مجله علوم پزشکی رازی
سال نهم شماره 2 (پیاپی 29، تابستان 1381)

We report on the occurrence of a necrobiotic palisading granuloma in the dermis, resulting from intralesional injection of corticosteroid in a 6-year-old boy with previous history of a cutaneous ulcer and formation of hypertrophic scar. Granulomatous inflammation frequently forms around either endogenous or exogenous material that comes in direct contact with the dermis where it is perceived as a foreign. The injection of corticosteroids into the skin results in the appearance of granular material in the dermis or much less commonly a granulomatous reaction resembling rheumatoid nodule.

The aim of this clinical trial was to compare the effects of two techniques, forward & backward runningon the functional performances of lower exterimity. These functional performances were, (i) Vertical Jump, (ii) Single leg hop, (iii) Six Meters timed Hop & (iv) Shuttle Run. In a pilot study the reliability of these tests was confirmed. A convenient sample of 30 young & healthy men were selected and randomly assigned into two groups of 15 each. The testing period lasted 6 weeks with 3 sessions per week. Each session took 15 minutes. Measurements were taken at the beginning and every two weeks henceforward. Therefore we had between and within group analyses, using independent t-test and ANOVA. After the end of the 6th week, significant increase in functional performances of lower exterimity was observed in both groups. But these two techniques had similar effects,i.e. the observed difference between group performances was not statstically significant. That is, forward & backward running excersices have equal effects on the functional performances of lower exterimity.

The various types of Glomerolunephritis (from the point of view of pathology) have different clinical and para-clinical presentations. Knowledge of such symptoms in each pathology could be very helpful in determining correct and precise clinical diagnosis. Therefore we decided to indicate all the clinical and para-clinical symptoms in 280 cases of biopsy and on the other hand we tudied and thoroughly investigated the most prevalent glomeralonephrite in our patients. In this investigation 28.2% of patients were suffering from MesPGN, 27.5% MCGN, 14% FSGS, 7% MCD, 4% Congenital nephrotic Syndrome, 4% Berger disease, 3.5% cresentic and 2.5% Alport syndrome. In our investigation the prevalence of MesPGN and NCGN were quite considerable. Hemturia and hypertension were common in MPGN and FSGS and were seen in membranous GN and MCD lesser. Increased serum creatinine and hypocomplementemia were seen more common in MPGN. Decreased level of serum complements were rare in others.

Systemic sclerosis classified to limited and diffuse types. Skin and visceral involvement is more sever and progressive in diffuse form and also pericardial effusion is more frequent in diffuse type of disease. There is only few case reports of symptomatic pericardial effusion in limited type. In this article we represented a case of limited systemic sclerosis (scleroderma) who hospitalized with chief complaint of dyspnea and diagnosed as a case of limited scleroderma with massive pericardial effusion. The patient received treatment and responsed to it.

To evaluate the reliability of modalities of management of patients with penetrating civilian abdominal and flank trauma, hospital records of all affected patients, who were managed in Hazrat Rasul-e Akram and Haft-e Tir hospitals in Tehran, have been reviewed over a seven-year period, ending on march 19, 1996. These hospitals are level two trauma centers affiliated to the Iran University of Medical Sciences. One hundred and five patients have been reviewed in this research. The positive predictive value of mandatory laparotomies performed for penetrating traumas to intrathoracic abdomen was high (100%). Thus, this is a reliable modality for the management of these patients. The positive predictive value of mandatory laparotomies performed for evisceration was 67%, which is not considerable. Thus, revision of this indication may be reasonable. In this study, the positive predictive value of routine laparotomies was very low(38%). This reemphasizes the point that routine laparotomies for peritoneal penetration must be avoided, if possible. The positive and negative predictive values of selective laparotomies were very well (91% and 87%). So, it can be recommended that in the management of patients with penetrating abdominal trauma, surgeons should employ diagnostic methods such as “diagnostic peritoneal lavage” (DPL), “imaging” and “observation”, if possible and where applicable.

