مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و یکم شماره 8 (پیاپی 152، آبان 1392)

Several studies indicate that gender differences exist in tolerance of the kidney to ischemia reperfusion (IR) injury. Recently، postconditioning (POC)، induction of brief repetitive periods of IR، has been introduced to reduce the extent of the damage to the kidney. This method was shown to attenuate renal IR injury by modifying oxidative stress and reducing lipid peroxidation. Considering the gender effect on the results of several treatment methods، in this study، we investigated the impact of gender on the protective effect of POC on the rat kidney. In this study، after right nephrectomy، 48 male and female rats were randomly divided into 6 groups of 8 rats: In IR group، with the use of bulldog clamp، 45 minutes of left renal artery ischemia was induced followed by 24 hours of reperfusion. In the sham group، all of the above surgical procedures were applied except that IR was not induced. In the POC group، after the induction of 45 minutes ischemia، 4 cycles of 10 seconds of intermittent ischemia and reperfusion were applied before restoring of blood to the kidney. 24 hours later، serum and renal tissue samples were collected for renal functional monitoring and oxidative stress evaluation. Postconditioning attenuated renal dysfunction considering the significant decrease in plasma creatinine and BUN compared with IR group only in male rats (P<0. 05). Also، POC attenuated oxidative stress in male rats’ kidney tissues as demonstrated by a significantly reduced malondialdehyde (MDA) level and increased superoxide dismutase (SOD) activity (P<0. 05). In female rats، there were no changes in functional markers and oxidative stress status in POC group compared to IR group. Considering gender difference، POC had protective effect against IR injury by attenuating functional and oxidative stress markers in male rat kidneys. This protective effect was not seen in female rats.

The aim of this study was compared the efficacy of the designed primers and already published primers for detection of the exoA، oprL and algD genes by PCR assay for finding a rapid، accurate and highly sensitive and specific procedure to detect the Pseudomonas aeruginosa in the serious and fatal infections such as cystic fibrosis disease، burned individual. A total of 150 clinical specimens were inoculated in to routine and selective culture media for Pseudomonas aeruginosa isolation. Specific primers were designed by bioinformatics analysis for detection of the virulence genes exoA، oprL and algD. The available sequences of these three genes were obtained from NCBI and multiple alignments were performed to find the conserved sequences of each gene for primer designing. Both multiple alignment and primer designing steps were carried out by AlleleID software، version 7. 0. Microbiological culture methods were showed that 70 Pseudomonas aeruginosa strains isolated from the 150 clinical specimens. PCR assay performed by using the designed primers shown 68، 70 and 69 positive results from 70 direct specimens for exoA، oprL and algD respectively that shown 97. 2%، 100% and 98. 6% sensitivity for above genes. PCR assay performed by using the already published primers shown 57، 49 and 28 positive results for above genes respectively that shown 81. 5%، 70% and 40% sensitivity. The present study shows that by using the high specific primers for detection of the mentioned genes of the Pseudomonas aeruginosa. The conventional PCR assay detected the early colonization of the organism in Cystic Fibrosis patients with more sensitivity and specificity before several mounts to obtain positive culture. Indeed PCR assay with high specific primers has more sensitivity and specificity as a rapid and accurate diagnosis of the organism in other deadly infections by using the direct clinical specimens.

A number of studies on reproduction have mentioned Origanum Vulgare extract’s ability to reduce mortality rates and improve fertility rates. However، other studies have suggested that it is possible to use Origanum Vulgare extract to induce abortion. The aim of this study was to investigate the effect of different doses of Origanum Vulgare on embryo survival and macroscopic abnormalities in mice. In this study، 24 mice Balb/c female weighting approximately 25-30 g were divided into 4 groups. Origanum Vulgare extract was prepared; different concentrations (2. 5، 12. 5، and 25 mg in 0. 25 ml distilled water) were administered، by oral gavage، to three experimental groups of mice between day 6 (starting gastrulation) until day 15 of pregnancy (end of organogenesis). The control group consisted of six mice that received 0. 25 ml of distilled water daily. On day 16 of study، pregnant mice were anesthetized by chloroform and fetuses were removed and stained with Alcian Blue، Alizarin Red s and microwave irradiation. Morphological and skeletal abnormalities were investigated by light and stereomicroscopes. The results of this study showed that high doses of the Origanum Vulgare extract significantly decreased the mean number of embryos (100. 5، P>0. 05)، mean number of live embryos (70. 5، P>0. 05) in each mouse and resulted in significant reduction in mean weight (11848 mg، P>0. 05) and crown-rump length (11. 90. 23 mm، P>0. 05) and the overall size of fetuses compared to control group، whereas there was no significant difference between the groups receiving low dose of Origanum Vulgare extract with control group. In addition، under the effect of the Origanum Vulgare extract the subcutaneous bleeding seemed (20. 1، P>0. 05) significantly more frequent compared to the control group. Origanum Vulgare extract did not have any positive effect on fetal development; and high dosages led to an increased incidence rate of abortion and fetal malformations in the fetuses of women who received it.

