2 1016-1430 Iran University of Medical Sciences 1394 General NEUROFIBROMATOSIS PRESENTING AS SCROTAL ELEPHANTI ASIS RAZZAGHI MR b HONARMAND AR c RAFII MR d b From the Departments of Urology . Medical School, Shahid Beheshti University of Medical Sciences, Tehran. Islamic Republic of Iran. c From the Departments of Urology . Medical School, Shahid Beheshti University of Medical Sciences, Tehran. Islamic Republic of Iran. d From the Departments of *Pathology. Medical School, Shahid Beheshti University of Medical Sciences, Tehran. Islamic Republic of Iran. 1 8 1994 8 2 137 139 20 10 2012 Neurofibromatosis being manifested as scrotal elephantiasis is a very rare condition and in review of the literature no such presentation was found. Here we report a 20 year old man who presented with scrotal elephantiasis and consequently, a pathological diagnosis of neurofibromatosis was reached.
1393 General NEUROGENIC TUMORS OF THE NOSE AND P OSTNASAL SPACE MORTAZAVI MASOUD e e From the E.N.T. Department, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran. 1 8 1994 8 2 133 135 20 10 2012 Non-epithelial, benign extracranial neurogenic tumors of the nasal cavities are reported in the literature with extreme rarity. These tumors differ from the more common congenital gliomas, encephaloceles, etc. in that they sometimes are detached from the brain tissues. These tumors have intracranial origins. They are congenital or acquired and may involve any of the nerves inside the nose. These tumors can grow to quite a large size and in such cases, lateral rhinotomy is often necessary for complete excision. 1392 Orthopedic MULTIPLE ENCHONDROMATA: OLLIER'S DISEASE MAHLOUJI KH f f From the Ali Asghar Medical Center, Children's Hospital, Iran University of Medical Sciences. Tehran, Islamic Republic of Iran. 1 8 1994 8 2 129 131 20 10 2012 This report is a brief presentation of one case of Oilier's disease. Ollier's disease (multiple enchondromata) patients have widespread involvement of the skeleton, especially the hands the lesions are detected because of bone pain or deformity. Virtually all cases have been sporadic. Roentgenographically, the lesions may be detectable in early infancy as clear, homogeneous, oval lesions with axes parallel to the longitudinal axis of the bone. 1391 Dermatology TUFTED HAIR FOLLICULITIS GOLCHAI J g SHAMS GILANY J g From the Department of Dermatology, Razi hospital, Rasht, Islamic Republic of Iran. 1 8 1994 8 2 127 128 20 10 2012 A 28 year old albino man presented with a cicatricial alopecic plaque on the vertex. The patient had multiple hairs emerging from a single dilated follicular opening. Following inflammatory changes, new tufted hair appeared in spite of several periods of antibiotic treatment, and the disorder followed a relapsing and destructive course. Tufted hair folliculitis (THF) is a relapsing localized inflammatory disease of the scalp. Unfortunately, this situation results in cicatricial alopecia. This disease, initially designated as "THF" by Smith and Sanderson in 1978, has been reported in only 10 patients to date. 1390 General ETHICAL ISSUES IN MEDICAL STATISTICS AYATOLLAHI SEYYED MOHAMMAD TAGHI i i From tile Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz 1 8 1994 8 2 121 125 20 10 2012 Medical statistics (biostatistics), as a vital essential part of modem life, does raise some fundamental ethical issues. Surprisingly, this aspect seems to have been totally ignored by books on medical ethics. This paper discusses how the statistical aspects affect the ethics. The relation between biostatistics and medical research is explored. All stages of a medical research exercise are vulnerable to statistical mismanagement which might lead to misuse of patients by exposing them to unjustified risk and inconvenience the misuse of resources including the researchers' time, which could be better employed on more valuable activities and the consequences of publishing misleading results, which may include carrying out unnecessary further work. These are specific and highly undesirable outcomes. Failure to guard against these is surely as unethical as using experimental methods that offend against moral principles, such as failing to obtain full informed consent from subjects. Raising statistical standards of medical researches and publications serves as a safeguard to observe the element of ethics. This can be achieved by widespread teaching of medical statistics at all levels, involvement of biostatisticians as active participants of any medical researches and ethical committees. Ethical issues in medical statistics require wider and more open debate. Those involved in medical research need to involve the whole medical profession. lndeed, moral philosophers, theologians, and other professional groups have an important contribution to make. 1389 General THE ROLE OF RELIGION AND ETHICS IN THE PREVENTION AND CONTROL OF AIDS 1 8 1994 8 2 115 119 20 10 2012 Itis unlikely that mankind has ever faced an epidemic as dangerous as the one we have come to call the Acquired Immunodeficiency Syndrome or AIDS, for short. Certainly, humanity has never given so much attention to or shown so much fear of a disease as it does with AIDS. AIDS is a terminal disease for which doctors have no effective cure as yet. Infection is predominantly through sexual intercourse performed under certain circumstances or in certain ways. Apart from this, no one knows when it first afflicted humans, nor can anybody predict, let