Iranian Journal of Medical Sciences
Volume:28 Issue: 3, Sep 2003

Sclerosing hemangioma of the lung is extremely rare. Herein, a case of sclerosing hemangioma of the lung in a 44-year-old woman is reported. On admission, the patient complained of pain in the left lower neck and upper chest. Chest x-ray revealed a mass in lingular lobe of the left lung. The patient underwent surgery and a mass was removed through left posterolateral thoracotomy. Pathologic findings confirmed sclerosing hemangioma. Sclerosing hemangioma of the lung should be considered in asymptomatic patients or those with symptoms in chest or lower neck.

Patients with Graves’ disease exhibit a considerable rate of relapse after treatment with antithyroid drugs and require ablative therapy. The purpose of this study was to evaluate variables which can be used as prognostic factors in predicting the outcome of Graves’ disease after treatment with antithyroid drugs. Age, sex, duration of antithyroid drug therapy, pretreatment T3 and T4 values, T3 to T4 ratio, size of thyroid gland before and after treatment, and the effect of salt iodination were determined in 439 patients at an endocrine clinic in southern Iran during a 15- year period. The patients included 338 (77%) females and 101(23%) males with a mean age of 34.1±11.2 years. Overall, the relapse rate was 62%. The relapse rates were 58% and 76% in females and males, respectively (P=0.001). The mean age was 35.0±11.6 years in the relapse group (n=275) and 32.6±11.3 in the remission group (n=164) (P=0.03). T4 was 20.4±6.3 and 18.1±5.4 mg/dl in the relapse and remission groups, respectively (P=0.000). In the relapse group, T3 was 443.0±189.5 ng/dl and in the remission group, it was 373.4±182 ng/dl (P=0.009). T3 to T4 ratio was higher in the relapse group (21.8±8.3 vs 18.6±7.0 ng/mg, P<0.005). Larger pre- and post-treatment thyroid size were associated with higher relapse rate (P<0.05 and P=0.001, respectively). Logistic regression analysis showed that male sex, old age, higher pretreatment T4, T3, and T3 to T4 ratio, and larger pre- and post-treatment thyroid size were associated with higher relapse rates. Iodinated salt consumption and duration of treatment beyond 12 months had no effect on the relapse rate. Patients with male gender, older age, higher pretreatment T3, T4 higher T3/T4 ratio, and larger thyroid size before and after treatment have higher risk of relapse.

The relaxant and anticholinergic (functional antagonism) effects, histamine H1 inhibitory effect, and calcium channel blocking effect of Nigella sativa have been demonstrated on guinea pig tracheal chains. Several therapeutic effects including anti-asthma and dyspnea have also been ascribed to the seeds of Nigella sativa. To evaluate the antitussive effect of this plant. The antitussive effects of aerosols of two different concentrations of aqueous and macerated extracts as well as an extract of concentrated boiled seeds, codeine, and saline were tested by counting the number of coughs produced 10 min after exposing animal to aerosols of different solutions of citric acid (n=7 for each solution). The results showed significant reduction in the number of coughs obtained in the presence of both concentrations of aqueous and macerated extracts, boiled seeds extract and codeine (p<0.05 to p<0.001). The cough number induced in the presence of higher concentrations of aqueous and macerated extracts were also significantly less than those with lower concentrations (p<0.05 for aqueous and p<0.01 for macerated extracts). There was no significant difference between the number of coughs obtained in the presence of all extracts with that of codeine. These results indicate an antitussive effect of Nigella sativa comparable to that of codeine.

Seizure disorders are common in infants and children. Cardiac dysrhythmias may manifest clinically as seizure disorders which, if missed, may cause serious consequences. To investigate the electrocardiogram, conduction and rhythm disturbances in a group of patients in pediatric age group clinically presenting as various types of seizures We studied electrocardiograms of 273 infants and children aged 5 months to 16 years who presented with febrile and afebrile seizures. Of these, 155 (56.8%) were male and 118 (43.2%) were female (M/F= 1.3). Most of the patients (n=230, 84.2%) presented with generalized tonic-colonic seizures. Beside neurological evaluation, a thorough cardiac investigation including auscultation, electrocardiogram, and when indicated, echocardiography, exercise tolerance test, and 24-hour heart monitoring, was performed on all of these patients. Out of 273 patients, 32 (11.7%) showed either prolonged corrected QT (QTc), or other dysrhythmias. In 6 patients, the 24-hour ambulatory heart monitoring also revealed abnormalities (mostly dysrhythmias). In 9 of the above patients, the anti-arrhythmic management was instituted, depending on the results of cardiac evaluation. Precipitation of "seizure" episodes by exercise and emotional upset predicated the presence of an underlying cardiac rhythm disturbance. In evaluation of refractory seizure disorders in children, particularly those provoked by emotional upset, one should bear in mind the cardiac sources of seizure.

