Medical Journal Of the Islamic Republic of Iran
Volume:18 Issue: 1, Spring 2004

Iran is recognized as an endemic area for lung hydatidosis. Surgical removal of some hydatid cysts may have setious morbid consequences. To determine the characteristics of these special cysts, a retrospective survey was carried out on patients admitted to Modarres Hospital in Tehran between 1989 and 1998. We have found that ruptured, bilateral, lung located, and giant cysts (>] 0 cm) cause more surgical and anesthetic complications, thus we named them "complicated cysts". Of 110 patients, 62(56.4%) had complicated hydatid cysts. Of these, 2 individuals died during anesthesia induction because of hypoxemia. Since sudden severe hypoxemia did not respond to all essential measures, the patients were returned to the supine position (from lateral decubitus position), then rigid bronchoscopy was performed for drainage of cyst secretions and fragments of laminated membrane. At the time of induction of anesthesia, the contents of a ruptured cyst may spill into the airway and cause hypoxemia and even death. In order to prevent this complication, two different approaches were used: (l)A chest tube was introduced into the cyst through the chest wall and its contents were drained; (2) Patients were placed in the sitting position during intubation. Double lumen endotracheal tube (DLT) may allow salvage of unaffected lung from inadvertent leakage of cyst contents or laminated membrane emboli formation, but it does not guarantee a safe operation. Thus, rigid bronchoscopy should always be available. Cystostomy was the most common surgical technique performed in our center (80%). Massive air leakage, bronchial fistula, and permanent lobar collapse were the main indications for lung resection in our series. Surgical complication rates of our study were higher than reports from the west. Coordination and cooperation of experienced surgeons and anesthetists can result in better outcomes following complicated cyst removal.

Massive cerebral infarction is often accompanied by early death, secondary to brain edema and trans-tentorial herniation. Several reports indicate beneficial effects of decompressive craniectomy in this situation, but the efficacy of this procedure is still a matter of debate. A n experimental study in a period of3 years was done on2 3 patients with brain edema due to massive cerebral infarction; 11 patients were subjects and were operated, and1 2 were in the non-operated group who only underwent conservative treatment. A ll patients in this study had GCS below 8. The m ean age of the operated patients was 54.5 yea r s and f o r the unoperated patients 64.4 yea r s. Mean GCS in the operated cases was 7.00 and in the unoperated cases was 7.66. In the operated g r o up 4 of 11 patient s lived (36.4%) and in the u l10perated group1 o f1 2 cases lived (8.3%). I n the living operated cases, 1 had GOS 4 and 3 cases had GOS 3. In unoperated cases 1 patient lived that had a GOS of2. These results show that decompressive craniectomy can be an effective lifesaving procedure for malignant brain edema after cerebral infarction and can also give acceptable functional recovery.

To describe and compare the clinical outcome of infants born to mothers with gestational and pregestational diabetes mellitus, this study was conducted between January 2000 to January 2002 in Tehran vali-E-- -Asr Hospital. Among 4472 deliveries, we found 107 infants born to diabetic mothers out of whom 6 were twins. The prevalence of diabetes in total deliveries was 2.39%. Mean age of gestational and pregestational diabetic mothers was 30.9 ±5.86 and 31 ± 5.37 respectively. 74 infants (69%) belonged to gestational diabetic mothers. 50% of infants were male. Mean birth weight of infants was 3067± 784.917 (700 -5600g). Gestational age in 57% of infants was less than 38 weeks.APGAR score at 1 & 5 minutes was <6 in 10 and 5 cases respectively. Hypoglycemia was detected in 31 %, hypocalcemia in 13%, hypomagnesemia in 4.5%, polycythemia in 6.8%, macrosomia in 28.6%, small for gestational age in 2%, respiratory distress syndrome in 8.2%, early sepsis in 9.2%, NICU admission in 23.7%, and hyperbilirubinemia in 34%. The incidences of most of these morbidities were higher in infants of pregestational diabetic mothers. The differences between the incidence of hypoglycemia, hypocalcemia & 5 minute APGAR score in infants of pre gestational and gestational diabetic mothers were significant (p<0.05). There was a significant correlation between the incidence of hypoglycemia and birth weight of infants (p< 0.05). The existence of congenital anomalies in infants of gestational diabetic mothers could be due to unrecognized cases of noninsulin dependent diabetes mellitus, and with respect to mean age of mothers it is advisable to detect diabetes before pregnancy in high risk groups and correct the level of hemoglobin Alc before pregnancy. Cleft palate and undescended testes among the anomalies support this hypothesis that prostaglandin deficiency may have a role in the pathophysiology of congenital malformations in these infants

