Medical Journal Of the Islamic Republic of Iran
Volume:20 Issue: 3, Autumn 2006

Several case studies have described the use of the superficialinferior epigastric artery (SIEA) flap as a pedicled flap for reconstruction of upper and lower ex tremities, or a free fasciocutaneous flap when a large amount of skin coverage is required for hemifacial atrophy, breast or head and neck reconstruction. Apparently, the anatomical findings of previous studies are relatively discrepant. This study was designedto describe the anatomical variations of SIEA and superficial inferior epigastric vein (SIEV). A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site of origin and drainage of vessels, caliber,length, and correlation between diameter and length of pedicle were identified. The SIEA and SIEV were identified at the inguinal ligament level in 38 (95%) and 40 (100%) dissections, respectively. The SIEA originated directly from the common femoral artery in 22 (57.9%) or as a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The mean±SD length of SIEA was 3.04±1.73 (0.5- 7) cm. The mean±SD caliber of SIEA was 1.45±0.35 (0.7- 2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a mean±SD of 5.45±2.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a mean±SD of 2.14±.45 mm. The length of SIEA correlated with caliber of the arterialpedicle (p<0.001 and correlation coefficient = 0.517). This study suggests that the SIEA flap can be applied for microsurgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required

Gastric cancer is one of the most common cancers in our country. Recent studies have shown that adenocarcinoma of the cardia and distal stomach has increased in the past 25 years. However demographic data is lacking in this regard. This study is a retrospective case series study. All records from 460 consecutive patients who were documented pathologically to have gastric cancer and had been referred for diagnosis and follow-up to a private clinic from 1992 to 2002 in Tehran were evaluated. 71 records were dismissed due to incomprehensive data. Among 389 remaining records 68.5% were males; mean age was 59.4 years (range 13 to 92 years), 31.1% of patients were 40 years old or less (which is very high). Also 85% (331) of patients had adenocarcinoma and 5.9% (23) had lymphoma, 8.1% (31) had undifferentiated carcinoma while only 1% (4) of cases had gastrointestinal stromal tumor(GIST). 64% of tumors were located in the middle part of the stomach, 19% in the lower and 17% in the upper part. In our study the association between H. pylori and adenocarcinoma was 23.2% in cases younger than 40 years (P<0.001) and 56% in cases older than 40 years. Cases with lymphoma had the highest correlation with H. pylori. There was a significant difference between cancer pathology and sex (P< 0.001). Our data is somehow in conflict with the western data. We donot recommend blind H. pylori eradication based on positive serology (at leastin Tehran) and we suggest conduction of larger multicenter studies in this fieldin our country

With respect to the difference in the interaction of thermal neutron and X rays with matter, using two radiography systems of thermal neutronand X rays will yield highly valuable information for studying the inner structure of biologic samples. The high sensitivity of thermal neutron to hydrogen, in particular, has led to recognizing this system as a useful tool in medical studies in as muchto substitute this system as a non-destructive-testing (NDT) technique in the pathology studies for the common microscopic method. In this study, by using two neutron and X radiography systems available at the Atomic Energy Organization Research Center, the inner structure of field mouse bone as a biologic sample was evaluated. The difference in the interaction of thermal neutron and X ray with organic and inorganic elements of bone led to development of different images that would supplement each other and we tried to show those differences by presenting the diagram and table obtained by measuring the optic density.

Evaluation of breast masses in women under 40 years old starts with a Triple Test Score (TTS) which is composed of clinical breast examination, mammography and fine needle aspiration. Increased breast density in this age group decreases the sensitivity of mammography. So deciding whether to biopsy such nondiagnostic lesions or not is subject to challenge. Breast masses up to 2mm could be observed by ultrasonography using probes with high frequencies (10-13 MHz) with a specificity and sensitivity of more than 80%. This study was conducted to evaluate the efficacy of ultrasonographyinstead of mammography in triple test scores (TTS) of nondiagnostic breast masses in women under 40 years of age and compare the results with open biopsy. To address this issue, breast masses in 100 randomly selected women under 40 were evaluated utilizing physical examination, breast ultrasonography and FNA as a modified triple test score(MTTS) which assigned score 1 for benign, score 2 for suspicious and score 3 for malignant results in each component of TTS. Summation of these three scores was assigned as MTTS. Thereafter all masses were evaluated by open biopsy. Among 100 masses in 100 women, 69 scored 3 points, 15 scored 4points; all of them were benign. Four scored 5 points; 1 of them was malignant.Five scored 6 points; three of them were malignant. Seven scored 7, 8, and 9;all of them were malignant. The MTTS is with 100% diagnostic accuracy for malignancy when it is greater than 7 points. Masses scoring 4 points or lower are benign.Seven up to nine points may proceed to definitive therapy. Five and six points need clinical evaluation and open biopsy. The results of MTTS are similar to TTS in evaluation of breast masses in women under 40 years old and could avoid unnecessary open breast biopsy.

