فهرست مطالب

Medical Journal Of the Islamic Republic of Iran
Volume:18 Issue: 4, Winter 2005

  • تاریخ انتشار: 1383/12/20
  • تعداد عناوین: 17
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  • Ali Zarei Mahmoudabadi Page 1
  • V. Hadavi, Dd Farhud, Mh Sanati, Sm Nabavi, M. Seyedian, M. Hushmand, M. Younesian Page 2
    Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system, with a complex etiology that includes a strong genetic component. The chromosome 19q 13 region surrounding the apolipoprotein E (APOE) gene has shown consistent evidence of involvement in MS. In a cross-sectional study, to show the APOE genotype and allele frequency in the MS population of Iran in comparison with the control group, we genotyped its polymorphisms (ε2, ε3 and ε4 alleles). The authors investigated 81 patients with clinically definite MS and 93 asymptomatic elderly volunteers. The frequency of the APOE allele in the MS population in comparison with controls was 9.3% vs. 0.5% for ε4,44.4% vs. 51.6% for ε3, and 46.3% vs. 47.8% for £2. The highest frequency of APOE genotype was from ε2/ ε3 with 66.7% vs. 94.6% and the lowest, £4/£4 genotype with 2.5% vs. 0%. The authors found significant differences in the distribution of ε 4 allele between patients with MS and controls (9.3% vs. 0.5%; X2=15.2; df=2; p<0.001). The highest frequency of £4 allele in MS patients was in Pure Turkish (25.0% vs. 5.3 %) ethnicity. There was no signifIcant relation between ethnicity and genotype. In the present study ε2/ε4, ε3/ε4 and ε4/ ε4 genotypes were more common in bout-onset cases compared to primary progressive cases, and the secondary progressive disease was higher in carriers of £4 allele. Also, the ε 2 allele was higher in relapsing remitting disease.
    Keywords: Multiple sclerosis_apolipoprotein E polymorphism_disease course_Iran
  • Mohammad Talebpoor, Mojgan Karbakhsh, Shokoofeh Sabeti, Moosa Zargar Pages 285-288
    Metastatic ovarian cancers occur in 3-8 percent of women undergoing surgical resection of a primary colorectal cancer. In this study we examined the characteristics of women with colorectal cancer for whom synchronous oophorectomy had been performed. In this cross-sectional study, records of patients with colorectal cancer from April 1991 through October 1999 who had undergone surgery for both colorectal cancer resection and oophorectomy for suspicious ovarian metastasis in the Cancer Institute, Imam Khomeini Medical Center, were reviewed. SPSS version 10 was used for statistical analysis. The studied cases (n= 82) comprised 44. 1 percent of all recorded cases of women with colorectal cancer during this period (N= 186). The mean age of our cases was 52. 19 years. 54. 9% of the studied women were in stage C of colorectal cancer. The commonest pathology of tumors was adenocarcinoma (89%). Well differentiated carcinoma was observed in 43. 9%, followed by moderately differentiated carcinoma in 37. 8%, poorly differentiated in 12. 2% and unspecified in 6. 1 %. 22 of our patients (26. 8%) had gross abnormalities of ovaries at operation. In 13 cases (15. 8% of our 82 studied cases and 6. 99% of all186 women with colorectal cancer), tumoral involvement of ovaries was proven through pathologic examination. 10 out of these 13 cases were among those with gross abnormalities of ovaries at operation (p= 0. 048). Among the 13 patients with ovarian metastasis, 11 cases (84. 6%) were in stage Cat operation (p= 0. 02) and 7 (53. 8%) had well differentiated carcinoma (p= 0. 04). Patients with ovarian metastases of colorectal origin are generally peri- or postmenopausal. Like similar studies, in our setting, about 7 percent of all recorded femalecases with colorectal cancer turned out to have ovarian metastases in surgical pathologic examination. In fact, 15. 8% of our 82 cases sustaining surgery for «colorectal cancer and suspicious ovarian metastasis» proved to have ovarian metastasis. We recommend that prophylactic oophorectomy be performed in postmenopausal women with advanced stage colorectal cancer or any other woman with colorectal cancer with gross abnormality of the ovaries at operation.
    Keywords: Ovarian metastasis, Colorectal cancer, Oophorectomy.
