مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و دوم شماره 2 (پیاپی 158، اردیبهشت 1393)

Considering nitric oxide (NO) has an important role in many biologic processes of cells and tissues such as in the digestive system and in this system act as a second messenger in pathological and physiological events in gastrointestinal region، in this study we investigated the effects of L-NG-Nitro arginine Methyl Ester (L-NAME) as the NO formation inhibitor on parietal cells of stomach in pregnant rats. Twenty four female rats were prepared and with eight weeks old and 200-250 g weight were used in this study. After matting of the female rats with the male rats، time of observing vaginal plaque considered as the zero day of pregnancy. Then the animals were divided into three groups of studying. Each group was containing eight rats. In this study، except the control group، the saline group received 2 ml/kg normal saline and experimental group received 20 ml/kg L-NAME interaperitoneally (IP)، respectively on third، fourth، and fifth days of pregnancy for evaluation of its effects. On the 18th day of pregnancy، after anesthesia with ether، the animals were killed and dissected and the laparotomy was performed to separate the mother’s stomach. Then، the stomach was fixed in 10% formalin and after tissue passage، the sections were stained with Hematoxylin-Eosin (H&E). Then the changes of count and diameter in parietal cells were observed via light microscopy and Image Tools III. Results of this study after analysis showed the significant changes in parietal cells count (mean 61. 3±4. 32) and its diameters (mean 16. 12±1. 18 µm) in L-NAME group in comparison to control and the sham groups in pregnant rats (P≤0. 05). Results of this study showed L-NAME with effects on NO synthesis can reduce the count of parietal cells and increase its diameter in pregnant rats and has destructive effects on structure of stomach parietal cells in pregnancy rats.

Article abstract: Complex of Burkholderia cepacia is one of the main and serious causes of infections in cystic fibrosis patients that can be highly transmissible. Small hospital outbreaks are frequent and are usually due to a single contaminated environmental source. The pulsed-field gel electrophoresis (PFGE) is widely used to identify the strain emission sources in cystic fibrosis patients. The aim of this research was to study genotyping of Burkholderia cepacia using PFGE method، and to evaluate diversity complex of clinical strains isolated from cystic fibrosis patients. This is a descriptive study، in which 100 pulmonary secretion specimens of cystic fibrosis patients admitted in Masih Daneshvari Hospital، Tehran Iran in period of 12 months 2012 to 2013 were collected. The specimens were cultured on BCSA plate’s. After incubation suspected colonies were isolated and identified by biochemical and phenotypic method. All samples were checked by API system (API20NE) and by specific PCR method for genus Bulkhorderia and Bcc as well. DNA was extracted by alkaline lysis method and confirmed by PCR analysis of recA genes. Genetic diversity of isolate was performed by PFGE analysis according to Pulsenet guideline by using XbaI، SpeI as restriction enzyme which digests infrequently among the Burkholderia cepacia genome. Out of 100 samples five were identified as Burkholderia cepacia. It is obviously different at variously reports. The electrophoresis data of PCR products and comparison of band in samples from patients with standard strain ATCC 25416 Burkholderia cepacia and compare and analyse the PFGE size marker bands of Salmonella choleransuis serotype Braenderup H9812 strain، were the same. Application of PFGE and identification of pulse-type is a potential tool to enhance the investigation of apparent nosocomial outbreaks of B. cepacia. Similar type of pulse patterns was observed in this study means that all of infection has been from one source; therefore the hypothesis of transferring person to person will be rejected. Base on these results environmental sources sampling should be considered in future investigation.