The provocative effects of sleep deprivation (SD) on patients with seizure disorder and on the electroencephalogram (EEG) are well known. The purpose of the study was to test its routine use and usefulness in the pediatric and adolescent age group with, or suspect of having, seizure disorder, especially those presenting with first unprovoked seizure. Between September 2000 and November 2002, among patients referring to the author's clinic and the Pediatric Emergency Department of Nemazi Hospital, Shiraz, 598 children and adolescents were randomly assigned to a 10-minute surface EEG, either routinely, or after a period of partial or total SD. Those who refused or could not tolerate the SD procedure entered the routine group. The EEG's were analyzed for the presence of epileptic abnormality. Of598 patients, 5 44(91 %) had clinical seizures; the rest (54,9%) were seizure suspects or had seizure "mimickers" (syncope, night terrors, pseudo-seizures, etc). Of seizure patients, 210 (38.6 %) suffered from a first unprovoked seizure, and the rest (334,61.4%) had more than one seizure episode at the time of EEG performance. Abnormal epileptiform EEG's were more frequently seen in the group of seizure patients who were sleep-deprived before performing the EEG, as compared to the routine group. Conversely, more normal EEG's were seen upon routine performance of EEG (p value <00001, X2 = 76.5). Similarly, more abnormal sleep-deprived EEG's were seen in patients with first unprovoked seizure than when EEG was done routinely in this subgroup of patients. Patients with complex partial seizure had significantly more abnormal EEG's when subjected to SD (p<0000 1). Older patients could tolerate SD better than the younger age group; so more routine EEG's had to be performed in the younger age group. Younger children could only tolerate partial SD. There was no difference in the yield of EEG in patients with absence epilepsy between the two groups. In 5 patients with juvenile myoclonic epilepsy, S D precipitated a generalized tonic-clonic seizure which necessitated acute antiepileptic drug administration to the seizure activity. All patients with non-seizure episodes showed normal EEGs. In conclusion SD can be safely applied in the work-up of selected pediatric patients with seizure disorder, especially in those with their ftrst unprovoked seizure, in whom an abnormal EEG might dictate anti-epileptic drug therapy. Not all children with seizure disorder need to undergo SD for EEG, as it may not be necessary i n some, and intolerable in others. In non-seizure episodes, i f used in appropriate pediatric age groups, it can be very helpful to ensure that a seizure disorder is not present.

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retroperitoneal masses within a 4 year period (1998- 2001) preoperative fine needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases. This study showed that the sensitivity and specificity of fme needle aspiration cytology for the diagnosis of malignancy and benignity (positive or negative for malignancy) is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after fine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases.

