مجله علوم پزشکی رازی
سال هشتم شماره 3 (پیاپی 25، پاییز 1380)

The negative symptoms of schizophrenia still cause one of the major problems in therapeutic work with schizophrenics. Although there has been great progress in the field of pharmacology for identifying effective drugs to alleviate the negative symptoms. We are still far away from having satisfactory and successful results. The purpose of the present project is to study the effects of a type of Dopamine Agonist such as Bromocriptine on the negative symptoms of schizophrenia.A double-blind cross-over controlled design was applied for this study. The participants, who were chosen on the basis of their diagnosis to prevent the effects of confounding factors, caution was made to choose those patients who showed severe negative symptoms, but who did not have any of the following: depression, active psychosis, substance abuse, physical diseases drug side-effects, and did not use drugs or have disorders which contraindicated the use of Bromocriptine. Out of 60 patients under treatment for schizophrenia, 14 met the above criteria, two of which refused to participate, (n=12).The 12 participants were randomly assigned to the experimental and the control groups, and were observed for 13 weeks. For 6 weeks the patients in the experimental group recived 15 mg of Bromocriptine, and those in the control group receive placebo. For one week, Both groups received placebo (washing period). And for the find 6 weeks the two groups were crossed over, the former experimental group receiving placebo, and the former control group receiving 15 my of bromocriptine. For measuring the effects of the drug on the positive and negative symptoms, the PANSS which is a standardized instrument for this purpose was applied. The data was analyzed by wileoxon, using the SPSS computer program, in two different ways. The results of the analysis showed that adding a Dopamine Agonist such as Bromocriptine to the drug regimen, can have significant effects on the negative symptoms of patients with schizophrenia. Bromocriptine can, not only reduce the negative symptoms of schizophrenia if can also prevent the risk of psychosis.

Conjunctival microbial flora is the main source of organisms causing postoperative endophthalmitis. Therefore this study has been performed to evaluate this flora in patients undergoing intraocular surgery. This nonselective study was done prospectively on 251 eyes of 211 patients who underwent intraocular surgery during 1378-1379 (1999-2000 AD) in Hazrat Rasul-e Akram hospital, Tehran, Iran. Specimens for microbial culture were taken from operated eyes in 100 patients, from opposite eyes in 71 patients, and from both eyes in 40 patients. This sampling was done just before the onset of surgery. All specimens were evaluated for bacteria and 100 specimens were also evaluated for fungi. Findings were classified and analyzed statistically. From 251 eyes, 56.6% had positive culture for at least one and 1.6% for two different bacteria. The isolated bacteria were Staphylococcus epidermidis 50.6% Staphylococcus aureus 3.6%, Bacillus species 1.6%, E.coli 1.2%, Actinomyces 0.8% and diphtheroids 0.4%. Fungi were found in 3% of appropriate cultures. Flora of both eyes showed no statistically significant difference. As mentioned in previous reports, this tudy showed that microbial agents were isolated from conjunctive in more than half of the eyes. Staphylococcus epidermidis was the most common isolated bacteria. In order to prevent postoperative endophthamitis, measures should be taken to decrease floral population before eye surgery.

Recently the Combined Therapy of omeprazole (O) a powerful anti ulcer drag with antibiotic has been studied in patients with helicobacter pyloi (HP) associated duodenal ulcer (DU). The efficacy of (O) plus ciprofloxacin (C) Therapy on healing of Du and eradication of HP was tested in a randomized, double-blind, placebo controlled prospective study. Eighty four patients with HP positive Du disease were randomly assigned to receive O 20 mg (28 days) plus C 250 mg bid (7 days) or placebo. The patients were devided in to following four groups. Group 1 (O+C n=22) Group 2 (O placebo +C placebo n=22)Group 3 (O placebo +C n=19)Group 4 (O+C placebo n=21)Endoscopy and two biopsies from antrum for rapid urease test and histology were performed in all patients at the entry and three to seven days after the end of the therapy.Du healing rates were 88% in group 1, 13% in group 2, 24% in group 3, and 78% in group 4, the proportions of Hp negativity were 65% in group 1, 13% in group 2, 19% in group 3, and 24% in group 4. The highest rates of ulcer healing or Hp eradication were observed in group 1 receiving O+C.1- Omeprazole is a safe and effective drug for short termulcer therapy in patients with Du disease.2- Omeprazole plus ciprofloxacin therapy is highly effective concerning Hp eradication. 3- Du healing rate with o plus c Therapy may be increased as compared to omeprazole therapy olane.

