Archives of Iranian Medicine
Volume:8 Issue: 3, jun 2005

Sulfur mustard (SM) or mustard gas is one of the most important agents of chemical warfare due to its simple and cheap chemical synthesis that makes it readily available for both military and terrorist use. SM acts as an alkylating agent that induces disruption of nucleic acids and proteins, impairing cell homeostasis and eventually causing cell death. It rapidly reacts with ocular, respiratory, and cutaneous tissues, as well as bone marrow and the mucosal cells of the gastrointestinal tract, resulting in several devastating long-term effects on human health, many of which are not clinically nor pathologically well defined. In light of the possible threat of SM use against military and civilian populations, physicians should be aware of its grave effects and know how to care for its victims. The pattern of immediate and long-term toxic effects following exposure to SM is reviewed with special references to the recent data on clinical and paraclinical investigations and management of more than 100,000 chemical war casualties incurred during the Iran-Iraq conflict

To evaluate the distribution and multiplicity of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage (SAH) and to characterize the age and sex distribution of these patients. We reviewed 130 patients with aneurysmal SAH documented by cerebral digital subtraction angiography (DSA). The mean age of patients was 45.8 years, with a female to male ratio of 0.68. In 13 (10%) patients there were multiple aneurysms. In 7 (5.4%) patients a giant aneurysm was discovered. Of 143 documented aneurysms found in 130 patients, the most frequent locations were anterior communicating artery (AComA) (29.4%), middle cerebral artery (MCA) bifurcation (21.0%), posterior communicating artery (PComA) (4.7%), internal carotid artery (ICA) bifurcation (9.8%), basilar tip (5.6%), pericallosal artery (5.6%), M1 segment of ICA (excluding ophthalmic and PComA origin) (2.8%), cavernous portion of ICA (2.8%), and ophthalmic artery origin of ICA (2.1%). The least common site for aneurysm was posterior inferior cerebellar artery (PICA) origin (1.4%). Our findings of the distributions of the aneurysms and the female to male ratio, suggest a contribution of ethnic background, which may need to be considered in diagnosis of these patients.

Obtaining tissue specimen for pathological diagnosis in small or deeply-seated intracranial lesions is critical to guide therapy and prevent unnecessary interventions. To present the experience of our unit with stereotactic procedures. Consecutive stereotactic intracranial biopsy procedures of the thalamus performed between July 1988 and August 2003 were studied in this retrospective review. Clinical, imaging, and histopathological data were reviewed for all patients. Two hundred eighty-eight patients (177 males and 111 females) with a median age of 31 (interquartile range: 24.5) years were studied. Successful (positive) histologic diagnoses were achieved in 264 (91.7%) patients. No mortality was associated with this procedure. Thalamic lesions can be biopsied stereotactically with an acceptable complication rate and a high diagnostic yield.

This study was conducted to obtain histological results in cases with atypical squamous cells of undetermined significance (ASCUS) found on Papanicolaou (Pap) smears. We reviewed cases with ASCUS found in cervical cytology from March 1999 through February 2002 of patients who attended Imam Khomeini or Mehr General Hospitals (n = 104). Except for one patient in whom cervical biopsy was done without colposcopy, the remaining 103 had biopsy under direct colposcopy. Histological examination revealed 28.8% squamous intraepithelial lesion (SIL) (14 low-grade SIL [LSIL] and 16 high-grade SIL [HSIL]), 1 invasive carcinoma, and 1 endometrial carcinoma. A Pap smear was repeated in 60 women with ASCUS before colposcopy and was normal in 7 (11.7%) cases, revealed ASCUS in 45 (75%) cases, and SIL in 8 (13.3%) cases including 6 LSIL and 2 HSIL. Among the 7 normal cases after the repeated Pap smear, histological examinations showed 2 cases of LSIL. In colposcopic examinations of 103 cases, 22 (21.4%) were diagnosed as normal, while one case had a histological report of LSIL. Since the cytopathologists’ reports do not differentiate between ASCUS and atypical squamous cells seen in HSIL, to detect any underlying SIL, it seems that immediate colposcopy and direct biopsy are more appropriate methods for managing cases with ASCUS.

Cholera continues to be an important public health problem in many communities. This study was performed to determine the epidemiology of Vibrio cholerae in Zabol city, South-East of Iran. The study was conducted in the hospitals affiliated to Zabol Faculty of Medicine, with patients referred from Zabol city and its 45 neighboring rural populations. Three thousand one hundred seventy-eight patients with watery diarrhea, who were referred to this center, were investigated in a descriptive retrospective study over a 4-year period. Vibrio cholerae strains were isolated from 362 (11.39%) samples. Of these, 336 (92.8%) were found to be Vibrio cholerae O1 Ogawa strain. Nonagglutinable (NAG) vibrios accounted for 26 (7.2%) strains. Twenty-four cases lived in an urban area, 270 had been referred from rural areas, and 68 came from Afghanistan. Two hundred forty-four cases were inpatients while the remaining 118 were outpatients. Twelve (3.31%) of these patients died of the disease. Vibrio cholerae remains an important cause of acute watery diarrhea in Sistan and Baluchestan Province of Iran especially rural area.

