Medical Journal Of the Islamic Republic of Iran
Volume:22 Issue: 2, Summer 2008

Despite the long-standing association of macrophage migration inhibitory factor (MIF) with delayed-type hypersensitivity response, the potential role of MIF in chronic allograft nephropathy is unknown. The association between upregulation of MIF expression, macrophage and T cell infiltration and the severity of chronic allograft nephropathy suggests that MIF may be an important mediator in the process of chronic allograft nephropathy. Therefore, the aims of this study were to measure urine concentration of MIF after renal transplantation, and to determine if it increases with time. In this prospective cross-sectional study twenty-two pediatric patients (case, group A) who received kidney transplants between 1999 and 2006, and forty healthy children (control, group B) were recruited. Urine MIF and creatinine were assessed in all patients. Urine MIF concentrations were quantitated by ELISA. The mean ratios of urine MIF/Creatinine (Cr) were calculated as 5.046(SEM=2.04) pg/μmol creatinine in transplanted-kidney patients (group A) and 1.85(SEM=0.35) pg/μmol creatinine in healthy individuals (group B). Agood significant correlation was seen between urine MIF/Cr ratio and time after kidney transplantation in recipients (P=0.002, rSpearman = +0.633). This study shows significant correlation between urine MIF/Cr ratio and time passed after transplantation. Increasing MIF/Cr ratios were seen in patients with a longer post transplantation period. Therefore, it is necessary to determine the role of macrophages in chronic renal nephropathy especially chronic rejection with additive studies and then study the effect of anti-MIF antibodies in the treatment of this condition.

Far lateral discal herniation is an uncommon disorder and is difficult to assess by physical examination alone. This study is designed to define clinical and epidemiological findings and to establish the indications of surgical and medical treatment for FLLDH. Between 2000 and 2005, a total of 2035 patients with lumbar disc herniation underwent surgical discectomy by the authors in several neurosurgical centers in Mashhad. Among these patients, 63 (3.1%) had FLLDH (42 men and 21 women). Clinically these patients had unilateral radicular pain with or without paresis. SLR was positive in 100% of cases. Conservative therapy consisting of bed rest, nonsteroidal anti-inflammatory drugs and physiotherapy had failed. We used a combination of classical interlaminar approach and the intertransverse route through a midline approach for the treatment of our patients. From 63 cases in our series, 42 were men and 21 were women. 19 patients had extraforaminal and 44 had foraminal disc herniation. The most common level for far lateral discal herniation was L4-L5. Our patients had LBP in 43.6% (27 cases) and positive SLR and radicular leg pain in 100% (63 cases). In all patients leg pain was relieved immediately after surgery. FLLDH should be considered in all cases with lower limb radiculopathy. These patients have more severe radicular pain than patients with paracentral lumbar disc herniation. FLLDH happens more frequently at L4-L5 and L3-L4 levels. It can often be difficult to diagnose or easily overlooked on radiographic studies. In almost all cases, conservative treatment is unsuccessful and surgical treatment is recommended.

Screening is a necessity for country health systems. In undeveloped countries that have no screening programs, cervical carcinoma is one of the major causes of mortality and morbidity. Although cervical cancer is preventable it is poorly controlled in some countries. The main cause of it is unawareness of people from cervical cancer and screening methods. The target population consisted of a consecutive sample of 1002 female patients, 15-45 years old, visiting the city health care centers in Tehran for any reason between January 2006 and January 2007. We used a self-administered, written, anonymous, multiple choice questionnaire that was developed by the study authors. Statistical significance was defined as P<0.05. The mean of age was 31.23 ± 4.3 years. Five-hundred and twentytwo cases (52.1%) had knowledge about Pap smear test. Only 230 cases (44.1%) knew the correct time of the first Pap smear that should be done in women. And 408 cases (77.9%) knew Pap smear can detect cancer of the cervix. 364 cases (71.9%) had heard about cervical cancer, 314 cases (59.9%) had heard something about symptoms of cervical cancer. It is obvious that in Iran (and especially in Tehran), Pap smear awareness (52.1%) is statistically similar to other developing countries, and only 45.9% had had at least one Pap smear test till the time of the interview. Thus, there is a need for an awareness campaign to increase the uptake of Pap smear testing.