According to studies which have been perormed in the following hospitals (Hazrat-e- Aliasghar and Labafi-Nejad 245 children who were affected by end stage renal failure have been taken under studiees in terms of etiology and clinical finding. The principal aim of this study was to find etiologies of CRF of these patients and teaching the families to prevent its complications. The methods which have been used, are retrospective and in the from of the study of patients records. All patients had GFR less than 10cc/min/1/73m2. The cause of Renal failure were studied in all patients and the epidemic etiology of CRF in different age range has been determined. On the basis of these studies, in the ages under 5 years, diseases were congenital and inherited, and in the ages over 5 years the cause of diseases were the reflux nephropathy, and the congential and inherited diseases were the most cause of renal failure.Regarding high rate reflux in our studies which have been performed in other countries, the conclusion in that: the absence of regular planing in diagnosis and treatment of children who were affected by UTI and reflux, made the above disease as the most cause of ESRD in age range of 5-9 years and 10-17 years. Also, the late diagnosis of the congential-inherited disease (Specially congential obstrustive diseases) made them as the probable cause of ESRD in the patients over 5 years groups. The conclusion of this study was that the average age of final process of CRF in patients of this study was less than other studies in the same category. The lower level of health and awareness in families, and lack of early diagnosis and attention of physician to the patients can be reason of this difference.

Coal dust is associated with coal worker’s penumoconiosis, and about one-third of them progress to massive pulmonary fibrosis,that eventually makes multiple pulmonary nodules. Rarely,ischemia happens in these nodules and necrosis and perforation occurs in them spontaneously.In this case report, we introduce a person with pneumoconiosis and massive pulmonary fibrosis who was admitted in hospital because of severity in his symptoms.Three days after admission in spite of improvement in general condition, suddenly and spontaneously he experienced massive and black sputum which is named melanoptysis. In his chest x ray cavitary lesion was replaced to one of his modules.Other causes of cavitary lesion was ruled out and therefore the diagnosis of massive spontaneous melanoptysis was done.

Digits in excess of five in the human are anomalous and polydactyly is the term to denote duplication of digite. Polydactyly is the second most common congenital deformity of the hand, only after syndactyly. In the blacks, the incidence is about 1 in 300, and in the whites it is 1 in 3000.The presence of an extra diggit can be inherited as an autosomal dominant trait. Numerous homebox genes are known to be expressed in various cell groups of the developing limb, uiding the developmental processes. It is likely that mutations involving Hox genes, growth factors, and morphogen receptors give rise to abnormalities of limb development. Regarding to researches in Shahid Akbarabadi Maternity hospital from 1993 to 1999, polydactyly incidence per 1000 is 0.83.

ITP is an autoimmune disorder, due to increased platelet destruction. This condition may be acute, chronic or recurrent. In the acute form, the platelet count returns to normal within 6 months after diagnosis. In the chronic form, the platelet count remains low beyond 6 months. In approximately 90% of children ITP is acute and self-limited disease. Splenectomy is indicated for severe acute ITP with life threateninig bleeding, which is nonresponsive to medical treatment. Splenectomy is also indicated for chronic form with bleeding symptoms or platelet count persistant below 30,000/mm3, which is nonresponsive to medical treatment for several years. The platelet count usually rises immediately after splenectomy, reaching a maximum 1 to 2 weeks postsplenectomy. If the peak of platelet count achived after splenectomy is above 500,000/ mm3, permanent remission is likely. In our study we evaluated 21 patients with chronic ITP that were splenectomized. In 18 patients, the duration of postoperation time was over 1 year and in 3 patients it was less than 2 months, so these 3 were not included in our final analysis. We divided the patients in two groups: 1- Group(P): Patients responded to splenectomy (10 patients) In this group, resing of platelet count after splenectomy in 6 patients was greater than 500,000/ mm3 and persistant at least for 1 year, without any medical therapy > 150,000/ mm3. 2- Group (N): Patients who did not respond to splenectomy (8 patients). We tried to find correlation between variables, and respond to splenectomy but because of limited number of patients, we achieved only a significant correlation between postsplenectomy response and patients age. Patients who had diagnosis of ITP in younger age, had better response to splenectomy later. A correlation between response to IVIg therapy before splenectomy and postsplenectomy was also observed. Because half of the patients of P group had platelet count greater than 500,000/ mm3 with IVIg tharapyso it is concluded that patients who respond well to IVIg therapy in the primary treatment may show a better respond to splenectomy.

