eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
59
62
article
Retroperitoneal Castleman disease: report of a case and review of the literature
Ali Ghafouri
aghafouri@sina.tums.ac.ir
1
N Mousavi
2
M Shamekhi Amiri
3
AR Soroush
4
Tehran University of Medical Sciences. Shariati Teaching HospitalSchool of Medicine, Kargar-e-Shomali Ave. Tehran, Iran
Shariati Teaching Hospital, School of Medicine, Tehran University of Medical Sciences
Shariati Teaching Hospital, School of Medicine, Tehran University of Medical Sciences
Shariati Teaching Hospital, School of Medicine, Tehran University of Medical Sciences.
Abstract Castleman disease or giant node hyperplasia is a rare disorder of the lymphoid tissue most often involving the mediastinal lymph nodes. We report a case of localized retroperitoneal hyaline-vascular type of Castleman disease. A 35-year old woman presented with mild epigastric pain with radiation to the back. Amild anemia was the only abnormal associated finding. Abdominal ultrasound and CT- scan showed a homogeneous well-demarcated mass beneath the pancreas. Excisional biopsy on laparotomy revealed a highly vascular encapsulated mass with a diameter of 6 centimeters. Histopathology examination was diagnostic: hyaline-vascular hype Castleman disease. Castleman disease, although rare, is one of the differential diagnoses of a retroperitoneal mass, most often discovered incidentally or due to pain and compressive symptoms. Excision is both diagnostic and curative for management of the localized form of Castleman disease.
http://mjiri.iums.ac.ir/article-1-277-en.pdf
Castleman disease
giant lymph node hyperplasia
localized
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
55
58
article
Cushing syndrome secondary to thymic carcinoid synchronous with tuberculous lymphadenitis and pulmonary tuberculosis: a case
F Esfahanian
1
A Sadeghi
2
Tehran University of Medical Sciences. Endoscopic Ward, 1st. Floor,Imam Khomeini Hospital, Keshavarz Boulevard, Tehran, Iran
Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran.
Abstract Thymic carcinoid is an uncommon neoplasm that can present with Cushing syndrome. We report a 39-year old woman with symptoms of Cushing syndrome secondary to thymic carcinoid and synchronous with tuberculous lymphadenitis and pulmonary tuberculosis.
http://mjiri.iums.ac.ir/article-1-276-en.pdf
thymic carcinoid
tuberculosis
Cushing syndrome
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
50
54
article
Aprospective randomized study comparing respiratory efficacy of percutaneous transtracheal and endotracheal, low-frequency jet ventilation during microlaryngeal surgery
Hassan Lal Dolat Abad
hassanlal@hotmail.com
1
Ali Reza Jalali
2
Department of Anesthesiology, Baqhiatallah University, No. 24, GolaraAlley, North Motahari St., Daria Boulevard, Saadat-Abad, Tehran, Iran
Department of Anesthesiology, Baqhiatallah University, Tehran, Iran
Abstract Background: Transtracheal jet ventilation is an alternative ventilatory approach in airway surgery. The purpose of this study was to compare respiratory efficacy of percutaneous transtracheal with endotracheal, low frequency jet ventilation during microlaryngeal surgery. Methods: Ninety ASA class I-II patients aged between 16 and 70 years undergoing elective microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups: Percutaneous Transtracheal Jet Ventilation (PTJV) group or subglottic Endotracheal Jet Ventilation ETJV via the Ben-jet tube group. Results: No significant differences in demographic data between the two study groups were observed. The understudy population included ETJV=42 (total) 25 men, 17 women PTJV= 48 (total) 34 men, 14 women. Age ranges were: ETJV: 43.83 ±11.52 yr, PTJV: 44.92±12.08 yr weight ranges were ETJV: 69.62±11.66 kg, PTJV: 71.33±11.57 kg BMI ranges were ETJV: 24.97±2.58, PTJV: 25.06±2.71. There were no significant differences between the measured pHa, PaO2, PaCO2 in two study groups at the initiation of operation. Significant differences were observed between measured PHa, PaO2 and PaCO2 during operation in ETJV group as compared with PTJV group. Conclusion: We conclude that ETJV procedure provides regular pulmonary gas exchange during microlaryngeal surgery and carbon dioxide elimination can be better maintained in this group compared to the PTJV group.
http://mjiri.iums.ac.ir/article-1-275-en.pdf
endotracheal
transtracheal
jet ventilation
microlaryngeal surgery
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
43
49
article
Appropriate use of vancomycin in an educational tertiary care hospital in Tehran, Iran
Ali Reza Nateghian
nateghian@hotmail.com
1
JL Robinson
2
B Samadi
3
N Abdi
4
Ali-Asghar Children’s Hospital, Zafar Ave, Shariati St, Tehran, Iran.
Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
Ali-Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
Ali-Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract Background: Inappropriate prescription of vancomycin has been shown to be asso- ciated with induction of antibiotic resistance. The objective of this study was to deter- mine the incidence of inappropriate use of vancomycin in a tertiary care hospital in Iran. Methods: A descriptive cross-sectional investigation was performed from September 2004 to March 2005 in all units of a general teaching Medical Center in Tehran. All adults and children who had vancomycin initiated in this medical center were enrolled in the study and the appropriateness of vancomycin use was determined according to Cen- ters for Disease Control (CDC) guidelines. Results: Forty-four percent of vancomycin use was inappropriate with the highest in- cidence of inappropriate use occurring in surgical units. The most common inappropri- ate indication for vancomycin was routine surgical prophylaxis. Conclusion: Inappropriate use of vancomycin is very common in a tertiary care hos- pital in Iran and could potentially be decreased by educating physicians about the CDC guidelines. These educational programs should target physicians in surgical units.
http://mjiri.iums.ac.ir/article-1-274-en.pdf
vancomycin resistance
inappropriate usage
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
38
42
article
Renal insufficiency after infrarenal abdominal aortic aneurysm reconstruction: An analysis of this risk factor in 45 patients
Mohammad Reza Kalantar Motamedi
Houman.KK@gmail.com
1
J Khoshnevis
2
H Khajouie
3
Ghods Square, Shohada-e-Tajrish Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract Background: Renal insufficiency is a potential complication after infrarenal abdominal aortic aneurysm repair and is a significant risk factor for postoperative mortality and morbidity. The aim of this study was to analyze the effect of this risk factor, before and during operation. Methods: In this prospective study, between 2003 and 2006, 45 patients underwent repair of an infrarenal abdominal aortic aneurysm. Elective surgical repair was performed in 34 patients and 11 patients underwent immediate surgical repair of ruptured aneurysms. There were 41 males and 4 females. The mean age was 68 years. The patients were divided into four groups depending on their preoperative serum creatinine (Scr), group I, serum creatinine less than 1.4 mg/dl, group II 1.4 < Scr< 2 mg/dl, group III 2 < Scr2.5 mg/dl. In each group postoperative changes in renal function were analyzed. Results: Several factors significantly influenced postoperative serum creatinine concentration and BUN level. These factors were: previous renal disease (diabetic nephropathy and renal artery stenosis), ruptured aneurysm and profound shock, blood transfusion greater than 4 units, duration of clamping time (greater than 2 hrs and 10 min), and age over 65 years. The postoperative rise in serum creatinine level was noted in 33 patients (73.3%) and BUN increased in 27 cases (60%), but only 2 patients out of these 33 patients required hemodialysis. Renal function recovery occurred after several days of surgery (3 to 5 days). Conclusion: The cause of renal dysfunction after elective or emergency repair of an infrarenal abdominal aortic aneurysm is multifactorial and the most important predictor is preoperative renal insufficiency, so special precautions are appropriate in such patients for prevention of this complication. Decreasing the aortic clamp time, operative time and blood loss, and administration of optimal volume loading seems to be essential.
http://mjiri.iums.ac.ir/article-1-273-en.pdf
renal insufficiency
infrarenal abdominal aortic aneurysm
hemodialysis
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
29
37
article
Gene assembling: a new approach in molecular diagnosis of hereditary breast cancer
Vahid Yassaee
vahid_r_yassaee@hotmail.com
1
A Dalton
2
Shahid Beheshti University of Medical Sciences, Koodakyar St., Daneshjoo Blvd,Velenjak Ave., Tehran, Iran.
North Trent Molecular Genetics Service, Sheffield Children’s Hospital, Western Bank, Sheffield - S102TH, UK
Abstract Background: Many disease susceptibility genes are large and consist of many exons in which point mutations are scattered throughout. Scanning each exon individually represents a tedious task which can be time consuming and expensive. There has been increasing demand for rapid and accurate methods for full scanning of unknown point mutations in large multi-exon genes. Gene Assembling is a new method for creating chimeric DNA molecules using a modified PCR reaction that allows maximizing the length of sequence that can be scanned by sensitive downstream technique. Methods: In the present study assembling of exons 2, 20, 23 and 24 of the BRCA1 gene and their subsequent analysis by direct sequencing is demonstrated. The BRCA1 exons 2 and 20 are hot spot regions that are known to harbor particularly deleterious mutations. In order to avoid missing any mutation in these two exons, the four exons previously mentioned were assembled in the following order of preferences: 23, 20, 2 and 24. However, the order of fragments can be predetermined by primer design. Results: The order and sequence of the component exons in the gene-assembled products were characterized by direct sequencing as predicted. Gene-assembled products from three previously ascertained heterozygotes for BRCA1 mutations were directly sequenced and gave the same sequence patterns. Conclusion: This experience suggests that Gene Assembling technique could be applied as a highly sensitive and cost-effective method in identifying mutation in complex genes such as BRCA and ColA1/2 helping clinical molecular diagnostic laboratories, to fulfill the demand for scanning complex genetic diseases at a lower cost.