Cancer is the third cause of mortality in Iran. Approximately 5-10% of all human cancers are thought to be caused by occupational exposure to carcinogens. Diffuse mesotheliomas of the peritoneum and pleura are considered «signal tumors،» or pa-thognomonic of exposure to asbestos. There is also evidence that nonasbestos agents can induce malignant mesotheliomas. Then، we need to study the history of exposure to asbestos in patients suffering from mesothelima to determine relationship between them in Iran، especially in occupational settings. We received the data of 272 mesothelioma''s patients having been registered in 1385 to 1389 in Cancer Bureau، Ministry of Health. 154 of them had telephone num-ber. We could finally interview with 60 families and gathered data about patient''s his-tory of occupation، cigarette smoking and residence based on our designed question-naire. Then we brought out the variants of age، sex، the province of birth place and the involved organs from the data of Cancer Bureau. Analysis of frequency of variants was carried out and compared once in 272 patients being registered in Cancer Bureau and then in the interviewed 60 patients. Frequency distribution of age، sex، the province of birth and living place and the involved organ were similar in cancer registry''s data and the interviewed patients. Distribution of cigarette smoking and exposure to asbestos in the interviewed patients were 28% and 63% respectively. Occupational distribution of interviewed patients con-sisted of construction workers 20%، oil company employees 13. 3%، administrative staff 8. 3% and drivers 6. 7%. The results of our study specified the jobs with high risks of exposure to asbestos and approved the relationship between the exposure to asbestos and the inci-dence of mesothelioma in Iran، according to researches in other countries. So the con-sumption of asbestos in Iran، like 20 other countries in the world is necessary to be banned.

Primary cardiac tumors are rare tumors which should be operated urgently. In this study، cardiac myxoma have been evaluated from diagnosis until discharge in a 10 years period and then results including presenting symptoms، approach to the patients were compared with similar study in this center on one decade ago. Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Eighteen patients included in the study، 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5. 8 days and mean time from surgery to discharge was 8. 6±6. 1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to transe thoracic echocardiography (TTE)، in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94. 4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5. 6%) was recurrent. In 16 patients (88. 9%) tumor were found in the L. A and in one case، tumor was found in both atria and in another case، tumor was in the ventricle. After tumor excision، atrial septum was repaired primarily in seven cases (38. 9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77. 8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5. 6%). Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but advances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.

The renal sympathetic nerve activity (RSNA) is enhanced in renal failure. Paraventricular nucleus in hypothalamus is an important central site to regulate sympathetic activity. There are angiotensin II (Ang) II receptors in this nucleus. The aim of this study was to evaluate the effects of angiotensin II in hypothalamic paraventricular nucleus (PVN) on renal ischemia-reperfusion injury and RSNA. One week before the induction of renal ischemia-reperfusion (IR) in Sprague-Dawley rats، a cannula was inserted into the right PVN for microinjection of different doses of Ang II (3، 30، and 300 ng). Then right nephrectomy was done. After one week recovery، renal IR injury was induced by clamping the left renal artery for 45 minute and then reperfusion for 3 or 24 hour. Ten minutes before the induction of renal ischemia-reperfusion، administration of different doses of angiotensin II were done in different groups. In all animals، left renal sympathetic activity was recorded before and during renal ischemia. After 3 or 24 hours reperfusion the blood، kidney and brain were collected to assay renal function and histology and oxidative stress indices Superoxide Dismutase، SOD and Malondialdehyde، MDA) in PVN. Administration of different pharmacological doses of angiotensin II into PVN exaggerated the renal IR injury. Angiotensin II in different doses increased the plasma creatinine and BUN levels and renal histological markers in comparison to renal IR injury (P<0. 05). Angiotensin II had detrimental effects on RSNA and oxidative stress indices Super Oxide Dismutase (SOD) and Malondialdehyde (MDA) in PVN as the dose was increased (P<0. 05). These data showed that the PVN is a responsive site for central Ang II-induced damage in renal IR injury. We suggested the central effects of Ang II in the PVN on renal IR injury are mediated by oxidative stress in the PVN، and the peripheral effects by a sympathetic pathway.

