Archives of Iranian Medicine
Volume:4 Issue: 2, Apr 2001

Background-In recent years, flexible fiberoptic bronchoscopy (FFB) has been applied for diagnostic and therapeutic purposes. Premedication along with the passage of FFB into the airway, even in the presence of supplemental oxygen, may cause hypoventilation leading to hypoxia and desaturation. Arterial oxygen saturation is usually monitored with pulse oximetry (Spo2) during FFB; end-tidal Pco2 (ET-Pco2) monitoring is not routinely used. Methods-Two-hundred patients, ages 53±19 years (mean±SD), underwent FFB and received supplemental oxygen during various stages of FFB: 1-before and during instillation of lidocaine on the vocal cords, 2-during passage of instrument into the trachea, RMB, IMB, 3-during bronchoalveolar lavage, bronchial biopsy, transbronchial biopsy (TBB), and 4-at the final stages of FFB. ET-Pco2 changes were studied with a capnograph and Spo2 using a pulse oximeter simultaneously and the results were recorded.Results-Mean ET-Pco2 significantly decreased from 28.7±4.5 mmHg before FFB to 28±5.7 mmHg, 27.9±5.5 mmHg, 27.5±5.6 mmHg, 27.1±4.5 mmHg, 27.9±5.3 mmHg during bronchoscopy of the right main bronchus (RMB), left main bronchus (LMB), bronchial washing, bronchial biopsy and transbronchial biopsy (TBB), and at the termination of FFB, respectively (p<0.05). In 118 patients (59%), the decrease of ET-Pco2 was equal to or greater than 4 mmHg; in 105 patients (52.5%) the amount of decrease in Spo2 was = 5% and in 32 patients (16%), Spo2 decreased = 10%. No correlation was found between decreasing ET-Pco2 and Spo2 during the procedure.Conclusion- ET-Pco2 and Spo2 decreased during bronchoscopy. We also speculate that this reflects airway obstruction by the instrument. Further studies and more experimental analysis in this field is recommended.

Objective-The present study aims at examining the lymphomas in Iran and the similarities and differences with those of western countries. Methods-In a descriptive observational study, the histochemical and immunohistochemical markers were used to examine the biopsied specimens of 263 patients with Hodgkin’s and non-Hodgkin’s lymphomas collected from six diagnostic centers. The non-Hodgkin’s and Hodgkin’s lymphomas were classified according to the updated Kiel classification and Rye classification, respectively. Results-Out of the 225 cases that were diagnosed as lymphomas, 170 were non-Hodgkin’s and 55 were Hodgkin’s lymphomas. Sixty-nine percent of the Non-Hodgkin’s lymphomas were of the B-type, 6.5 percent of the T-type and the rest were Hodgkin’s lymphomas (24.5 %). Conclusion-The comparison made between the findings of this study and those of western countries indicates that high-grade non-Hodgkin’s lymphomas are more prevalent than low-grade lymphomas in Iran. The use of the updated Kiel classification reveals the similarities and differences between the lymphomas of our study and those of western studies. Such studies provide useful information for a more precise diagnosis and hence more success in the treatment of lymphomas. The results also call for more research into the reasons for the prevalence of high-grade lymphomas and rare occurrence of follicular lymphomas in Iran.

Background-With prevalent consanguineous marriages taking place in Iran, the probability of the incidence of some rare metabolic disorders are anticipated to be higher in this population.Methods-In a 10-year period, 128 families including 196 cases referred to the Dr. Karimi-Nejad Genetic Center with neurometabolic and neurogenetic disorders were evaluated. The diagnosis of suspected cases of "inborn errors of metabolism" were confirmed in collaboration with the Genetics and Metabolic Department of Erasmus University, Rotterdam. Results-Among the surveyed families, mucopoly-saccharidoses (MPS) was present in 41 families with 52 affected members, lipid storage diseases in 48 families with 77 patients and micromolecular metabolic disorders in 39 families with 67 affected members. In 50 families, prenatal testing showed 11 (22%) affected fetuses. In some instances, very rare metabolic disorders were observed, which were not previously reported in Iran.Conclusion-This study shows that in a population with high incidence of consanguineous marriages, some rare metabolic disorders are relatively common. Preventive measures including genetic counseling and detection of high-risk families by detailed investigation of index cases and appropriate family members are mandatory. Based on this information, detection of affected fetuses by prenatal testing is recommended.