Choanal atresia is the most common congenital anomally of the nose and has a frequency of aproximately 1/7000 live births. It consists of a unilateral or bilateral bony (29%) or bony-membranous(71%) wall. Nearly 50% of affected infants have other congenital anomalies or CHARGE syndrome that include: coloboma, heart disease, choanal atresia, growth and development retardation, CNS anomalies, genitalia anomalies, hypogonadism or both, ear anomalies or deafness. Clinical manifestations: When only one side is affected, the infant usually dose not have severe symptoms at birth and maybe asymptomatic for a prolonged period, often untile the first respiratory infections. In bilateral atresia, they have cyanosis and respiratory problem with sucking that relieved with srying. Diagnosis: inability to pass a firm catheter through each nostril more than 3-4 cm into the nasopharynx. The atresia plate maybe seen directly with fiberoptic rhinoscopy. The anatomy is best visualized by using CTscan of the nasopharynx. Treatment of choanal atresia depends on the severity of the obstruction and clinical presentation of the infant. Unilateral atresia rarely requiers surgical intervention durin infancy and is usually corrected before school begins(4-5 years old). In bilateral atresia, if an oral airway is tolerated by the infant, surgical correstion is best deffered until the infant reach to the 4th-6th week of age or more than 4kg. In CHARGE syndrome, tracheosotomy may preferable to immediate repair, depending on the severity of the associated anomalies. In this article, a newborn present with bilateral choanal atresia, that after birth had cynosis. General examination, heart and pulmonary examination were normal. In nasal examination a catheter could not pass through each nostril more than 3 cm and with bilateral choanal atresis diagnosis was operated. After operation, the infant hospitalized in intensive care unit and had been under conservation treatment. After 3 weeks, the infant discharged with good condition.

Jaundice is one of the most complications in the neonatal period. Bilirubin encephalopathy (kernicterus) is one of the important complications of indirect hyperbilirubinemia, that causes extrapyramidal, audiotory and visual disturbance. To prevent of this dangerous complication can used from three manner treatment including: phototherapy, exchange transfusion and drug. Exchange transfusion is done from the umblical vein catheterization. The purpose of this study was to evaluate the prevalence of bactremia which is one of the complications of exachange transfusion. This study designed prospectively and conducted on the infants who where hospitalized with jaundice between 1996-1999 in shahid Akbar Abadi hospital and underwent exchange transfusion. Blood culture was done before and after exchange transfusion (ET) and also the most common responsible organism that causes bacteremia after transfusion was recognized. In this study, the pre-term infants (less than 37 weeks) and neonates who had clinical manifestation of sepsis and so infants who had more than one exchange transfusion were omitted. Of 402 hospitalized infants, who possessed the qualifications in this 4 years, 40 infants (9.95%) underwent exchange transfusion (19 infants were female and 21 infants were male). Of these 40 infants, in 29 infants (67.5%) blood cultures (before and after ET) were negative. In 13 infants (32.5%) blood culture was positive in 4 of them (10%) before ET, and in 9 of them (22.5%) after ET. The most common micro organism in positive blood cultures after ET, was coagulase positive staphylococcus (66.5%). Based of this study, the rate of bacteremia after ET was 22.5% which is higher than other countries (8-10 percent). The most common responsible micro organism of bacteremia after ET as the same as other researches was coagulase positive staphylococcus.

In facial burns, nose is commonly and seriously damaged with grotesque fatial disfigurement. Surface wound constraction results in visible nostril, vestibule and septum in frontal and lateral views causing the patient to suffer from serious disfigurement. In literature there are at least three different ways of nasal reconstruction in burned nose,e.g. scalping converse flap, arm flap and inversion radix skin technique. This article is based on the surgical work we carried out at the Motahary Burn and Reconstractive Hospital, a university-affiliated burn refferal center in Tehran. It discusses a number of patients with partial or subtotal nasal burn preserving the bony bridge in most of the cases. In the method described in this report, the nose is restored to its natural form in single-stage procedure. The radix skin is inverted down for restoring of lining of alar margins, nasal tip and columella. A layer of skin is then used to cover the nose. A patch of arm skin, which is the nearest available color-matched organ, is used for this purpose. We believe the presented method has several advantages compared to other complicated forms of burned nose reconstruction and believe it is the preffered procedure in such cases.