  • M.H. Alavi, Z. Talaie Rad, S.R. Dadgar Pages 289-292
    Physiologists have shown that increased fluids improve skeletal muscle performance in prolonged exercise. Typical orders provide for 125 mL of intravenous fluids per hour in patients taking limited oral fluids during labor. Our purpose in this study was to determine whether increased intravenous fluids affect the progress oflabor. In a prospective randomized institutional clinical trial, one-hundred ninety-four nulliparous women with uncomplicated singleton gestations at term in spontaneous active labor with dilatation 2-5 em and a cephalic presentation were selected. 82 were designed to receive 250 mL per hour of intravenous normal saline in dextrose water (first group), and 112 to receive 125 mL per hour of the same solution (2nd or control group). Prerandomization variables such as mother''s age, weight, previous pregnancy history, general health, sex and weight of the newborn, rupture of the membranes and presenting part were balanced between the two groups. The frequency of labor lasting> 10 hours was statistically higher in the 125mL group ([16.7%] vs [7.4%] p< 0.0002). This study showed that increasing fluid administration for nulliparous women in labor is associated with a shorter duration of the first stage and possibly less need for augmentation of uterine contraction ([4.8% vs 6.25%] p= 0.002).Thus dehydration in labor may be a contributing factor for dysfunctional labor and need for cesarean-section, and oxytocin infusion.
    Keywords: Intravenous hydration, Labor, Nulliparous, Term pregnancies
  • Jahanbakhsh Samadikhah, S. Hadi Hakim, Azin Alizadeh Asl, Rasoul Azarfarin Pages 293-296
    This study sought to compare the clinical features and outcome of a first acute myocardial infarction (AMI) with onset of symptoms during or within 30 minutes of exercise, at rest and in bed. Information collected using a standard questionnaire was used to relate activity at the onset of symptoms and in-hospital outcome in 500 consecutive patients admitted to our heart center with a first AMI between 2000-2002. Patients with exercise-related onset were more likely to be younger and male. Those with onset in bed were more likely to be older and have a history of stable or unstable angina. By way of comparison between patients whose symptoms began at rest and exercise, those with exercise-related onset had lower in-hospital mortality after adjusting for age and gender [odd''s ratio (OR) 0.53, 95% confidence interval (CI) 0.39-0.93 (p= 0.03)]. Compared with patients whose symptoms began at rest, patients with onset in bed had a higher mortality rate [OR 1.42,95% CI 1.03 -1.98 (p= 0.028)]. The incidence of moderate or severe left ventricular dysfunction was also lower for exercise -related onset [OR 0.79,95% CI 0.6-1.01 (p= 0.32-but not statistically significant)] and higher when onset was in bed [OR 1.5, 95% CI 1.2-1.77 (p=0.039)]. There is an association between activity at onset and outcome of AMI. Differences in pathophysiology or in the population at risk could explain this observation.
    Keywords: Activity, Acute Myocardial Infarction, Outcome
  • J. Eivazi Ziaei, I. Asvadi Kermani Pages 303-307
    Repeated bone marrow examination was found to be of value in assessing response to treatment in megaloblastic anemia. The objective of this study was monitoring the response of megaloblastics to treatment, concerning the location of neutrophilic myeloperoxidase and myeloperoxidase index (MPXI) and their variation in megaloblastic erythroid progeny. It is possible to follow up megaloblastic cases using a Technicon HI (Bayer) automated cell counter. Complete blood counts (CBC) of 50 patients whose bone marrow aspirations revealed megaloblastic state and subsequently responded to treatment with B 12 and folate were studied through pre- and post-treatment measurements. MPXI level in 41 patients was above normal range (normal: -10 to + 10). Nine patients had normal MPXI, though mean cell volume (MCV) was higher than 100 fL. The highest value of MPXI was 41.5. The mean values of MPXI were 18.3 and 2.05 in pre- and post-treatment measurements respectively. MPXIs were decreased after treatment in 92% of patients (p= 0.008). According to this investigation, the MPXI measurement is a suitable test in monitoring the response for treatment.
    Keywords: Myeloperoxidase index, treatment, megaloblastic
  • Hassan Mansouri Torghabeh, Ali Akbar Pourfathollah, Mahmood Mahmoodian Shooshtari, Zahra Rezaie Yazdi, Habibollah Esmaili Pages 309-313
    Patients with coagulation factor(s) deficiency who use coagulation therapy are susceptible to forming inhibitors against coagulation factor(s). In this survey we detected factor V and VIII inhibitor in ten patients with combined deficiency of factors V and VIII from north east of Iran (Khorassan province). It was revealed in our survey that eight patients had both factor V and factor VIII inhibitors and two patients had none. Because factor V and factor VIII share approximately 40% amino acid sequence homology in their A and C domains, it remains to be elucidated if it is one molecule that recognizes both factor V and VIII or whether there are two inhibitor molecules against common sites.
