مجله علوم پزشکی رازی
سال دهم شماره 3 (پیاپی 35، پاییز 1382)

Vesicouterine fistula is a very rare disease which develops after cesarean section in most of the reported cases. The patients usually have symptoms such as urinary incontinence in early stages of disease and cyclic hematurea in late stages. Prolonged use of Intra-Uterine Devices(IUDs) was reported rarely to be the cause of vesicouterine fistula. This is the report of a 30-year-old woman with history of repeated cesarean sections and pregnancy with IUD in uterus. Six months after her last cesarean, with symptom of cyclic hematurea, she was diagnosed to have vesicouterine fistula which was repaired via surgery. Disease presentations, diagnosis criteria and complications of Vesicouterine fistula along with medical and surgical approaches in treatment of this disease were discussed in this paper.

Renal scarring secondary to vesicourethral reflux is associated with an increased incidence of hypertension, which has been reported in up to 38% of children with reflux nephropathy. In this study the results of captopril test on 20 patients with reflux nephropathy(reflux+Scarring) were assessed within 8 months. For this purpose we studied the plasma renin activity and blood pressure responses to a single oral dose of captopril in patients. In all of the patients, PRA in baseline measurement was high. 90 minutes after captopril intake, PRA in all of patients increased. The mean rise of PRA in two groups of patients (with normal and high blood pressure) was equal. The rise of PRA in 5 patients with normal blood pressure and 2 patients with high blood pressure was remarkable. Also, changes of systolic pressure before and after captopril test were significant (Pv<0.002). These results suggest that renin angiotansin system is activated in our patients and is the probable ethiology of hypertension in these children. Furthermore, we can use this test as a screening test to find the patients with reflux nephropathy who have potentiality for renin mediated hypertension.

The role of helicobacter pylori infection in gastric and duodenal lesions(benign and malignant) is well known. In this study 170 patients who referred to internal medicine clinic in Firoozabadi hospital and complained from dyspepsia were accepted. One group was older than 45 years with dyspepsia and the other group was younger than 45 years with dyspepsia whose symptoms had not been treated after 2 weeks of treatment. The aim of this study was to determine the frequency of H.pylori infection and its relation to duodenal and gastric lesions. 91 patients (53.5%) were female and 79 patients (46.5%) were male. 50% of patients were illiterate and only 2.9% of our cases have education higher than diploma. The reports of pathology were classified in 11 groups that 29.4% of cases suffered from chronic gastritis with lymphoid follicle in lamina proproa in association with H.pylori. Two cases of adenocarcinoma in stomach were reported. 50% of cases suffered from dyspepsia over 1 year without any assessment to detect H.pylori infection. In conclusion, the rapid diagnosis of peptic lesions due to H.pylori is very important because the chance of stomach cancer will decrease after treatment.

The patient of this study was a 30 year old woman with history of left maxillary mass from 24 years ago and recurrences of this lesion which was diagnosed as fibrous dysplasia. The last time she referred, she was presented with maxillary swelling and pain, epistaxis and proptosis of the left eye. She was reoperated and ultimately osteosarcoma was recognized.