Objective-The aim of this study was to determine the effects of ultrasound therapy on cell counts and the depth of healing of the rabbit’s skin scar.Method-Under general anesthesia and sterile conditions, four full-thickness incisions were made on the back of seven rabbits. The first, second, third and fourth wounds were selected for ultrasound therapy, placebo ultrasound, application of lubricant gel and betadine, respectively. Ultrasound therapy program (1 MHz, pulsed 2:8, 0.5 Watt/cm2 and 4 minutes duration) and other treatments were performed daily from day zero to day 30. On day 30, the rabbits were sacrificed by ether and tissue samples were prepared and stained with hematoxylin and eosin (H & E). The fibroblasts, macrophages, neutrophils and endothelial cells were counted and the depth of the scars and new epidermis was measured with special eye pieces. Finally, data was analyzed with the analysis of variance method. Results-The highest number of fibroblasts, macrophages and neutrophils belonged to the placebo group, the highest number of endothelial cells and depth of scars were present in the gel group, while the highest mean new epidermis depth belonged to the ultrasound therapy group. However, none of above-mentioned results were statistically significant.Conclusion-According to this study, ultrasound therapy has no beneficial effect on the incisional wound scar tissue of rabbit’s skin.

Background-According to a recent report published by the Ministry of Health and Medical Education of the I. R. of Iran, gastric cancer (GC) is the most common fatal cancer in this country and its prevalence is highest in Ardabil province, Northwest of Iran. This descriptive endoscopic survey was designed to determine the type of upper gastrointestinal (GI) malignancy in this high prevalence area.Method-This study was conducted in the first established subspeciality outpatient GI clinic in the city of Ardabil. From 11,518 patients who attended this clinic in a one-year period, 1,152 (10%) with persistent upper GI symptoms underwent upper GI fiberoptic endoscopy and 162 (14.1%) had a tumor with malignant appearance. At least six endoscopic punch biopsies were obtained from all the tumors and sent for histopathologic examination. Demographic data was obtained from all 162 patients. Statistical analysis was performed using the SPSS statistical software.Results-The mean age of the patients with cancer was 63.5 ± 10.8 years and the male to female ratio was 2.14:1. Villagers constituted 111 (70.7%) and urban dwellers constituted 46 (29.3%) patients. Upper GI cancer was diagnosed by histopathology in 157 patients (13.4%). Stomach cancer constituted 107 cases (68.2%), 53 (49.5%) of which were cancers of the gastric cardia and 50(31.8%) were esophageal cancer. The most common site of upper GI malignancy was the gastric cardia 53 (33.8%) followed by the antrum 32(20.4%), esophageal body 27 (17.2%), distal esophagus 23 (14.6%), and gastric body 22 (14.0%).Conclusion-Cancer of the gastric cardia is now the most common upper GI malignancy in Ardabil and constitutes almost half of all gastric cancers. It is recommended that subsite-specific gastric cancer risk factors, including H. pylori and dietary nitrates, be studied in the future in this region.

Objective-This study was conducted to determine the reference intervals for CD3+ (T cells), CD4+ (T helper/inducer cell, Th), CD8+ (T suppressor/cytotoxic cells, Ts/c), CD3+CD4+/ CD3+CD8+ ratio, CD19+ (B cells) and CD16++56+ (NK cells) in a healthy Iranian population. Method-Becton-Dickinson Immunocytometry Systems (BDIS) Simultest IMK-lymphocyte (dual color) reagents were used. The samples were first stained with appropriate monoclonal antibodies and then lysed using BDIS FACS lysing solution. The samples were analysed by BDIS FACS Caliber flowcytometry using the SimulSET software, version 2.5.Results- The study population consisted of 152 healthy, male and female non-smokers, 18 to 60 years of age. The mean CD3+ percentage was 69.95% for males and 71.46% for females, and the mean percentage of CD3+ CD4+ Th subset was 40.4% and 44.21% for males and females respectively. The mean CD3+ CD4+/CD3+ CD8+ ratio was 1.55±0.54 for male population and 1.7±0.65 for female populations. The mean percentage of B lymphocytes (CD19+) was 14.52% for the females and 13.08% for males. Conclusion- This study indicates that race, sex and age should be a consideration in the evaluation of the immune status.