Toxoplasma gondii، is a mandatory intracellular protozoa، that many people worldwide are infected with. In children، the infection enters central nervous system and leads to inflammation of the gray matter. Autism، is a complex developmental disorder، altering social communication، with unknown origin. Neuropathological changes in autism are the same as those occurred in brain toxoplasmosis. The objective of this survey was to evaluate positive serology of toxoplasma gondii، in autistic children. This case-control study was done on 3-12 years old children، referring to the neurology and psychiatry sub-special clinics of Baqiyatallah hospital and also autistic children of Omid-e Asr and Navid-e Asr general rehabilitation centers in Tehran، Iran. 40 autistic children were placed in the case group and 40 children، suffering from no neuropsychiatric disease or other ones، were placed in the control group. A folder، containing demographic data، type of the disorder، onset of diagnosis and child characteristics at birth، such as time of birth (preterm/ term) fulfilled for each child. Sampling was done with 5 ml blood، for determining IgM and IgG antibody levels against toxoplasma gondii، using ELISA method. Data analyzed by the software SPSS ver. 17 and descriptive and analytic analysis were done، using central and dispersion indexes and also chi-Square test. The autistic group contained 34 boys and 6 girls (85 and 15 percent respectively)، with the average age of 6 (±2. 71) years old [minimum of 2. 33 and maximum of 12]. The average age at the time of diagnosis was 4. 01 (±1. 87) years old. 87. The non-autistic group contained 17 boys and 23 girls (42. 5 and 57. 5 percent respectively)، with the average age of 5. 67 (±3. 09) years old [minimum of two and maximum of 12]. IgM and IgG serology of all autistic children were negative، while in non-autistic group، 2. 5 percent (1 child) were positive and 97. 5 percent (39 ones) were negative. There were no statistically significant difference among these two groups according to the serology results. (P=0. 31). There was no statistically significant difference in comparing positive serology of toxoplasmosis، between the two groups. However، to obtain a perfect result، a larger sample size are required.

Toxic shock syndrome (TSS)، a dangerous consequence of Toxic shock syndrome toxin-1 (TSST-1) caused by Staphylococcus aureus. The early detection for infections of Staphylococcus aureus in burned children is very important، also the prevention for consequences of TSST-1. Fever is one of the most noticeable sign in burned children. On the other hand، fever is one of the important consequences of TSST-1 production. This study aimed to assess the toxic shock syndrome toxin-1 level in the wound’s specimens of two groups febrile and afebrile in the hospitalized burned children in Motahari hospital Tehran، Iran in the year 2013. In this case-control study، 90 children who admitted to the burn unit، divided in two groups of 45 patients: febrile (cases group) and afebrile (control group). All of burned children under went wound biopsy، and then all of wound’s specimens were tested by PCR for specific primer of toxin producing genome. Finally all of data collected and statistically analyzed. This data include group febrile and afebrile، demographic characteristics، percentage of burned surface severity and result of PCR. The positive result for PCR test، production of TSST-1 in febrile burned children (cases group) was 37. 7% and in afebrile burned children (control group) was 11. 1% that this different was statistically significant (P=0. 003). The mean and standard deviation for percentage of burned surface (severity) in samples with positive result for PCR test was 30. 9±16. 93 and in samples with negative result for PCR test was 20. 09±11. 02 that this different was statistically significant (P=0. 01). There was no difference between positive PCR result and negative PCR result of age and sex. Direct association was approved between the production of TSST-1 and the occurrence of fever in burned children. Increased surface severity of burns also related to the production of TSST-1. Further research is recommended.

