2 1016-1430 Iran University of Medical Sciences 850 Dermatology THE ASSOCIATION OF THYMOMA AND SUPERFICIAL PEMPHIGUS IN AN OLD WOMAN DANESHPAZHOOH M b CHAMS C c NARAGHI ZS d AKHYANI M e ARAD S f GHODSI SZ g SOTOODEH S h b From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. c From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. d From the Departments of Pathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran e From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. f From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. g From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. h From the Departments of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran. 1 2 2001 14 4 411 413 18 09 2012 The association of pemphigus and thymoma is real, although rare. We report a 73-year-old woman presenting with cutaneous bullac and erosions superimposed on erythematous and urticarial plaques, and a positive Nikolsky sign. She. had a large mediastinal mass that proved to be a benign thymoma. Her skin biopsy and direct immunofluorescence test were suggestive of superficial pemphigus.
849 Surgery INTRALARYNGOTRACHEAL GOITER: A CASE PRESENTATION AND REVIEW OF THE LITERATURE DAVARI HR i i From the Department of Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, I.R. Iran. 1 2 2001 14 4 407 410 18 09 2012 Thyroid tissue located within the upper airway has received only sparse attention in the English literature. Aberrant benign thyroid masses may present as either an unrelated autopsy finding or with symptoms such as dyspnea, hemoptysis or adult -onset asthma. There is no place for medical management in the therapy of these lesions, although the appropriate surgical procedure is not clearly established. In this article a patient with respiratory distress and subglottic goiter is presented. She had subtotal thyroidectomy performed for goiter about 10 years ago. She was managed with tracheotomy and submucosal resection of subglottic thyroid tissue, followed by iodine ablation therapy and thyroid hormone replacement. 848 Pathology PANCREATIC SCHWANNOMA: A CASE REPORT TORABI-NEZHAD S j YOUSEFI YOSEF k HOSEIN-ZADEH MASOOD l j From the Departments of Pathology Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, IR. Iran. k From the Departments of Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, IR. Iran. l From the Departments of Pathology Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, IR. Iran. 1 2 2001 14 4 403 405 18 09 2012 Schwannomas may occur anywhere in the soft tissues or viscera, but do not commonly involve the pancreas and retroperitoneum. We present a case of benign pancreatic schwannoma which clinically simulated a malignant neoplastic process. 847 Gastroenterology THE ROLE OF ENDOSCOPY IN BILIARY ASCARIASIS: A CASE REPORT FROUTAN H m MANSOUR GHANAIE F n GHOFRANI H o m From the Department of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran n the Department of Gastroenterology, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, I.R. Iran o From the Department of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1 2 2001 14 4 399 402 18 09 2012 Biliary ascariasis is a common disease in certain geographical areas of the world. The adult form of the worm usually lives in the human intestine. Biliary complications due to ascaris infestation are uncommon but are becoming an important clinical problem, as fatal cases have been reported in the literature. Many authors have recommended traditional surgical treatment for removal of the worms. Since the development of endoscopy and related techniques, it has become possible to treat biliary ascariasis endoscopically. In this article, we have presented a case of biliary ascariasis which was diagnosed with ultrasonography and confirmed with ERCP. We have also assessed the role of endoscopy in the diagnosis and treatment of this disease in the literature. 846 Pathology INVASIVE GASTRIC MUCORMYCOSIS: REPORT OF A CASE AND REVIEW OF THE LITER ATURE GERAMIZADEH B p AZIZI S p From the Department of Pathology, Shiraz University of Medical Sciences, Shiraz, I.R. Iran. 1 2 2001 14 4 397 398 18 09 2012 Invasive gastric mucormycosis is a rare and fatal disease. We report a rare case with longstanding SLE who presented with fever. Autopsy showed multiple small shallow-based ulcers in the antrum. Histologic examination showed invasive mucormycosis. This is a rare case of invasive gastric mucormycosis localized exelusively in the stomach. 