New studies in neuromuscular control have indicated that the strength of muscle contraction isn’t the only important factor in a task. But the speed at which a muscle responds, preparation of muscle and synergistic pattern at which a group of muscles recruit to a task or respond to a condition are much more important in constant joint stabilization and potential injury prevention. The purpose of this study was to assess the timing and scaling of knee related muscles’ electrical activity. Included muscles were: vastus medialis, vastus lateralis, rectus femoris, gastrocnemius, lateral hamstring and medial hamstring. The electrical activity was collected with the use of surface electromyography during selected active and reactive movement patterns. This research was a quasi-experimental design on 30 healthy young men (assigned by the sample of convenience) between 20-30 years of age (avg: 25.36). Our subjects sequentially and randomly were asked to perform different movement patterns and during these tests EMG signals were collected from each muscle. These signals were collected to assess onset time and the amount of muscle electrical activity (IAV) in each task. All movement patterns were in three main categories. Active movements included forward step up and lateral step up abrupt movements included vertical jump and distance jump and reactive movements (angular perturbation of base of support) included anterior and posterior perturbation with knee straight and knee bend. In this research both muscles in reactive movement patterns were significantly activated before active movements. Vastus medialis in anterior perturbation was activated 182.6 ms sooner than FSU (P<0.0001), and medial hamstring was 279.5 ms earlier under the same situation. The gastrocnemius muscle activity was 23.154 µv in distance jump, but 5.46 µv in FSU. In anterior perturbation VM and VL were significantly activated faster than posterior limb muscles, for example, VM was 23.3 ms before medial hamstring. However, in posterior perturbation the findings were vise versa and posterior muscles were faster. In all reactive movements medial hamstring had greater level of muscle activity, related to lateral hamstring and itself, in active movements. In posterior perturbation MH was activated 7.2 µv more than LH. Results indicated that learned movements had more efficiency in CNS decision for choosing a pattern of movement among possible ways of doing a task, and unnecessary muscle activity was much less in learned movements. Gastrocnemius muscle had a great role in abrupt and posterior perturbation movements in comparison with VM and VL muscles. The role of medial hamstring in reactive movements was clear and this role was not seen in lateral hamstring. This muscle can act as a propericeptive and postural muscle trigger, especially in proximal stability for trunk and pelvic region, and in distal perturbation we dont expect to see an ascending muscle synergy all the time.

In this case report we present an 11-year-old boy with a history of trauma to distal phalanx of the forth finger of his left hand from three years ago. This trauma led to a lesion which was resistant to antibiotic therapy. Underline bone and nail of finger have been destructed by tumor. Microscopic examination revealed plump spindle cells arranged in sheets with paralleled orientation and foci of calcification. Final diagnosis was calcified aponeurotic fibroma, a very rare tumor of soft tissue which has been reported only in few cases since its discovery. Additionally, clinical presentation of tumor in this case is also very rare.

Since the prevalence of frozen shoulder disease is relatively high and efficacy of its treatment is obscure, this study was undertaken to evaluate the effect of manipulation in improving the range of motion, pain and daily activities. In this study that was conducted between 1996 and 2002, 30 patients(9male & 21 female) with mean age of 48 years (40-69) were under investigation. Patients were in the second stage of primary (idiopathic) frozen shoulder disease with the mean time of 9 months involvement and with 30% involvement in non dominant side of the body. After average of 7 sessions of physiotherapy the patients were treated with manipulation under anesthesia and intra articular steroid injection in shoulder in Shohadaye Haftom-e-Tir Education and Treatment Center. The patients were studied with using clinical trial (comparing before and after treatment) and with interview and examination. Then gathered information was analyzed through “matched t-test”. After average of 9 months of follow up, from range of motion point of view, 60 degree increase in forward elevation of upper limbs, 26 degree increase in external rotation of upper limbs and 2.5 vertebral level increase in internal rotation of upper limbs were observed. Pain in a 10 degree scale decreased from 7 to 1.5. Daily activities including wearing a coat, sleeping on the affected side and washing the back of body (while bathing) improved significantly. In no patient joint instability or recurrence in the same shoulder after manipulation or complications like fracture of humerus bone or rotator cuff tearing or dislocation occurred. The results were excellent or good in 29 patients. As a general conclusion it can be said that manipulation causes quick and noticeable improvement in movements, activities and pain and the patients become very much satisfied.

