Medical Journal Of the Islamic Republic of Iran
Volume:21 Issue: 1, Spring 2007

Cervical cancer is the most common female genital tract malignancy and is the major cause of death from gynecologic cancer worldwide. The majority of cervical cancers develop through a series of gradual, precancerous lesions. Screening asymptomatic women with regular Pap smears allows diagnosis of the readily treatable preinvasive phase. We performed this study to determine the prevalence of precancerous lesions and assess the effect of demographic, pathologic and family economic factors on developing lesions.This cross-sectional, descriptive, analytic study was carried out on 6024women under coverage of Tabriz health care centers. Pap smear was done in all subjects and questionnaires were filled by health providers. The data were analyzed with SPSS statistical software (version 12) and statistical methods such as chi-square and t-test. Of 6024 Pap smears, 62 (1.02%) demonstrated precancerous lesions of which 41(0.68%) were atypical squamous cell of undetermined significance (ASC-US), 11 (0.18%) were low grade squamous intraepithelial lesion (LSIL) and 10 (0.16%) were high grade squamous intraepithelial lesion (HSIL). No invasive cancer case was observed in this study. According to our observation, the following factors increased the risk of precancerous lesions: multiparity > 3, abortion > 1, gravida >3, husband marriage >1. The protective effect of condom as a barrier contraceptive was observed. According to this study it is imperative to make readily available facilities for screening asymptomatic women all over Iran.

Psoriasis is a chronic proliferative condition of the skin. Its accuratepathogenesis has not been known yet, but interactions between genes and environmental factors have been implicated in its initiation. The role of malassezia in psoriasis is still undetermined, but several reports have associated these lipophilic yeastswith the development of skin lesions in psoriasis.Our aim was to investigate the correlationbetween malassezia and psoriasis. In this case control study over a 6 month period skin samples were obtained from lesions of 50 psoriatic and 50 healthy volunteers to evaluate malasseziainfestation. Obtained data were collected by questionnaires and analyzed by SPSSsoftware and applying statistical tests of χ2 and Mann-Whitney. There was no difference between malassezia infestation in scalp lesionsof psoriatic and control cases (P=0.86). Malassezia infestation in psoriatic patientswith scalp involvement was more than those without it, but it was not a significant relationship (P=0.069). There was an inverse significant correlation between scalp infestation with malassezia and chronicity of psoriasis (P=0.04). This infestation intrunk skin of patients was less than normal individuals (P<0.000). There seems to be an initiating role in inducing immune mechanismsinvolved in the pathogenesis of scalp psoriasis by malassezia, but with chronicity andformation of dry and hyperkeratotic plaques, the environment will be inappropriatefor malassezia, so malassezia infestation decreases with chronicity of disease.

Screening for patients at risk of renal scarring is a challenge in children with acute pyelonephritis (APN). Diuretic Tc-99m mercaptoacetyltriglycine(MAG3) scintigraphy with zero time injection of furosemide (MAG3-F0) was observedto display focal parenchymal disorders. The advantages of MAG3 include: lower radiationdose and short duration of the test. The aim of this study was to compare the role ofTc-MAG3 (F0) dynamic study and Tc-99m dimercaptosuccinic acid (DMSA) scan inearly detection of renal scarring of children with suspected pyelonephritis in comparisonto after-6-month Tc-DMSAscan as gold standard. 28 patients (56 renal units) with their first urinary tract infection (UTI)episode were evaluated prospectively for renal scarring with radioisotope scan. The patients were divided into 2 groups: Group Aconsisted of patients who underwent MAG3scintigraphy in acute phase of pyelonephritis and Group B consisted of patients who underwent DMSA scan in this phase for renal cortical assessment. Follow up DMSA scanwas performed for all patients in both groups 4-6 months after UTI episode. The accuracy of MAG3-F0 scintigraphy and DMSA scan in detectingparenchymal changes in acute pyelonephritic phase were 89.3% and 96.4%, respectively.Positive predictive value (PPV) of both MAG3-F0 and DMSA was 100%. Whereas,negative predictive values (NPV) of MAG3-F0 and DMSA scan were 62.5% and 75%,respectively. Conclusively, if the MAG3 parenchymal image is abnormal, then thereis renal damage but if this image is normal, a focal defect has not been excluded. Thus anabnormal MAG3-F0 precludes the need for a Tc-DMSAscan for detection of persistentrenal damage in acute phase of pyelonephritis.

