Acta Medica Iranica
Volume:47 Issue: 6, Nov-Dec 2009

Inverted Follicular Keratosis (IFK) a benign tumor of skin appendages which is mostly presented as a solitary nodule with keratotic or scaling surface on the face of a middle aged or old patients but it can develop in other parts of the body. Different studies have lead to development of different theories about the role of human papillomavirus (HPV) in this kind of skin tumor. The purpose of this study is to determine the probable role of HPV in this lesion. In a cross-sectional study, we selected all the samples with the diagnosis of IFK referred to pathology department of Farabi Eye Hospital, from April 1995 to April 2006. All these samples were evaluated for histopathologic changes specific for HPV. Immunohistochemistry (IHC) staining was performed using antibody against HPV common antigen. The age range of the patients was 37 to 78 years (Mean=53). 18 patients (58%) were males and 13 patients (42%) were females. The lesion can develop in deferent areas of eyelid. Histopathologic changes regarding viral infection such as focal parakeratosis (80.6%), acanthosis (80.6%), papillomatosis (64.5%), hypergranulosis (67.7%), large keratohyaline granules (32.2%) and koilocytosis (16.1%) were evident within the lesions but HPV detection by IHC revealed positive result in any of the samples. The results about age, sex, anatomic site of the lesion and IHC staining were consistent with previous studies which consider no role for HPV in development of IFK lesions. Performing a more sensitive test such as PCR in order to strongly reject the role of HPV is recommended.

This randomized clinical trial aimed to assess the efficacy of phlebotomy on improvement of hearing loss. 71 patients with sudden sensorineural hearing loss were enrolled in this randomized clinical trial study. They were divided into two groups: group A received steroid and hydration therapy plus phlebotomy، while group B received the same regimen without phlebotomy. They were matched according to sex، age، Hb، and Htc. Pure tone audiometries were administered to examine the hearing levels before and after treatment. Statistical analysis showed higher improvement in 250-1000 Hz in patients whit phlebotomy (P<0. 001). However، there was noticed no significant difference in hearing improvement in 2000-8000 Hz between two methods. The number (%) of patients who had improvement was 29 (85. 3%) in phlebotomy group and 21 (56. 8%) in non-phlebotomy group. On the other hand، the number (%) of patients who showed no improvement in A and B group was 5 (14. 7%) and 16 (43. 2%)، respectively (P=0. 008). Using phlebotomy accompanied by steroid and hydration therapy leads to higher improvement in hearing loss especially in 250-1000 Hz. We think that this method has the ability to achieve better result in the management of patients with SSNHL.

To find if some indices have predictive value for renal complications. We conducted a cross sectional and included 80 patients with the age ranged 5-17 years, all with the proven diagnosis of β-thalassemia major. A urine and 5 ml of blood sample were obtained from all of the cases. Biochemical indices such as serum levels of creatinine, Na, Mg, Hb, and ferritin and also urine levels of Na, Mg, creatinine and β2 microglobulin was measured. All data analysis was performed using SPSS 14.0. P-Spearman test was applied to assess correlation between urine beta-2-microglobulin and other variables. Patients GFR was in normal range. Abnormal level of urine β2 microglobulin was reported in 44 patients (55%). P Spearman test proved correlation only between urine β2 microglobulin and FE-Mg. We concluded that renal proximal tubular dysfunction may oocur in children with β thalassemia major without clinical manifestations of renal dysfunction or decrease in GFR. We warn not to rely only on GFR as a early indicator for renal complications among children with β thalassemia major.

