Acta Medica Iranica
Volume:44 Issue: 4, July - Aug 2006

Fatty acids play important roles in biological systems and the newborns fatty acids requirements are covered only by the milk. It is of particular interest to qualify the content of the fatty acids in the milk. This study was performed to determine the levels of some fatty acids in the infant formulas and also to describe a method without derivatization for the fatty acids analysis and applying it to the control of infant formulas. Free fatty acids were produced by adding isopropanol- KOH to milk fat extract and heating it to saponify and acidify by H2SO4. Free fatty acids were extracted and were quantified by capillary gas chromatography on a fused silica column (AT-1000) and flame ionization detector. The average experimental values of lauric, palmitic, stearic and linoleic fatty acids contents of twenty infant formulas were 6.47, 16.52, 2.11 and 14.56 g/100g, respectively. The obtained experimental values of lauric and linoleic fatty acids contents of twenty infant formulas were in good agreement with the values proposed by standards of codex alimentary.

Since many years it has been a general belief in Iranian traditional medicine that unripe grape juice (verjuice) has lipid-lowering effect. This study was designed to test this hypothesis. Fifty rabbits were selected and divided into 5 groups with 10 rabbits in each. Group 1 had no supplemental diet. Group 2 were fed 10 ml egg yolk daily and group 3 were fed 10 ml egg yolk plus 20 ml verjuice daily for six weeks. In the second part of study, 20 rabbits rendered hypercholesterolemic by feeding egg yolk for six weeks, then they were divided into two groups: Group 4 received 10 ml of the egg yolk daily, and group 5 received 10 ml of the egg yolk plus 20 ml verjuice daily for the next 6 weeks. The plasma lipid profiles were measured at the beginning and then every two weeks. In the first part of study total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) concentrations in group 2 rose 10 times in comparison with group 1, but addition of verjuice in group 3 did not prevent rising of these values. In the second part of study, TC and LDL-C values rose in groups 4 and 5 in a parallel fashion. Changes in high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were not statistically significant throughout the study. In conclusion, this study did not support preventive or therapeutic effect of verjuice in hypercholesterolemia.

Wound healing in the skin depends upon the availability of appropriate trace metals as enzyme cofactors and structural components in tissue repair. The present study is a part of a series of experimental investigations to examine the influence of Bentonite on skin wound healing. Surgically induced skin wounds in 48 young adult male rats were exposed topically to Bentonite (12 round wound and 12 incisional wound) and control wounds (12 round wound and 12 incisional wound) received de-ionized water only. Skin wounds (round and incisional) treated with Bentonite exhibited no significant difference in margins with erythema and edematous changes. Scab and wound debris was more extensive and persisted for at least 7 days after surgery in control group (P < 0.05). Skin wounds exposed to Bentonite exhibited a mild retarded re-epithelialization, the treatment wounds were characterized by a prominent central mass of inflammatory cells, cell debris and wound exudate. The intense infiltrate of lymphocytes, macrophages, monocytes and fibroblasts extended from the wound margin into the region of the panniculus carnosus muscle and hypodermis. Vascular dilatation and dermal oedema were prominent features of these wounds. External utilization of Bentonite for wound healing is safe and feasible, and we finalized that macroscopic healing of wound that treated by Bentonite was superior versus control group.

Preeclampsia is a major cause of morbidity and mortality during pregnancy. Several independent investigators have demonstrated the association of androgens with hypertension. The main purpose of this study was to determine whether maternal levels of sex hormones, especially testosterone, are higher in patients with preeclampsia than in matched normotensive control subjects. Serum levels of testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S) and estradiol were measured in 60 subjects in the 3rd trimester of pregnancy with documented preeclampsia (including 30 cases of mild and 30 cases of severe preeclampsia) and 60 healthy normotensive women with similar maternal and gestational ages and body mass index (BMI) and neonatal sex. All subjects were primigravid with singleton pregnancies. Cases of polycystic ovary (PCO), diabetes, chronic hypertension and chronic systemic diseases such as lupus and patients using steroid hormones and anti-hypertensive drugs were excluded. Levels of testosterone, DHEA-S and estradiol were not higher in primigravid women with preeclampsia than in normotensive women with similar gestational and maternal ages, BMI and neonatal sex. There were no significant differences in sex hormones measured between groups of mild and severe preeclampsia and normotensive women. There were also no significant differences in sex hormone levels according to neonatal sex. These findings are against the hypothesis of mediating or amplifying role of high androgen levels in pathophysiology of preeclampsia.