To evaluate the surgical treatment of total anomalous pulmonary venous connection (TAPVC) and determination of predictors for postoperative death. Between 1995 and 2005, 80 patients aged from 1 month to 12 years underwent surgical repair for supracardiac (39), cardiac (34), infracardiac (3) or mixed (4) type of TAPVC. Systemic pulmonary hypertension (PH) in 53.8% of patients, half systemic PH in 26.3% and mild pH (<40 mmHg) were found by preoperative evaluations. Twelve patients (15%) had some degree of pulmonary vein obstruction preoperatively. Seven patients (8.7%) died in the operating room. Early postoperative mortality (during 48 hours) occurred in 11 cases (13.7%) and nine patients died during first hospitalization. We did not have late mortality in survivors during follow-up period; therefore the overall mortality rate was 33.8%. The incidence of postoperative death was highest in the infracardiac type (2/3). Approximately two-thirds of dead patients (21/27) had presented with systemic PH and 89% of them had at least half-systemic PH preoperatively. Mortality rate in patients with normal pulmonary artery pressure (PAP) was zero. In contrast to early surgical results we had excellent mid-term outcome. The role of myocardial protection and surgical technique are the most probable causes of high death rate in our series. However influences of poor preoperative stabilization process as well as anesthetic technique and cardiopulmonary bypass related problems should be considered. PAP more than half of systemic pressure and patient age smaller than 3 months were the primary predictive factors for premature death (P<0.05).

Wound infection is a frequent and severe complication in burn patients accounting for a high number of mortalities. There are some reports comparing swab and biopsy cultures of wounds of various etiologies or chronic wounds. The aim of the study was to evaluate burn wound infection by different bacteriologic methods of surface swab and tissue biopsy culture and see if they can predict the outcome. Aprospective study was conducted in Shahid Motahari Burn Center, Tehran, on patients suffering from burns with more than 20% of TBSAadmitted in 2001-2002. Wound swab and biopsy specimens were collected within the second week. Patients were followed to the point of their discharge or death. Bacterial growth was reported in 100% of swabs, in 89.3% of the biopsies in differential culture media, and in 18.7% of the biopsies in selective culture media. These different cultures had similar pathogen reports. Of the 75 studied patients, 78.7% died. The frequency rates of positive tissue cultures and bacterial load were not different between the dead and those who survived. Bacteriologic methods do not have enough predictive value to assess clinical outcome.

To evaluate and review our experience with pediatric spinal injuries and factors affecting outcome, the authors conducted a retrospective clinical study of 43 cases (32 boys, 11 girls) of pediatric spine injuries treated during four years (January 1999 to December 2003). Forty-three children with spinal injuries were studied retrospectively over four years and were divided into two age groups: 0-9 years and 10-17 years. We reviewed the level(s) involved, types of bony injuries, presence of spinal cord injury, treatment received, length of hospital stay, discharge status, any associated injuries, and any complications during the hospital stay. Analysis of variance and chi-square were used to analyze differences between groups. Motor vehicle accidents were the most common cause in this series. There were twelve patients aged 0-9 years and thirty-one aged 10-17 years. Spine injury incidence increased with age. There was 14% cervical, 46.5% thoracic, 34.9% lumbar, and 4.6% multilevel involvement. Thirteen patients had spinal cord injury. Spinal cord injury was more common in the 0-9 age group. One patient with spinal cord injury without radiographic abnormality (SCIWORA) was in the 0-9 age group and had complete neurologic injuries. Young children with spinal injuries were more likely to die than older children. The associated injuries were 25.7%. Twenty-five point six percent underwent decompression, fusion, and instrumentation. The complication rate in surgical patients was higher than in patients treated non-surgically and in multiply injured patients. This may be related to the severity of the initial injury. Our results suggest age-related patterns of injury that differ from previous work. Potential for neurological recovery is good. Young children have a higher risk for death than older children. There was no predominance of cervical injuries in the young child. The incidence of SCIWORA was low. Higher complication rates were seen in polytrauma and surgical patients.