845 Neurosurgery PARAGANGLIOMA OF THE FILUM TERMINALE EXTERNUM AND CONCURRENT ARTERIAL HYPERTENSION: A CASE REPORT SABERI H JAHANZAD I HUSSAIN KHAN Z SAFFARIAN N From the Departments of Neurosurgery Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran From the Departments of Pathology Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran From the Departments of Anesthesiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran the Dept, of Cardiology, Baghiyatollah Hospital, Baghiyatollah University of Medical Sciences, Tehran, IR. Iran. 1 2 2001 14 4 393 396 18 09 2012 Paragangliomas are extra-adrenal counterparts of pheochromocytomas and are found at various anatomical sites such as the retroperitoneum, mediastinum, jugular foramen and carotid bifurcation, the latter two fonns being coined as chemodectomas. The vertebral column, especially the llUllbar zone, is one of the rarest sites to be involved by paragangliomas. These lesions may have secretory functions and produce symptoms and signs mimicking cathecholamine oversecretion as was noticed in our case. A 60-year-old woman with a sacral mass, backache, and cauda equina syndrome along with arterial hypertension is being presented who had been managed with antihypertensive medications. Magnetic resonance imaging revealed involvement of sacral canal and L5 and S 1 bodies producing a soft tissue bulge near the right buttock and computed tomography showed a destructive sacral lesion. Surgery was performed to resect the turnor mass and surprisingly the postoperative blood pressure reached the normal range and henceforth antihypertensive therapy was withheld. Tissue diagnosis of paraganglioma was made on the basis of histopathological examination and ascertained by immunohistochemical study for chromogranin, neuron specific enolase, synaptophysin and S 1 00 protein. One month later the tumor site was subjected to radiation for any remnants following surgery. After two years, the patient was found to be doing well and had been normotensive Without medications. Spinal paragangliomas are treated with total excision and irradiation for residual tumor, if present. The role of immunohistochemistry could not be overemphasized for diagnostic confirmation. 844 Pharmacology THE PROTECTIVE EFFECT OF INDOMETHACINE ON SULFUR MUSTARD-INDUCED OCULAR DAMAGE IN THE RABBIT EYE OSTAD SN KEBRIAEE-ZADEH A ZAREKAMALI R ABDOLLAHI M MARZBAN H AKHGARI M From the Department of Toxicology and Pharmacology, Faculty of Pharmacy Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. From the Department of Toxicology and Pharmacology, Faculty of Pharmacy Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. From the Department of Toxicology and Pharmacology, Faculty of Pharmacy Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. the Department of Anatomy and Embryology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. the Department of Anatomy and Embryology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. From the Department of Toxicology and Pharmacology, Faculty of Pharmacy Faculty of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. 1 2 2001 14 4 385 391 18 09 2012 Sulfur mustard, a bifunctional alkylating agent, causes severe eye injury. The injury is a result of late inflammation, which is mediated by prostaglandins. Theoretically, inhibition of prostaglandins by reagents such as indomethacine could result in alleviation of clinical adverse effects. In this study, the protective effect of topically applied indomethacine against sulfur mustard toxicity was assessed on the rabbit eye. Ocular toxicity was studied by using light microscopy, electron microscopy and visual inspection methods. Methods used in this assay showed that 100 µL of indomethacine solution (0.5% W N) two hours before exposure and throughout the experiment could markedly decrease the toxic effects of mustard. 843 Immunology INFLUENCE OF NERVE TISSUE-DERIVED NEUROTRANSMITTERS ON MAST CELL MIGRATION KERMANIZADEH P HAGAN P CROMPTON DWT From the Division of Immunology. Faculty of Medicine. Tabriz University of Medical Sciences. Tabriz. I. R. Iran . the Division of Infection & Immunity. Joseph Black Building. IBLS. University of Glasgow. Glasgow Gi2 BQQ the Division of Environmental & Evolutionary Biology. T he Graham Kerr Building.IBLS. University of Glasgow. Glasgow Gi2 BQQ. UK. 1 2 2001 14 4 379 383 18 09 2012 In vitro culture systems using bone marrow cells from BALB/C mice were set up in medium supplemented with spleen-derived medium. Bone marrow cells grown in spleen-derived medium gave rise to cultures containing >97% mast cells. The cells were used in polarisation chemotaxis assays with the intention of determining the effect of nerve tissue-derived neurotransmitters on mast cell migration. Some available neurotransmitters including (substance-p, histamine, serotonin, Dopa, noradrenaline, acetylcholine, aspartic acid, epinephrine and nerve extracts) were tested. Mast cells showed a significant morphological response to 10-3 and 10-4 M histamine, 10-9 M serotonin, and 10'2 M Dopa Nerve extracts induced some shape changes in mast cells. 