Pseudohypoparathyroidism (PHP) refers to a spectrum of disorders which is characterized by resistance of target organ to parathyroid hormone(PTH) followed by hypocalcemia, hyperphosphatemia and hypersecretion of PTH. Nowadays different types of PHP (1A, 1B, 1C, 2) can be distinguished the most common type among them is type 1A accompanied by Albright’s phenotype (round faces, shortening of metacarpals & metatarsals, …). PHP is an inherited disease and prevalence rate in different societies is variable. Can Albright’s phenotype be identified in most patients with PHP in our country? Is PHP always accompanied by hypocalcemia? As there has not been any study on PHP in our country, and considering possible differences among patients with PHP in different geographical regions, and in an effort to answer aforementioned questions, we decided to study clinical manifestations, laboratory findings and frequency of Albright’s phenotype in patients with PHP, who referred to the Institute of endocrinology and metabolism during past 10 years in an observational descriptive manner. 10 patients with PHP including 6 girls (60%) and 4 boys (40%) with the mean age of 13.8 ± 2.62 years were examined. Clinical manifestations of patients consisted of seizure(70%), paresthesia (30%), carpopedal spasm (20%), muscle cramps (20%), basal ganglion calcification (20%), chvostek’s sign (10%), cataract (10%), abdominal pain (10%) and malaise (10%). Laboratory findings consisted of increased plasma PTH level in 100% (mean 172±85.56 pg/ml), hyperphosphatemia in 90% and hypocalcemia in 70% (mean 7.3 ± 1.23 mg/dl) of patients were observed. Thyroid function tests done in 90% of patients were normal. Albright’s phenotype was identified in one patient (10%). Short stature in 30% and obesity in 10% of patients was observed. 8 patients (80%) had normal puberty and in 2 prepubertal patients (20%) secondary sexual characters had not appeared. PHP was common in females & adolescents. The most common clinical manifestations & laboratory findings were seizure & increased plasma PTH level respectively. PHP with normocalcemia was identified in 30% of patients. This may be due to the relative response of bones to PTH. Albright’s phenotype was identified in just 10% of the patients which can be attributed to the non prevalence of PHP type 1A in our patients and this neccessitates conducting more studies in this regard. There was not any case of resistance to TSH and gonadotropines. As seizure is the most common clinical sign in PHP patients therefore, measuring the level of serum calcium should be considered as a priority in each patient with seizure and PHP should be subjected to differential diagnosis.

Transfusion associated graft versus host disease(GVHD) is a serious clinical complication that occurs in some cases after blood and blood products transfusion. The mortality ratio of this disorder is very high and in over 90% of cases lead to patients’ death. The procedure routinely used to inhibit GVHD is inactivation of donor blood lymphocytes and prevention of their proliferation in recipients. Gamma radiation is currently the only recommended method for GVHD prevention. In spite of vast studies in this field,effective dose for completely inactivation of lymphocytes is not known. In this study, the effect of γ-ray of teletherapy cobalt machine (mean energy of γ-ray is 1.25 MeV) on lymphocytes viability and proliferation was investigated. Lymphocytes were isolated from normal donor blood and irradiated at doses ranging from 500 to 40000 cGy of γ-ray. Cell viability after 24 and 48 hours in each dose step, was evaluated by colorimetric tetrazolium method (MTT). MTT and BrdU assays were used to assess the response of lymphocytes proliferation with PHA mitogen. By inceasing dose of gamma radiation, cell viability and proliferation function were decreased. In high level of dose and longer time of culture, this effect was observed well. Do value estimation by MTT colorimetric assay was 1.44 Gy. Statistical analysis by t-test method was not significant (P>0.05) and decrease in irradiated cell proliferation was similar for two assays. By paying attention to decreased proliferative function in high level of irradiation, the range of 3000-4000 cGy of γ-ray is recommended for blood lymphocytes inactivation.

Disseminated TB refers to simultaneous involvement of multiple organs like Pleura, Peritoneum, and Meninges. TB peritonitis manifests itself as a serous form with an exudative fluid usually containing 500-3000 cells and lymphocyte is typically predominant.The patient was a 19-year-old Afghan woman who referred to the hospital with acute abdomen. Analysis of peritonal fluid showed 50,000 cells with 95% PMNS. Smear and culture for mycobacteria were positive. The patient was under antituberculosis drug treatment and she didn’t have any problem after 10 months.