Just regarding different risk factors for antibiotic resistant uropathogenes, it seems justice to improve diagnostic power for drug resistant uropathogenes and well appropriate empirical therapy. 300 and 145 cases of clinicopathologically diagnosed nosocomial and spinal cord injured (SCI) associated urinary tract infection (UTI), respectively, were considered as our samples included in our 24 months study (2005 and 2006). 50 (16.6%) and 26 (17.9%) correctly diagnosed Klebsiella, respectively, were cultured from our specimens. MIC pattern of this uropathogenes for 8 antibiotics was determined by gradient concentration method. The prevalence of antibiotic resistant Klebsiella was more among nosocomial associated UTI rather than SCI UTI (P<0.05). According to susceptibility cut-off point criteria of CLSI M7-A6 (Clinical and Laboratory Standard Institute), Klebsiella resistance rate of nosocomial and SCI were 40% and 0 in amikacin (P <0.0001), 86.2% and 16.7% in ceftazidime (P<0.001), 69% and 25% in ceftriaxon (P<0.005), 5.1% and 0 in imipenem (P<0.0001), 50% and 25% in ciprofloxacin (P< 0.05), 81% and 22.2% in gentamicin 100%and 62.5% (P<0.001) in trimethoprim/sulfamethoxazole (P<0.05) respectively. Only resistance to nalidixic acid was mildly higher in SCI Klebsiella (68.8%, 66.7%). MIC 50 of all antibiotics except nalidixic acid and trime-thoprim/sulfamethoxazole were higher in nosocomial Klebsiella (P<0.05). In conclusion although the whole risk factors for UTI in the cases of SCI associated UTI are more than for nosocomial UTI. Inte-restingly, the prevalence of Klebsiella resistant UTI was more in the second group.

Infant colic is a common problem characterized by excessive crying and fussing. We examined whether colic symptoms of exclusively breast-milk-fed infants would be improved by temporary strict maternal avoidance of cow''s milk. This study is analytic and experimental. Sixty-six subjects were recruited during winter of 2006 from a clinic in Isfahan, Iran. Breast-milk-fed in-fants with "colic", age 3-6 months and to be in otherwise good health were referred by pediatri-cians. The intervention was 1 week period of strict maternal avoidance of cow''s milk while they continued exclusive breast-milk-feeding. All infants showed improvement in distressed behavior (crying and fussing) during intervention. The total recorded crying and fussing time was reduced by an average of 31%. A significant difference was found in cry and fuss time between first and last 2 days of intervention (P = 0.000). Cow''s milk proteins may play an etiologic role in colic. We propose that a brief intervention with strict maternal avoidance of cow''s milk may be an effective treatment for colic in some breast-milk-fed infants.

To review children with Kawasaki disease admitted in 17-Shahrivar hospital of Rasht from 1999 to 2007. We reviewed retrospectively 64 children with Kawasaki disease between 1999-2007 admitted in 17-Shahrivar Hospital of Rasht. Frequency distributions of variants including age, sex, season, clinical and laboratory manifestations, response to treatment and complications of the patients were abstracted using SPSS 14. Patients'' age ranged from 2 month to 12 years (median: 41.5 months). The male / female ratio was 1:0.78. The most cases were admitted in the autumn and then spring. Fever in 100%, changes in lip and mouth in 92.1%, rash in 87.5%, Conjunctivitis in 82.8%, changes in extremities in 67.1%, and cervical lymphadenopathy in 59.3% were present. Coronary aneurysm was found in one case. The most common extracardiac complication in this study was vomiting (85.7%). With respect to Kawasaki disease differential diagnosis and its treatment, Better knowledge can help us to make diagnosis more accurately.

In the natural disasters such as earthquake, based on severity of trauma, time under the rubble and quality/quantity of hydratation we will confront with a spectrum of traumatic rhabdomyolysis. In present study we evaluate victims of Bam earthquake to show different stage of muscle trauma, from minor trauma with almost normal level of muscle enzyme to those with moderate trauma leading to crush injury and finally to advanced crush syndrome. Questionnaire consisted of clinical, biochemical and demographic items was designed and completed by our research team retrospectively. We divided the patients to crush and non-crush and also crush injury and crush syndrome, and then compared aforementioned items between them. Clinical and laboratory data of 2962 hospitalized victims, with an average age of 28.4(SD14.2) years (range 1-90) were collected (40% female). 611 patients were affected with crush injury (20%). These were entrapped 2.2 hours longer than the others (P<0.001). Mean IV intake in first 5 days was 3.6(SD2.6) liters for these patients in compare with 2.5(SD1.4) liters for others (P<0.001). 200 cases showed complete feature of crush syndrome. Electrolyte imbalance and systemic complications were drastically increased in the worst patients with crush syndrome. In approach to crushed patients of natural disasters by attention to the wide spectrum of muscle damage and systemic problems, the stepwise management protocol based on severity of traumatic rhabdomyolysis is inevitable and warranted.