    Keywords: Combined factor V_VIII deficiency_Factor V inhibitor_Factor VIII inhibitor
  • H. Lal Dolat Abad, A. Jalali Pages 313-317
    The purpose of this study was to evaluate the therapeutic result of CT -guided celiac plexus block for managing intractable upper abdominal pain due to pancreatic carcinoma or chronic pancreatitis. We treated 22 cancer patients who were on regular narcotic medication. After an IV infusion of 10mLlkg Ringer''s lactate solution, all patients were rolled onto prone position, and lidocaine was used to infiltrate the skin and subcutaneous tissues. Then CT guided injection of the celiac plexus was performed with 25 mL 50% ethyl alcohol with 0.25% bupivacaine. Vital signs, quality of analgesia and any adverse effects were recorded. The age range of our patients was 68.63± 7.48 years and weight was 64.68± 7.54 kg (mean±SD).All patients had a history of abdominal operation due to disease and also a history of morphine injection due to pain. In 100% of our patients, sedation in the first hour was gained; excellent pain relief was achieved in 86.4% of cases during the first 24 hours after the procedure. No serious complications occurred in the study, a 30% drop in systolic blood pressure or even more was found in 13.6% of the cases, while nausea and transient orthostatic hypotension requiring no treatment developed in 31.8% and 100% of the cases respectively, and mild diarrhea was reported in 18.1 % of the cases for two weeks. CT-guided neurolytic celiac block appears to be a safe and effective technique for relieving abdominal pain due to cancer.
    Keywords: Pancreatic cancer pain, neurolytic celiac plexus block.
  • A. Heidarnia, T. Dehdari, F. Ghofranipour, A. Kazemnejad, M. Heidarnia Pages 319-326
    The purpose of this study is to evaluate the ability of the health education program to improve patient''s health-related quality of life with coronary artery bypass graft surgery. Seventy patients in pre-operation were randomized into the study, with 35 patients in the experimental and 35 patients in the control group. The demographic information, Sf-36 and Nottingham Health ProfIle questionnaire were administered and fIlled out before surgery by seventy patients. Patients in the experimental group received the educational intervention. Educational intervention was according to Mico'' s education planning model. For the second phase of Mico'' s model, knowledge, attitude and function were measured in seventy patients by questionnaire before education. These patients were followed up to 1 month. Afterwards Sf- 36 and Nottingham Health Profile questionnaires were administered I-month after education to be filled out by patients again. SPSS and EXCEL softwares analyzed all data. Significant improvements in quality of life between the two groups, as measured by the Nottingham Health ProfIle, were seen in energy (p<0.00I), pain (p<0.006), emotional reaction (p<0.0000I), sleep (p
    Keywords: Health education, coronary artery bypass graft surgery, quality of life
  • Shahla Bahremand, Yahya Aghighi, Zohreh Oloomi Yazdi, Heshmat Moayeri, Laleh Razavi, Mansour Nateghi Pages 327-330
    Wilson''s disease is a rare but treatable condition with variable clinical presentations. Its diagnosis depends on a combination of clinical and laboratory findings. We evaluated the clinical and laboratory findings in children with Wilson''s disease (WD). Twenty -seven children (4-14 years, 59.2 % male, 40.7% female) with confirmed WD were evaluated between 1994 and 2003 at Imam Khomeini Hospital. Seventeen patients (64%) presented with liver abnormalities, 3(11 %) with neurological features, 3(11 %) with fulminant hepatic failure and 4(14%) were asymptomatic siblings of patients with WD. The presence of Kayser Fleischer rings, high urine copper excretion, low ceruloplasmin level, and elevated liver copper concentration were detected in 51.8%, 77.7%, 92.5% and 72.7% of patients respectively. We emphasize on clinical findings together with one or more laboratory findings as a diagnostic guide in WD and also recommend evaluation of serum ceruloplasmin level and 24 hour urine copper excretion particularly when liver biopsy may not be obtained.
    Keywords: Wilson's disease, laboratory findings, children.
