مجله علوم پزشکی رازی
سال هشتم شماره 4 (پیاپی 27، زمستان 1380)

Organic presentation is the main complain in psychiatric disorders which represent in different features, symptoms like shortness of breath and chronic cough are common when patient complication of pulmonary problems. One of the psychiatric disorder which presents with organic problems is factitious disorder. In this disorder patient complain about some organic dysfunctions that are voluntary but unconsciously. Patient tries to deceive the physician and his or her relatives without any obvious and recognazible to assume the sick role.In this article we introduce two cases with chief complaint of hemoptysis that we found production of this physical sign was intentional and the motivation for the behavior is to assume the sickrole. The diagnosis of these two patients was factitious disorder with prodominantly physical signs and symptoms.

Phenobarbital is a drug of barbiturates class that it’s Anticonvulsant and sedative effects has been caused it’s widely. Usage in nervous system diseases espicially epilepsy. The epileptic pregnant women who taking this drug maybe bear neonates with congenital malformation e.g:hypoplasia or occasionally aplasia of finger - and toenails and distal phalanges, cleft lip, cleft palate and cardiac malformation. Phenytoin is another antiepileptic drugs that teratogenic effects was better known than the phenobarbital as a “Fetal Hydantoin Syndrome”. This report was focused on the infant whose epileptic mother’s consumed phenobarbital during pregnancy. The infant had palatine and labial cleft associated with low set ears, ear deformity, ocular hypertelorism, broad nasal bridge, short neck. Most of this anomallies was seen in Fetal Hydantoin syndrome.

Pulmonary hypertension is one of the causes of cyanosis in children. Pulmonary hypertention may be primary or secondary. Etiology of secondery PH are variable and one of them is pulmonary ventilation abnormality. One of the rare causes of secondary PH is congenital central hypoventilation syndrome or ondines curse. The patient was 6 years old boy presented with easy fatigability and mild cyanosis. Evaluation of the patient showed pulmonary hypertension and ondines curse was considered.

The main objective of the research was evaluation of the effects of breakfast on attention and short-term memory of 8-years old school children. The study design was randomized controlled trial (RCT) which is done in a cross-over frame. 38 school children divided into two groups randomly and group one was given a standard breakfast (as 20% of RDA for energy in this age) at 8:00 AM. Before and one hour after breakfast pre-and post test of arithmetic and vocabulary tests were performed. At phase 2 of study (after two days), by crossing over the groups new tests were given and results analysed. All individual characteristics such as anthropometric, socio-economic, parents and teacher’s opinion about children activity and school performances, and school average scores were obtained. Results indicate that both attention ability and short-term memory scores of subjects have elevated at least 2 scores (P<0.05) in breakfast group, but in other group memory test failed, although decrement was not significant. Because of similarity of both groups, we suggest that the promotion of scores is due to consumption of breakfast.

Natural Killer cells (NKs), are considered an important first line of defence and were originally defined by their ability to kill certain tumor cells and virally infected cells. Our aim is to study expression of HLA class-Ia on tumor cell lines and their susceptibility of NK cells. In this study MDA-MB-468 tumor cell line (NCB1, C208) That derived from human breast adenocarcinoma, is selected as a model which expresses total alleles of HLA class I. To test HLA class I expression, we used the F.I.T.C conjugatedm Ab W6/32 which recognize assembled HLA-A, B and C locus products. Surface expression of HLA class I on the cell line are determined with single- color flowcytometry analysis. NK cells are obtained from PBL of healthy donors. Results of our study indicate that expression of HLA class I molecules on MDA- MB- 468 Tumor cell line are increased after IFN-γ Treatment. Cytolytic activity of NK cells have direct correlation (r =1) with up- regulation of HLA class I expression on the MDA- MB- 468 tumor cell line. Therefore, on the basis of this results, we suggest that, on the surface of NK cells may exsist activating receptors that recognize allogenic HLA class I molecules and/or non HLA class I ligand that is upregulated by IFN- & treatment, and cause lysis of target cells.