Magnesium (Mg) deficiency has not usually been considered in clinical practice due to lack of relevant blood tests and because the symptoms are often vague and nonspecific. Serum concentrations may not adequately reflect Mg status. Mg Loading Test (MLT) can provide infonnation on total body Mg stores. We prospectively studied 21 critically ill patients (10 male, 11 female) admitted to the ICU, to investigate the prevalence of Mg deficiency. Their mean age was 50±21 years. To determine serum Mg, venous blood specimens were obtained just before the MLT. Mg sulfate (30 mmol) was infused during an 8-hr period and 24-hr urine samples were collected from the starting of Mg infusion. Although low serum Mg «1. 8 mmol/L) was present only in 2 patients, MLT showed Mg deficiency in 18 patients. MLT detected Mg deficiency in 13 out of 14 patients with normal serum Mg, in 2 out of 2 subjects with hypomagnesemia, and in 3 out of 5 cases with hypennagnesemia. 0f7 fetal cases, 6 occurred in individuals with hypomagnesemia (6118) and 1 death occurred in the nonnomagnesemic group (1/3). There was no relationship between Mg retention, age (r= 0. 33, p= 0. 63) and serum Mg concentrations (r= 0. 15, p= 0. 925). There was a significant correlation between Mg uptake and APACHE II score (r= 0. 46, p= 0. 035). In conclusion, Mg depletion is highly prevalent in ICU patients according to MLT. MLT is superior to serum Mg in determining actual Mg status in this group. Therefore, we suggest that MLT, and not serum Mg, should be carried out in patients when Mg deficiency is suspected.

The association of celiac disease and type I diabetes mellitus has been known for some time. This study was undertaken to investigate the prevalence of celiac disease (CD) in diabetic children and adolescents. Eighty-seven patients (44 females, 43 males) aged 2- 18 years, with type I diabetes participated in this study. A group of 87 healthy unrelated girls and boys matched for age and gender served as controls. They were screened for the presence of celiac disease related marker [IgA - endomysial antibody (EMA)] and patients who were EMA positive further investigated with intestinal biopsy. Among diabetic patients a 3.4% prevalence of celiac disease was observed, a value significantly higher than that found among healthy controls. Girls were more frequently EMA positive than boys. Intestinal biopsies of all 3 patients with positive EMA showed a histologic picture confirming the diagnosis of CD. Diabetics with CD were significantly younger, had an earlier onset of diabetes, had a lower height and weight standard deviation score and poorer glycemic control compared with diabetics without CD (p

The effects and interaction between cAMP-analogue dibutyryl-cAMP and calmodulin antagonists were investigated on de novo synthesis and secretion of lipids in cultures of hepatoma McArdle-RH7777 cells and normal rat hepatocytes. Dibutyryl cAMP caused a significant decrease in the secretion of de novo synthesized triacyl [3H] glycerol in both cultures of McArdle cells and rat hepatocytes. The inhibitory effect of dibutyryl-cAMP was concentration-dependent and appeared at the lowest concentration examined, 5 µM. Dibutyryl-cAMP at a concentration of 50 11M suppressed secretion of triacylglycerol by approximately 38% (p<0.05) and secretion of phosphatidylcholine by 30% (p<0.05). Dibutyryl-cAMP did not affect the synthesis of triacylglycerol and phosphatidylcholine, except at the highest concentration tested, 500 µM, where both triacylgJycerol and phosphatidylcholine synthesis were suppressed significantly. Anticalmodulin W-7 also inhibited secretion of newly made triacylglycerol in a concentration-dependent manner in both cultures of McArdle cells and rat hepatocytes. W-7 at a concentration of 20 µM suppressed triacylglycerol secretion by about 37% (p<0.05), while the secretion of phosphatidylcholine and synthesis o f triacylglycerol and phosphatidylcholine were not affected, unless at more than 20 µM concentration, at which both triacylglycerol and phosphatidylcholine synthesis were decreased significantly. The inhibitory effect elicited by dibutylyl-cAMP (100 µM) was not abolished in the presence of calmodulin antagonists, W-7 (20 µM), trifluo perazine (20 µM) and chlorpromazine (20 µM). The simultaneous effects of dibutyryl-cAMP and e ither calmodulin antagonists were not additive or synergistic. None of the calmodulin antagonists affected the cellular content of de novo synthesized triacylglycerol and p hosphatidy1choline significantly. Neither dibutyryl-cAMP nor any calmodulin antagonist or their combination did affect the overall rate of de novo synthesis of triacylglycerol and phosphatidylcholine. All calmodulin antagonists examined alone also had a net significant inhibitory effect on the secretion of newly made triacylglycerol. The results presented here suggest that calmodulin antagonists have net direct effects and hence could not overcome dibutyryl-cAMP-induced suppressive effects on the secretion of newly made triacylglycerol. The cell types, normal hepatocytes relative to hepatomas, did not influence the results.