842 Physiology EFFECT OF CYANIDE IN CARDIOPLEGIC SOLUTION ON ISOLATED RAT HEART FUNCTION SHACKEBAEI D From the Department of Physiology. School of Medicine, Kermanshah University of Medical Sciences. Kermanshah, I.R. Iran. 1 2 2001 14 4 373 378 18 09 2012 It has been known that cardiomyocytes possess a remarkable ability to downregulate their energy expenditure on restricted 02 supply. However it has also been speculated that an ability to suppress aerobic respiration and ATP utilization could be a protective response to prolonged hypoxia. Having the role of the cytochrome oxidase enzyme in mind, one can ask if its inhibition by using cyanide has a role in improving the heart's function after the cardioplegic period. In order to answer this question, the present study was carried out on two groups of rats. The test and control groups included 10 male rats. Each animal in both test and control groups received cyanide (LP., 1.6 mg/kg/ day) and saline (1 ml/day) respectively, and each heart experienced three stages: 1) normal activity, 2) cardioplegia, and 3) reperfusion stage. St-Thomas II cardioplegic solution was used while it contained 0.5 mmol/L cyanide in the test group. The results indicated that recovery percentage in the reperfusion stage, for the De.L. v.P. and dp/dt parameters were significantly higher in the test [(14S.1%±11.97) and (l30.97%±9.619)] than the control group [(91.62%±4.S9) and (96.1 %±4.91)] [(P<0.01) and (p<0.005)]. H.R. parameters, the rate of coronary solution flow, the variations of left ventricular diastolic pressure in the reperfusion period and tissue pathologic damages did not show significant differences between the two groups. These results indicated that the application of cyanide in cardioplegic solution induces an improvement of cardiac function in relation to the control group which is likely to be due to the impact of cyanide on cytochrome oxidase. 841 Parasitology and Mycology PRELIMINARY COMPARATIVE STUDY OF ENTAMOEBA HISTOLYTICA AND ENTAMOEBA DISPAR BY PCR TECHNIQUE IN IRAN FALLAH M HAGHIGHI A TACHIBANA H From the Department of Parasitology, School of Medicine, Hamadan University of Medical Sciences, Hamadan the Department of Parasitology, Shahid Beheshti University of Medical Sciences, Tehran, l.R Iran. the Department of InfectiOUS Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan 1 2 2001 14 4 369 372 18 09 2012 It has been suggested that two distinct species exist within what was originally known as Entamoeba histolytica and E. dispar. These are Entamoeba dispar for the nonpathogenic and E. histolytica for the pathogenic fonn. Differentiation of these two organisms is of great clinical importance since they are morphologically indistinguishable and both fonns can infect the human intestinal cavity. A study was carried out to differentiate E. histolytica from E. dispar by polymerase chain reaction (PCR) using two sets of primers (p11plus p12 and p13 plus p14) specific for either species of ameba. The extracted DNA was used for the identification of the species in the stool and culture media by PCR. A total of 16 samples, cysts and trophozoites, were analyzed. In all, 15 samples reacted with E. dispar primers, resulting in the expected 10 I-bp PCR products however, none of these reacted with E. histolytica primers. Only one sample reacted with E. histolytica primers. Because of high sensitivity of the PCR method and the high risk of laboratory contamination during processing and extracting DNA and its polymerization, and because of many existing cultures of E. histolytica in the same laboratory, the chance of contamination can not be ruled out in the single case of E. histolytica. This preliminary study could be an introduction for a PCR -based epidemiological study to detennine the importance of E. histolytica in Iran. 840 Physiology SUBTYPES OF α1-ADRENOCEPTORS IN RABBIT SAPHENOUS VEIN MOHAMMADI NAGHADEH M McGRATH JC From the Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, I.R. Iran the Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow, Glasgow G21 8QQ, U.K. 1 2 2001 14 4 363 367 18 09 2012 We investigated the a,-adrenoceptor subtypes of rabbit saphenous vein which has a mixed functional population of α1 and α2 -adrenoceptors. Lateral saphenous veins were obtained from male rabbits weighing 3.20-4 kg, which were killed by overdose with pentobarbitone sodium (i.v. injection). They were easily dissected out and placed in cold, oxygenated modified