http://mjiri.iums.ac.ir/article-1-272-en.pdf
gene assembling
breast cancer
mutation detection method
BRCA1
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
25
28
article
The frequency of post-stroke depression in an outpatient elderly population
Azizeh Afkham Ebrahimi
afkhami@iums.ac.ir
1
A Elahi
2
H Yousefi
3
Sh Nohesara
4
A Aghebati
5
Tehran Institute of Psychiatry-Mental Health Research Center, Iran University ofMedical Sciences, Tehran, Iran
Iran Psychiatry Hospital, Iran University of Medical Sciences, Tehran, Iran
Tehran Institute of Psychiatry-Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
Assistant Professor of Psychiatry. Rasoul-e- Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Iran University of Medical Sciences, Tehran, Iran
Abstract Background: The purpose of the present study is to determine the frequency and severity of depression in post-stroke patients. Methods: Based on a cross-sectional research design, 30 recent stroke outpatients were assessed with DSM-IV interview for depression and two self-rating depression scales, CES-D and BDI. Sex differences in depression, the relationship between depression and the location of the brain lesion and other clinical manifestations (sensory, motor and verbal) were also determined. Results: 68% of the patients reported depression on CES-D, among them 64% suffered from moderate to severe depression according to BDI and interview-based information. Women were more depressed than men (63% and 37% respectively). Differences were found in lesion side, with patients with lesions in right side reporting higher levels of depression than patients with left side lesions. Motor disturbances were the most prevalent clinical features. Conclusion: There seems to be an increased incidence of depression in stroke patients. The mechanism of pathophysiological processes underlying this association is poorly understood and is an important area for full investigation. Since depression is a significant risk factor for stroke it is important that psychiatric examination of post-stroke patients be conducted.
http://mjiri.iums.ac.ir/article-1-271-en.pdf
Stroke
Depression
CES-D
BDI
Location of the lesion
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
17
24
article
Early detection of renal scarring in children with suspected pyelonephritis: Comparison of diuretic MAG3 scintigraphy (F0) and DMSAScan
Hassan Otukesh
1
Seyed Mohammad Fereshtehnejad
sm_fereshtehnejad@yahoo.com
2
Amir Jalali
3
R Hoseini
4
A Bordbar
5
N Najimi
6
A Tabarroki
7
Iran University of Medical Sciences and Health Services, Labafi Nejad Hospital, Tehran, Iran.
Iran University of Medical Sciences
Shahid Beheshti University of Medical Sciences, Labafi-Nejad Hospital,Tehran, Iran
Iran University of Medical Sciences, Labafi-Nejad Hospital, Tehran, Iran.
Pediatrician, Iran University of Medical Sciences, Labafi-Nejad Hospital, Tehran, Iran.
Iran University of Medical Sciences and Health Services, Tehran, Iran.
Abstract Background: Screening for patients at risk of renal scarring is a challenge in children with acute pyelonephritis (APN). Diuretic Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphy with zero time injection of furosemide (MAG3-F0) was observed to display focal parenchymal disorders. The advantages of MAG3 include: lower radiation dose and short duration of the test. The aim of this study was to compare the role of Tc-MAG3 (F0) dynamic study and Tc-99m dimercaptosuccinic acid (DMSA) scan in early detection of renal scarring of children with suspected pyelonephritis in comparison to after-6-month Tc-DMSAscan as gold standard. Methods: 28 patients (56 renal units) with their first urinary tract infection (UTI) episode were evaluated prospectively for renal scarring with radioisotope scan. The patients were divided into 2 groups: Group Aconsisted of patients who underwent MAG3 scintigraphy in acute phase of pyelonephritis and Group B consisted of patients who underwent DMSA scan in this phase for renal cortical assessment. Follow up DMSA scan was performed for all patients in both groups 4-6 months after UTI episode. Results: The accuracy of MAG3-F0 scintigraphy and DMSA scan in detecting parenchymal changes in acute pyelonephritic phase were 89.3% and 96.4%, respectively. Positive predictive value (PPV) of both MAG3-F0 and DMSA was 100%. Whereas, negative predictive values (NPV) of MAG3-F0 and DMSA scan were 62.5% and 75%, respectively. Conclusion: Conclusively, if the MAG3 parenchymal image is abnormal, then there is renal damage but if this image is normal, a focal defect has not been excluded. Thus an abnormal MAG3-F0 precludes the need for a Tc-DMSAscan for detection of persistent renal damage in acute phase of pyelonephritis.