alone claim to know, what will befall the human race as a result of its spread over the coming years. The mystery surrounding this disease is made much more complicated by the fact that, years after it was fust discovered, it became clear that its infection had been widespread in many countries before the disease was even detected by scientists and before the fust AIDS case was diagnosed in 1981. Scientific sources concerned with monitoring the spread of AIDS point out that by the year 2000, the number of cases is likely to reach 40 million, of which 30 million will be among adults and the rest among children. The same sources say that if the spread of AIDS continues unchecked, with no effective and accessible cure becoming available to those infected, the number of cases is likely to reach uncontrollable proportions. The present situation is no better than that which is being predicted for the future. The World Health Organization (WHO) believes that between 300,000 and 500,000 people will suffer symptoms of AIDS every year, i.e., between 1,000 and 1,400 cases a day.' All this no doubt justifies the horror expressed by the concerned agencies and institutions, as well as by ordinary people. It also justifies the interest shown by various specialist bodies, headed by WHO, in providing information, advice and knowledge with regard to prevention methods against this very serious disease. With scientific and medical efforts still unable to find a vaccine or a cure that would protect people against the AIDS epidemic and its horrors, the only way to combat the disease is through prevention, slaving off the evil before it strikes and keeping away from the sources of danger. Nothing can be more helpful in this preventive effort than religious teachings and the adoption of proper and decent behaviour, as advocated and urged by all divine religions. The World Health Organization, and the Eastern Mediterranean Regional Office in particular, have conducted some experiments in this field. In the health programmes carried out in collaboration with Member States, it has taken account of indigenous traditions and cultures that are basically built on religious beliefs. The effect has been tremendous, as can clearly be seen in encouraging public reponse to these programmes. Accordingly, WHO's Eastern Mediterranean Regional Office took the initiative to organize a Regional Consultation on the Role of Religion and Ethics in the field of the prevention and control of AIDS and other sexually transmitted diseases to which a select group of experts in the fields of religion and medicine have been invited. The Consultation was held on 9 and 10 September 1991, at the Eastern Regional Director and a larger number of directors and advisers at the Regional Office. It was also attended by ten prominent legal and religious scholars, both Muslim and Christian (See Annex II). A number of papers were submitted and distributed for study and consultation. As a result, several recommendations and conclusions were formulated (Annex I). These dealt with the importance of religion and its role in the field of prevention of AIDS and other sexually transmitted diseases. They also highlighted the role of religious establishments and the media, the rights of victims and those who come in contact with them, the effect of prevention and diagnosis procedures on human rights, early marriage, the laws dealing with patients and infected persons, and doctors' duties. The aim of this booklet is to introduce the role of religion and ethics in the prevention and control of AIDS and sexually transmitted diseases, and to convey a strong and direct message of warning about the risks and side effects of misbehaviour. It also urges people to observe religious teachings and cherish moral and ethical values that prevent individuals from getting involved in risky relationships. Furthermore, it aims to encourage them to develop the necessary self-control to prevent them from such dangerous practices, whose risks for human life as a whole are not yet fully understood. It has "become very clear that the factors and conditions leading to infection by AIDS and other sexually transmitted diseases can be avoided if people adopt proper and decent patterns of behaviour, and if they adhere to the fundamental teachings of religion and the moral ethos based on them, which have become the central component of the unique culture of the people of this Region, and their inherited traditions" .42 Finally, the Regional Office is pleased to present the reader with two documents on this subject the fust one is the full text of the recommendations of the Regional Consultation on the Role of Religion and Ethics in the Prevention and Control of AIDS and other Sexually Transmitted Diseases (Alexandria, September 1991), and the second is "Health Promotion through Islamic Lifestyles: the Amman Declaration" (June 1989, and the reference document attached to it.) These two documents, which we hope will help readers learn more on the subject of the present booklet, are included in issue number 5 of the Health Education through Religion series. 1388 Microbiology and Anatomy CD38 MOLECULE-A MULTILINEAGE GLYCOPROTEIN AND ITS UNIQUE EXPRESSION ON PLASMA CELLS A. GHADERI ABBAS j AMIRGHOFRAN ZAHRA j From the Dep. Of Microbiology and Immunology, Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. 