The purpose of the present study is to determine the frequency and severity of depression in post-stroke patients. Based on a cross-sectional research design, 30 recent stroke outpatients were assessed with DSM-IV interview for depression and two self-rating depression scales, CES-D and BDI. Sex differences in depression, the relationship between depression and the location of the brain lesion and other clinical manifestations (sensory, motor and verbal) were also determined. 68% of the patients reported depression on CES-D, among them 64% suffered from moderate to severe depression according to BDI and interview-based information. Women were more depressed than men (63% and 37% respectively). Differences were found in lesion side, with patients with lesions in right side reporting higher levels of depression than patients with left side lesions. Motor disturbances were the most prevalent clinical features. There seems to be an increased incidence of depression in stroke patients. The mechanism of pathophysiological processes underlying this association is poorly understood and is an important area for full investigation. Since depression is a significant risk factor for stroke it is important that psychiatric examination of post-stroke patients be conducted.

Many disease susceptibility genes are large and consist of many exons in which point mutations are scattered throughout. Scanning each exon individuallyrepresents a tedious task which can be time consuming and expensive. There hasbeen increasing demand for rapid and accurate methods for full scanning of unknownpoint mutations in large multi-exon genes. Gene Assembling is a new method for creatingchimeric DNA molecules using a modified PCR reaction that allows maximizingthe length of sequence that can be scanned by sensitive downstream technique. In the present study assembling of exons 2, 20, 23 and 24 of the BRCA1 gene and their subsequent analysis by direct sequencing is demonstrated. The BRCA1 exons 2 and 20 are hot spot regions that are known to harbor particularly deleterious mutations. In order to avoid missing any mutation in these two exons, the four exons previously mentioned were assembled in the following order of preferences: 23, 20, 2 and 24. However, the order of fragments can be predetermined by primer design. The order and sequence of the component exons in the gene-assembled products were characterized by direct sequencing as predicted. Gene-assembled products from three previously ascertained heterozygotes for BRCA1 mutations were directly sequenced and gave the same sequence patterns. This experience suggests that Gene Assembling technique could be applied as a highly sensitive and cost-effective method in identifying mutation in complexgenes such as BRCA and ColA1/2 helping clinical molecular diagnostic laboratories,to fulfill the demand for scanning complex genetic diseases at a lower cost.

Renal insufficiency is a potential complication after infrarenal abdominal aortic aneurysm repair and is a significant risk factor for postoperative mortality and morbidity. The aim of this study was to analyze the effect of this risk factor, before and during operation. In this prospective study, between 2003 and 2006, 45 patients underwent repair of an infrarenal abdominal aortic aneurysm. Elective surgical repair was performed in 34 patients and 11 patients underwent immediate surgical repair of ruptured aneurysms. There were 41 males and 4 females. The mean age was 68 years. The patients were divided into four groups depending on their preoperative serum creatinine (Scr), group I, serum creatinine less than 1.4 mg/dl, group II 1.4 < Scr< 2 mg/dl, group III 2 < Scr<2.5 mg/dl and group IV Scr >2.5 mg/dl. In each group postoperative changes in renal function were analyzed. Several factors significantly influenced postoperative serum creatinine concentration and BUN level. These factors were: previous renal disease (diabetic nephropathy and renal artery stenosis), ruptured aneurysm and profound shock, blood transfusion greater than 4 units, duration of clamping time (greater than 2 hrs and 10 min), and age over 65 years.The postoperative rise in serum creatinine level was noted in 33 patients (73.3%) andBUN increased in 27 cases (60%), but only 2 patients out of these 33 patients required hemodialysis. Renal function recovery occurred after several days of surgery (3 to 5 days). The cause of renal dysfunction after elective or emergency repair of an infrarenal abdominal aortic aneurysm is multifactorial and the most important predictor ispreoperative renal insufficiency, so special precautions are appropriate in such patientsfor prevention of this complication. Decreasing the aortic clamp time, operative time andblood loss, and administration of optimal volume loading seems to be essential.

