prediction model II is not affected by the standards of treatment after admission to ICU. The information needed to calculate mortality prediction model II is easy to collect, and the model is applicable to all ICU admitted patients.
  • K. Ghandehari, Z. Izadi, Mood Page 327
    Background
    The hospital-based stroke registry is useful for understanding diverse clinical characteristics of stroke related to geographical, racial, or environmental differences.
    Methods
    The Khorasan Stroke Registry was established for evaluation of incidence, clinical manifestations, risk factors, topography, and etiology of ischemic stroke in Southern Khorasan, Iran, during 2001 – 2005. Consecutive stroke patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Topography and etiology of brain infarction was determined based on the Practical Iranian Criteria classification.
    Results
    The incidence of ischemic stroke in Khorasan population is 43.17 cases per 100,000 people per year. During a 5-year period 1,392 ishemic stroke patients (738 females, 654 males) were evaluated in the Khorasan Stroke Registry. Atherosclerosis constituted 53.6% of etiologies followed by uncertain causes (19.9%), cardioembolism (11.8%), and miscellaneous etiologies (2.9%). Eleven point seven percent of our patients had both atherosclerosis and cardioembolic mechanisms. Rheumatic valvular disease was present in 44.8% of cardioembolic strokes and caused 4.31 preventable stroke cases per 100,000 Iranian population per year. Hypertension and history of ischemic cerebrovascular events were the most frequent risk factors, 53.1% and 22.3% respectively. In-hospital mortality of our ischemic stroke patients was 7.3%.
    Conclusion
    High frequency of atherosclerotic etiology in the Khorasan Stroke Registry is because of its classification criteria, which does not separate small vessel territory infarcts as a different etiologic subtype. Rheumatic valvular disease is an important cause of stroke in Khorasan population
  • S. Afhami, M. Rasoulinejad, E. Razeghi, S. Shahriari, N. Esmailpour Page 335
    Background
    HIV infection affects all body organs including kidney. Since the frequency of HIV-related renal disorders is unknown in Iran and the number of HIV-infected patients is increasing, this study was conducted for the first time in Iran to assess the frequency of electrolyte imbalance, renal failure, and proteinuria among HIV-infected patients.
    Methods
    Between April and December 2005, 65 HIV-infected patients who were receiving care at an outpatient counseling center in Tehran, participated in this study. Blood samples were collected to measure serum levels of sodium, potassium, calcium, phosphorus, blood urea nitrogen, and creatinine. Urine samples were analyzed to detect protein, red blood cells, white blood cells, and cast.
    Results
    Of the 65 HIV-infected patients, 86.2% were males. The mean age of the patients was 37 ± 8.7 years, and 58.5% of the patients had a history of injecting illicit drugs. Urinalysis was normal in all patients, and serum levels of electrolytes, blood urea nitrogen, and creatinine were all in normal range.
    Conclusion
    We found no electrolyte imbalance, proteinuria, or renal failure in HIV-infected patients. It seems that renal disorder is infrequent in Iranian HIV-infected patients.
  • M. Sharifian, M. Dadkhah, B. Einollahi, M. Nafar, N. Simforoush, A. Basiri, H. Otukesh Page 339
    Background
    Bardet-Biedl syndrome is an autosomal recessive disorder characterized by obesity, polydactyly of hands and feet, retinitis pigmentosa, hypogenitalism, various degrees of intellectual impairment and renal anomalies. Other clinical features include speech disorder, brachydactyly, developmental delay, polyuria/polydipsia, ataxia, poor coordina­tion/clumsiness, diabetes mellitus, left ventricular hypertrophy, hepatic fibrosis, and renal hypoplasia/dysplasia. If spasticity and mental retardation present, it fulfills the criteria for Laurence-Moon-Bardet-Biedl syndrome.