Cerebellar ataxias are a heterogenous group of disorders, clinically and etiologically, that result in considerable health burden. Finding out about the various etiologies, and their relative prevalences in the population suffering from cerebellar ataxia helps the clinician to perform a better management, in treatment process. This is a cross sectional study designed to estimate the relative prevalence of each etiologic factor. One-hundred and thirty-five patients, in the range of 6 to 73 years from march 1993 to march1999, were classified in different groups on the basis of etiological findings. Relative prevalence of each of the etiological factors, common accompanying disorders besides ataxia in the patients,CT and MRI changes,and CSF alterations are studied and recorded. A widely spread age group, and the extended number of the cases under study, are the advantages of the current study over the previously reported case series. Among the etiologic groups, multiple sclerosis, cerebrovascular accidents and hereditary cerebellar ataxia, were the most common etiologic factors associated with cerebellar ataxia respectively.

Vancomycin-resistant enterococci (VRE) are becoming a major concern in medical practice. Their increased prevalence and their ability to transfer vancomycin resistance to other bacteria have made them a subject of close scrutiny and intense investigation. Colonization is usually acquired by susceptible hosts in an environment with a high rate of patient colonization with VRE. The aim of this study was to define the prevalence and risk factors of infections with VRE in Amir-Alam Hospital (Tehran, Iran). Fecal samples of 422 newly admitted patients (Group A) and 93 patients with either at least 48-hours of hospitalization or chronic renal failure under hemodialysis (group B) were evaluated for VRE isolates by MIC method in microbiology laboratory in Pasteur Institute of Iran. Stool cultures were positive for enterococci in 310 (73.4 %) and 89 (95.7 %) patients in group A and B, respectively. The prevalence of VRE isolates was 1.42 % (6 patients from 422) in group A and 7.52 % (7 patients from 93) in group B by MIC method (P < 0.05). In group A, a significant relationship was found between the VRE colonization and underlying conditions like as history of hospitalization and surgery within previous year and antibiotic therapy within three months ago. Prevalence of VRE colonization is increasing in hospitals. Our results indicate the importance of underlying diseases as risk factors for VRE colonization.

Population pattern in Guilan province represents a dramatic increase in youth population. Regarding high prevalence of substance use among them, its destructive effects and consequences and paucity of previous related studies, this research was performed to determine the prevalence of substance use among students of Guilan University of Medical Sciences (GUMS). We conducted a cross-sectional study in a representative sample of 845 students in 2005-2006. Data were collected by a questionnaire including demographic data and history of substance use and were analyzed by EPI 2002 software and chi-square. 30.1% of students had a history of substance use at least once during their lives. Cigarette (26.36%), alcohol (17.04%) and opium (3.86%) were the most prevalent used substances. Substance use was significantly associated with male gender, higher age groups, living with friends or alone and being married. There were significant relationships between substance use during past 30 days and studying medicine or dentistry and substance use during life and past 30 days was significantly higher in residency period. This study demonstrated substance use between our samples was considerable and specific interventions to reduce it seem necessary.

Leprosy is an infectious and non-fatal disease that mainly involved skin and peripheral nervous system and caused by Mycobacterium Lepra. This case is a 41-year-old woman with intermittent nasal bleeding and a mass (1.5×2.5 cm) in the right side of lateral nasal wall and a (1×1 cm) mass on septum in the left side of the nose. Considering the probability of intranasal tumor, endoscopic biopsy for histopathologic examination had been done and the result confirmed the diagnosis of leprosy. After unexpected proving of pathologic leprelepromatose, the patient put under 3-drug- treatment.