Direct coronary stenting is the primary therapeutic option for the treatment of many coronary lesions. Depending on the operator’s experience, it can result in a good outcome and low restenosis rates. To assess the outcome of direct coronary stenting in patients who underwent this procedure. Two hundred and ten (164 males and 46 females) patients from April 2000 through April 2002, who had significant (> 70%) coronary artery stenosis were included in this study. Patients were recruited from Mehrad, Day, and Pars Hospitals. Direct coronary stenting was performed on unioperator procedure for 162 (77.1%) patients in one location, 43 (20.5%) in two locations, and 5 (2.4%) patients in three locations. Age, sex, involved vessel, failure rate, possible complications, and restenosis rate were assessed. The mean ± SD age of participants was 55.62 ± 10.08 years. The target vessels of those 266 lesions were left anterior descending (LAD) (70.4%), circumflex (CX) (11.7%), right coronary artery (RCA) (8.9%), obtus marginatum (OM) (3.2%), ramus (2.3%), posterior descending artery (PDA) (1.7%), and saphenous vein graft (SVG) on OM (1.7%). Lesion types were graded as A (50%), B1 (20%), B2 (20%), and C (10%). Stents were successfully deployed in 99% of patients and were 2.5 – 3.5 mm in diameter and 8 – 23 mm in length. AVE (32.7%), Nexus (26.7%), Bio (18.8%), Multi-Link (16.1%), Cordis (2.6%), Jomed (1.8%), and others (1.3%) were the stents applied in the lesions of these patients. There were no mortality nor any major in-hospital complications. Seventy percent of patients were closely followed up for at least 6 months. Exercise stress, thallium, and/or angiography tests were performed when indicated. The stent restenosis rate was 1% in short-term (one month) and 14% in long-term (six months) follow-up. Good short- and long-term results of stent implantation without predilatation will be obtained in carefully selected patients. This technique can be used in the high grades (B2, C) of lesions safely and effectively. Furthermore, direct stenting can reduce the radiation exposure, costs of hospitalization, and the operation time.

Locally advanced breast cancer (LABC) remains a clinical challenge as the majority of patients with this diagnosis develop distant metastases despite appropriate therapy. To evaluate the treatment results of patients with locally advanced breast carcinoma who attended our hospital in Mashhad, North-East of Iran. Some presumed prognostic factors were also assessed. We retrospectively reviewed the medical records of 133 patients with LABC who were treated in Omid Hospital, affiliated to Mashhad University of Medical Sciences, between April 1995 and April 1999. One hundred and five patients with available follow-up information were selected for statistical analysis. Ninety-seven of 105 patients had undergone mastectomy prior to referral. Eight cases had received neoadjuvant chemotherapy. All patients were treated with adjuvant radiotherapy with 95 receiving adjuvant or neoadjuvant chemotherapy (40 CMF, 50 CAF, and 5 cases CAF sequential to CMF). We used the Kaplan-Meier survival analysis for evaluation of survival rates and the log-rank test to compare the survival profile between groups. During a median follow-up period of 32 (range: 5 – 96) months, 47 (45%) of 105 patients experienced recurrence. The mean ± SEM 2- and 5-year overall survival rates were 80.4 ± 5% and 47.7 ± 9%, respectively. The mean ± SEM 2- and 5-year disease-free survival rates were 69.3 ± 6% and 42.6 ± 8%, respectively. Advanced nodal disease (N2, N3 vs. N0, N1: P = 0.031), more advanced tumor stage (T4 vs. T3: P = 0.025), and younger ages (≤ 35 vs. > 35: P = 0.0001) had significant adverse effects on survival rates. There was not a significant difference in survival rates between the chemotherapy regimens of CMF and CAF (P = 0.9). A high recurrence rate in our patients underlines the need for general public education and the design of a program for the early diagnosis of breast cancer in Iran. We should also seek more effective systemic regimens for LABC.