Primary or spontaneous infarction of omentum is a rare disease producing acute abdominal condition. This is due to vascular changes in circulation of greater omentum. Infarction can be caused by torsion of omentum around the adhesion band following an operation, or it can occur spontaneously without an adhesion and operation. Rarely this condition is not due to torsion and is spontaneous without any visible cause at operation. In either cases the signs and symptoms of an acute abdomen is produced. Our case was an idiopathic segmental infarction of omentum which is much rare compared with 2 other causes of omental infarction. Less than 150 cases of idiopathic segmental infarction of omentum has been reported after its first presentation in almost 100 years ago. The importance of this disease is in differential diagnosis of acute appendecitis which is indistinguishable before surgery. At laparotomy the appendix is normal and variable amounts of serosanguinous fluid is present in peritoneal cavity and a segment of greater omentum is infarcted. Our case was a 37-year-old overweight male with a spontaneous segmental infarction of greater omentum. Suggested surgical treatment is appendectomy and resection of the necrotic segment of omentum.

Necrotizing enterocolitis is the most common acquired life threating intestinal disease in the neonates. This disease affects predominately preterm infants (less than 37 weeks gestational age). The pathogenesis of NEC is unknown predisposing. Risk factors for NEC include: lschemia, Hypotension, RDS (Respiratory distress syndrom), umbilical artery catheterization, Hypothermia, patent ductus arteriosus- early entral alimentation and infection. Clinical manifestation of NEC include: Feeding intolerance, delayed gastric emptying time, Abdominal distension tenderness, Occult blood or bloody stools, lethargy, Apnea-Respiratory distress. In progressive stage, Acidosis, shock, Bactremia and disseminated intravascular coagulation (DIC) were occured. Studied that the infection is an important ethiology of NEC,and studied effects of prophylactic oral antibiotic therapy in prevention of NEC in preterm infants, with different results. So we studied the effect of prophylactic oral Gentamicin in NEC in AliAsghar hospital on 40 preterm neonates with history of fetal distress, respiratory distress syndrome or postnatal asphyxia and umbilical artery catheterization, Hypothermia, PDA, early entral alimentation and infections. This was a clinical trial study. The 40 preterm infants with history of risk factors divided in 2 groups.(each groups 20 infants). 20 neonates were randomized selected for remedy with 5 mg/kg/day BD oral gentamicin with density 2.5 mg/ml in DW 5% for 21 days. The same as equievalent density volum of DW 5% has been given to the control group. Clinical diagnosis of NEC was based on the blood or occult blood in stool, abdominal distention, Radiologic evidence include existance of pnumatosis intestinalis and intestinal marginal edema. In controlled group (20 neonates), 5 neonates affected NEC: These were 2 (25%) of them died. In exprimental group (20 neonates), 3 neonates (15%) affected NEC that 3 of them died. At the base of this study useage of oral gentamicin had positive effects in prevention of NEC in preterm infants.

Menier’s disease or Idiopatic endolymphatic hydrops is a disorder of the inner ear associated with a symptom complex consist of spontaneous, episodic attacks of vertigo, sensorineural hearing loss that usually fluctuates, tinnitus and often a sensation of aural fullness. The pathologic basis of disease is a disorder of the membranous labyrenth, due to endolymphatic hydrops. Acute attacks typically last from minutes to hours but symptom of dysequilibrium and unsteadiness may persist for several days. Electrocochleography or recording the electrical activity of cochlea and auditory nerve is a useful test about the function of inner ear. Audiotory Brain stem Response (ABR) is representing the activity of the some part of auditory pathway, that is useful undiagnosis of cochlear disorder. In this study we consider the electrocochleography and ABR changes in 100 patients with Menier’s disease. There is increased of SP/AP in 67% of cases and in 54% of patients.