Inappropriate prescription of vancomycin has been shown to be associated with induction of antibiotic resistance. The objective of this study was to determine the incidence of inappropriate use of vancomycin in a tertiary care hospital in Iran. Adescriptive cross-sectional investigation was performed from September 2004 to March 2005 in all units of a general teaching Medical Center in Tehran. All adults and children who had vancomycin initiated in this medical center were enrolled in the study and the appropriateness of vancomycin use was determined according to Centers for Disease Control (CDC) guidelines. Forty-four percent of vancomycin use was inappropriate with the highest incidence of inappropriate use occurring in surgical units. The most common inappropriate indication for vancomycin was routine surgical prophylaxis. Inappropriate use of vancomycin is very common in a tertiary care hospital in Iran and could potentially be decreased by educating physicians about the CDCguidelines. These educational programs should target physicians in surgical units.

Transtracheal jet ventilation is an alternative ventilatory approach inairway surgery. The purpose of this study was to compare respiratory efficacy of percutaneous transtracheal with endotracheal, low frequency jet ventilation during microlaryngeal surgery. Ninety ASA class I-II patients aged between 16 and 70 years undergoing elective microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups: Percutaneous Transtracheal Jet Ventilation (PTJV) group or subglottic Endotracheal Jet Ventilation ETJV via the Ben-jet tube group. No significant differences in demographic data between the two studygroups were observed. The understudy population included; ETJV=42 (total) 25 men,17 women; PTJV= 48 (total) 34 men, 14 women. Age ranges were: ETJV: 43.83 ±11.52yr, PTJV: 44.92±12.08 yr; weight ranges were ETJV: 69.62±11.66 kg, PTJV: 71.33±11.57 kg; BMI ranges were ETJV: 24.97±2.58, PTJV: 25.06±2.71. There were no significant differences between the measured pHa, PaO2, PaCO2 in two study groups at the initiation of operation. Significant differences were observed between measured PHa, PaO2 and PaCO2 during operation in ETJV group as compared with PTJV group. We conclude that ETJV procedure provides regular pulmonary gas exchange during microlaryngeal surgery and carbon dioxide elimination can be bettermaintained in this group compared to the PTJV group.

Thymic carcinoid is an uncommon neoplasm that can present with Cushing syndrome.We report a 39-year old woman with symptoms of Cushing syndrome secondary tothymic carcinoid and synchronous with tuberculous lymphadenitis and pulmonary tuberculosis.

Castleman disease or giant node hyperplasia is a rare disorder of the lymphoid tissue most often involving the mediastinal lymph nodes. We report a case of localized retroperitoneal hyaline-vascular type of Castleman disease. A 35-year old woman presented with mild epigastric pain with radiation to the back. Amild anemia was the only abnormal associated finding. Abdominal ultrasound and CT- scan showed a homogeneous well-demarcated mass beneath the pancreas. Excisional biopsy on laparotomy revealed a highly vascular encapsulated mass with a diameter of 6 centimeters. Histopathology examination was diagnostic: hyaline-vascular hype Castleman disease.Castleman disease, although rare, is one of the differential diagnoses of a retroperitoneal mass, most often discovered incidentally or due to pain and compressive symptoms. Excision is both diagnostic and curative for management of the localized form of Castleman disease.