Aprotinin has been used increasingly to reduce postoperative blood loss in open-heart operations; due to the potentialities for complications and high cost, it would seem reasonable to use aprotinin more selectively in small doses in the prime solution of the pump. We prospectively studied the effect of preoperative low dose aprotinin [2 million units (230mg)] on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. One-hundred and fifty patients were randomly assigned to two groups: prophylactic low dose aprotinin (group 1) and a non-medicated control group (group 2). The two groups were comparable in all demographic and operative variables. Postoperative chest tube drainage was significantly decreased in theaprotinin group compared with that in the control group (372.73 mL in group 1 and 482.2 mL in group 2, p<0.05). No significant difference was seen between the two groups in regard to transfusion requirement (p>0.05). The use of fresh frozen plasma (FFP) was significantly less in group 1 than in group 2 (469.87 mL versus 680.69 mL, p<0.05). Prophylactic use of low-dose aprotinin immediately before cardiopulmonary bypass reduced the need for transfusion of blood & fresh frozenplasma (FFP) during the post operative period

To investigate the predisposing and precipitating risk factors for suicide ideations and suicide attempts in young and adolescent females, we tried to introduce a holistic model of suicidal behavior in young and adolescent girls. This study is based on the survey studies and was cross-sectional.Considering high rates of suicide attempts in provinces of Iran, three provinces (Kermanshah, Hamedan, Ilam) which had the highest rates of completed suicide were selected. Then among female high school students (aged 14 to 21 years), in two stages a representative sample was selected by a multi-clusteral and simple randomized sampling methods. The research data were gathered by administering (1) The inventory of predisposing and precipitating factors of suicide, demographic and family characteristics (based on the literature review) (2) Symptom Check List (SCL) 90-R (3) Suicidality Subscale of the Depressive Symptom Index (DSI-SS) (4) Center for Epidemiological Studies (CED- SSI) (5) Beck Hopelessness Scale (BHS) and (6) Child Abuse Self Report Scale (CASRS).Then, subjects were characterized by dividing them in to two categories: at risk, and low risk. The scores of 2 categories were analyzed and discussed. Relationships were found between suicide ideations and psychologicalproblems and disorders (especially depression). Also, the students who reported suicide ideation and suicide attempt had a history of being abused. Based on the results, predisposing and precipitating risk factors and also some protective factors of suicide ideations and suicide attempts were found and a theoretical model was presented. Some predisposing, precipitating and protective factors can predict suicide ideation and suicide attempts significantly

It is well recognized that different patients respond in different ways to medications. The inter-individual variations are greater than the intera- individual variations, a finding consistent with the notion that inheritance is a determinant of drug responses. The recent identification of genetic polymorphisms in drug-metabolizing enzymes and drug transporters led to the hypothesis that genetic factors may be implicated in this interindividual variation. Single nucleotide polymorphism in common metabolic pathway, cytochrome P450 and common transporter, multidrug resistance-1 gene are two important sites that might involve clinically significant genetic variations. Ethnicity greatly influences these genetic polymorphism distributions. We studied the inheritance patterns of polymorphisms for MDR1 andCYP3A5 genes in the Iranian population and compared its genotype and allele frequencieswith 3 different ethnic groups: Caucasian (United Kingdom), Chinese and Japanese. We found striking differences in the distribution of MDR allelic variantsbetween Iranian, Japanese and Chinese (p<0.02) and similar between the Iranian and Caucasian population. (p=0.06). Almost 50% of Iranian and Caucasian individuals were homozygous carriers of the variant T allele compared with 32% of the Japanese and 43% of the Chinese (p<0.02). More than half of Iranian subjects have at least one T allele, with lower P-gp level in small intestine. We also noted dramatic differences in the CYP3A5 alleles and genotypes distribution between Iranian subjects with other compared populations. 99% of Iranian individuals were homozygous carriers of the variant G allele compared with about 70% of the Chinese and Japanese and 19% of the Caucasian population. The G/G genotype has a very low level of active cytochrome P450 enzyme. Our results emphasize the role of ethnicity in interindividual variability of the pharmacokinetic and pharmacodynamic characteristics of drugs.