The present study has been investigated the teratogenic effects of retinoic acid (RA) on development of neural tube in mice. We has studied the effects of teratogenic retinoic acid on central nervous system development, because use of RA in drug-compositions and significance of this system. For teratogenic studies, after natural mating, pregnant mice were divided into a intact group, control group and two experimental groups. On the 8th day of gestation, the pregnant mice were given DMSO and RA in DMSO intraperitoneally in a dose of 40 or 60 mg/kg of body weight. Embryos were then isolated at 10th day of gestation and evaluated for macroscopic (apparent form, size and number of embryos), microscopic (neuroepithelial cells changes) and morphometric characteristics. The results show that RA cause craniofacial anomallies, decrease of size and the number of embryos of experimental groups which has a direct relation with the higher dose of this substance. Some cases show unfused neural folds in the dose of 40 mg/kg, but in the dose of 60 mg/kg this anomally is found in all the cases. Changes of neuroepithelial cells and disorganization enhance with the increase of dose. As a whole, doses of 40 and 60 mg/kg, cause disorganization and qualitative changes and also, delay the process of neural tube development.

The Patient is a 58 years old woman who admitted in Hazrat-Rasoul Akram Hospital because of enlargement of anterior of neck and signs of upper respiratory tract obstruction. By X-Ray, sonography and C-T scanning, a mass in pararetropharyngeal region (4.5×10 cm) was detected. After FNA and biopsy, plasmacytoma was suggested which confirmed by immunohistochemical staining. This uncommon case should be controlled and even cured by proper diagnosis and radiotherapy.

The significant variation of Antihypertensive drugs and also in extensive clinical studies has led to different ideas about administration of these drugs.In such conditions the acceptability of therapeutic schedulls by the patient considering either the cost or side effects, physician’s ideas and underlying diseases are of the factors which can influence the suitable drug.The objective of this research is to evaluate the influence of such factors such as age, sex, underlying diseases and the physician’s speciality on this choice. In order to achieve this purpose, 38 general physicians, Internists and cardiologists were chosen to accomplish a discriptive and cross-sectional, stratified-random study. The required data of the sheet forms about antihypertensive Drug were fulled by the physicians the collected data from 400 pateints had been analysed in the basis of the goals and the aid of the descriptive statistics. Results of this study on 400 cases showed that blockers are the commonest drugs being used in %48 of cases and the ACE inhibitors for patient with underlying problems these observation indicated that the adminsteration of these drugs compatible with the suggestion pattern of the international advisor committes.

Coronary artery disease (CAD) is the leading cause of death among non-insulin dependant diabetic (NIDDM) Patients. One of risk factor for CAD in dyslipidemia. In regards to high prevalence of NIDDM and CAD among our people, in the present study, levels of lipids and lipoproteins in two groups of patients, CAD+/NIDDM+ group and CAD+/NIDDM- group, were evaluated and compared. The study contained 50 NIDDM patients with CAD by coronary angiography (CAD+/NIDDM+ group) and 50 patients with CAD but without NIDDM (CAD+/NIDDM- group). The study also included a control group without CAD and NIDDM (CAD-/NIDDM- group)comprised 30 healthy subjects. The concentrations of cholesterol and triglyceride and HDL-c in serum were measured by an enzymatic colorimetric assay using an automated analyzer. Serum lipids and lipoproteins were not significantly different in CAD+/NIDDM+ group as compared to CAD+/NIDDM- group. Serum HDL-c was decreased in CAD+/NIDDM+ group compared to the healthy sabjects (P<0.01). We observed the significant increase in TC/HDL-c and LDL-c/HDL-c ratios in CAD+/NIDDM+ and CAD+/NIDDM- groups compared to healthy subjects. In conclusion, we have shown no significant differences in serum lipids and lipoproteins in diabetic patients with CAD compared to non-diabetic patients with CAD, therefor, dyslipidemia does not appear to be correlated with CAD in diabetic patients. However, serum levels of HDL-c and TC/HDL-c and LDL-c/HDL-c ratios in diabetic and non-diabetic patients with CAD were significantly different compared to those of healthy subjects. These results show the importance of these factors as markers for monitoring the progression of CAD.