Krebs-Henselite solution (Krebs). Each preparation was cut transversely into 3-4 mm rings and suspended between thick wire supports. The vein rings were mounted in 10 mL isolated organ bath, bathed in Krebs maintained at 37°C and gassed with 95% 02 plus 5% CO2, Cumulative concentration-response curves (CCRC) were constructed by increasing the concentration of the agonists in half-log increments. The preparations were left for a further period of 45-60 min before re-exposure to the agonist. Competitive antagonists like prazosin and rauwolscine were incubated in preparations at least for 45 minutes prior to the onset of a second CCRC. The strategy was based on using the a1-adrenoceptor selective agonist, phenylephrine (PE). Prazosin, an α1 -adrenoceptor selective antagonist, competitively inhibited contractile responses to phenylephrine with a pA2 value of 8, WB-41 0 1 had a pA2 of 8.6 but a low Schild plot slope, while low potency was found with 5MU (PA2 7.2) and HV -723 (pA2 7.97). This data is not consistent with a definitive for αlA or αlN and taken alone the evidence from prazosin is in favour of αIL' However the selective α2- adrenoceptor antagonist delequamine inhibited phenylephrine-induced contractions. Overall the data is consistent with phenylephrine-induced contractions being mediated by a,- and a2 -adrenoceptors. The best estimate of the subtype of ajadrenoceptor mediating contraction is aiL due to the relatively low absolute pA2 values for prazosin. 839 Immunology DIFFERENTIAL EXPRESSION OF SURFACE MARKERS CD45RB AND CD44 ON MURINE CD8+ CELLS EBTEKAR M KHANSARI N SARRAFNEJAD A From the Department of Immunology, Tarbiat Modarres University, Tehran the Department of Immunopathology, Tehran University of Medical Sciences, Tehran, I.R. Iran. the Department of Immunopathology, Tehran University of Medical Sciences, Tehran, I.R. Iran. 1 2 2001 14 4 359 362 18 09 2012 Considering the emerging importance of phenotypic markers as indicators of cell function and differentiation, we studied patterns ofCD44 and CD45RB expression in CD8+ murine T cells with prior exposure to antigen or staphylococcal enterotoxin B ( SEB ). Following in vivo priming with two purified protein derivatives (one from a virulent WHO strain and the other from an avirulent strain), T cell enrichment was performed on murine spleen cells and followed by in vitro restimulation with SEB. Flow-cytometry studies were done to monitor the expression ofCD44 or CD45RB. Results indicate that primed or memory CD8+ cells do not display any significant change in the expression ofCD45RB. The expression ofCD44 exhibited significant variations among unprimed and primed mice and between different antigens. We were also able to see differential expression relevant to the virulence of the bacterial strain. This study suggests that by activation of those populations ofCD8+, CD44+ cells, resistance to virulent bacteria occurs. 838 Pharmacology ANTISPASMODIC EFFECT OF AERIAL PART OF TEUCRIUM POLIUM L. ESSENTIAL OIL ON RAT ISOLATED ILEUM IN VITRO SADRAEISADRAEI H HAJHASHEMI V GHANNADI A MOHSENI M From the Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran. 1 2 2001 14 4 355 358 18 09 2012 Teucrium polium L. (Lamiaceae) is used in the traditional medicine of Iran for the treatment of disorders of the gastrointestinal tract. The essential oil from the aerial parts of T polium was assessed for antispasmodic activity and compared with the effect of atropine and dicyclomine. Acetylcholine and KC I were used for induction of contraction on rat isolated ileum. Teucrium polium essential oil (TPEO) at concentrations of 8.6 to 34.4 µg/mL attenuated the maximum inducible response to acetylcholine concentration-response curve. It also inhibited the response to 80 mM KC I in a concentration dependent manner (pD2= 1.2±0 .13). Dicyclomine (3.46 & 34.6 ng/mL) also reduced the response to acetylcholine on rat isolated ileum and inhibited KC1-induced contractions while atropine only inhibited the response to acetylcholine. This study shows that TPEO is a relaxant of rat isolated ileum and may have some clinical benefits for gastrointestinal disorders such as colic. 