  • K. Haddadian, O. Rezaee, S. Sadeghi, A. Modarres Zamani, G. Sharifi, A. Ali Asgari Pages 331-335
    We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy (CSM) to determine [mdings which had a predictive value for surgical outcome. Consecutive patients with CSM caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in Loghman Hakim Hospital from 1999-2003 were prospectively enrolled. Patients were evaluated postoperatively by office visit. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. Forty - three patients (30 male, 13 female) with a mean age of 48.8 years fulfilled our inclusion criteria. The most common preoperative symptoms were sensory deficit in distal upper limbs (88.4%), gait disturbance (69.8%) and sensory deficit of distal lower limbs (58.1 %). The most common signs were hyperreflexia (95.3%), Hoffman''s sign (93%) and Babinski''s sign (83.7%). Vertebral osteophyte and soft disc herniation were found in 86% and 14% of the patients, respectively. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale was noted in 79.7% of the patients who had an abnormal scale preoperatively. Strength improved considerably and significantly after operation. However, less than half of the patients experienced functional improvement in the lower limbs, a discrepancy that was probably caused by persistent spasticity. Atrophy of the hand muscles, preoperative spastic gait and cord atrophy as shown in MRI were poor prognostic factors.
    Keywords: Cervical Spondylosis, Myelopathy, Anterior Cervical Decompression
  • A. Afsharfard, M. Mozaffar, Ar Fadaee Naeeni, F. Aghaee Meybodi, Am Tofigh Pages 337-340
    Regarding the increasing numbers of IV drug addicts, the incidence of infected pseudoaneurysm is increasing. So far, different therapeutic strategies have been tried, but each method has its own drawbacks. Therefore, discovering an appropriate therapeutic method is necessary. 65 patients with infected pseudoaneurysm due to drug injection referred to Shohada Medical Center from Feb 1994 till Oct 2003 were chosen. After obtaining proximal control of the external iliac artery, femoral artery ligation was performed in all patients. The patients were observed for signs and symptoms of ischemia. After primary ligation of the involved artery, acute ischemia occurred in only 6 patients who later underwent extra-anatomical bypass. Only 3 patients underwent amputation. One of them was performed after extra-anatomical bypass and two cases after arterial ligation, as ischemia and gangrene had been present on admission. During patient follow up (minimum 3 months, maximum 3 years and average 12 months), 8 cases of slight claudication (9.3 %) and 3 cases of severe claudication were reported and the rest have been symptom-free. Various treatments have been used for infected pseudoaneurysm, but none of them are faultless. According to infection of the site and existence of extensive necrosis and inflammatory tissue, anatomical and even non-anatomical bypasses are almost improbable. The results of this study indicate that arterial ligation could be the fIrst and probably the best choice of treatment in such patients with less cost and also without mentionable morbidity or mortality. This procedure must be performed in a vascular surgery center to perform vascular bypass if needed.
    Keywords: Aneurysm, IV drug abuse, Pseudoaneurysm, Mycotic aneurysm
  • K. Ghandehari, A. Shuaib Pages 341-343
    Silent Brain Infarcts (SBI) are associated with an increased risk of subsequent stroke. SBI are incidentally revealed by CT or MRI executed in stroke patients. A prospective study was undertaken involving 200 consecutive patients aged >45 years with brain infarct admitted in University of Alberta Hospital, Canada (100 patients) and Valie-Asr Hospital, Iran (100 patients) in 2003. Patients were divided in age groups aged <65 and >65. All of the patients underwent brain CT. A stroke neurologist with knowledge of stroke history subsequently reviewed the scans and diagnosed SBI. The relations of race, gender and age groups with SBI were analyzed with chi-square and Fisher exact tests. SBr were present in 26.9% of patients aged <65 and 48.6% of patients aged >65. Canadian patients were significantly more preponderant to SBI in age group> 65 (p= 0.013). The mean age of Canadian patients was significantly higher than Persians (p<0.001). Within a total of 200 patients the female gender was significantly more preponderant to SBr (p= 0.02) which was not related to age and race groups. Small vessel territory infarct was present in 87 % of our patients with SBI. SBr are cornmon in stroke patients. The frequency of SBI is higher in female gender and the elderly.