The cytotoxic activity of natural killer cells is usually tested by radioactive assay CSI Cr release assay), which detects the release of cytoplasmic contents after plasma membrane disintegration of dying cells. In contrast to this indirect evaluation of cytotoxicity, the assessment of cell damage by flow cytometry aims to provide a more exact characterization of the death pathway via detection of the percentage of apoptosis and necrotic cells. Annexin V-FITC (Axv -FITC) can be used to label cells in the early apoptotic state, while propidiurn iodide (PI) indicates late apoptosis or necrosis. The NK cytotoxicity of cord blood (CB) and peripheral blood (PB) was determined after 4 hours of incubation in the absence of cytokines. After 4 hours in vitro incubation, co-staining with Annexin V-FITC (Axv-FITC) and propidiurn iodide (PI) pelmitted discrimination between viable, early apoptotic and necrotic cells. As we would expect, the cytotoxicity pathway in PB mononuclear cells (MNCs) consists of both apoptosis and necrosis pathways but in CB MNCs it almost consists of early apoptosis; and necrosis is negligible. With escalating E: T (effector: target) ratio changes in the percentage of apoptotic cells in PB samples were significantly higher than CB samples. The mechanism(s) of the low cytotoxicity of resting cord NK cells is not welllmderstood. Complementary research in this field is recognized to elucidate the phenotypical and functional properties of CB cells and how they relate to maturational stages. CB studies are important for transplantation research and may provide insight to the suppressive mechanism by which the host -recipient could evade GVHD and rejection.

Bacterial vaginosis (BV) has been considered to be the most prevalent infection found in sexually active women. BV is thought to play an important role in the premature rupture of membranes (PROM) and preterm birth. Preterm delivery accounts for a substantial percentage of low birth weight infants and perinatal mortality and morbidity. Bacteroides and Prevotella species have been isolated from the amniochorion of women with preterm birth and PROM. Women with> 104/mL Prevotella bivius (formerly Bacteroides bivius) have a 60-100% higher rate of preterm delivery. The purpose of this study was to determine wether some strains of Prevotella species isolated from PROM and BV patients produce proteases especially collagenase enzymes which faciliate the rupture of membranes leading to preterm birth. Vaginal specimens have been obtained from 120 women with BV and premature rupture of membrane in 30-44 weeks gestational age. Twenty anaerobic coccobacilli consisting of Bacteroides fragilis, black pigmented Bacteroides and Prevotella bivius were isolated and identified. The isolates were examined for protease activity, using porcine skine gelatin and casein as substrates by Martleys method. Elastase and collagenase activity were detected using elastin, guinea pig skin collagen, bovine achilles tendon col1agen, FALGPAand GP,VPKas substrates by Levenson method. Collagenase and elastase activity was detected in 90 and 100% of isolates. Gelatinase and caseinase activity was detected in 40 and 50 % of isolates. Collagenase produced by Prevotella bivia isolates was purified by ammonium sulphate precipitation, gel filtration and ion exchange chromatography. The collagenase was cleaved from the synthetic collagen substrate F ALGPA, and GP, VPK substrates. The activity of the enzyme was inhibited by EDTA, Antipain and PMSF. This study suggests that proteases produced by Prevotella bivia may be involved in the pathogenesis of premature rupture of membrane. PROM before 37 weeks has been reported to be significantly higher among patients with Bacteroides and Prevotella colonisation of the genital tract. The amniochorion consists of collagen and elastin which convey physical integrity to the placenta. Collagenase and elastase released into the genital tract may promote connective tissue destruction in the cervix and chorioamnion membranes.