836 Biological Sciences THE EFFECT OF ASCORBIC ACID ON BLOOD HISTAMINE LEVEL AND DELAYED-TYPE HYPERSENSITIVITY IN GUINEA PIGS JALALI M NEYESTANI TR KESHAVARZ SA SIASSI F From the Department of Nutrition and Biochemistry, School of Public Health & Institute of Health Research, Tehran University of Medical Sciences, P.o.Box 14155-6446, Tehran the Department of Biochemistry & Nutrition, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran From the Department of Nutrition and Biochemistry, School of Public Health & Institute of Health Research, Tehran University of Medical Sciences, P.o.Box 14155-6446, Tehran From the Department of Nutrition and Biochemistry, School of Public Health & Institute of Health Research, Tehran University of Medical Sciences, P.o.Box 14155-6446, Tehran 1 2 2001 14 4 351 354 17 09 2012 The effect of ascorbic acid on blood histamine level and delayed-type hypersensitivity was studied in thirty male guinea pigs. Animals were sensitized to B.C.G., trichophytin and mallein during the first four weeks. The diet was ad libitum during this period. After this "sensitization period" animals w er e tested intradermally with tuberculin, trichophytin and mallein. The number and diameter of positive delayed type hypersensitivity responses (antigenic and cumulative scores) were evaluated as an effector state of cell mediated immunity. Animals were fed low, adequate or high ascorbate diets (0.5, 2.0 or 50 mg ascorbate x 100g body wt-1xd-1) for the next four weeks. Antigenic and cumulative scores were evaluated after this period once again. Mean liver ascorbate paralleled dietary intake and the values obtained w er e significantly different in the three groups. Blood histamine was significantly depressed in the high ascorbate group compared to the adequate and low ascorbate groups, and liver ascorbate was inversely correlated to blood histamine levels (r= -0.97, p<0.001). Although mean antigenic and cumulative scores in the low ascorbate group were lower than those of adequate and high ascorbate groups, the differences were not significant. It was concluded that ascorbate may enhance immune function through detoxifying histamine, an immunodepressor compound. However, the immunostimulatory effect of ascorbate on cell mediated immunity was not confirmed in this study. In chronic ascorbate deficiency, there may be a predisposition to infectious diseases due to depressed immune function, at least because of disturbances in metabolism of other nutrients influencing immune responsiveness, especially iron and folate. 835 Pediatric STUDY ON THE EF FICACY OF RECOMBINANT HEPATITIS B VACCINE IN IRANIAN INFANTS ZAMANI A SHAJARI H SEDIGHY I From the Departments of Pediatrics School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. From the Departments of Neonatology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. From the Departments of Pediatrics School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran. 1 2 2001 14 4 347 349 17 09 2012 In order to determine the efficacy of recombinant hepatitis B vaccine in Iranian infants, we analyzed the efficacy of a recombinant hepatitis B vaccine in 115 infants aged 12-24 months born to HBsAg negative mothers who received three doses of HBV Antibody to hepatitis B surface antigen (anti-HBs) was checked after the third dose of the vaccine, 94.8% of the infants had developed protective antibody levels. The vaccine was well-tolerated and no serious adverse effects were reported. This study is in agreement with a WHO report which recommends that the easiest and most cost-effective strategy for the control and eventual eradication of HBV would be to immunize all newborns with hepatitis B vaccine only [World Health Organization report, 1984]. 834 Surgery IS BILE SCOLECIDAL? A. IZADPANAH A From the Department of Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, I.R. Iran 1 2 2001 14 4 343 345 17 09 2012 Spillage of scoleces is a major problem in surgery of hydatid cysts, because each of them may develop into a new cyst if it settles on a suitable site such as the peritoneum. Many surgeons believe that scoleces in ruptured hydatid cysts of the liver containing bile are not able to develop new cysts, because bile kills thein. In order to prove this idea, the viability of scoleces in such cysts was assessed and the effect of bile on live scoleces of unruptured liver cysts of sheep and human beings was also assessed in the laboratory. It was concluded that bile is not scolecidal, and an unfavorable environment is the cause of death bf the •scoleces. Scoleces in ruptured cysts may be alive and able to develop a new cyst. Therefore the surgeon should use all necessary precautions to prevent spillage. 