An increasing success in induction of labor and subsequent termination of pregnancy in presence of unfavorable cervix requires cervical ripening in order to reduce complications and to diminish the rate of cesarean sections as well as the duration of labor. However, there is no consensus on the efficiency of conventional methods for cervical ripening. To determine and compare the effects of PGE2 suppositories and inflated Foley catheter on pre-induction ripening of the cervix. In a quasi-experimental study, 70 pregnant women with a gestational age between 14 and 28 weeks and unfavorable cervix, requiring induction of labor were randomly allocated into to 2 groups. For each mother, digital cervical examination was performed before and at regular intervals to determine the Bishop score. One group received vaginal suppository of 3 mg dino-prostone that was re-administered after 6 hours, if necessary. For the other group, a Foley catheter balloon was inserted in the internal os of cervix that was filled with 30 mL sterile normal saline and kept under traction. Serum oxytocin augmentation was given to both groups after 12 hours as a routine. The outcome variables including the change in cervical Bishop score, beginning of uterine contractions and complications during and after labor were assessed. Student’s t test and Chi-square were used for the analyses of data. Induction to delivery time in Foley catheter group (15.0±7.7 h) was significantly (p<0.01) lower than that of PGE2 group (20.8±5.8 h). The rate of post-partum curettage for residual placenta or post-partum infections which required hospitalization and other complications were similar in both groups. The time saved for cervical ripening in Foley catheter group was 6.4±4.2 h.

Sialic acid is a component of serum that is elevated in diseases such as diabetes and certain malignancies. The normal range of SSA concentration and serum neuraminidase activity in different populations are varied, probably due to racial differences. The purpose of the present study was to obtain the average SSA concentration and serum neuraminidase activity, in an Iranian population, and to show whether these indices could indicate the severity, and serve as risk factors, for diabetes and CVD. Serum sialic acid (SSA) concentration and neuraminidase activity were measured in 214 male and female patients and 150 normal individuals. The patient groups were composed of diabetics, diabetics with vascular disease and CVD patients. A mean±SEM value of 60.06±3.36 mg/100 ml for SSA and 50.82±2.93 mU/ml for serum neuraminidase activity were obtained in the randomly selected normal controls. SSA was significantly higher in the patient groups as compared to the values in the age and sex-matched controls. Increased SSA in the diabetics with vascular complications was significantly higher than that for diabetics without retinopathy. The serum neuraminidase activity was also increased in the patient groups. In contrast to the pattern for SSA levels, serum neuraminidase activity in the diabetic patients was not significantly lower than that for diabetics with retinopathy. While serum neuraminidase activity may serve as a factor which tends to increase in CVD, diabetic and retinopathic patients, it may not be as reliable as the SSA level which correlates the severity or monitoring of these diseases. However, it can be a useful index to be used along with SSA measurements.

Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip (CDH) is a common congenital malformation which occurs worldwide with variable frequencies in respect to the race and geographic distribution. To determine the incidence of DDH, its predisposing factors and the diagnostic value of click for its detection. In a cross-sectional study of over 9-month duration, all of neonates born in the four teaching hospitals of Mashhad were examined during 48 hours after birth by Ortolani test. For all newborns with unstable joints, data regarding maternal history were collected. If clunk was felt on the first examination or click on repeated examinations, sonography was performed for more accurate diagnosis. All infants with definite CDH or unstable hip was referred to orthopedic clinic. A total number of 6576 newborns were examined over a period of nine months. Clunk or click was found in 3% (197 neonates). Only 10 newborns had CDH by clinical and sonographic findings. Of these, eight had clunk at birth and two had persistent click on repeated examinations. These were finally diagnosed as CDH. Eleven neonates were born in breech position. CDH was bilateral in 60% of patients, and solely left-sided in 30 %. The incidence of congenital dislocation of the hip was 1.5/1000. There was a significant association between the first parity and CDH (p<0.05), but not with maternal age. The incidence of CDH in the sample studied (1.5/1000) is similar to other studies reported so far. Many of unstable hips showed no abnormality or click on repeated examinations and were thus of no value in diagnosis of CDH.