The study has strived to compare the leucocyte-esterase stripe activity on sputum samples with gram-stained direct smear microscopy. This is for the demonstration of white blood cells (WBCs) and so to develop a simple method for selecting suitable sputum samples for cultural examination and laboratory diagnosis.. A total of 17(34.0%) out of 50 samples studied were shown to be unsuitable for microbiological examination and for identification of mycobacterial infection. Sputa of patients between the ages of20-29 years old were found to be more positive by demonstrating more WBCs and squamous epithelial cells (SECs). We believe this technique should offer an alternative to the conventional direct smear microscopy used for examining patient's sputa in our hospital laboratories.

In this descriptive cross-sectional study 14 national basketball team players attending the preparatory camp for the Asian games with mean age of 25. 6 ± 3.1 yrs, height of 191 ± 6 em,w eight of87.3 ±8. 1 kg and BMI of 23.9 ±1.7 were surveyed. The subjects underwent anthropometlic, aerobic power, body fat content and V02max measurements in three stages of the training period (before training, during training and before the actual competition). In two stages (before and during training) nutritional assessment and food intake using weighing method in 7 intermittent days was made. Anthropometlic measurements showed body weight and BMI changes during the period of study to be negligible and non-significant. Subcutaneous fat was reduced significantly (p< 0.02). Also V02max increased appreciably (p<0.001) from 42. 3± 3.3 in the first stage to 44.3 ± 4.4 and 44.5 ± 2.2 mL/ Kg body weight per minute in the second and third stage respectively which demonstrates the positive role of exercise on maximum oxygen uptake or V02max. The results of quantitative food intake assessment showed the energy intake to be at 3900 kcal per day. At this stage carbohydrate,f at and protein provided 50,35 and 15% of energy respectively. In the second stage energy intake was 3600 kcal with 55, 30 and 15% of energy coming from carbohydrate,f at and protein respectively which were in the normal range in both stages. Regarding vitamins and minerals, intake of iron, calcium and ascorbic acid was above the range, while thiamin, riboflavin and niacin were within the range and vitamin A as well as B6 were below the recommended levels. Further research regarding nutrient intake monitoring, nutrition education of athletes and coaches as well as international nutrition research offering a defined menu in preparatory camps is necessary.

In his book «Canon in Medicine (AI-Ghanoon)», Avicenna has specified a chapter containing two sections pertaining to fever. After defining fever and explaining it''s different stages, he divides it into three types: hectic fever, infection-induced fever and daily fever. After accurate attention to the patient''s history and key-points in examination, he focuses on fever signs and its treatment regarding each type of the three. In this article, we intend to discuss Avicenna''s views on fever in comparison to those of modem medicine.

Testicular schwannoma is a very rare benign scrotal tumor. It is a painless mass, but sometimes referred because of pain or sensory losses. Tumor markers are normal and radical orchidectomy is its best treatment. Here we present an unusual case of intrascrotal schwannoma in a 57 year old man, with a review of the literature.

Congenital cutis laxa is an exceptional condition. No large scale pedigree has been reported from Iran. We report a family with 106 members with two members affected with cutis laxa. Our cases were two patients (male and female) with pre- and postnatal growth retardation, cutis laxa, characteristic facies and other manifestations which proved that they were affected with cutis laxa. Their family history was studied and a large pedigree was drawn up. Based on the findings in their pedigree pattern, in addition to clinical and pathological studies, one can say that cutis laxa in this family is autosomal recessive. We also showed obligate carrier members in the family. Recent studies have shown that cutis laxa is a heterogeneous group of conditions both clinically and genetically. Autosomal dominant, autosomal recessive, X -linked and also acquired forms have been reported. Our study indicates that our case is an autosomal recessive type I. We discussed the pedigree that covers five generations.