Among the causes of ascites, there is two kinds, including cirrhotic and malignant ascites that conventional diagnostic method for them is Paracentesis. This method is invasive and time consuming, however sonography is an easy and available method for providing valuable results in a short period of time. The aim of this study is survey of valuability of gallbladder wall sonography in discrimination between cirrhotic and malignant ascites. During the period of 1.5 years, from the patients with complaint of cirrhotic and malignant ascites, who refered to educational hospitals of Iran university we selected 50 patients and gallbladder wall thickness and patterns in them were studied. In all cirrhotic patients, gallbladder wall thickness was more than 5mm, and in 69% of them the wall was thick and Double layered, and in 31% the wall was thick and single layered, However in 71% of patients with malignancy, gallbladder wall thickness was normal. The result of this study was: The use of Sonographic gallbladder wall thickness and patterns as a predictor of cirrhotic and malignant ascites has a significant sensitivity and specificity.

The Macintosh Laryngoscope has proved itself over half a century and is still one of the most popular laryngoscopes. Even in experienced hands, however, complications can occur notably damage to the maxillary incisors. Damage to teeth is reported to be the most common single reason for complaints against anesthesiologists. Dental injuries could be caused by friction or by contact of the upper teeth with a hard blade during a rigid laryngoscopy there are three major groups of causative factors 1- unfavorable patient anatomy, 2-the skill of the laryngoscopist, 3-the designof the laryngoscope blade. Generally a combination of these factors is responsible. We modified macintosh laryngoscope for redution of dental complication when the optimum visibility of the glottis was obtained.100 elective surgical patients scheduled for general anesthesia with endotracheal intubation, were enrolled in this study. After induction, they were intubated using both the modified and standard macintosh laryngoscope. The distance between the blade and the upper central incisors was measured when the optimum visibility of the glottis was obtained. The visibility was determined according to the Cormack-Lehane grading. All laryngoscopies were performed by the same anesthesiologist. If a spo2 value decreased to less than 90% the measurment of the blade-tooth distance was to be interrupted temporarily while the patients was further ventilatd with 02 100%. Visibility in standard blade were, grade 1=84%, grade 2=11%, grade 3=5% and grade 4=0, and for modified blade were, grade1=38%, grade 2=44%, grade 3=18% and grade 4=0. The first intubation attempt was successful in 72pt (72%) of the modified blade group and in all patients of the standard blade group. The modification resulted in reduction of the forces and damage on the teeth but increased of the laryngoscopic view, also, the modification resulted in reduction of the success of intubation. These results suggest that laryngoscope blade with low proximal step, might be less traumatic than blade in which proximal step is high.

The selection of this subject is, because of the importance of determination of fetal age for evaluation of the fetal growth and preventing of complication due to preterm delivery, prolonged pregnancy and the absent of the complete conforming of refrence table in this case is by the measure of Iranian fetus, particular in the third trimester. This study which is descriptive and prospective, it has exactly been done for one year in 817 pregnancies (in the second and third trimester) by certain date LMP (last menstrual period). In this study the femur length was measured by real time sonography system by 3/5-5 MHZ probe and then the fetal age was calculated by the use of LMP, then the central indexes and dispersion of obtained data was calculated, and the final forcasting fetal age, was used based on the obtained measures from the way of linear regression statistical and at last the obtained results was compared with Hadlock study result. The obtained results contain the femur length in the fetus of this study is compatible with study of hadlock to 22 week and shorter than fetus under studying of Hadlock from 22 week to term. In attention to the above findings, it is suggested to use of the obtained table from this study to determain Iranian fetus age.