    Methods
    Between July 1985 and January 2005, 2,282 kidney transplantations were performed at Labbafinejad Medical Center, of whom 262 were children under 15 years of age (61% males). Among children, five (four females) had Bardet-Biedl syndrome who were transplanted preemptively. Kidneys were taken from living unrelated donors.
    Results
    All five patients had retinitis pigmentosa and obesity with body mass index up to 39.33 kg/m2. The cause of end-stage renal failure was reflux nephropathy in one, neurogenic bladder in one, and renal hypoplasia/dysplasia in three patients. The mean age at transplantation was 11 years (range: 6 – 17 years). Immunosuppressives administered were prednisolone, cyclosporine, and mycophenolate mofetil. All of them suffered at least one episode of acute rejection shortly after transplantation but reversed with methylprednisolone pulses; in the last follow-up, the mean creatinine was 1.2 (range: 0.6 – 2.3 mg/dL). The mean glomerular filtration rate before transplantation was 10 mL/min/1.73 m2; in the last follow-up it was 79 (range: 38 – 137).
    Conclusion
    Renal transplantation is a safe and successful procedure and renal replacement therapy of choice in patients with Bardet-Biedl syndrome and end-stage renal failure, but special attention should be paid to body mass index and steroid-free immunosuppression if other suitable drugs, such as sirolimus and basiliximab are affordable.
  • M. H. Bahremani, M. R. Parwaresch, R. K. Gupta, M. R. Raffii Page 343
    Background
    The present study aimed at examining the lymphomas in Iran.
    Methods
    This study was conducted in 1994 on patients’ specimens who were referred to our centers during 1981 – 1994. Using the histochemical methods, the immunohistochemical markers were used to examine the biopsied specimens of 434 patients with non-Hodgkin''s and Hodgkin''s lymphomas. The patients were classified according to the updated Kiel and Rye classifications, respectively.
    Results
    Out of the 385 cases that were diagnosed as lymphoma, 277 had non-Hodgkin''s and 108 had Hodgkin''s lymphomas. Sixty-four point five percent of those with non-Hodgkin''s lymphoma had the B type disease; 7.5% had the T-type; and the remaining 28% had Hodgkin''s lymphoma. In the present study, most (48%) patients with Hodgkin''s lymphoma had mixed cellularity whereas in western countries the most common type is reported to be nodular sclerosis (69.4%).
    Conclusion
    The comparison made between the findings of this study and those of western countries indicates that high-grade non-Hodgkin''s lymphomas are more prevalent in Iran.
  • Y. Zahedpasha, M. Ahmadpour, Kacho, M. Hajiahmadi, S. Naderi Page 349
    Background
    Hyperbilirubinemia is a common problem in newborn infants. It can progress to kernicterus in severe forms, unless an intervention is initiated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term neonates with nonhemolytic jaundice.
    Methods
    A randomized clinical trial was performed on two groups of full-term jaundiced neonates: the clofibrate-treated group (n = 30) and the control group (n = 30). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate while the neonates in the control group received distilled water (same color and volume); both groups received phototherapy. Serum total and direct bilirubin levels were measured at the beginning, 16, 24, 48, and 74 hours, after the start of the trial.
    Results
    The mean ± SD total serum bilirubin level of the control and clofibrate groups at enrollment was 17.5 ± 2.3 and 18.2 ± 1.9 mg/dL, respectively (P = 0.199). The mean ± SD total serum bilirubin in the control and clofibrate groups after 48 hours was 11.4 ± 2.4 and 10.1 ± 2.4 mg/dL, respectively (P = 0.047). After 72 hours of intervention, 25 (83%) neonates of the clofibrate group and 16 (53%) of the control group were discharged with a total serum bilirubin of <10 mg/dL (P = 0.026). No side-effect was observed on serial examination during hospitalization, and on the first and seventh day after discharge.
    Conclusion
    Clofibrate results in a faster decline in TSB, shorter duration of hospitalization and had no side effects in jaundiced full-term neonates.