Venous thromboembolism (VTE) is one of the most common problems involves patients in a surgical ward. This problem will be preventable, if we consider risk factors in these patients and use preventive measurments on time. To evaluae our colleages in surgical ward for using preventive medications and physical methods in prevention of venous thromboembolism, we conducted this cross-sectional prospective study. Two hundred and forty five (92.4%) of 265 patients who were admitted and undergone surgery entered the study. Of this population, 182(74.2%) found to have risk factors for VTE, so that 103 patients (56.6%) had just one, 53(29%) had two, 15 patients (88.3%) had 3 and 11 (0.6%) of them had more than 3 risk factors. Of these patients only 25 (13.7%) were placed on preventive anticoagulant therapy with a 4±2.8 days delay in starting it. From these patients 4 of them diagnosed for VTE which received therapeutic doses of heparin. Despite high rate of risk factors of VTE in the patients of this ward, in most cases no preventive anticoagulant therapy had been undertaken in this hospital.

Macular Amyloidosis is relatively common cutaneous disease in Asia and middle east. This study was performed to determine the disease sex and age distribution, besides evaluation of its frequency among the author’s dermatology clinic patients. The probable role of some risk factors were also evaluated. For this purpose all patients of the author’s dermatology clinic with gray to brown or brown reticular lesions located on interscapular and/or upper arm regions without previous history of other cutaneous conditions at that site, were considered as macular amyloidosis cases. During 35 manths (march 21, 1997 to February 21, 2000) one hundred macular amyloidosis cases were found(0.55% of dermatology clinic cases) and 93% of cases were female. This sex distribution is dramatically different from other studies. The age of patients ranged from 16 to 76 years and the mean age of involvement (mean ± SE) was 36.25 ± 3.41 years. There was a significant difference between the mean age of females and males (difference of two means was 10.26 years and P=0.027). Eigthy one percent of patients were 21 to 50 years, compatible with other series. There was no evidence of probale causative role for UVB, back scratcher use, or known accompanying diseases.

Adhesion bands and adhesion formation is one of the most importants post surgical complication in pelvic and abdominal operations. Post operation adhesions are the most common cause of intestinal obstruction in the western world. Approximatly one-third of all intestinal obstruction are likely to be due to adhesions. In over 10% of infertile women, adhesion formation is the main cause of infertility. Major studies in prevention of adhesion formation have based on anti-inflamatory agent. In this study we decided to compare corticostroid agents in intraperitoneal injection for reduction of postsurgical intraperitoneal adhesions. Forty rats devided to 4 groups (N=10) and after anesthesia with 50mg ketamine intraperitoneally and laparatomy, an abrasion between uterine horns was created and then, 10mg talc powdered in each rat. Also in the group A 10ml normal saline, group B 1mg/kg betamethazone phosphate, group C 1mg/kg dexamethazone and group D 1mg/kg betamethazone-LA added into peritoneum. Then abdominal wall was repaired. After 4 weeks relaparatomy was done and adhesions with modified Swolin method was registered. In comparison among groups there were statistically significant difference in the rate of adhesions (P=0.04). It showed betamethazone-LA decreases grade of adhesion (P=0.07). Difference between betamethazone-LA and control group in amount and thickness and strength of adhesion was statistically significant. In the previous studies multiple intramuscular injection of betamethazone phosphate decreased fibrin formation in rats and multiple dose of dexamethazone intraperitoneally and orally were effective in reducing of adhesions. But at the present study single dose of betamethazone-LA intraperitoneally reduced rate of adhesion and betamethazone phosphate and dexametazone were ineffective.

The purpose of this study was to investigate the extend of bacterial contaminatim of ice blocks being used on daily basis in the community. In this study fifty samples of ice blocks from April to September 1999 were collected from different areas in the city of Tehran. Experiments were carrid out for the determination of total count of bacteria and the identification of pathogenic organisms. The results indicated that from the total of 50 samples, 34(68%) were contaminated. The isolated pathogenic bacteria were 5 cases E.coli (10%), 21 cases pseudomonas aeroginosa (42%) and 5 cases staphylococcus aureus (10%). Other opportunistic bacteria present in the environment such as alkaligenes (%6), Acinetobacterspp (%4), Diphtheroidsspp (%46), Micrococcusspp (%16), Bascillusspp (%20) and coagulase negative staphylococcus(%40) were isolated from all the 50 samples. These results suggest that necessary precautions should be taken in production, transportation and distribution of the ice blocks to reduce the rate of bacterial contaminations.