Foods contain nonnutritional phytochemicals that may affect human health. The effect of phytochemicals on sperms is controversial. To determine whether kiwi (Actinidia chinensis) extract can change sperm quality and the blood level of sex hormones. 40 male rats were divided into 4 groups; 3 experimental groups were fed with 75, 100, or 150 mg/kg of hydroalcoholic extract of kiwi and the control group was fed with the solvent for 50 days each. Blood samples were taken and the levels of estradiol and testosterone were measured. The number of sperms and the percentage of motile sperms in semen samples were also calculated. The level of testosterone and sperm count were decreased significantly in groups treated with 150 mg/kg of kiwi extract. The estradial level also was decreased in groups treated with 100 and 150 mg/kg at the extract. It seems that hydroalcoholic extract of kiwi has deleterious effects on spermatogenesis. It is therefore, recommended to use it with caution if there is a reproductive problem.

all societies, regardless of the legal, moral, or cultural issues of abortion, there are some women who desperately seek to terminate an unwanted pregnancy. With the growing desire to limit childbearing to one or two children, and while accessibility to effective contraception is limited, abortion is common worldwide. This hospital-based study was conducted to determine the abortion complications and outcome of pregnancy. About 78% of the 75 cases studied attempted to induce abortion through injection of prostaglandin (Prostine) but others attempted by curettage. Forty percent of females had complete abortion, 18.5% had failed abortion, and the remaining had incomplete abortion. The use of prostaglandin alone has been replaced by curettage, but it succeeds in terminating pregnancy in just 40% of the cases

Warfarin is a widely-used anticoagulant drug in clinical practice. However, its use is with caution due to serious side effects including gastrointestinal bleeding (up to 5%) and mortality (0.5% – 2.0%). Therefore, the correct dosing of warfarin is of paramount importance. We examined warfarin maintenance dose requirements in 115 outpatients in Kermanshah, North-West of Iran, who had a history of isolated aortic or mitral valve replacement and were on stable maintenance doses of warfarin with international normalized ratios (INR) of 2.0 – 2.5. The mean daily warfarin requirement was 4.6 ± 1.8 mg, with 75% of patients requiring < 5 mg/day. No significant difference was noted between the two sex groups; however, there was a noticeable decline in dose requirement by increasing age. This study suggests that a relatively small dose (as low as 5 mg) of warfarin is required for maintaining anticoagulation in our patients.

Dislocation of more than one joint in a digit is a rare injury and there are only a few reports of double joint injuries in the thumb. In this report, a patient with concurrent dislocation of carpometacarpal and metacarpophalangeal joints of her thumb is introduced. The patient’s management and outcome are presented.

A 10-year-old girl was admitted to the hospital because of gross hematuria and abdominal pain. She had hepatosplenomegaly and a miliary pattern on chest X-ray and CT-scan. Histopathologic studies of bone marrow and liver revealed findings in favor of type B Niemann-Pick disease (NPD). This is a fatal and nonneuropathic form of NPD that is usually detected as an incidental finding during routine physical examination.

We report on a newborn at Ghaem Hospital, Mashhad who was diagnosed with congenital malaria. This baby was admitted for evaluation of a fever and cough, which began one day prior to admission. The newborn was pale with splenomegaly and normal neonatal reflexes.Medical laboratory tests, including a peripheral blood smear, revealed Plasmodium vivax in red blood cells. His mother had been suffering from a fever for almost a week prior to delivery. She was tested and found positive for P. vivax.Both the newborn and mother were successfully treated with chloroquine. They were discharged from the hospital in good condition with negative blood smears

This is a report of immunopathological study of our previous work on autobuffy-coat therapy of dry-type cutaneous leishmaniasis, which focused on cytological activation of macrophages to eradicate engulfed Leishman bodies by the synergistic effects of lymphocytes, neutrophils, and inactive monocytes. We, again, present a case report of skin biopsies which were stained immunohistochemically before and during autobuffy-coat therapy.The results revealed increased CD4 and CD8 lymphocytes, CD1a Langerhans cells, interferon gamma, and TNF-alpha-producing cells during therapy, but IL-10, IL-4, and TGF -beta-positive immunostained cells were decreased.We conclude that this kind of therapy induces a Th1-like and suppresses a Th2-like response in active lesions of dry-type cutaneous leishmaniasis accompanied by overactivity of the neutrophils and activated histiocytes to eradicate the engulfed Leishmania amastigotes

Postcesarean section pseudoaneurismal changes in the local uterine arterial wall are rare. Usually, the patient presents in hypovolemic shock with recurrent massive vaginal bleeding. Herein, we report on two patients who had recurrent massive hemorrhage on the days 17, 21, and 50 after an uncomplicated elective cesarean section. These patients had severe hemorrhage and hypovolemic shock. After general evaluation, they were treated with multiple broad-spectrum antibiotics, uterotonic medications, dilatation and curettage, and hysterectomy (case 1) and ligation of the feeding vessel (case 2).Pathology report of the first patient revealed pseudoaneurismal changes in the uterine arterial vessels at the site of cesarean incision.