Hepatitis B virus infection is an important cause of liver morbidity and mortality worldwide. HDV changes the natural course of HBV. The prevalence of HDV infection wasn’t determined in the various groups of HBV infection (carriers, acute hepatitis, chronic hepatitis, cirrhosis and HCC) in Iran. We aimed to research the prevalence of hepatitis D virus infection in various groups with HBV infection in Imam Khomeini Hospital, Tehran (2005-2006). Serological markers of HBV and HDV infection [HBs Ag, Hbe Ag, Anti Hbe Ab, Anti HDVAb (IgM, IgG)] were determined by ELISA test in 206 patients with HBV infection who referred to Imam Khomeini Hospital (2005-2006).These patients were categorized to asymptomatic carriers, acute hepatitis, chronic hepatitis, cirrhosis and HCC according to history, physical examination and lab findings. HDV infection was detected in 12.6% (26/206) of HBV infected patients. It was detected in 1.6%(1/62) of asymptomatic carriers, 20% (1/5) of acute hepatitis, 5.6%(5/88) of chronic hepatitis, 37.2% (16/43) of cirrhosis and 37.5% (3/8) of HCC patients. HDV infection showed a five-fold increase in chronic hepatitis (P<0.05) and ~16 fold increase in cirrhosis (P< 0.001) compared to HDV infection in asymptomatic carriers. HDV infection was equally distributed between sexes. Mean ages of HDV carriers, acute hepatitis, chronic hepatitis, cirrhosis and HCC were (28), (33), (39.521), (47.111.5), (58.69,2) year respectively. The prevalence of HDV infection was 12.6%. The higher prevalence of HDVinfection in more severe forms of hepatitis B virus infection suggests that HDV infection increases the severity of chronic hepatitis B. HDV infection remains a major cause of chronic liver disease in Tehran in spite of its decreasing prevalence in countries such as Italy.

Bicornuate uterus is class IV and septate uterus is class Vin uterine anomaly classification. Bicornuate uterus is almost always treated by laparotomy and metroplasty. But the treatment of choice for septate uterus is hysteroscopic metroplasty. Bicornuate- septate uterus which is described in this paper is a new class of uterine anomaly(between class IV & V). The advantages of hysteroscopic metroplasty to laparotomy and metroplasty have been proven previously. It is important to know if the uterine anomaly is pure bicornuate or bicornuate-septate. In the latter case, we suggest the first line of operation should be hysteroscopic metroplasty.

A32 year-old multigravid patient with 10 weeks of pregnancy was referred to the emergency ward with massive vaginal bleeding and preshock state. Suction curettage, laparotomy, uterine artery ligation, Macdonald cerclage, and hysterectomy was done, in that order. After hysterectomy and massive transfusion she recovered. When a diagnosis of cesarean scar pregnancy is made in the emergency state and especially in the presence of underlying disease, morbidity is high and fertility lost.

The leg is a complex district with functions of weightbearing support, stability, and motility. The management of extensive and complex defects is more challenging and often results in leg amputation or shortening. Leg amputation is a severe mutilation that alters the patient’s work and social life by limiting ambulation and self-sufficiency. During a 3 years period we treated four patients with leg injury consisting of tibial defect who underwent one-stage surgery for soft tissue and bone reconstruction. The follow-up period was from 31 to 36 months. Time to bony union ranged from 4 to 7 months. Time to full weight bearing was from 5 to 9 months after operation. All of the transferred tissue showed hypertrophy after weight bearing. Nonunion & abscess occurred in one case. Arterial thrombosis & valgus deformity were other postoperation complications. The limb was shorter by an average of 0.5 cm in three cases, longer by 1.1 cm in one case, and in the last case, it was not measurable. Other disabling complications were not seen. We believe that this forgotten method can be a valuable alternative to other techniques such as free fibula flap in certain cases that the surgeon can reconstruct bone & soft tissue defects in one stage.