http://mjiri.iums.ac.ir/article-1-264-en.pdf
acute pyelonephritis
scar
dimercaptosuccinic acid (DMSA)
mercaptoacetyltriglycine (MAG3)
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
11
16
article
Psoriasis and infestation with Malassezia
Z Javidi
zari_javidi@yahoo.com
1
Maleki
2
Fata
3
Nahidi
4
Esmaeili
5
Hosseini
6
Department of Dermatology, Imam-Reza Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Dermatology, Imam-Reza Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Laboratory Sciences, Imam-Reza Medical Center, Mashhad University of Medical Sciences
Imam-Reza Medical Center, Mashhad University of Medical Sciences
Health & Social Medicine Dept., Quaem Medical Center, Mashhad University of Medical Sciences
Abstract Background: Psoriasis is a chronic proliferative condition of the skin. Its accurate pathogenesis has not been known yet, but interactions between genes and environmental factors have been implicated in its initiation. The role of malassezia in psoriasis is still undetermined, but several reports have associated these lipophilic yeasts with the development of skin lesions in psoriasis.Our aim was to investigate the correlation between malassezia and psoriasis. Methods: In this case control study over a 6 month period skin samples were obtained from lesions of 50 psoriatic and 50 healthy volunteers to evaluate malassezia infestation. Obtained data were collected by questionnaires and analyzed by SPSS software and applying statistical tests of χ2 and Mann-Whitney. Results: There was no difference between malassezia infestation in scalp lesions of psoriatic and control cases (P=0.86). Malassezia infestation in psoriatic patients with scalp involvement was more than those without it, but it was not a significant relationship (P=0.069). There was an inverse significant correlation between scalp infestation with malassezia and chronicity of psoriasis (P=0.04). This infestation in trunk skin of patients was less than normal individuals (P<0.000). Conclusion: There seems to be an initiating role in inducing immune mechanisms involved in the pathogenesis of scalp psoriasis by malassezia, but with chronicity and formation of dry and hyperkeratotic plaques, the environment will be inappropriate for malassezia, so malassezia infestation decreases with chronicity of disease.
http://mjiri.iums.ac.ir/article-1-263-en.pdf
psoriasis
malassezia
etiology
eng
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
2007-05
21
1
1
10
article
Screening for cervical cancer and precancerous lesions in Tabriz
M Jafari Shobeiri
jafarimsh@yahoo.com
1
Halimi
2
Dastranj
3
Shahamphar
4
Department of Oncology- Gynecology, Alzahra Hospital, Tabriz University of Medical Sciences, South ArteshAve, Tabriz, Iran
Pathology Department of Tabriz University of Medical Sciences
Pathology Department of Tabriz University of Medical Sciences
Social Medicine Department of Tabriz University of Medical Sciences
Abstract Background: Cervical cancer is the most common female genital tract malignancy and is the major cause of death from gynecologic cancer worldwide. The majority of cervical cancers develop through a series of gradual, precancerous lesions. Screening asymptomatic women with regular Pap smears allows diagnosis of the readily treatable preinvasive phase. We performed this study to determine the prevalence of precancerous lesions and assess the effect of demographic, pathologic and family economic factors on developing lesions. Methods: This cross-sectional, descriptive, analytic study was carried out on 6024 women under coverage of Tabriz health care centers. Pap smear was done in all subjects and questionnaires were filled by health providers. The data were analyzed with SPSS statistical software (version 12) and statistical methods such as chi-square and t-test. Results: Of 6024 Pap smears, 62 (1.02%) demonstrated precancerous lesions of which 41(0.68%) were atypical squamous cell of undetermined significance (ASC-US), 11 (0.18%) were low grade squamous intraepithelial lesion (LSIL) and 10 (0.16%) were high grade squamous intraepithelial lesion (HSIL). No invasive cancer case was observed in this study. According to our observation, the following factors increased the risk of precancerous lesions: multiparity > 3, abortion > 1, gravida >3, husband marriage >1. The protective effect of condom as a barrier contraceptive was observed. Conclusion: According to this study it is imperative to make readily available facilities for screening asymptomatic women all over Iran.
http://mjiri.iums.ac.ir/article-1-262-en.pdf
screening
precancerous cervical lesions
cervical cancer
risk factors
Pap smear