  • M. Safavi, A. Honarmand Page 354
    Background
    This study examines the efficacy of the predicting power for need for mechanical ventilation and duration of mechanical ventilation of three different scoring systems in a medical-surgical intensive care unit.
    Methods
    One-hundred eighty critically ill patients were included prospectively in our study in a consecutive period of seven months. On the day of admission, data were collected from patients to compute the Acute Physiology and Chronic Health Evaluation (APACHE) II and III, and Infection Probability Score (IPS). The sensitivity, specificity, and overall correctness of prediction were calculated, and the cut-off point giving the best likelihood ratio was determined. The area under receiver operating characteristic curve was computed.
    Results
    For prediction of need for mechanical ventilation the best cut-off points were 52 for APACHE III, 12 for APACHE II, and 12 for IPS. The area under the curve was 0.89 in APACHE III, 0.74 in APACHE II and 0.82 in IPS. There were statistical differences between APACHE III, APACHE II and IPS in terms of likelihood ratio and the area under the curve (P < 0.05). None of the three scoring systems provide good discrimination in prediction of more than 5 days respiratory support under mechanical ventilation.
    Conclusion
    For prediction of need for mechanical ventilation, the APACHE III has better accuracy than APACHE II or IPS
  • H. E. Blum, H. C. Spangenberg Page 361
    Hepatocellular carcinoma is one of the most common malignant tumors worldwide. The major etiologies and risk factors for HCC development are well-defined and some of the multiple steps involved in hepatocarcinogenesis have been elucidated in recent years. Despite these scientific advances and the implementation of measures for early hepatocellular carcinoma detection in patients at risk, patient survival has not yet significantly improved during the last three decades. This is in part due to the advanced stage of the disease at the time of diagnosis, and in part due to the limited therapeutic options. These fall into five main categories: 1) surgical interventions, including liver transplantation; 2) percutaneous interventions, including ethanol injection and radiofrequency thermal ablation; 3) transarterial interventions; 4) radiation therapy; and 5) drugs as well as gene and immune therapies. While surgery and percutaneous as well as transarterial interventions are effective in patients with limited disease (1–3 lesions, <5 cm in diameter) and compensated underlying liver disease (cirrhosis Child A), at the time of diagnosis, more than 80% of patients present with multicentric hepatocellular carcinoma and advanced liver disease or comorbidities that restrict the therapeutic measures to best supportive care. Therefore, early diagnosis, the development of novel systemic therapies for advanced disease and hepatocellular carcinoma prevention are of paramount importance. New technologies, including gene expression profiling and proteomic analyses, should allow to further elucidate the molecular events underlying hepatocellular carcinoma development and to identify novel diagnostic markers as well as therapeutic and preventive targets.
  • M. M. Motazacker, E. Taherzadeh, Fard, Z. Husseini, F. Behjati, F. Esteghamat, K. Kahrizi, H. Najmabadi Page 372
  • S. Jahanfar, E. Bt. Kamarudin, M. A. B. Sarpin, N. B. Zakaria, R. Bt. Abdul Rahman, R. D. Bt. Samsuddin Page 376
    Domestic violence during pregnancy is a key issue in maternal and fetal mortality and morbidity. This cross-sectional study aimed at obtaining the prevalence of domestic violence amongst pregnant women who attended Ipoh General Hospital in Perak, Malaysia and to determine the risk factors associated with domestic violence during pregnancy. The prevalence of domestic violence was low (4.5%). Comparison between the two groups of subjects with or without domestic violence did not show any significant difference in terms of risk factors. The effect of domestic violence on pregnancy should be investigated comprehensively in a multicentral or community-based study using a culturally sensitive questionnaire. With the estimated low prevalence of domestic violence in this study, the need for screening it in health-care services in Malaysia is yet to be determined.