The goal of this study was to evaluate، functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL) reconstruction. Fifty patients (male and 18-45 years old) with isolated ACL injury، randomly allocated in two equal groups (in one group، ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft) and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder، in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC) questionnaire. In this study for first time، rotational torque strength of knee was recorded with new design measure، from isometric aspect and not isokinetic. Although significant improvements in IKDC scores، flexion and internal rotation capacity of the knee were observed in both groups، post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0. 05 or more than 95% confidence Interval of the difference) This study demonstrates that ACL reconstruction surgery، improves knee performance in flexion and internal rotation، regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient)، it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex، for more worthfull conclusion، we suggest future study in both sex and with long duration of follow up.

Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization (IVF) protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone (GnRH) agonist protocols versus the GnRH antagonist protocol in PCOS patients. In the present study، we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression، patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol، half or one-third dose depot Decapeptyl (1. 875 mg، 1. 25 mg) was injected on 21st day of previous cycle. In GnRH antagonist cycles، cetrotide 0. 25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation (COH) characteristics were analyzed. Basal characteristics including: age، FBS، prolactin، hirsutism، length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation، number of gonadotrophin ampoules and metaphase II (MII) oocytes were found in GnRH antagonist protocol (P<0. 001، P<0. 001 and P=0. 045)، while the decrease in biochemical pregnancy (P=0. 083) and live birth rate (P=0. 169) wasn''t significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles (P=0. 881). The incidence of OHSS weren''t significantly different between 3 groups (5%، 4. 9% and 12. 8%، P=0. 308). Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome (OHSS) as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonist.

Nasal polyp (NP) is a benign mucosal mass located in both sinuses and nares which is mostly seen in association with cystic fibrosis، asthma or oversensitivity to aspirin. The prominent histological feature of NP is inflammatory cell infiltration with eosinophil predominance. Superantigens role in causing NP complications is already proven. Superantigens، which are mostly originated from Streptococci and Staphylococci، activate T cells strongly and increase the process of production and release of cytokines، and secretion of IgE from B cells، which in turn directly affects proinflammatory cells such as eosinophils، both in their tissues infiltration and functions. The samples are collected from patients referring to ENT clinic in Rasoul Akram training Hospital in Tehran after thorough clinical and paraclinical examinations. For control group the samples collected from patients undergoing rhinoplasty. All the samples kept frozen and sent to immunology lab. The DNA of the excised tissues extracted and amplified by using the superantigens specific primers and PCR product detected by gel electrophoresis. The date analyzed by using mean and SD and χ2 analytical tools. Fifteen healthy individuals، 25 patients with rhinosinusitis and 24 with polyposis entered this trial. Group A Streptococcus toxin detection was significantly more frequent in those with nasal polyp and rhinosinusitis compared to healthy individuals (P=0. 001 and 0. 005، respectively)، but the results were almost the same for those with nasal polyp and rhinosinusitis (P=0. 4). Streptococci may play an important role in induction or clinical exacerbation of polyposis and group A Streptococcus pyogenes exotoxin (SPEs) with superantigenic effects may have a crucial role in etiology and pathogenesis of polyps with or without rhinosinusitis. It is postulated that، T cells polyclonal activation by SPEs may cause recruitment of inflammatory cells in nasal mucosa. These inflammatory cells include IgE producing B cells laeding to allergic and inflammatory reactions in NP.