Emergency department is one of the most important departments in a hospital that its function can mainly be effective in the functions of the other departments and satisfaction of the patients. The speed of the offering services in treatment centers, specially emergency, has a great importance in reducing mortality causing disability rates. Researchers have found out that one of the most important indicators in assessment of emergency centers is the time lost to treatment and diagnostic services. This research was a cross-sectional study in nature in order to determine the speed of offering services in emergency department at Kerman Bahonar hospital. Population of the study consisted of all patients who referred to the hospital’s emergency (Feb. 2000). In this research, data were collected through interview and recorded observations. The questions of application form were about patient’s demography, examiner’s, speciality, the first diagnosis, the final diagnosis, waiting time for the first diagnosis, waiting time for the final diagnosis, receiving treatment services, receiving consultative services, and also releasing the patient from the emergency. Data analysis was done via SPSS software, statistic tests of T, analysis of unilateral Variance and also Chi square. The findings of the study revealed that the mean time between accident till arriving at physician room was 67 minutes waiting time for patient’s first visit in screen room: 4 min, lab tests: 40 min, preclinical procedures with x-ray: 25 min, C T scan: 31 min, waiting time for first consultation: 60 min, performing procedures till diagnosis: 72 min, waiting time in operating room: 10 min and waiting time surgery was 21 min. Comparing the indicators with international standards revealed a low speed of offering services in Kerman hospital emergency. The most time lost was the disease diagnosis in most cases physicians were engaged in other sections. Also, the examiners didn’t match with their specialty. With due attention to %60 consultations by orthopedists, it seems necessary to employ specialists or at least orthopedists instead of physicians or inters in order to reduce the wasted time in treatment or diagnosis.

Intraventricular hemorrhage (IVH) is one of the most important complications in prematurity and low birth weight. Its early diagnosis and treatment has an effective impact on patients’ outcome. This study was conducted to determine IVH percent in under 2000 gram newborns and its related factors. During this observational retrospective study, 641 neonates with 2000 grams or lower birth weight were identified among 12251 total live births in hospitals of Iran University of Medical Sciences (1999-2001). After exclusion of newborns, who expired or left the hospital before diagnosis, 200 newborns were evaluated. IVH was investigated via brain Ultra sonography. The percentage of IVH among assessed newborns was 28.0% (95%CI: 25.2-30.9%). The most common and the least common types of IVH were degree I (37.5%) and degree IV(3.7%) respectively. The percentage of IVH in the present study was lower than that of some similar studies. This can be due to higher mortality of very low birth weight newborns(under 1500 grams) in Iran or transfer of some cases to other centers because of intensive care limitations.

Cancer of the bladder comprises 5.2% of all malignancies and it is the fifth common malignancy in Iran. Transitional cell carcinoma represents 92% of all bladder tumors. Voided urine cytology and cystoscopic biopsy are used for screening and final diagnosis respectively in Iran. Selection of the therapy is according to the tumor grade which is detected by bladder biopsy. The hypothesis of this investigation was whether the results of TCC grade through cytology, which is a rapid, cost-effective & non-evasive method, were different from that of biopsy or not. Between 1998 and 2000, 375 Urine cytology speimens and 107 bladder biopsy were studied through double blind method in Shahid Hasheminezhad Hospital. Ultimately, TCC were detected in 38 patients both in urine cytology and biopsy. Then, cytologic grade was compared with histologic grade. The sensitivity was high but it was not validated because bladder biopsy was not taken from patients with negative urine cytology. The hypothesis was evaluated through Pearson’s Correlation Test which showed a strongly positive correlation in grade of tumor between urine cytology and biopsy (=0.936) Due to incomplete correlation, (Zc=1.705) bladder TCC grading can not be a wise choice only according to urine cytology.