Ashworth and modified Ashworth scales are the most widely used tests to assess the severity of muscle spasticity. These clinical scales offer qualitative and subjective information and consequently there are issues concerning reliability when two or more clinicians are involved in assessment of spasticity. This article presents the result of a study assessing inter-rater reliability of the original and of the modified Ashworth scales for the assessment of elbow flexor muscle spasticity in patients with hemiplegia. Thirteen patients with hemiplegia (8 men and 5 women) participated in this study. Two physiotherapists rated the muscle tone of elbow flexors according to the original and to the modified Ashworth scales. Each patient was assessed during a single session in a supine position on a bed with the arms at the sides of the body. Movements were performed three times by each assessor. No discussion of the results between the assessors occurred during the course of the study to ensure they were blind to each others’ results. Kappa values for the original Ashworth and the modified Ashworth scales were 0.22 (SE 0.27, P = 0.43) and 0.24 (SE 0.23, P = 0.24), respectively. The modified Ashworth scale was slightly more reliable than was the original scale but this difference was not significant (P > 0.05). Inter-rater reliability of the original and of the modified Ashworth scales in the assessment of elbow flexor spasticity was poor and therefore these spasticity scales may not be valid.

The formal study of human error is relatively recent, especially in medical domain, and is tied closely to a several other relatively new fields. Organizational root cause of human error is less considered. Despite growing social, industrial and scientific interest in the organizational causes of incidents, the concept of organizational failure and related tools are still less considered in many developing countries e.g. Iran. Also, there is few incident record-keeping in medical domain on human error. Therefore, this study draws on case study research to investigate the applicability of a European taxonomy of organizational failure in Iran, in aviation domain with a fair incident record-keeping. This case study resulted in 10 incident in-depth descriptions, which occurred during one year in a part of civil aviation due to operator error. Within each case study, an explanation building method is used to develop a tool for classifying organizational root causes. Results include 100 root causes. The distribution of organizational root causes over the main categories of the former taxonomy shows a need to add a new sub-category to improve its applicability in Iran. The new sub-category is related to culture.

Amyotrophic lateral sclerosis is a progressive neurodegenerative disease with uncertain etiology. For many years, viruses have been suspected as causative agents. There are conflicting reports about the possible role of viruses such as human herpes virus 8 (HHV8) and retroviruses in the pathogenesis of the sporadic amyotrophic lateral sclerosis. We conducted a prospective case-control study to investigate the association of seropositivity of HHV8, human T lymphotropic virus 1 (HTLV1) and human immunodeficiency virus (HIV) with risk of amyotrophic lateral sclerosis. Thirty patients with confirmed amyotrophic lateral sclerosis and 30 controls matched by sex and age were included in this study. Enzyme immunoassays for the determination of antibodies to HHV8, HTLV1 and HIV were performed on the serum samples of cases and controls. For HHV8, one in case group and one in control group were considered reactive for anti HHV8 IgG. For HTLV1 and HIV, the results were negative in both groups. This study does not support any association between seropositivity of HHV8, HIV and HTLV1 with amyotrophic lateral sclerosis.

The term ultra short is not clearly defined in ultrashort-segment Hirschsprung’s disease. The limited extent of the ultrashort-segment Hirschsprung’s disease allows for treatment with extended sphincteromyectomy. In anal sphincter achalasia, anal sphincter dilatation under general anesthesia may be sufficient to treat the condition; in cases with persistent constipation, sphincteromyectomy is indicated. Some investigators believe that the term ultrashort-segment Hirschsprung’s disease and anorectal achalasia are the same. Our study was performed to define the efficacy of transanal anorectal ‎myectomy and digital dilation under general anesthesia in children with ultra short-segment Hirschsprung’s disease and internal anal sphincter achalasia. A total of 87 patients were included in our study. Among these, 15 cases (17.24%) were female and 72 (82.76%) were male. In 12 patients (13.79%), the muscle strip had normal ganglion cells in both distal and proximal ends (group A). In 10 patients (11.49%), there was not any ganglion cell in both distal and proximal ends of muscle strip (group B). In 65 patients (74.71%), there were normal ganglion cells in proximal end with no ganglion cell in distal end of the muscle strip (group C). ‎There was no meaningful differences between group A, B and C in their outcome and partially or complete response to anorectal myectomy. We recommend the term “sluggish rectum” for these patients instead of ultrashort-segment Hirschsprung’s disease or internal anal sphincter achalasia that causes ambiguity in diagnosis and treatment of these cases.