Intrauterine insemination (IUI) is one the most common methods in infertility treatment، but its efficiency in infertile couples with male factor is controversial. This study is a retrospective study about correlation between semen parameters and male and female age with successful rate of IUI in patients attending to Royan Institute. A total of 998 consecutive couples in a period of 6 months undergoing IUI were included. They were classified into two groups: couples with successful and unsuccessful pregnancy. Main outcome was clinical pregnancy. Data about male and female ages and semen analysis including concentration، total sperm motility، class A motility، class B motility، class A+B motility and normal morphology was extracted from patients’ records. Semen samples were collected by masturbation or coitus after 2 to 7 days of abstinence. Their female partners were reported to have no chronic medi-cal conditions and have normal menstrual cycles. One hundred and fifty seven of total 998 cycles (15. 7%) achieved pregnancy. The average of female age in successful and unsuccessful group was 28. 95±4. 19 and 30. 00±4. 56 years، respectively. Mean of male age was 33. 97±4. 85 years in successful group and 34. 44±4. 62 years in unsuccessful group. In successful and unsuccessful groups، average of sperm concentration was 53. 62±38. 45 and 46. 26±26. 59 (million sperm/ml)، normal morphology of sperm was 8. 98±4. 31 (%) and 8. 68±4. 81 (%)، sperm total motility was 47. 24±18. 92 (%) and 43. 70±20. 22 (%) and total motile sperm count was 80. 10±63. 61 million and 78. 57±68. 22 million، respectively. There was no significant difference in mean of females’ age and males’ age between successful and unsuccessful groups (P<0. 05). In addition، there was no significant difference in semen parameters including concentration، total sperm motility، class A motility، class B motility، class A+B motility and normal morphology between two groups. It was shown that common semen analysis and male and female ages cannot predict IUI outcome.

Gastric cancer is the most prevalent cancer with poor survival in gastrointestinal tract. Caspase 3 and 9 play an important role in the development and progression of cancer. Polymorphisms in the genes for these enzymes can affect gene activity and thus may influence susceptibility to gastric cancer. In this study، caspase 3 and 9 genes polymorphisms in patients with gastric cancer were examined. In a case - control study، 100 patients with gastric cancer and 100 healthy individuals were evaluated in the region rs4647601: G> T for caspase-3 and -1263 A> G gene promoter for caspase 9. DNA extraction was performed from whole blood according to manufacture protocol. RFLP-PCR method was carrying out for detection of caspase 3 and 9 genes genotype in two groups. In this study، 143 men and 57 women were evaluated. All of them were selected from the same race and geographical area. The results indicated an increase of the mutant G allele in the control group، which leads to a decreasing in the incidence of gastric cancer (P<0. 0001، OR: 0. 096، (%0. 95CL) =0. 04-0. 23). It seems that screening of -1263 A> caspase 9 polymorphism could be a useful marker in personal sensitivity to gastric cancer and help to cancer treatment and prevention process. It is concluded that caspase gene variation may be a diagnostic factor in the gastric cancer.

Hydatid disease or echinococcosis is a common parasitic disease of human and bovine، caused by infection with larva of the cestode echinococcus. Liver is the most common organ that is involved in this disease. Pelvic involvement and neurological symptoms، due to mass effect of pelvic involvement، in lower extremities are very uncommon manifestations of the disease. A forty six year old man was referred to clinic of surgery at Ghaem Hospital، Medical University of Mashhad، Iran. The patient complained about weakness and motor impairment in right lower extremity accompanied by numbness and radicular pain over past two months. Physical examination demonstrated muscular atrophy and reduced muscular strength in right lower extremity. Computed tomography and ultrasonographic studies showed a cystic mass in right side of the pelvic cavity with extention to the sciatic notch and another cystic mass in right gluteal region. Surgical operation revealed a cystic mass deep in pelvic cavity with the extention to the right sciatic notch with compression of nerve roots. The cystic mass was contained of daughter cysts which confirmed the diagnosis of hydatid cyst disease. This diagnosis was confirmed by pathologic assessment. Although uncommon، but hydatid disease can involve the pelvic cavity and make a pelvic، usually cystic، mass; that can make compression on nerve roots and so making neurologic symptoms in lower extremities. So in endemic areas for hydatid disease، such as Iran، pelvic hydatid cysts should be considered as a possible differential diagnosis in patients presenting with the sciatic pain and neurological manifestations in whom a pelvic mass has been found too.

The Trigemino-cardiac reflex (TCR) has been studied as a phenomenon including; bradycardia، arterial hypotension، apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve. We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing، sensory neural hearing loss، nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However، it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally، it was treated by administration of a single dose of atropine (0. 5mg/IV) and did not happen again. The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches، especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence، immediately.