The incidence of nonobstetrical acute abdomen during pregnancy is 0.2 to 2 percent. In spite of low incidence of Acute Abdomen in pregnancy, it is with high complications and mortality rate because differential diagnosis between obstetrical and nonobstetrical causes are difficult and often diagnosis and management are too late and inappropriate. This case series prospective study was done from 1995 to 2001 in teaching centers of Iran University of Medical Sciences. All of the pregnant women with diagnosis of Acute Surgical Abdomen entered in this study. The mean age of cases was 22.86 years(SD +4.22 years) and mean number of previous pregnancies and previous live deliveries were 3.26 (SD +2.18) and 2.37 (SD+0.99) respectively. Most of cases were in second trimester of pregnancy and the most common synptom was abdominal pain and the most common sign was abdominal tenderness. The most common cause of Acute Abdomen was Ectopic pregnancy(%62) and then Ruptured ovarian cyst(%27), hemorrhagic ovarian cyst (%10) and acute appendicitis(%1). Fortunately there was no mortality in this study. In conclusion, acute abdomen during pregnancy can be risky. Thus, appropriate & quick diagnosis is highly important in its prognosis and result.

This analytical observational and epidemiological study was done in order to evaluate the relative immunity to mumps in healthy and unvaccinated children in Karaj aged 4 to 7 years.Therefore, 194 serum samples were taken through no probability sampling and tested by hemagglutination inhibition test. For each of the samples dilution of 1/2 to 1/128 was tested using guinea pig red blood cells and mumps virus anti genes prepared in laboratory on cell culture. Then, obtained results were analyzed, as absolute and relative frequency in total, in girl and boy groups and in different age groups separately which revealed that 35% of total had no measurable antibody titer(below 1/2). Also 66% of total studied children were susceptible to mumps by considering the titer equal or greater than 1/8 as the protective titer. There was no significant difference between sex and susceptibility to the disease(P<0.05). According to the high percentage susceptibility of children to mumps, it is recommended to pay enough attention to immunization programms against this disease.

The brain abscess is an uncommon disease that usually occurs after underlying diseases such as: otitis, sinusitis, and … The microbiological profile of this disease has changed in recent years. In addition to surgery, widespread antibiotic regimen is also of importance in treatment of cerebral abscess. The initial antibiotic therapy should be instituted emprically and it should be based on the incidence of various organisms and their sensitivity to antibiotics. The goal of this study is: 1-determination of the underlying diseases in brain abscess for future Preventive strategies and 2-determination of the microbial agent in brain abscess and their sensitivity to conventional and available antibiotic in Iran for better selection of the antibiotic regimen. This descriptive study was done on patients with brain abscess who were hospitalized in Rasool Akram and Firoozgar hospitals from 1998 for 3 years. 26 patients were admitted for 36 months. Direct smear was positive in all patients. Results of culture were positive in 22 cases (84.6%) that only 3 cases had mixed aerobe and anaerobe microorganism. The most common isolated organisms were streptococci (52%) and enterobactriace (36%) that were sensitive to conventional antibiotics. All isolated aerobe bacteria were sensitive to ciprofloxacin. These findings can indicate: 1-The higher incidence of the otitis as an underlying cause of brain abscess in our patients. 2-Inability of our microbiological technique in detection of anaerobe microorganisms. 3-The important role of the direct smear in the primary diagnosis of the brain abscess. 4-Probable role of ciprofloxacin in the treatment of the brain abscess and especially underlying diseases.

