Iranian Journal of Medical Sciences
Volume:31 Issue: 4, Dec 2006

Helicobacter pylori (H. Pylori) infection is currently recognized as the major cause of chronic active gastritis, peptic ulcer disease and mucosa associated lymphoid tissue (MALT) lymphoma and carcinoma of the stomach. Eradication of the infection will prevent the recurrence of the majority of such diseases. Different combined treatments have been tried in Iran for eradication of H. Pylori, but the optimal eradication needs further evaluation. Herein, we have reviewed the eradication regimens of H. Pylori used by Iranian scientists during a 16 year period from 1990 to 2006, regarding the number, the type of drugs used, the duration, eradication rate, and their side effects.From 26 articles retrieved, 22 drug regimens were evaluated. Triple drug therapy was favored in our country, as it consisted of 63% of the regimens. But it could not achieve an optimal eradication rate. Of eight quadruple drug regimens, two led to an optimal eradication rate, with the highest eradication rate being 92% based on furazolidone quadruple regimen. But this regimen had significant side effects in more than 62% of the patients.The best first line treatment regimen for eradication of H. Pylori in Iran seems to be a type of furazolidone or clarithromycin based quadruple therapy for a minimum duration of two weeks. However, the patients should be monitored for furazolidone side effects. Furthermore, in metronidazole based quadruple therapy drug resistance is a major problem, even with doses of more than 1 gm/day. In patients with treatment failure, medication should be adjusted according to antibiotic sensitivity and newer antibiotic therapies, which is designed as clinical trials

It has been reported that several species of Helicobacter colonize the biliary tract of animals and human, but their participation in hepatobiliary diseases are not established. This study is undertaken to determine if Helicobacter genus members, especially with regard to H. pylori, could be detected in the bile and gallbladder diseases. Thirty-eight gallbladder tissues and thirty-six bile samples recovered from 38 patients with different gallbladder diseases were subjected to rapid urease test, culture and an established Multiplex-PCR using two pairs of primers based on 16s rRNA and isocitrate dehydrogenase genes specific for Helicobacter genus and H. pylori species, respectively. Bile and tissue samples from 40 autopsy gallbladders with normal pathology were tested by PCR as control group. In 4 of 36 bile samples H. pylori was identified using PCR. None of the tissue samples of the patients and controls were positive in PCR for Helicobacter DNA. We were not successful in isolation of Helicobacter using culture method. This study showed the presence of H. pylori DNA in the bile samples of a small sample size of patients with biliary diseases in south of Iran. We could find no pathogenetic role for H. pylori in the formation of hepatobiliary disease. To establish a clinical role for Helicobacter species in the hepatobiliary diseases, more studies on a larger group of patients and control groups are needed to ascertain whether Helicobacter species or their component might have a role as a causative agent or cofactor in the pathogenesis of biliary tract diseases in human.

After each natural disaster a comprehensive treatment protocol is needed for volunteers of healthcare personnel of the disaster zone. The aim of this study was to emphasize the psychological aspects of coping strategies, personality, psychological distress and pain of patients survived the Bam earthquake. Eighty-six patients who had suffered several kinds of psycho-cognitive and emotional impairment of the Post-traumatic stress disorder (PTSD) were selected six months after the earthquake. They completed a battery of questionnaires including the Hospital Anxiety and Depression Scale (HADS), Ways of Coping Checklist, Eysenck Personality Questionnaire (EPQ), and McGill Pain Questionnaire (MPQ). Multiple regression analyses and Correlation Analyses were applied for inclusion and exclusion of variables. Correlations were reported between the HADS, EPQ and MPQ. Both anxiety and depression showed significant positive correlations with five of the dimensions of MPQ. High levels of neuroticism were associated with greater use of denial and passivity. Psychoticism was negatively associated with external support, given the social withdrawal to be associated with psychoticism. Correlation analysis confirmed that high neuroticism was related to greater degrees of emotional distress. Anxiety and depression were both associated with increased scores in denial and passivity. Female patients were found to score significantly higher than males on the factor of “relying on external support”. The main problems of patients that survived from Bam earthquake were emotional distress, coping deficiency and adjustment disorders. It seems that psychological intervention might be more effective than the conventional medical treatments that were administered in the hospital.