Background-Hirschsprung’s disease has several surgical treatments, including curative surgery which consists of total or subtotal resection of the aganglionic segment followed by a pull-through of the normally innervated intestine. This study intends to assess the aftermath of two-stage endorectal pull-through procedures.Methods-Medical records of 62 patients (46 males, 16 females), who were treated for Hirschsprung’s disease during a 10-year period, were reviewed. Age, sex, extent of aganglionosis, primitive surgical procedure, age at colostomy, age at definitive procedure, number of stages, immediate and late postoperative complications, postoperative causes of death and time of the first postoperative defecation were retrieved in all patients. Results- Results showed that 61 patients had colostomy or ileostomy as the primitive procedure. Two-stage Soave Boley procedure was done in 54 cases; in 32 (52.4%) patients the Soave-Boley procedure was followed by appendectomy and tube cecostomy and in 22 (36%) patients, Soave-Boley pull-through was done without appendectomy and tube cecostomy. The results of the definitive operations were promising in 90.1% of the patients who gained normal defecation. Early complications were met in 9 cases (14.7%) and late complications were present in 14 cases (22.9%). The mortality rate was 4.9% (3 patients); the first patient had sepsis following ileostomy, the second patient suffered from enterocolitis 6 months post-operatively and the third patient died four days after treatment.Conclusions- By eliminating one of the stages in the surgical procedure, superior results with less complications are achieved. This in turn precludes the use of costly staplers. Altogether, the Soave-Boley procedure has proved to be a cost-effective and desirable procedure in comparison to other techniques in the treatment of Hirschsprung’s disease.

Background and Objectives-Differences in the activities or concentration of certain enzymes in cancerous cells and their normal counterparts have been well documented. The purpose of this investigation was to determine and compare the activities of arginase and rhodanese in selected normal and cancerous human tissues.Methods-Cancerous tissue specimens were obtained from surgically resected organs and normal tissues were obtained from fresh frozen corpses in the Forensic Medicine Center, Shiraz, Iran. Rhodanese was assayed by the modified method of Sorbo and arginase activity was based on urea determination. Results-In most cases, the activity of arginase in the cancerous tissues was higher than the normal tissues, but in the stomach cancer, the increase was significant (p<0.05). The comparison between the activity of rhodanese in the normal and cancerous tissues revealed variable results; the activity was higher in the breast cancer group while it showed significantly (p<0.05) reduced activity in the lung cancer.Conclusion-The results presented in this study indicated that arginase activity was higher in the cancerous tissues than their normal counterparts and this might be consistent with the role of arginase in ornithine biosynthesis. Different patterns of rhodanese activity in the malignant tissues and its reduced activity especially in the lung cancer has no satisfactory explanation in the medical literature

Background and Objectives-Although breast-feeding is highly appraised and widely practiced in Iran, human milk supplies all necessary nutrients except a few including vitamin D. Despite abundance of sunshine, vitamin D deficiency rickets is not rare in Iran.Methods-In a retrospective study, the medical records of all patients with rickets admitted to Bahrami Children’s Hospital in a 16-year (March 1982-1998) period who were below 6 months of age and not receiving vitamin D supplementation, were reviewed. Result-Forty-one cases of rickets less than 6 months of age without a history of vitamin D supplementation were detected. Convulsion was the most common presenting feature. Rachitic rosary and widening of the wrists were present in one-third of the cases while a quarter showed craniotabes. Ninety-five percent of the patients belonged to the lower socioeconomic class. Vaccination was not performed or was delayed and incomplete in 21 cases. Conclusion-Early occurrence and presence of rickets in breast-fed infants below six months of age with no vitamin D supplementation is documented in Iran. Health professionals should be informed of this risk and should supervise the oral administration of vitamin D in breast-fed infants and other measures, including sunlight exposure and vitamin supplementation in lactating mothers, should be encouraged.

Background-Chitosan, a polymer of glucosamine, appears to interact with bile acids and/or lipids in the intestinal lumen. As it is well established that the ingestion of some types of dietary fibers has been shown to influence lipid levels, it appears possible that chitosan may also influence protein metabolism.Methods-In the present study, we investigated the effect of chitosan on nitrogen metabolite concentrations in mice. Mice in the treatment group received 10 mg chitosan orally 2 times a day for 21 days. Serum urea and creatinine levels were measured in the test and control groups.Results-In the chitosan-treated group, serum creatinine levels were lower as compared to controls [0.63±0.13 (mean±SD, n=90) vs. 1.14 ± 0.21 mg/dl]. A significant decrease in average serum urea level was also observed after 28 days of chitosan ingestion by the mice in the treatment group [27.45±2.53 (mean±SD, n=90) vs. 39.68±2.47 mg/dl].Conclusion- Daily consumption of chitosan significantly reduced the serum creatinine and urea levels in mice, although there are no confirmed explanations for these effects. This work also provides an insight to the perspectives for using chitosan in clinical practice.