Opium use is one of the most common forms of substance abuse in Iran and there are some evidence indicating it is a risk factor of transitional cell carcinoma (TCC) of the urinary bladder. The majority of opium users are also cigarette smokers, so consideration of the high prevalence of smoking which is the most important risk factor of TCC of the urinary bladder among opium users is essential to assess the role of opium use as a possible risk factor of TCC. This study was done to evaluate the role of opium as a risk factor of TCC. A case-control study was performed on 255 individuals diagnosed with TCC of the urinary bladder by pathologic light microscopic examination of the tumor biopsies. Control population was chosen from individuals who had no history or presenting signs or symptoms of urinary problems. Case and control groups were matched by sex and age and also by cigarette smoking habits. Forty-one (18.1%) of the cases and 12 (5%) of controls were recognized to be opium users. Mantel-Haenszel analysis showed an odds ratio of 3.88, with 95% confidence interval of 1.99-7.57 and P value of < 0.001. Results indicate that opium use is a risk factor for TCC. The majority of opium users are also cigarette smokers, which is another important risk factor for TCC. Routine urine cytology and early evaluation in the patients presenting with any of the symptoms of urinary bladder malignancy by means of cystoscopy and urine cytology are highly recommended.

Mediastinal tracheostomy is a complex surgical procedure for the management of airway reconstruction in patients whose distal trachea is not sufficiently long to be reconstructed as cervical tracheostomy after tracheal resection for malignant diseases. In this article (study), we present our 10 year experience of this uncommon procedure in thoracic surgery ward of Imam Khomeini''s Hospital, Tehran. Sixteen patients (87.5% male, 12.5% female, 58.4±1.4 y/o) underwent this procedure because of thyroid cancer (31.3%), SCC of cervical trachea (12.5%), postcricoid esophageal cancer (12.5%), and laryngeal cancer (43.8%). The procedure was associated with cervical exenteration in 12.5% and total laryngectomy (44%), thyroidectomy (6.2%), laryngopharyngoesophagectomy (12.5%), resection of neck mass (18.5%) and repair of cervical esophageal fistula with myocutaneous flap (6.2%).They had history of total thyroidectomy (25%), total laryngectomy (25%), cervical tracheostomy (13%), and hemi-laryngectomy (6%). Six percent of patients died because of uncontrolled intraoperative hemorrhage, and 94% were complicated with postoperative hypocalcemia (31%), osteomyelitis (13%), fistula (13%) and necrosis of the flap (13%).

Most often in the posterior of the mandible of patients who need implants, the inferior alveolar nerve (IAN) is too high to insert the implants, and the surgeons have to reposition IAN. In conventional techniques (to make the windows in the buccal aspect of the mandible) removal of the corticocancellous bone may cause weakness of the mandible. Here we present a new technique in which the bone is removed to a lesser extent and the IAN is best protected by the curet. This new technique is called the guard technique. As a primary report, evaluation of 11 patients (who were treated by this technique) is reported. There were few complications and IAN function was preserved in all patients. The mean time which the patients had temporary anesthesia was 7.3 days and the mean time that complete function of the nerve was returned was 3.3 months. Meanwhile the surgeon should also make an effort to make surgery and osteotomy far from the IAN. Most of the surgeons always avoid involving the IAN in a mandibular surgery; therefore, sometimes, they have to replace the IAN. Primary results of the new technique are promising.

Amyloidosis of the upper aerodigestive tract is rare in the pediatric age group. We present two cases of pediatric laryngeal amyloidosis. Both of them had hoarseness as the presenting symptom. Diagnostic evaluation included flexible nasopharyngoscopy, rigid laryngoscopy, biopsy, computed tomography scan and laboratory tests. The results of Congo red staining of the specimen were characteristic of amyloid. The most common area of reported laryngeal involvement have been the vestibule, followed by the false cords, the aryepiglottic folds and subglottic region. In our cases, the masses were limited to supraglottic larynx. Management depends on the severity of the symptoms regarding the individual patient.

Treacher Collin’s syndrome (TCS) is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. Patients with TCS present a serious problem to anesthetists maintaining their airway as upper airway obstruction and difficult tracheal intubation due to severe facial deformity. Because of retrognathia, airway management of these patients is often challenging. We report the case of a 25-yr-old patient with TCS undergoing microtia repair under general anesthesia twice. In the first time he could not be intubated via direct laryngoscopy and was intubated via blind nasal intubation. In the second time, he was intubated through an ILMA using endotracheal tube.

Idiopathic hypereosinophilic syndrome represents a heterogeneous group of leukoprolifrative disorders associated with prolonged eosinophilia of an undetectable cause with multi organ system dysfunction. It is a rare group disorder in children, most cases are reported in adult age group. We report a child with this syndrome who along with the usual features of the syndrome also had the presentation of cardiac and neurologic complications which did not respond to treatment.

BCG (bacille Calmette–Guérin) vaccine is administered worldwide to prevent severe forms of tuberculosis. It is considered to be safe; however, occasional complications are seen. The most serious complication is BCGosis. We report a case of BCGosis with granulomatous hepatitis and acid-fast bacilli in liver and spleen. We treated the patient with antituberculosis drugs without any response to treatment.