Early warning of potential damage to spinal cord during major spinal surgery is highly desirable to prevent post-operative neurological deficits. Wake-up test is a simple, safe and reliable method of recognition of such a complication, and has been extensively used in many spinal surgical units. The present study is evaluating the remifentanil, propofol versus alfentanil, propofol as a part of balanced anesthesia for rapid performance of wake-up test during major spinal surgery. Fifty patients undergoing elective spinal surgery were randomized to receive either remifentanil/propofol (group A) or alfentanil/propofol (group B). Premedicated patients received remifentanil (a loading dose of 2 μg/kg and a continuous infusion of 1 μg/kg/min), or alfentanil (a loading dose of 25 μg/kg and a continuous infusion of 1 μg/kg/min). Propofol was given as a loading dose of 1.5 mg/kg and a continuous infusion of 100 μg/kg/min.The awakening was accomplished by withdrawing propofol and N2O at 20 and 5 minutes before the test, respectively, whereas remifentanil or alfentanil infusion continued through the wake-up period at a rate of 0.02 ug/kg/min. The onset of intra-operative neurological examination in remifentanil/propofol receiving group (4.6±1.4 minutes) was significantly faster than that for alfentanil/propofol receiving group (7.5±1.8 minutes). Combination of remifentanil and propofol induced a balanced anesthesia for intra-operative awakening and provided a faster opportunity for detecting any potential damage that may occur during spinal instrumentation.

Allergic fungal sinusitis is a non-invasive disease, and accounts for approximately 6-8% of all chronic sinusitis requiring surgical intervention. As the treatment and prognosis of these disorders vary significantly, it is extremely important to recognize allergic fugal sinusitis and differentiate it from chronic sinusitis of bacterial and fungal origin. This prospective study evaluates the occurrence of allergic fungal rhinosinusitis in patients with chronic rhinosinusitis with or without polyposis, who were surgically treated in Khalili Hospital during one year. The study comprised 38 patients with chronic rhinosinusitis with or without polyposis as case and 10 patients with chronic rhinosinusitis as control. The diagnosis of allergic fungal sinusitis was based on analysis of clinical, radiological, histological, mycological, and immuno allergic criteria. From a total of 38 patients, 9 were consistent with allergic fungal rhinosinusitis. Twenty-one patients had histological, clinical, and radiological findings suggestive of allergic fungal sinusitis but were negative for fungal culture. Some of these patients had characteristics that recently described as eosinophilic mucin rhinosinusitis. None of the control cases had histological or mycological evidence of allergic fungal sinusitis. Nine (23.7%) patients had findings consistent with allergic fungal rhinosinusitis. However, more specific diagnostic tests such as skin test and specific IgE should be performed to confirm the diagnosis.

Myopia has different prevalence rate worldwide and there is controversial points about its environmental risk factors. The prevalence of myopia in medical interns at Shiraz Medical School and its probable risk factors were studied. In this retrospective cross-sectional study, three hundred interns (7th-year medical students) at Shiraz University of Medical Sciences were examined by auto refractometer and subjective refraction. We Also administered a questionnaire to evaluate the age of the onset of myopia, the power of the first spectacles, and its power in the first year of medical school, parental refractive error, prematurity, mean amount of time spent for studying, sleeping, and TV watching per day among myopic students and a comparable control group. Ninety-two out of 300 (31%) interns had myopia over 0.5 diopters with similar age, sex, time spent for sleeping and studying as 88 randomly selected non-myopic controls. Parental myopia was reported in 54% of cases and 25% of controls (p<0.05). 60% of myopic interns had more than 0.75 diopters of progression during medical school years with similar age, sex, and time spent for sleeping and studying as 40% with less than 0.75 diopters of progression. Mean age of onset of myopia was 17.00±2.88 years with mean initial amount of -0.96±0.45 diopters in former subgroup, but in the latter subgroup, these were 13.84±2.99 years and -1.37±1.40 diopters, respectively (p<0.05). Those students with myopia progression during medical study had later onset with less amounts of initial myopia than those without progression during the same period.