Gastric cancer (GC) is one of the most common cancers in the world. Despite some improvement in the treatment of this type of cancer, the 5-year survival rate has been already remained low. Therefore further exploration of biological features and causes of gastric cancer is needed to reduce its occurrence. In sequential changes from superficial gastritis to dysplasia and cancer, intestinal metaplasia (IM) plays a pivotal role. Most investigators agree that the risk of GC is proportional to the extent IM and as a possible premalignant lesion. According to the differences in enzyme production and mucus content two types of IM have been identified. The different variants of (IM) may exhibit different risks of GC development, thus incomplete type that changes neutral mucin to acidic mucin shows stranger risk. In this study the influences of H.pylori on gastric cancer has been evaluated and also to detect premalignant lesion before morphological changes, combined PAS/Alcian blue (PH=2.5) stain is performed for distintion of two types of mucin. This study was performed in a series of 100 cases of chronic gastritis with H.pylori, 20 cases of gastritis and IM and 10 cases of chronic gastritis without H.pylori (negative control). Combined PAS/Alcian blue (PH=2.5) stain performed for distinction between neutral and acidic mucin. According to this staining, no changes in mucin (neutral mucin) is observed in H.pylori gastritis without intestinal metaplasia. In this study we found that neutral mucin is not changed in H.pylori gastritis without IM, however for better interpretation study in a large number and cases is recommended.

Bladder cancer consists of about 5.2% of all cancers in men and 2.3% in women. About 90% of them have the origin of transitional cells(TCC). There are some predictive factors that knowledge of them is useful for management and follow-up of the patients. Expression of oncoprotein P53 is one of these factors. Considering influence of P53 expression on prognosis, we decided to study the correlations between tumor grade and stage with P53. Whereas these correlations to be found, the clinician may treat their patients, with high-grade and invasive tumor with P53 expression, aggressively and earlier, without any need to stain for P53. In our study we reviwed 27 patients in shahid Hashemi-Nejad hospital that 12 of them had low-grade urothelial carcinoma and the others had high-grade urothelial carcinoma according to WHO/ISUP system. Also 7 patients had invasive tumors and 20 of them had superficial tumors. After immunohistochemistry staining for P53, all the high-grade and invasive tumors were positive with the cut-off of 10%. But there was no meaningful statistical correlation between superficial and low-grade tumors and P53 expression. Obtained Pvalue with Fisher’s test for P53 expression and tumor grade and stage were 0.028 and 0.018 respectively and with Spearman test were 46% and 50% respectively.

Intestinal obstruction associated with pregnancy is a rare but serious event. Morbidity and mortality are significant for both of the mother and the fetus, mostly owing to delayed diagnosis. Clinical picture is often complicated by the numerous causes of abominal pain in the gravida. The most common causes of obstruction in pregnant woman are adhesions from previous surgery and volvulus. The goal is to know the details of the patient’s history and physical examination, understanding the physioligic changes of pregnancy, formulate differential diagnoses and utilize appropriate laboratory and radiographic tests. We report a 37 - year - old Afghanstian pregnant woman G19 Livingchild = 0 with gestational age of 32W with small bowel volvulus complicating pregnancy who presented with vomiting and epigastric pain. Acute abdominel pain in the pregnant woman like appendicitis, pancreatitis, pepticulcer and pre-eclampsia must be considered as differential diagnoses. The treatment is immediate surgery.

Imperforated hymen occures rarely in newborns. The estimated frequency is approximately 0.1% in female newborns. During nine years (1992-2000), nine patients (aged 12-14 year, mean 13.2 year) with imperforated hymen admitted in Firoozabady hospital. The diagnosis was based on history, physical examination (genital-rectal) and ultrasonography. Of the 9 patients, 5 (56%) presented with urinary retention. One patient had hydronephrosis. Urinary symptoms disappeared after the operation. A history of no menses in an adolescent girl with abdominal and urinary complaints is cause for consideration of imperforated hymen.