833 Gynecology & Obstetrics ENVIRONMENTAL FACTORS AND POLYCYSTIC OVARIES JAHANFAR SHAYESTEH EDEN JOHNA From the School of Obstetrics and Gynecology, Royal Hospital for Women, Sydney, Australia N. S. W. University 1 2 2001 14 4 337 342 17 09 2012 This study was designed to investigate the effect of environmental factors on the appearance of polycystic ovaries (PCO) during the first two decades of life. Ninety-four female-female twins who underwent a transabdominal ultrasound at the Royal Hospital for Women were sent a questionnaire asking about their birth details, feeding history as a baby, childhood illnesses and vaccination as well as exercise patterns. Seventy-seven subjects returned the questionnaire. All of the variables were studied in two groups of subjects those with ultrasound evidence of polycystic ovaries (US-PCO, n= 37) and those with normal ovaries (US-normal, n= 40). The data were also analyzed in a group of scan-discordant twins (7 pairs) in whom one of the twins had US-PCO and the co-twin had normal ovaries. Analyzing the data from the whole database suggested that US-PCO subjects had lower birth weight compared to US-normals. Vaccination against mumps was also found to be significantly higher in the US-PCO group compared with US-normals. Matched results for scan-discordant twins did not confirm these results. Other environmental variables such as feeding history, type of delivery, birth order and physical activity during the first 20 years of age did not seem to have any significant influence on the prevalence of PCO. No significant difference was found in childhood illnesses between the groups. In conclusion, this study examined the effect of some environmental factors during childhood and early adulthood. Analyzing the whole database and scan-discordant twins failed to show any particular environmental factor associated with PCO. 832 Pediatric EVALU ATI ON OF THE CAUSES OF CHOLESTASIS IN INFANTS FARAHMAND F From the Department of Pediatric Gastroenterology, Children s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran. 1 2 2001 14 4 333 335 17 09 2012 During a period of three years from 1996 to 1998, 124 infants (64 male and 60 female) with an age range of 1-6 months (mean age 1.5 months) with cholestasis were studied. Idiopathic neonatal hepatitis was the most common cause of cholestasis, accounting for 48 cases with a rate of 3'8.70% in a total of 124 patients, followed by galactosemia in 29 patients (23.38%) and extrahepatic biliary atresia in 20 patients (16.12%). The prompt identification and diagnostic assessment of these infants are imperative to early surgical intervention (e.g. in biliary atresia) and specific medical therapy (e.g. in galactosemia) and in order to institute effective nutritional and medical support to allow optimal growth and development and prevent progressive liver disease and death. 831 Biological Sciences EFFEC T OF HEMODI ALYSIS ON TRACE ELEMENTS IN PATIENTS WITH ACUTE AND CHRONIC RENAL FAILURE GHORESHI Z AHALEY SK RASOOLI I From the Department of Biochemistry, Government Medical College, Miraj, India, and the Dept. of Biology, Shahed University, Tehran, I.R. Iran. 1 2 2001 14 4 329 331 17 09 2012 Hemodialysis is being implicated in the development of metabolic disturbances, as complications have been observed and the role of trace metals in their development has been questioned. In 78 renal failure patients who underwent hemodialysis, serum levels of zinc and copper were determined before and after first hemodialysis. Acute and chronic renal failure patients were found to have lower serum zinc levels before hemodialysis and higher levels after hemodialysis, while serum copper levels were found to be higher before hemodialysis and to increase further after hemodialysis. Disturbances in acid-base balance lead to acidosis which can alter the binding, transport and excretion of these elements. Dialysis fluid containing salts of trace elements may have also contributed to this alteration of trace element levels. 830 Biostatistics and Epidemiology REFERENCE CHARTS FOR ARM, CHEST AND HEAD CIRCUMFERENCES OF SOUTH IRANIAN INFANTS AYATOLLAHI SMT From the Department of Biostatistics and Epidemiology. School of Public Health, Shiraz University of Medical Sciences, P. 0. Box. 71345-1874, Shiraz, Islamic Republic of Iran. 1 2 2001 14 4 321 327 17 09 2012 The reference charts for mid upper arm (MUAC), chest (CHC) and head (HC) circumferences of a cohort of 317 healthy infants (153 boys and 164 girls) born in Shiraz (Southern Iran) and monitored from birth for 2 years are presented. Centiles for MUAC and HC lie below the Netherlands and US subjects respectively. However, there is no suggestion of ill health for Iranian subjects. The use of locally based MUAC, HC, and CHC charts are essential for clinical work in Iran. Operational simplicity and measurement validity and accuracy suggest that monitoring these measurements should be performed both by health workers in the Iran primary health care system and by mothers for preventive measures as well as child health promotion and development. The paper concludes that the charts presented here are likely to be applied to the urban infant population of Iran due to its structural representativeness and sophisticated methodology. 