  • M. Faraji, Rad, F. Samini Page 379
    Brain abscess continues to be a problem in neurosurgery and associates with morbidity and mortality even in the antibiotics and computed tomography (CT) era. In this study, we tried to recognize the indications of operation, effectiveness of preoperative CT scan, and antibiotic therapy in the diagnosis and treatment of these patients, and to identify the morbidity and mortality rates of adult patients with brain abscess. In a retrospective study from 1994 through 2004, we reviewed 83 adult patients with brain abscess (aged > 16 years), who had been treated medically or surgically by the authors in neurosurgical centers. Of 83 patients, 52 (63%) had infection with only Streptococci viridans, 13 (16%) had other types of streptococcal infections, and 13 (16%) had infections with other organisms like Pseudomonas, Enterococci, etc. Three (4%) had anaerobic infection and 2 (3%) had polymicrobial infections. Nineteen patients had paranasal and skull base sinusitis; 32 patients had mastoiditis. Five (6%) patients were treated medically. Others were treated medically and surgically (n = 78; 94%). The mortality rate was 5% (n = 4).Our data, in accord with the majority of authors, allow the conclusion that an aspiration-type operation must be performed for the diagnosis and therapy in most patients with brain abscess. Parenteral antibiotic therapy should be given for six to eight weeks, depending on the type of operation. Prognosis is favorable with early diagnosis and prompt treatment.
  • A. Rabbani, M. Moini Page 383
    To evaluate the processes of care and outcomes of injured patients, many different models have been devised and "Trauma and Injury Severity Score" and "A Severity Characterization of Trauma" score have been among the most widely used models. We conducted this study to determine the effectiveness of these systems of evaluation to our setting in Iran, which is substantially different from the North American trauma centers, where these models were developed.Using our data registry on trauma patients, we derived new coefficients for Trauma and Injury Severity Score and A Severity Characterization of Trauma scoring systems to calculate the probability of survival of patients. Finally, we determined the calibration and discrimination of the models by calculating the Hosmer-Lemeshow statistic and the area under the receiver operating characteristic curve. In our study, TRISS and A Severity Characterization of Trauma provided an adequate estimation of the survival probability and both models showed better discrimination in penetrating trauma. Discrimination in blunt injuries was a little lower, yet satisfactory. In pediatric patients the discrimination was also good and A Severity Characterization of Trauma had a better performance. Both models can be used reliably to predict outcome of trauma patients in our setting
  • M. Momtahen, S. Abdi, Z. Ojaghi, Z. Javady, Nejad, S. Momtahen Page 387
    This study assessed changes in global and regional systolic left ventricular function after successful percutaneous recanalization of coronary artery occlusions.A consecutive series of 110 patients with mean ± SD age of 53.6 ± 9.1 years, in whom a complete angiographic evaluation was available before angioplasty, underwent successful percutaneous recanalization of significant occlusions of coronary arteries. Left ventricular ejection fraction and wall motion score index were assessed by echocardiography at baseline, and 1, and 6 months after recanalization.Left ventricular ejection fraction increased from a mean ± SD of 40.7 ± 4.52% at baseline to 50 ± 8.3% after one month (P < 0.001) and to 50.9 ± 8.5% after 6 months. There was no significant difference between left ventricular ejection fraction at the end of the first and the sixth month of treatment (P = NS). The wall motion score index decreased from 1.3 ± 0.2 at baseline to 1.1 ± 0.2 after one month (P < 0.01). There was no significant difference between 1 and 6 months results. Six-month follow-up of all patients showed significant improvement in both angina severity and NYHA class.The restoration of coronary potency of occluded coronary arteries by successful percutaneous recanalization is associated with significant improvement in regional and global left ventricular function and clinical outcome.
  • B. Tamizi, Far, A. Taghavi, M. Rismankar, Zadeh Page 390
    Thrombotic thrombocytopenic purpura is a disseminated form of thrombotic microangiopathy. Although most cases are assumed to be idiopathic, its association with malignancy is well-recognized and it usually occurs at the terminal stage of cancer. The condition is characterized by microangiopathic hemolytic anemia and thrombocytopenia. It is generally idiopathic, and its association with adenocarcinomas is extremely rare.