Acute respiratory infections (ARI) are a leading cause of childhood illness and death. In most countries, ARI occurs more frequently than other acute illnesses, including diarrhea and tropical disease. WHO estimates that in 1990, ARI caused 4.3 million death in this age group. Pneumonia is responsible for the majority of these deaths. The type and severity of the illness are influenced by several factors including age, season of the year, immune status of the host and Enviromental factors. Most cases of pneumonia are caused by microorganisms but a number of noninfectious causes sometimes, need to be considered, these non infectious causes include but are not limited to aspiration of food or gastric acid, foreign bodies, hypersensitivity reactions, and drug induced pneumonitis. This study was done retrospectively by the study of case records during 1990-1993. 457 cases were hospitalized with primary diagnosis of pneumonia. Diagnosis was made by physical examination, result of chest radiography and culture of blood, urine, and respiratory tract secretions. Description of cases: Of 457 cases that met the criteria for inclusion, age distribution: 0-3 month 147 cases, 4 month-5years 266 cases and 6-16 years 44 cases. Sex distribution male 273 cases, female 184 cases. 30 cases were hospitalized with recrrent pneumonia, in 14 cases there were no definitive cause and in others, asthma, cerebral palsy, gastroesophageal reflux, foreign body, lymphoblastic leukemia esophageal atresia and convulsion were found. the symptoms of the disease by their prevalence were as follows: cough, increased respiratory rate per minute, respiratory distress, poor feeding, vomiting, lethargy and cyanosis. Growth & development. 75% of patients had some degrees of FTT. Temperature. 58.5% of patients had high temperature. Respiratory Rate per minute was increased in 80.1%. Lab test: ESR was elevated in 66%., Bandemia were seen in 147 cases, and cultures were positive in 78 cases asfollow: blood culture in 24 cases, urine in 24 cases, CSF in 9 cases, eye, ear, pustules, respiratory secretions and stool culture in 21 cases were positive. ABG was done and 37 cases had hypoxia and 39 cases had metabolic acidosis. The results of chest radiography finding was diffuse infiltration in all three age groups. Antibiotic treatment was done in 373 cases, and duration of treatment was equal or less than 14 days in (95.7%), and more than 14 days in (4.3%). Mortality rate of pneumonia in this study was 31 cases (7%) because of young age and FTT. As life threatening lower respiratory tract infections do occur especially among infants younger than three months and those with underling conditions such as FTT (that were seen in this study), With appropriate antibiotic therapy instituted early in the course of the illness the mortality rate during infancy and childhood can be reduced.

Due to the frequency of major thalassemia in our country and cardiac complications secondry to iron overload as one of the most important causes of death in these patients and the absence of any similar study in this region (Kashan city), we studied the cardiac complications in patients with major thalassemia in Kashan in 1999 and 2000. A prospective descriptive study was performed on seventeen patients with major thalassemia. All patients underwent a thorough noninvasive cardiovascular investigation including history taking, physical examination, electrocardiography (ECG), chest roentgenography (CXR) and complete two-dimensional, color M-Mode Doppler echocardiography. Arterial blood pressure and indices of diastolic function by Doppler echocardiography were measured in seventeen age and sex-matched healthy individuals as control group. The obtained data were recorded and standard deviation was calculated. P value less than 0.05 was considered as significant. A study was carried out on seventeen patients (including eleven male and six female) with the age range of 18 months to 25 years old (mean 14 years). Weakness and easy fatiguabiltiy were the most common complaints in the history of patients. In all patients arterial blood pressure was between the 5% and 25% for height, sex and age (significantly lower than the control group) ECG and cardiac size in CXR were normal in 82% and 76% of patients respectively. Abnormal findings in the ECG included left ventricular hypertrophy in two patients and first degree atrioventericular block (not present in the ECG of the same patient at six months ago) in one of the cases. Diastolic and systolic dysfunction were observed in 82% and 11% of cases respectively, by echocardiography. Diastolic dysfunction occurs earlier than systolic dysfunction in patients with major thalassemia and electrocardiography and chest X-Ray are not sensitive tools for early detection of diastolic dysfunction in these patients. Echocardiogarphy is the best noninvasive means for evaluation of ventricular function particularly diastolic function and is recommended for early detection of cardiac complications in these patients.