The main purpose of this study was to determine the six months prevalence of neck pain in patients who referred to physical therapy clinics in greater Tehran.A cross-sectional study was investigated through Interrogation and observation of the patients who referred to the physical therapy over a six-month-period. Greater Tehran was divided into five regions and 1-2 physical therapy clinics were randomly selected in each region. The subjects were selected from population of all the subjects referred to those physical therapy clinics (a total of 1272 patients). All the subjects complaining from neck pain entered this study (136 subjects). The prevalence of neck pain in patients in different clinics was averaged 10.7% (minimum 9% and maximum 12.4%) in all clinics. The rate was 11.9% for women and 10.2% for men. There was no significant difference in prevalence between the five regions.

Protein-c deficiency is a rare disease that is two form: Homozygote and Heterozygote. Protein-c circulates in healthy adult Plasma is valu ranging from 70-140 Percent. Protein-C level in newborns are 20-40 Percent of normal adult level. Newborn with homozygote protein-C deficiency almost always manifest skin necrosis, fulminant purpura after birth and or central nervous system thrombosis. Mutation is near the active site of the protein-C and DNA analysis shows double variant. Treatment option includes Fresh Frozen Plasma (FFP) and Protein-C concentrate in the acute phase follows by oral anticoagulant therapy. Three pateints were refered to Hazrat Ali Asghar Pediatrics Hospital, with developed skin necrosis on the abdomen and upper extrimitis, after 24 hours of life. One case had CNS hemorrhage after anti-coagulation therapy. Their protein-C activity were less than 1% and for their parents were less than 60%.

The patient was a 10-month-old infant with respiratory distress.During clinical examination and radiography we suspected to congenital laryngeal disorder.The infant was examined by direct laryngoscopy under general anesthesia. After laryngoscopy we diagnosed laryngeal ductal cyst and resected by Co2 laser. After several days the symptoms of the patient improved and he left hospital.

In a cross sectional study over a period of two years (Sep 1997-Sep 1999), 107 children with febrile convulsion were evaluated in Firooz-Abadi Hospital. The mean age of first occurrence of febrile convulsion was 20.5 ± 9.8 months and for children with a family history of febrile seizure was 14.8 ±8.02 months. In those without a family history the mean age were 22.1±9.7 months. A male preponderance (60%) was observed. There was a predominance of generalized seizures (81%). The duration of convulsions in the majority of children (85%) were less than 15 minutes. Children with a positive family history were at increased risk of recurrent febrile seizures.

In this case report, A 53 year-old woman is presented whom was prepared for nonemergency laminectomy surgeny under general anesthesia. Balanced anesthesia was chosen for her planned surgery. At the end of the surgery, patients’s blood pressure dropped unexpectedly. Vasopressor durg plus intravenous crystaloid solution were the only treatment then. After turning patient to normal position (supine) and extubation of the trachea, there was another sudden drop in blood pressure, tachycardia, unconciousness and distention of the abdomen. Patient was resuscitated with tracheal intubation, Intravascular fluid adminstration and was returned to operating room for emergency laparatomy. During laparatomy, large amount of blood was inside peritoneal cavity and the source of the bleeding was two tearings in the abdominal aorta. Invasive monitoring was instituted at the beginning of the laparatomy (Arterial line/CV line). After emergency laparatomy, the patient had three episodes of laparatomy for finding of the bleeding source around the abdominal aorta, IVC and vertebral arteries during three consecutive days. Patient received 109 units of blood & blood products during 96 hours after laminectomy Surgery and was retained in ICU for 83 days.