  • D. Sadri, I. Yazdi Page 393
    Malignant fibrous histiocytoma is the most common soft tissue sarcoma in adults. The common sites of involvement are the retroperitoneal space and limbs. The occurrence of this tumor in the head and neck is rare. Recent studies have shown that the occurrence of malignant fibrous histiocytoma in the head and neck can follow radiotherapy for the treatment of other tumors. We, herein, report a case of malignant fibrous histiocytoma, which developed 17 years after radiotherapy of a carcinoma in the maxillary sinus.
  • M. Nikanfar, M. Farhoudi, M. Halimi, F. Ashrafian, Bonab, K. Mehrvar Page 397
    Creutzfeldt-Jakob disease is increasingly being reported in the last three decades as a result of increased awareness for the disease. Various studies have reported an annual incidence of 0.5 – 1.5 cases of Creutzfeldt-Jakob disease per million of general population. However, in our country, like other developing countries, the disease is still under-reported. Herewith, we described our clinical experience with an autopsy-proven case of Creutzfeldt-Jakob disease.
  • N. Hooman, H. Otoukesh, E. Talachian, F. Hallaji, M. Mehrazma Page 401
    Cholelithiasis is an unusual complication of hemolytic uremic syndrome. A 12-year-old boy with hemolytic uremic syndrome, established by renal biopsy, who developed cholestatic jaundice is presented here. Laboratory results for secondary causes of hemolytic uremic syndrome were normal. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed extrahepatic obstruction. A common bile duct stone, discovered by retrograde cholangiopancreatography was extracted by sphincterotomy. In conclusion, cholelithiasis should be considered as a cause of abdominal pain and cholestasis in patients who are diagnosed as having hemolytic uremic syndrome.
  • R. Ferasatkish, H. Naddafnia, S. M. Alavi, M. H. Naseri Page 404
    Disseminated intravascular coagulation is a pathologic syndrome with different medical disorders. Diagnosis and treatment of this syndrome is one of the difficult managements in medical science. Thromboelastogram is the only guide for early diagnosis and precise management of this syndrome. We describe a patient who developed disseminated intravascular coagulation due to endocarditis and spleen abscess. She was diagnosed by thromboelastography and treated successfully
  • S. Sadeghian, S. Darvish, S. Shahbazi, M. Mahmoodian Page 409
    Ecstasy normally contains 3,4 methylenedioxymethamphetamine (MDMA) that increases the levels of serotonin, dopamine, and epinephrine in the central nervous system with consequent adverse effects on the cardiovascular system. Herein, we presented a case of ecstasy abuse which resulted in two episodes myocardial infarction during a three month period; the second episode led to death due to thrombus formation.
  • A. Afshar Page 413
    In this report divergent dislocation of the elbow in an 11-year-old boy and its outcome is presented. His right upper limb was trapped in a water irrigation machine and sustained an extreme pronation thrust through the hyperextended elbow. He had also suffered from a segmental fracture of both bones of the forearm and a fracture of the humerus. The median and ulnar nerves were functionless at his presentation. Considering the 16 cases described in the literature, different types of divergent dislocation of the elbow and the plausible mechanisms in producing this type of injury are reviewed.
  • V. Hosseini, S. Nasseri, Moghaddam, A. R. Soroosh, M. R. Hakimian Page 417
  • M. Bahadori, M. H. Azizi Page 420
    The School of Medicine of Tehran University was officially established in 1934. Then, in December 1939, Professor Charles Oberling (1895 – 1960), the famous French pathologist was appointed as the Dean of Medical, Pharmacy, and Dentistry Schools and a new era of medical education was ushered in. He suggested to the Ministry of Culture’s authorities to publish a medical journal; subsequently, the first Persian academic medical journal in Iran was founded and published in 1943. Herein, we present a brief account of this medical journal’s foundation as well as biographies of its founders and editorial board
  • H. Razjouyan Page 424
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