829 Surgery Z-PLA STY FOR TREATMENT OF THE RESIDUAL CAVITY AFTER P ILONIDAL SINUS EXCISION BEHDAD A HOSSEINPOOR M From the Department of Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, I.R. Iran. 1 2 2001 14 4 317 319 17 09 2012 In order to evaluate the outcome and complications of Z plasty in pilonidal cyst repair, 90 patients with pilonidal cysts of the natal cleft were selected and repaired by Z-plasty in Al-Zahra hospital. The patients were followed for 6 months and complications such as seroma, infection and relapse were evaluated. The incidence of seroma, infection and relapse after Z-plasty was 12%,3.3% and 3.6%, respectively. These results show that Z-plasty is an effective form of operation for pilonidal cyst treatment. 828 Surgery EARLY POST-OPERATIVE RESULTS AFTER TOTAL CORRECTION OF TETRALOGY OF FALL OT: THE EXPERIENCE IN SHIRAZ, IRAN NAVABI SHIRAZI A ALAVIAN GHAVANINI A SAJJADI S From the Cardiac Surgery Division, Department of Surgery, School of Medicine, Shiraz University of the Center for Research Consultation, School of Medicine, Shiraz University of Medical Sciences the School of Medicine, Shiraz University of Medical Sciences, Shiraz, l.R. Iran 1 2 2001 14 4 311 316 17 09 2012 In order to compare early post-operative results in primary versus two-stage repair of tetralogy of Fallot at Shiraz University of Medical Sciences, one􀁱hundred and eleven patients with tetralogy of Fallot with right ventricle to pulmonary artery continuity and no other major associated anomaly were repaired in one center by one surgeon in a one or two-stage protocol. Those patients who were initially palliated with shunt were either referred from other centers for total correction, presented with cyanotic spells, or were shunted due to their severe and diffuse right ventricular outflow tract obstruction or pulmonary artery branch stenosis or hypoplasia. Hospital mortality and ratio of right to left ventricle pressure after correction were compared between the primary and the two-stage groups as early outcome indices. The patients were also divided to those who needed a trans-annular (TAP) or a sub-annular patch and were compared. In the primary group, 25 (37.3%) of the patients needed TAP, while in the two-stage group 28 (63.6%) needed TAP. Requirement for TAP was increased significantly with two-stage correction (p= 0.006, relative risk= 1.71, 95% CI= 1.16-2.5). Mortality was significantly higher in the primary group (p= 0.03, relative risk= 3.94, 95% CI= 0.93-16.76). In the primary group TAP significantly increased the mortality risk (p= 0.006, relative risk= 5.04, 95% CI= 1.5-16.89). In the two-stage group, there was no significant difference in the mortality rate between the patients with and without TAP. The TAP group had statistically significant less time interval between shunt and total correction. Our patients generally did better on two-stage repair, because of their older age at operation. The long period of low pulmonary blood flow has induced unbalanced. ventricles for them and exaggerated right ventricular outflow tract obstruction due to muscle hypertrophy. In such patients, shunting will prepare the left ventricle for accepting the extra blood volume that will reach it after total correction. 827 Oncology CLINICAL FEATURES AND TREATMENT OUTCOME IN 26 CASES WITH Ki-l (CD30) POSITIVE ANAPLASTIC LARGE CELL LYMPHOMA MOSALAEI AHMAD From the Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, l.R. Iran 1 2 2001 14 4 307 309 17 09 2012 In order to present the clinical features and outcome of patients with Ki-l positive lymphoma and also the role of treatment modalities in this type of malignant disease, twenty-six patients with peripheral lymphadenopathy and a biopsyproven diagnosis ofKi-l positive lymphoma referring to the Radiation Oncology Department during a seven year period were treated with chemotherapy and radiotherapy according to the stage of the disease and after about 3 years of followup the outcome was evaluated. After an initial complete remission for a few months, most patients in advanced stages and a few cases in early stages developed recurrence for whom chemotherapy was started. The majority achieved remission again. After 3 years of follow 'up 18 of 26 patients were alive with no evidence of disease. As the behavior of this lymphoma is related to initial stage of disease rather than to Ki-l expression, radiation therapy may be an acceptable modality adjunctive to chemotherapy in patients with such lymphomas, particularly in those with localized disease for getting better disease control.