Thrombophilia is a clinical problem throughout the world and it is particularly a major problem in western countries. Factors causing thromboembolic diseases are numerous and they may be inherited or aquired. In order to investigate causes of venous thrombosis. The level of antithrombin (AT), protein C, protein S and the presence of antiphospholipid antibodies (APA) in 300 patients with a history of thrombosis measured. The activity of AT was examined by chromogenic, protein C and protein S by clotting assaies and APA was also detected using ELISA method. A deficiency in one or more of natural anticoagulant determined in 35 out of 156 patients (22.43%) without receiving anticoagulant drugs and 87 out of 144 patients (60.41%) with a recent history of anticoagulant therapy. A significant differences (P<0.01) between the results of these two groups of patients may explain the interference of anticoagulant drugs. In this study a defidiency of AT in 7 cases, protein C in 77 cases, protein S in 39 cases and APA in 47 out of 300 cases were observed. Altogether, the abnormal results of these 4 tests may provide an explanation for thrombosis in (38.46%) of group one patients. If the other causes of thrombosis such as APCR are considered, this percentage will be increased significantly. Therefore this study indicate that some other laboratory tests need to be stablish to define the hypercoagulable state of thrombotic disorders.

Mandibular condyle fractures are relatively common. Because of longterm morbidity of temporomandibular joint dysfunction and ankylosis, correct management of these fractures are very important. The contraversy between closed and open approaches, has not yet been solved in the management of these fractures. In this article, we reviewed 302 cases of mandibular fractures since 1993 to 2000. These 69 cases had 81 condylar fractures alone or in combination with other mandibular fractures. Of these, 57 cases (83%) had unilateral and 12 cases (17%) had Bilateral fractures. Most cases (64%) were injured either by car or motorcycle accident. Fifty four cases (78%) were managed by closed reduction and intermaxillary fixation (IMF) and 12 cases (17%) were treated by open reduction and rigid fixation with short coures of IMF. The indication of open reduction in our study were severe lateral or medial displacement of condyle. Two cases were treated conservatively. One neglected bilateral case came back with open bite as complication. The patients were followed between 6 month and 5 years. In all cases, we found the ability to open the mouth more than 4cm. The results of closed and open approaches in our study were comparable without any significant difference. As conclusion, in most cases of mandibular condyle fractures, closed approach is recommended and open approach are preserved for cases with severe displacement, which can not be reduced properly with open technique.

Since anesthetic drugs have different unsuitable effects on fetus, local anesthesia is considered as the best method to prevent pain in the cesarean sections. Epidural usage of drugs is the choice of maintaining anesthesia. Epidural methadone and sufentanil both have been used separately in cesarean sections. This study was conducted to compare the anesthesia period and complications in cesarean section between the epidural methadone and sufentanil-administered women. Sixty cesarean candidate women were selected and divided in two groups. After local anesthesia induction, 0.15mg/kg methadone and 0.2 µg/kg sufentanil were administered for the first and second group, respectively. Anesthesia period and complications were determined using a previously validated questionnaire. Mean ages of study population were 33.4±7.8 and 34.3±6.4 years for methadone and sufentanil administered group, respectively. Mean anesthesia period for methadone group was significantly higher than sufentanil group(296±42min. Vs. 197±40min., p<0.05). The most prevalent complications were diaphoresis for the methadone and drowsiness and euphoria for the sufentail administered women. Anesthesia period in the epidural methadone administered women was significantly higher than sufentanil administered women. Considering the lower complication frequency, higher anesthesia period, lower costs and better access of methadone, respect to sufentanil, it seems that methadone is still more suitable to use in Iran.

We prospectively studied the usefulness of intraoperative cytology (directed scrape preparation) and frozen section in the diagnosis of 100 breast lesions (53 benign and 47 malignant). This study used sensetivity, specifity and accuracy as statistical tools based on binary principles. The intraoperative results have been compared with the final histological diagnosis, Intraoperative cytology as compared to histopathology had 90% accuracy, with 85% sensetivity and 94.3% specifity. Frozen section was more accurate than intraoperative cytology as compared to histopathology(accuracy 98%, sensetivity 95.7% and specifity 100%). However the differences were not statistically significant (P>0.05). These data confirm the value of intraoperative cytology in the diagnosis of breast malignancy and suggest that it could be used as an alternative to frozen section, if technical condition required for frozen section are not available or suitable.