    Keywords: Silent stroke, infarct, gender, incidence
  • Mehdi Zahedi Khorasani, Sohrab Hajizadeh, Saeed Semnanian, Yaghoub Fathollaid Pages 353-359
    Adenosine has many of the characteristics of a regulator of cerebral blood flow and adenosine receptors change in morphine dependency. In this study the changes in adenosine receptors'' responsiveness of pial vessels in the hind limb area of the sensory cortex were evaluated in morphine dependent rats (MDR) using the laser Doppler flowmetry technique. Adult male Sprague Dawley rats (250-350 g) were used in all experiments. Animals were made morphine dependent, thereafter local effects of adenosine receptor agonists and antagonists on regional cerebral blood flow (rCBF) were investigated. Results obtained in this study show that adenosine (10-5, 10-4, 10-3M) increases rCBF in a dose dependent manner in sham operated, control and MD R, so that the increase of rCBF inMD R is statistically significant (p<0.01). This response was inhibited by theophylline (5x 10-5M). Lidocaine (2%) reduced adenosine-induced increase in rCBF o f MDR. N6-cyclohexyladenosine (10-6, 10-5, 10-4 M) and 8 - cyclopentyltheophylline (1 G-6M) as a selective agonist and antagonist of adenosine A l receptors had no significant effect on rCBF in control and MDR. CGS-21680 (10-6 M) as a selective adenosine A2a receptor agonist, increased rCBF in MDR significantly (p<0.05). This response was antagonized by ZM-241385. NECA (10-6M) as a adenosine A2b receptor agonist, increased rCBF in MDR significantly (p<0.05). This response was antagonized by Alloxazine. The results of this study indicate an increase in adenosine A2 receptors'' (including A2a and A2b subtypes) responsiveness in hind limb sensory cortex of MDR.
    Keywords: Cerebral blood flow, Morphine dependent rat.
  • F. Hadizadeh, Bf Anaraki-Firooz, Sih Taqavi Pages 361-364
    In order to investigate the effects of dimethylamino substituent at position 2 of the dihydropyridine nucleus on activity, starting from dialkyl l, 4-dihydro-2,6-dimethyl-4- (l-benzyl-2-alkylthio-5-imidazolyl)-3,5-pyridinedicarboxylates (5a-f) which their synthesis and effects as calcium channel antagonist on guinea-pig ileum has been reported previously, dialkyl l,4-dihydro-2-[2-(dimethylamino)ethyl]-6-methyl-4-(l-benzyl-2- alkylthio-5-imidazolyl)-3,5-pyridinedicarboxylates (6a-f) were synthesized. Rabbit jejunum was used to determine the relaxant or antagonistic activity of the test compounds. The test compounds (6c-e) inhibited the spontaneous contractile activity dose-dependently and completely, while high-K+ contracted tissues were relaxed partially.
    Keywords: 2, Dimethylamino, substituted dihydropyridines, Rabbit jejunum, Calcium Channel
  • Leili Yazdchi -Marandi, Sheela Ramanathan, Philippe Poussier Pages 365-370
    The BioBreeding- Diabetes Prone (BB-DP) rat spontaneously develops an autoimmune diabetic syndrome that is dependent on the RT1 u Major Histocompatibility Complex (MHC) haplotype and homozygosity for an allele at the Lymphopenia (Lyp) locus. Lyp mutation is responsible for a peripheral T -lymphopenia. There are other genetic loci contributing to diabetes susceptibility in this strain. BB rats carrying wildtype Lyp alleles are not lymphopenic and are resistant to spontaneous diabetes (Diabetes R esistant [DR]). Our study shows that thymectomy and exposure to one sublethal dose of g-irradiation (TX-R) at 4 weeks of age result in the rapid development of insulitis followed by diabetes in 100% of DR rats. Administration of CD45RCCD4+ TCRcb+ T cells from unmanipulated syngeneic donors immediately after irradiation prevents the disease. Splenic T cells from TX -R induced diabetic animals adoptively transfer type 1 diabetes to T-deficient recipients. WAG, WF and LEW strains are resistant to TX -R induced insulitis/ diabetes. This novel model of TX -R induced diabetes in BB-DR rats can be used to identify environmental and cellular factors that are responsible for the initiation of antipancreatic autoimmunity.
    Keywords: BB_DR_type 1 diabetes_TX_R_BB_DP.
  • Mehri Najafi, Ahmad Khodadad, Gholam Reza Khatami Pages 371-373
    A 34 day-old girl infant was admitted for poor feeding and cholestasis. She had a bulging fontanelle, with no evidence of intracranial infection or hemorrhage. Investigations demonstrated that she had galactosemia. Computed tomographic scans demonstrated the presence of diffuse cerebral edema. After treatment the edema resolved.
    Keywords: Galactosemia, cerebral edema, increased intracranial pressure