Surgery is one of the best choices for the treatment of hydatidosis. The use of effective scolicidal agents during surgery for hydatid cyst is essential to prevent the secondary infection. Up to now no effective and safe agent has been identified for this purpose. Berberis vulgaris called “Zereshk” in Persian has been traditionally used as herbal remedy for the treatment of complaints and it is widely cultivated in Iran. Many studies have shown that it has antibacterial، antifungal and antiparasitic effect. In this study the scolicidal effect of Berberis vulgaris aqueous and hydro-alcohol extract for different concentrations (for aqueous: 0. 5، 1، 2 and 4 mg/ml and for hydro-alcohol: 0. 25، 0. 5، 1 and 2 mg/ml) at different exposure times (5، 15 and 30 minutes) was evaluated. For this purpose، we obtained liver hydatid-cysts from a slaughter house. Viability of protoscolices was assessed by 0. 1% eosin staining. Normal saline and hypertonic saline were used as negative and positive controls respectively. All the different concentrations of Berberis vulgaris aqueous and hydro-alcoholic extracts had scolicidal effect. An aqueous extract with 4mg/ml concentration acted as positive control and we observed to lead to the death of 100% of protoscolices in the first 5 minutes. The least scolicidal effect (12. 3%) was observed in an aqueous extract with 0. 5 mg/ml concentration. The scolicidal activity of hydro-alcoholic extract with concentration of 2 mg/ml was 100% after 5 min of application، which was the same as positive control group. We noticed a significant increase in protoscolicidal activity with an increase in concentration in the two extracts of Berberis vulgaris (P<0. 001). It is important to mention that all the concentration levels and exposure times applied in this experiment are relatively low، since scolitical activity in both of the extracts is at its highest in this low spectrum. For further experiments، we suggest that the stability of cyst fluid in both of the extracts should be assessed. Therefore، after In vivo examination and additional experiments، it may be used as a suitable and effective scolicidal in surgery.

Laparoscopic cholecystectomy is a way of removing the gallbladder. But like other surgeries، this procedure has some side effects such as postoperative shoulder pain. This study evaluates the effect of different gas flow rates into the abdominal cavity on postoperative shoulder pain in laparoscopic cholecystectomy patients. The study as a randomized clinical trial was conducted on laparoscopic cholecystectomy patients in Imam Khomeini Hospital- Esfarayen 2011-2012. One hundred participants were selected by available sampling، and were divided randomly into two groups of 50 patients. In group I flow rate of CO2 gas was two liters per minute and in group II flow rate of CO2 gas was five liters per minute. After reversing anesthesia، six، 12 and 24 hours post operative، shoulder pain was evaluated by Visual Analogue Scale (VAS) pain questionnaire. The study findings analyzed by independent t-test. The mean age of participants was 48. 8±7. 5 years and mean surgery duration was 36. 5±13. 1 minutes، and there was no significant differences between two groups (P>0/05). However، the mean shoulder pain scores in group I (blowing with low pressure) was differed significantly with group II (blowing with high pressure) (P<0. 05). In group I، pain was lower than group II. Results showed that if CO2 gas flow rate be two liters per minute (blowing with low pressure)، the patients complain less shoulder pain. Therefore low pressure gas insufflation for laparoscopic surgery is recommended. Further studies in this field should be considered.

A balanced reciprocal translocation is a structural abnormality، which at least consist of breakage of two non-homologous chromosomes along with pieces exchange and form quadrivalant structure that can produce unbalanced chromosomes during meiosis I and result in a fetus abortion. The aim of the present study is to offer using preimplantation genetic diagnosis (PGD) 24sure array، which delivers aneuploidy screening of 24 chromosomes، within a few hours to increase fertility and bearing a child without chromosomal abnormality of this couple. This technique could replace embryo donation for child bearing of this couple.

A young couple with recurrent pregnancy loss in 6th and 7th week of pregnancy without family history of recurrent miscarriage and any clinical signs had conferred. All laboratory tests including hormonal، infections، semen and hysterosalpingography were normal except karyotype that showed balanced reciprocal translocation between chromosomes 5 and 18 in male. Chromosomal study of male parents showed normal karyotype.

A balanced reciprocal translocation carrier is phenotypically normal، but during meiosis І، carrier chromosomes cant pair normally and form quadrivalant instead of bivalant that depend on type of their segregation (alternate، adjacent 1، adjacent 2،3:1،4:0)، produce gametes that are chromosomally unbalanced which can result in early fetus abortion. Considering the number of abnormal gametes، the most effective way to help couples with this problem seems to be PGD 24sure، since it can identify reciprocal and Robertsonian translocation and allows concurrent screening of all chromosomes for aneuploidy. Another technique that can be compared with PGD 24sure is fluorescence in situ hybridization (FISH)، but it has several technical limitations such as it is expensive and complexity، in addition it has only few probes (for chromosomes 21، 13، 18، X، Y) so sometimes necessary to create patient specific protocols.