Since lack of awareness, fear of unknown and also lack of prenatal preparation in pregnant women increase complication of the pregnancy, labor and consequently the medical intervention, this investigation was carried out in order to assess the effectiveness of the preparation classes for pregnancy courses on decrease of complications and medical intervention in pregnant women who referred to Hedayat hospital between May 2000 and March 2001. A clinical experimental study (Sequential Randomized control trial) was carried out on 200 pregnant women expecting their first child, under 35 years of age, with gestational age of about 20 weeks and absence of hypertension, diabetes, multifetal pregnancy, smoking, habit and threatened abortion symptoms in their history. They were randomly divided to experimental & control group. Mothers in exprimental group were trained both theoretically and practically in 8 sessions, while those in control group received routine care only. Mother’s emotional and physical health during pregnancy and the collected data from labor and neonates health situations were recorded and analysed and then compared between the 2 groups. The collected data showed that back pain, pelvic pain and tiredness during pregnancy were less in trained women and their daily activities were more in comparison with non-trained women. There was not any significant difference in the quality of sleep, marriage and social relationship between the two groups. Women who attended antenatal classes had an increase in the percentage of fullterm delivery(7%), whereas the others had a higher risk of cesarean sections (16%) Moreover, duration of active labor and the second stage of it was shorter in trained women. Statistically, there were significant differences between the criteria mentioned above (P<0.04, P<0.04, P<0.002, P<0.004). The rate of prescription of oxytocin, antispasmodic drugs and sedative and also birth weight and apgar in neonates were the same in the two groups. The findings show that an increase in awareness and preparations during pregnancy help mothers to pass this important period of their life with more ease and enjoyment and less medical interventions. Hence, arranging preparation for pregnancy courses and more studies on methods of preparations for childbirth used in other countries is recommended.

In this case report, we present a 40-year-old man with the history of flank pain and weight loss in recent months. A left adrenal mass was the sonographic finding supported by CT-Scan. After light microscopic and immunohistochemistry examination and based on “pheochromocytoma of adrenal gland scaled score(PASS)” the diagnosis was “Histologic malignant pheochromocytoma”.

In order to study the tendency of amino acid neighbors in helical structures, proteins with known structures were carefully analyzed. The studied helical positions: N, Ncap, N1, N2, N3, N4, M, C4, C3, C2, C1, Ccap, C and their doublet counterparts: N Ncap, NcapN1, N1N2, N2N3, N3N4, M1M2, M2M3, C4C3, C3C2, C2C1, C1Ccap, CcapC were carefully analyzed. The propensity for all amino acids in different helical positions and also the propensity for all 400 different doublet positions were calculated and compared. For this purpose, a databank of 3705 helices was designed and used. In this database helices were longer than 7 amino acid residues and were derived from 696 non-homologous proteins with less than 25% identity. SLP(Single Local Propensity) for each 20 amino acid in different helical positions was calculated. Furthermore, DLPo or the observed Doublet Local Propencity which is based upon prefered occurrence of paired amino acids in different doublet positions of alpha helices and DLPe or the expected Doublet Local Propensity calculated directly using SLPs was also calculated. If the propensity of a particular doublet in a specific alpha helical positon or DLPo becomes more than the calculated single positions in alpha helices, in other words, DLPo>>DLPe it indicates that this particular doublet has a tendency in staying as neighbors in that particular helical position. Results showed that doublets in which DLPo>>DLPe are as follows: Met-Thr for N’Ncap position, Glu-Pro in NcapN1, Pro-Arg at N1N2, Lys-His in C2C1, Thr-Gly in C1Ccap, and Gln-Pro in CcapC’. It was also seen that Gly in Ccap position has a tendency to neighbor on a hydrophobic amino acid at C’ position. Studying the tendency of amino acids in neighboring each other in alpha helices can be used in designing novel helical structures and can also be used in modifying existing helical structures in proteins.

In this case report we present a 49 year old man with history of a mass in right upper quadrant and microscopic hematuria who referred to the hospital 2 months ago. In sonography, one cystic mass with multiple irregular septa in upper segment of right kidney and in CT scan, a multiloculated cystic mass in anterior of right kidney was reported. Under light microscopic examination the diagnosis was multilocular cystic renal cell carcinoma.