There is a rapidly growing trend in the consumption of herbal remedies in the developing countries. The Phoenix dactylifera date palm pollen (DPP) is used in the traditional medicine for male infertility. The aim of this study was to determine the effects of orally administered DPP on the reproductive system of adult male rats. Fifty Sprague-Dawley rats were maintained according to standard laboratory conditions. They were divided into five groups (n=10) and received daily gavages of aqueous suspensions DPP containing 30, 60, 120 and 240 mg/kg, for 35 consecutive days. At the end the sperm was collected from ductus deferens under anesthesia and their numbers, motility, and morphology were determined under light microscopy. The DNA integrity or denaturation was also evaluated by acridine orange staining. The weight of the testis and reproductive appendages was also determined, and after tissue processing, their histology were studied by light microscope. The comparative evaluation between control and experimental groups revealed that consumption of DPP suspensions improved the sperm count, motility, morphology, and DNA quality with a concomitant increase in the weights of testis and epididymis. It did not significantly affect the weight of the prostate and the seminal vesicle or the histology of the reproductive tissues. Date palm pollen seems to cure male infertility by improving the quality of sperm parameters. However, further studies are needed to see its beneficial effects in man.

Saliva is an alternative biological matrix in drug testing. It has several advantages in comparison with other biological fluids such as blood and urine. Collection of saliva is simple, noninvasive and can be controlled under direct observation in drug abusers, or opium addicts. In the present study we report our experience with saliva collection, liquid-liquid extraction and quali-quantitation of morphine abuse. The GC-MS method was applied to the analysis and determination of morphine in saliva samples obtained from addicted persons. LOD of the method was 1ng/ml and LOQ 5 ng/ml, with acceptable within-and between-day reproducibility and a linearity (r2=0.998) over a concentration range from 5 to 500ng/ml. The results of this study indicated that saliva may have potential use for identification of patients suspected to drug abuse.

Respiratory problems are common after long bone fractures. The objective of the present investigation is to evaluate the effect of early fixation of femoral shaft fracture on the incidence of respiratory problems. The results of early and late stabilization of femoral shaft fractures were studied in 150 patients. The patients were divided into two groups according to the status of their fractures. Group I (n=123) had single and group II had multiple fractures including femoral fractures. The patients in each group were divided into two subgroups, depending on whether operated within 48 hours (early) or in a longer period (late) after injury. Serial arterial blood gas and chest radiographs were obtained to assess the acute respiratory distress syndrome, fat embolism syndrome, and abnormal blood gas values. Among 123 patients in group I, 63 were operated early after trauma, and the incidence of respiratory complications was 3.3% in comparison with 23.7% in the group II. Whereas, in group II, 14 patients were in early operated subgroup and 13 in late operated subgroup and the incidences of respiratory complication were 7.1% and 76.5% respectively. There was a significant difference in subclinical fat embolism between early and late operated subgroups in group II. Early fixation of femoral shaft fracture in patients with femoral fractures greatly reduces pulmonary complications.

Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures. The present study was performed on 56 patients, scheduled for elective endoscopic sinus surgery under general anesthesia, to examine the effects of topical TA on providing a bloodless surgical field and evaluate the bleeding volume. The study comprised 26 patients who received topical TA and 30 patients used placebo. The hemodynamic endpoints were to maintain the mean arterial blood pressure at 30% bellow its preoperative level. Intraoperative bleeding was assessed using a six point scale. There was less bleeding volume in the TA group than in the placebo group (174.0±10.6 vs 229.1±23.8 ml; P<0.05). The frequency of score 3 was 26% in TA group which was significantly lower than of placebo group (70%). The bleeding score of TA group was significantly lower than of placebo group (2.3±0.2 vs. 2.5±0.15). In conclusion it seems that topical application of tranexamic acid reduces intraoperative bleeding in endoscopic sinus surgery.

Conventional hydrostatic barium reduction or pneumatic reduction of intussusception is associated with considerable ionizing radiation. The aim of this study was to evaluate ultrasound-guided hydrostatic reduction for childhood intussusception using water enema. A total of 76 children who diagnosed as having intussusception were referred to Doctor Sheikh Children Hospital in Mashhad (northeast Iran) during a 4.5-year period from March 2002 to September 2006. Hydrostatic reduction of intussusception was performed under sonographic guidance in 66 patients, whereas, 10 patients were excluded due to clinical contraindications. The disease was observed mostly at the age of 5-9 months. In 53% of patients, there was a recent history of gastroenteritis or common cold. The most common site of intussusception was the transverse colon (49%) with the mean duration of 22.1±17.3 hours. The overall rate of successful reduction was 78.8% and the mean reduction time of 14.8±18.56 minute. The successful reduction rate would have been 94.5%, if the patients with gangrene were excluded. We conclude that ultrasound-guided hydrostatic reduction using water enema is an optimal, simple, and safe procedure for the treatment of childhood intussusception

Acute myelogenous leukemia (AML) is a hematological malignancy, which accounts for about 15-25% of childhood''s leukemia. Genetic factor is one of the most important predisposing elements in childhood acute leukemia, especially AML. In this case report, a rare presentation of familial AML is presented in three monozygotic triplets. Two were 10 months old, and the other one was 16 months old at presentation. Chemotherapeutic regimen was administered for all three sisters with good response and success in maintaining remission.

Echinococcus is endemic in some parts of the world but cardiac involvement with hydatid cyst is rare. Here, we report a 55-year-old man who developed right ulnar fracture and was scheduled for surgery. During routine preoperative evaluation abnormal findings in ECG were found. In echocardiography, a large mass was detected in the inferior wall of the left ventricle. Coronary angiography showed normal findings. The patient underwent cardiac surgery to excise the mass which later on identified as a hydatid cyst.

A 75-year–old patient was referred with vaginal bleeding. Her physical exam showed two flat dark plaques on the posterior fourchette, mostly on left lateral side of the vulva. A black soft mucosal nodule was present on the left lateral side of upper vagina, and a polypoid ulcerative cervical lesion extended into the right parametrium. Cervical and vaginal biopsies were in favor of malignant melanoma, while vulvar biopsy was in favor of lentigo maligna melanoma. The diagnosis was confirmed using immunohistochemical studies with S100 and HMB 45. The patient was treated by wide local excision of the vulvar lesion followed by high-doses of fractionation radiotherapy of the cervix and upper vagina. Due to advanced and aggressive melanoma of the cervix, in comparison to the lentigo maligna of the vulva, and the presence of vaginal melanomas on the opposite site of the cervical lesion, it is suggested that the origin of these two lesions are multi focal rather than the direct extension.

Esophageal cancer is a lethal disease with poor survival rate. It is necessary to determine the extension, and the stage of the tumor to predict the outcome of patients. Of the two common pathologic types, squamous cell carcinoma is still the most common form, and adenocarcinoma is the leading one. Early diagnosis and radical treatment of esophageal cancer, regardless of tumor spreading, increases the curability and the survival time to five years. Herein a case of cured esophageal cancer with 14 years survival without recurrence is presented. He was operated to remove the esophageal tumor. This can presumably raise the question whether the origin of the tumor or its involvement has to be appreciated as recurrence or new independent one.