To study the prevalence of infertility, both primary and secondary, also outcome of pregnancy and uptake of medical services about that and some demographic factors in a given population of women. An interview-questionnaire survey of 1200 married women in the age group 40-50 who lived in the west of Tehran. Method of women selection was stratified random sampling. 26 questionnaire excluded because of incorrectly completed. Therefore response rate was 98%. The type of study was cross-sectional. Analysis of data performed by SPSS. Among the 1174 women contacted, 87.3% reported no difficulties in having children. 98 (8.3%) women had primary infertility and 43(3.7%) had secondary infertility (definition of one year). In total 98 (8.3%) women with primary infertility, 80(6.8%) eventually conceived. Of the 43 (3.7%) with secondary infertility only 33(2.8%) conceived. Overall 49(4.2%) of the population were left with an unresolved problem of infertility. Only 63% infertile women had made use of specialist and 7% did not seek medical services. Between use of medical services and occupation and literacy of women were not significant difference. The prevalence of infertility was 12%, although 2/3 of these women eventually conceived. Primary infertility was more common that secondary infertility and only 63% of infertile women attended specialist services.

Due to high prevalance of mumps infection in Iran, (in results of no routine vaccination of children with mumps vaccine) and sequale of its that mostly manifestes as meningoencephalitis (M,E) for detection of ferequancy, clinical course and complication of mumps meningo encephalitis in children less than 15 years this longitudinal study was done in mumps meningoencephalitis patients whom admited in pediatric ward of Rasool Akram & Firroz Abadi Hospital in 1995-1997. These patients grouped in Benign and malignant group regard to duration of hospital stay and complication. 70% of all grouped in benign form M.E, that discharged without sequle in 5 th day of admission, Remanant of patients(30%) grouped as malignant M.E, died (1 case) or discharged after 5 days and with sequles (Recurrent convulsion, hydrocephallus, cerebellitis, facial palsy, sensory neural hearing, changes loss…). These two groups compared for age, sex,season, positive CSF findings. Mean age of patients was higher in malignant form than benign form of M.E.Two form of M.E were seen in spring season. Benign form of M.E were higher in spring and summer, but malignant M.E were equal in winter and spring, No cases of malignant form were seen in Autumen. M/F ratio of ME was 4/1, No sex diferrence were seen two groups, positive CSF finding (Aseptic meningitis) was due to benign form. (Pvalue, 0.01) Results compare with studies in developed countries (prevaccination period). It was determined that complication of mumps M.E in this study probably more common than previous studies in developed countries.

This prospective study has been performed to compare antimicrobial effect of Povidone lodine (PVI) and Normal Saline (N/S) on conjunctival flora by washing the culdesac before starting intraocular surgery in Rasool-Akram Hospital from July 1999 to July 2000. 100 eyes that underwent intraocular surgery were included for this study randomly (67 cases cataract surgery and 33 cases vitrectomy). From each eye in 2 phases specimens were taken and cultured in blood agar, Macconkey agar, sabouraud dextrose agar & thioglycollate medias. In first stage before prep & drep specimen was taken & then culdesac washed by 10cc N/S or 10cc 5% PVI for 1 minut in each group respectively. Second specimen was taken at the end of the operation. Culture specimen were studied and reported by microbiologist results classified and underwent statistical analysis by X2 tests. Microorganisms grew up from 85% of 1 st stage culture and it was staph epidermidis mainly. Overall use of PVI has decreased growth of microorganism significantly in comparision to N/S (76.2% in PVI group versus 46.5% in N/S group). In cataract surgery group there was no significant difference between PVI and N/S (75% versus, 55.2% respectively) but in vitrectomy group this difference was significant (78.6% versus, 28.6% respectively P=0.021). If operation time was longer than 2 hours there was significant difference (75% in PVI group versus 35.3% in N/S group) between N/S and PVI groups (P=0.037). PVI is safe, cheep, available, with least side effects and has good bactericidal effect if used for culdesac washing at the begining of intraocular surgeries, especially if operation time takes longer than 2 hours.