Adenylyl cyclase is a membrane-bound enzyme that catalyzes the conversion of ATP to cAMP. The inhibition of adenylyl cyclase was carried out by measuring the ability of the macrophage chemotactic protein-1 to inhibit the forskolin-induced enzyme activity. Measurement of adenylyl cyclase activity was performed according to the procedure described by Wiegn.Adenylyl cyclase activity in the present macrophage chemotactic protein-1 was decreased compared to that in controls [2.11+/- 0.15(mean +/-SD.)vs. 6.83+/-0.45, activity (µ mol cAMP/mg protein/min)].Macrophage chemotactic protein significant reduced adenylyl cyclase activity by 79.9%.

Pityriasis versicolor is a fungual infection of the superficial mycosis group. But it is not contagious. This study was done to reach to the truthfulnes and the meticulous findings of the previous researchers in our society, regarding the incidence of the disease in both sexes, The age of onset, its incidence in dermatologic clinics and the possible associations such as: immune deficiency, cushingoid Appearance, mulnutrition and immunosuppression. During a twenty seven month period, all the patients with cutaneous features of white, yellow. Ochre or brown macules and patches with pityriasiform scales on the upper trunck, whom had improved with topical clotrimazole cream and selenium sulfied shampoo within two weeks and whom were visited twice, before and after treatment and diagnosed as having PV based on clinical grounds, were included in the study. Overall one hundred cases of PV were seen which covers 4% of dermatologic clinic patients. The age of patients was between 8 and 49 years with mean age of 24.8 years. 89% of the patients were between 11 and 40 years old. 49% of the patients were male and 51% female. Consistent with the references of this study no significant statistical difference was seen between the age of male and female patients. Also none of the patients had any associated immune deficiency, immunosuppression, cushingoid appearance and /or malnutrition.

In this survey, microbiological examinations for bacterial contamination were conducted on 100 unpasteurized cheese samples collected in different regions of Tehran since June 1998 till Junel 1999. Thirty paseurized cheese samples were also collected and similarly examined as control. The results indicates heavy contamination of unpasteurized cheese with Escherichia Coli (54%) and strphylococcus aureus (3%). Only one pasteurized cheese sample was contaminated with coliforms. Since salt water is often used for cheese storage, we examined the stabilty of E.coli and other commonly contaminating bacteria such as listeria monocytogenes, Vibrio cholera, and yersinia enterocolotica to different salt concentrations. The results indicate that E.coli can remain viable in 1-10percent, 20%, 30%, and saturated salt solutions for 70, 30, 15, and 2 days, respectively. Vibrio cholera remains alive for 42 days in low salt solution, but can resist at 9-10percent salt solution for only 48 hours. Yersinia enterocolitica ceased to grow after a week at 1-10percent salt solution. The only bacteria capable of resisting at saturated salt solution for over 63 days was listeria monocytogenes.

Cryptosporidium parvum in humans,as a re-appeared and as one of the four most important ubiquitous enteric pathogen which can cause diarrhare with high level of mortality mainly in the munocompromised patients has stimulated research interested in the world. The quick and accurate laboratory diagnostic report of the pathogen are hlighly important in the prevention of the disease progress. Although kynion acid-fast(AF)staining procedure is accepted in the most clinical laboratories,a comparative study on the preferences of direct fluorescent (DF) antibody with staining techniques has undertaken in this recent work.During,months,beginning 1/5/1999,the stool samples of 340 apearantly healthy people,185 from patients under chemotherapy and 170 from children under 10 years with chronic diarrhae have been collected for our research studies.The obtained results are as following:1-The sensitivity,specificity and the simplicity of the direct fluorescent (DF) was 100% as compared with kynion acid-fast (AF) technique.2-With regard of minimum detection time unit,each (DF) slide needs one minute, while this time limit for each (AF) slide was 5 minutes.3-By compering the minimum diagnotic level(MDL) by expert technologists in two tecniques, it was 8 for (DF). In other words, at least 60000 oocysts/ml of liquid stools are needed until to be able to detect by (AF) while (MDL) for (DF) was 7500 oocysts/ml.4-By using a single blind test the experience quality of the technologist in two techniques of (DF) and (AF) were evaluated. This test was significantly prefered as compared with (AF) technique.5-In these studies we have found that 0.7% of healthy people, 0.5% of patients under chemotherapy and 4.1% of diarrhaetic children were infected with Cryptosporidium parvum.