Leprosy is an ancient deforming disease caused by Mycobacterium leprae, which is still poorly understood and often feared by the general public and even by some in the health care professions Fortunately, the outlook for patients has dramatically improved over the last three decades with the introduction of multi-drug treatment and management strategies that have somewhat diminished the stigma of this diagnosis. We report a rare case of leprosy of larynx. A 45 year old man presented with complaints cough, dyspnea and hoarseness since many years ago. Because of demonstration of acid fast bacilli in smear of his sputum, the diagnosis of tuberculosis was made and anti tuberculosis treatment was initiated. But he developed fever and his symptoms exacerbated. In examination there was a tender erythematous nodule on right supraclavicular region, loss of eyebrows and lashes and disseminated hyper and hypo pigmented cutaneous lesions on abdomen, thorax, back with normal chest x ray. Laryngoscopy to rule out laryngeal tuberculosis was done and granulomatous lesion was seen. Laryngeal and skin biopsy was performed which numerous acid fast bacilli, macrophages and foamy cells suggestive of lepromatous leprosy were demonstrated in both specimens. Treatment was started on multi bacillary regime of WHO multidrug therapy. In conclusion, this report highlights the importance of systemic involvement in lepromatous leprosy especially when the initial presentation is laryngitis or respiratory symptoms. Laryngeal leprosy may mistaken with tuberculosis laryngitis due to respiratory problems and existence of acid fast bacilli in respiratory secretions.

Non Hodgkin lymphoma (NHL) constitutes 5% of all head & neck cancer. The incidence of it has been increased over the last four decades. One of main characteristic of NHL is extranodal presentation that has different pattern in various part of world. A retrospective was designed in a tertiary referral center. It has been done between January 1996 and March 2006. All clinical and pathological characteristics were evaluated. 129 patients were included in this study, 89 male and 49 female. The mean age was 49 year. The most common site of involvement was Waldeyer''s ring and the most common presenting symptom was cervical mass. 48% of patients had lymphadenopathy and 12% had B symptom. The most common histologic type was diffuse large cell lymphoma. In our series male to female ratio was 2.2 that are more than other studies. it seems that extranodal presentation is more common in Iranian patients than other population.

Burkitt''s lymphoma is a lymphatic tumor classified as non-Hodgkin lymphoma with small non cleaved cells. The disease has an incidence of two cases per million patients in North America, and usually present with an intra-abdominal tumor, or enlarged cervical lymph nodes. Massive amounts of peritoneal and plural fluid is rarely seen in these patients. A three year-old girl presented with massive pleural effusion, ascites, mesenteric infiltration, and intraperitoneal mass is discussed in this report. Burkitt''s lymphoma is a highly aggressive tumor with a very rapid growth and a variety of different presentations. It is potentially curable, if highly intensive multidrug chemotherapy is used with aggressive central nervous system prophylaxis.

There is a paucity of literature regarding iatrogenic aortic valve perforation after cardiac operation is performed in the vicinity of the aortic valve. This report describes the clinical, echocardiographic, and angiocardiographic recognition of iatrogenic aortic valve perforation in a patient who had previously under gone membranous ventricular septal defect and pulmonary stenosis. Five days after the operation, the patient showed subacute signs and symptoms of congestive heart failure in surgical ward. Echocardiographic examination revealed free aortic regurgitation. The patient was scheduled for operation, which was performed using cardiopulmonary bypass and cardioplegic arrest. During the operation, exploration of the aortic root revealed tearing non-coronary aortic cusp at the level of the aortic ring and slightly dilated the left sinus. Despite close examination, no suture could be identified. It was reasoned that the tension created by the dacron patch pulled on the adjacent tissue and caused the separation of the non-coronary cusp from its ring and the patient was treated by aortic valve replacement with prosthetic aortic valve. We did not have the facility to use transesophaseal echocardiography for the examination of aortic valve repair and the poor condition of the patient did not permit us to repair the valve. Precise preoperative diagnosis of this lesion allows optimal surgical planning and treatment.