The loop colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion. We are introducing the use of a full thickness skin bridge under the large bowel instead of a glass rod which alleviates problems such as protrusion of the large bowel, retraction of the bowel into the abdomen after removing the rod and hindering proper application of a colostomy bag over the stoma. Seventeen patients needing double barrel colostomy for completediversion of fecal material were selected using loop colostomy with skin bridge. Three patients had Fournier''s gangrene and 14 had penetrating rectal injury Omega loop colostomy with a full thickness skin bridge was performed for fecal diversion. All of the 17 patients had gas passing and full passage of fecal materialwithin 3 days postoperatively. No case of skin necrosis and stitch abscess was encountered. No parastomal hernia or large prolapse was noted until healing was completed and patients were discharged and after at least 8 weeks and in Fournier''s gangrene somewhat longer, the loop colostomy was closed without the need for formal laparotomy and without any case of anastomotic leak. In this study we confirmed that diverting loop colostomy usinga skin bridge is a safe, rapid and easy to manage colostomy technique whichgives complete diversion similar to double barrel colostomy without the needof performing a laparotomy for closure of the colostomy.

Secular trends in stature, weight and mid upper arm circumference(MUAC) of 2397 school children (1268 boys and 1129 girls) of the same age (6.5-11.5 years) and sex in representative samples from primary schools of Shiraz (southern Iran) at an interval of 15 years (1988 vs 2003) are reported. Cross-sectional weight, height and mid upper arm circumference(MUAC) curves were created for both sexes. One sample t-tests were utilized to analyze differences between average height, weight and MUAC of the 1988 and 2003 samples (the values of the previous study treated as constant). Both samples included children of various socio-economic backgroundsfor both males and females of each age-class. There are significan positive secular trends in stature, weight and MUAC of children born in the post-war period sampled in 2003. These children are generally taller, heavier, and larger than their peers of 15 years earlier born pre- and during the imposed war period of Iraq against Iran. The 2003 sample shows less growth deficits in relation to the CDC reference data. The positive trend can be explained as the result of economicdevelopment and improvement of social and health indicators in Iran in the post-war period.

Attention Deficit Hyperactivity Disorder (ADHD) is characterizedby a developmental disorder involving inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity and/or both. In order to assess the prevalence of children with ADHD in Tehran,a sample of 2667 children including both boys & girls aged between 7-12 years were selected by a 2-stage method sampling among a grid of sectors of 19 different educational areas by stratified random sampling. We tested the rate of ADHD in the considered children based on two questionnaires of Conners Parent and Teacher Rating Scales (CPRS and CTRS) and semi-structured interviews. According to the recent studies, it is possible to describe the rate ofADHD prevalence based on the CPRS and CTRS questionnaires and semistructured interview among the primary school children in Tehran (aged between 7- 12 years of age) with a range of 3% to 6%. These mentioned findings are somewhat similar to the announcedstatistics of the American Psychiatric Association (APA) (2003).

Colon lipomas are rare. They are almost always asymptomatic; only when their diameter is more than 3 cm do they become symptomatic. They tend to occur in an older population and most of the cases are located at the right side of the large bowel. Usually the diagnosis is not made until operation is performed. We describe a 67-year-old woman with a large colonic submucosal lipoma causing left-sided abdominal pain and altered bowel habit. Abdominal sonography, CT scan and colonoscopy showed a mass 5 cm
4.5cm
4 cm located 90cm from the anal verge. Left hemicolectomy was performed, and histologicexamination revealed the mass to be a benign colonic lipoma. We also reviewed the literature on the subject to examine the main characteristics of lipoma of the colon

Malignant germ-cell tumors (MGCT) are rare tumors of childhood accounting for less than 3% of pediatric malignancies. Endodermal sinus tumor (EST) forms the most common histologic subtype of MGCT. The vagina is an extremely rare site for GCTs. An 8-month-old female was admitted with a short history of vaginal bleeding, and a mass protruding from the vagina. She was pale and a mass was palpable anteriorly on rectal examination. Computed tomography (CT) showed a tumor mass posterior to the bladder. A biopsy revealed a vaginal EST. The serum alpha-fetoprotein (AFP) was elevated. Vaginohysterectomy was done. The patient was subsequently referred to the oncologistfor further management. EST is the most common GCT in children. In females, it is usually encountered in the ovary. EST of the vagina is a rare, highly malignant GCT that exclusively involves children less than 3 years of age. The diagnosis is based on histology and raised AFP. Vaginal EST is both locally aggressive and capable of metastasis. The serum AFP level is a useful marker for diagnosis and monitoring the recurrence of vaginal EST in infants.