For evaluating the effects of anesthesia on the incidence of postoperative nausea and vomiting, 61 patients candidated for total abdominal hysterectomy were selected and randomly entered in two groups, epidural (n=34) Vs. general anesthesia (n=27). Information about the complications was gathered after 24h by single blind manner. In general anesthesia group premedication drugs were fentanyl (1-2 µ g/kg) and Morphine (0.1mg/kg), Induction with thiopental (5mg/kg) and succinylcholine (1mg/kg), maintenance with Halothane (0.8-1.25%) and nitrous oxide (50%), pancrunium (0.1mg/kg) was used for muscle relaxation and at the end of the surgery patients were reversed by neostigmine and atropine.Local anesthetics (lidocaine and bupivacaine) were used for epidural anesthesia. Post Operative Nausea and Vomiting (PONV) after general anesthesia occurred in 74% of cases and in 41% of epidural cases (P=0.020). Patients were divided in four groups according to the severity of PONV, then severity were compared between two Methods of anesthesia.

One of the most important causes of patellofemoral pain syndrome is malfunction of quadriceps muscle, specially vastus medialis muscle weakness. Twenty seven normal healthy subjects (21.4±3.4 years) and 17 patients with patellofemoral pain (24.1±3.6 years) were included in this study. Recruitment Internal of the patients and normal subjects were recorded by using a coaxial needle electrode in vastus medialis during voluntary contraction. The effects of ten sessions of closed chain quadriceps exercise were evaluated on the control group and patients by methods of RI recording. Following exercise program there was significant decrease of mean value of RI in Vastus medialis muscle (P<0.0001). RI recording method could be used for assessing the weakness of Vastus medialis muscle.

The patient is a 49 year-old woman, a mother of four with enlarging thyroid gland for the past 15 years. Thyroid scan showed multinodular goiter. Thyroid hunction tests were in the range of normal. Fine needle aspiration of the thyroid was unsatisfactory. In the thyroid physical exam bilateral multiple and movable lymphadenopathies were detected on the anterior cervial chain.The thyroid was hard and nontender and nodular on population (CEA=400 ng/ml,calcitonin=1100 pg/ml). A relatively fixed and non-tender mass measuring 1 × 1.5cm was felt in the superior-external lobe of the right breast this mass was present from eight months prior to the time of presentation.There was neither skin change nor nipple discharge. Excisional biopsy of the mass revealed infiltrating ductal carcinoma of the breast. Modified radical mastectomy was subsequently performed.The patient then was prepared for thyroid surgery. Total thyroidectomy and modified neck dissection were carried out when the frozen section reportes malignant which was then confirmed to be medullary carcinoma of the thyroid gland.

Occlusion is a method that has been used in the treatment of amblyopia since before and CAM visual stimulation (CAM therapy) is other method which can be used for amblyotherapy.In this study twenty two 6-year-old, previously untreated amblyopic children were divided into two subgroups with regard to anisometropic and ametropic amounts.The first group was treated by occlusion therapy and the second group was treated by CAM method. These two methods were compared in improving visual acuity,accommodation, ocular movement(saccades-pursuits)and stereoacuity.We found that CAM therapy was significantly more effective and better than occlusion in improving visual acuity and stereoacuity.There was significantly no difference between two method in improving amplitude of accommodation. However occlusion therapy was significantly more effective than CAM therapy in improving accommodative facility and saccadic and pursuit movement.It is concluded that CAM therapy is valuable method in the treatment of anisometropic amblyopia, however it is not a complete method and must be used with occlusion.