Bakground: Granulocyte colony-stimulating factor (G-CSF) is a cytokine that stimulates hematopoiesis and induces proliferation and differentiation of granulocyte progenitor cells as well as production of bone marrow neutrophilic granulocyte colonies. Nowadays, human recombinant G-CSF(hr G-CSF) is used for the treatment of chemotherapy- and radiotherapy-induced neutropenia, and also in patients with bone marrow transplantation. A cDNA of human G-CSF (hG-CSF) was synthesized by PCR from recombinant cloning vector, with two altered nucleotides for increasing mRNA stability and overexpression, then inserted into a pET expression vector under the control of T7 promoter and cloned in E. coli strain BL21 (DE3). After culture and induction of recombinant E. coli with IPTG, we achieved a high level expression of the hG-CSF, where it represented approximately 35% of the total protein as determined by SDS-PAGE and confirmed by western blotting with polyclonal and monoclonal hG-CSF antibodies. rhG-CSF was produced in a significantly high quantity with a yield of 35% of total protein as determined by SDS-PAGE. Since it is easily obtained by simple purification steps, it may be cost-effective, even on an industrial scale.

Little information is at hand on the diagnostic values of the clinical symptoms and signs in the level diagnosis of patients with lower lumbar disc herniation. We examined one hundred and thirty nine consecutive candidates for lower lumbar discectomy. Monoradicular pain with signs attributed to the fifth lumbar and first sacral root dysfunctions were evaluated independently in each patient. Intra-operatively, all patients were assessed by a single neurosurgeon for the level of disc herniation. We reached the conclusion that the diagnostic value of clinical features of the herniated fifth lumbar disc is higher than that of the fourth lumbar disc herniation. The value of clinical presentation in the level diagnosis of lower lumbar disc herniation is highly specific, but rather insensitive.

The distribution of total plasma homocysteine concentrations in relation to the sex and age is described, in a population of Shiraz, South West of Iran and compared to those reported in other populations. Two hundred and one healthy males and 201 healthy females aged >15 y were randomly selected. Total Plasma homocysteine concentrations were measured using high performance liquid chromatography. The mean plasma homocysteine level was significantly higher in men (geometric mean 7.3µmol/L) than in women (geometric mean 6.3µmol/L, p<0.001). The geometric mean levels for age ranges 15-25, 26-36, 37-47, 48-58, 59-69 and 70-80 years, were 5.9, 5.4, 5.2, 6.7, 7.3 and 7.6 µmol/L in women and 7.5, 8.7, 5.9, 5.9, 7.2 and 9.1 µmol/L in men respectively. The first data on homocysteine distribution in a representative sample from South West of Iran indicate that the ethnic differences have an important impact on homocysteine metabolism.

A 19-year-old girl referred to our clinic complaining of a painless lump on the left side of her tongue. The patient had no history of dysphagia, lingual paresthesia or bleeding. Physical examination revealed the presence of multiple enlarged lymph nodes on the left side of her neck. Histopathology of lingual mass and lymph nodes showed pleomorphic adenoma. To our knowledge, this is the first case of pleomorphic adenoma of the tongue with metastasis to the cervical nodes.

Brucellosis is a rare cause of acute acalculous cholecystitis. We report a 45-year-old, previously healthy, man with brucellosis who presented with abdominal pain due to cholecystitis.

Hyperekplexia is a rare non-epileptic disorder characterized by an exaggerated and persistent startle reaction to the unexpected tactile and acoustic stimuli. The disorder is occasionally associated with generalized muscular rigidity and has the clinical hallmark of positive nose tapping test.The disease is inherited in an autosomal dominant fashion. Recessively inherited and sporadic forms of the disorder are also seen.Neonatal hyperekplexia is extremely rare but important because, if undiagnosed and untreated, the disease can be fatal. Hyperekplexia is easily mistaken for commoner disorders such as spastic cerebral palsy and epilepsy. Clonazepam is of benefit, but it does not always stop the prolonged spasms. Forced flexion of baby’s head toward the trunk is the most effective treatment. We report a young female infant who presented with excessive jerky movements of the limbs in response to tactile stimuli, associated with episodic generalized stiffness and irritability since her birth.Marked improvement was seen following the use of clonazepam.