1 8 1994 8 2 109 113 20 10 2012 A hybridoma clone designated 6G5 has been selected by fusion of mouse myeloma cell line Ag. 8653 with spleen cells from mice immunized with human peripheral blood mononuclear cells (PBMC). The antibody produced by this clone was found to be strongly reactive with four human B-cell lines in the conventional immunological assays. Despite the fact that expression of most B cell-associated markers are lost upon differentiation of B-cells to plasma cells, the expression of the 6G5 reactive molecule remains unchanged. The lack of reactivities of this MAb for mature T-cells, and monocytic cell lines indicates that this MAb recognizes a B cell associated marker. Western blot analysis indicated that the 6G5 MAb detected a single band with molecular weight of 41 KDa from cell lysates of two human B-cell lines, DAUDI and NALM6. Comparison of data obtained for 6G5 MAb with those of the MAb known as OKTIO indicated that both MAbs may have reacted with the same molecule. 1387 Biological Sciences MOLECULAR STUDIES ON THE DIST RIBUTION OF β - THALASSEMIA IN IRAN: THE BASIS FOR PRENATAL DIAGNOSIS NOORI-DALOII MR l MOAZAMI N m IZADYAR M n FARHANGI S o BEYRAMI JAMAL F p ATALAY A GEREN LN AKAR L ATALAY E CIRAKOGLU B BERMEK E l From the Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran m Department of Biotechnology, Iranian Research Organization for Science And Technology, Tehran n Children s Medical Center, Tehran University of Medical Science, Tehran o Queshm Island Medical Center, Queshm, Islamic Republic of Iran p Department of Biotechnology, Iranian Research Organization for Science And Technology, Tehran the Marmara Research Center, Gebze-Kocaeli, Torkey. the Marmara Research Center, Gebze-Kocaeli, Torkey. the Marmara Research Center, Gebze-Kocaeli, Torkey. the Marmara Research Center, Gebze-Kocaeli, Torkey. the Marmara Research Center, Gebze-Kocaeli, Torkey. the Marmara Research Center, Gebze-Kocaeli, Torkey. 1 8 1994 8 2 101 107 20 10 2012 By application of modern recombinant DNA technology, especially the polymerase chain reaction (PCR)/dot-blot hybridization techniques, we have investigated the molecular basis of β-thalassemia from four different regions of Iran: central, south-east, south and north. In this study, the DNA samples were isolated from patients and for the identification of the mutations, the 6 oligonucleotide probes for the mutations of IVS.1/nt. 110, .lVS.1/nt.6, IVS.1/nt.1 , nonsense codon 39, frameshift codon 8 and IVS. 2/nt.1 were selected with respect to their relative frequency in the neighbouring country, Turkey. Four mutations accounted for76.2% and of these, the most frequent was the nonsense codon 39 mutation, which accounts for 60.3% of the β-thalassemia alleles tested. The remainder, in decreasing order of frequency, wereframeshift codon 8(9.5%), lVS. 1/nt.6 (4.8%) and IVS.1/nt.11O(1.6%). No hybridization was observed with the probes corresponding to the mutations of rvS.I/nt I (0/ A) and rvS.2/nt.1 (0/ A). These results also revealed that the distributions of different types of mutations were different in the four regions. This information and the introduction to the methodology used in this study will facilitate the prenatal diagnosis of the disease in Iran. 1386 Internal Medicine VISCERAL LEISHMANIASIS AS FEVER OF UNKNOWN ORIGIN OMRANI GHR FARHADl A PARHlZGAR A ARDEHALl S HAGHSHENAS M From the Departments of Internal Medicine Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. From the Departments of Internal Medicine Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. From the Departments of Internal Medicine Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. From the Departments of Microbiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. From the Departments of Internal Medicine Medical School, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran. 1 8 1994 8 2 97 100 20 10 2012 Visceral leishmaniasis is the second most common cause of fever of unknown origin in our study. This disease is not common in adults, although it's endemic among the pediatric age group. The majority of the affected individuals were young. High grade spiking fever, chills and splenomegaly were unique findings. Other common findings were neutropenia, anemia, abnormal liver function tests, sterile pyuria and microscopic hematuria. Except for I case, parasites were absent from tissue biopsies (e.g. bone marrow, liver, lymph node). Diagnosis was suggested by indirect fluorescent antibody (IFA) and confirmed by response to meglumine antimonate (Glucantime) and decline of IFA titer on follow-up. 1385 Parasitology and Mycology SEROPREVALENCE OF TOXOPLASMA ANTIBODIES AMONG PREGNANT WOMEN IN KERMAN SHAH ATHARI A SHOJAEIAN S ELIASI O DELFANI K From the Department of Parasitology, Shahid Beheshti University of Medical Sciences, Tehran, Dept. of Gynecology Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran. Sina Hospital, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran. Sina Hospital, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran. 1 8 1994 8 2 93 95 20 10 2012 Sera from 495 pregnant women were examined for toxoplasma antibodies by indirect fluorescent antibody testing (IFAT). Antibodies were positive in 32.7%. Seropositivity was not increased significantly with age but showed a statistically significant rise in accordance with frequency of parity, abortion and contact with cats. The high rate of seronegativity (67.3%) observed in pregnant women represents a high risk group for acquiring toxoplasma infection and also congenital toxoplasmosis. 1384 Pathology VACCINES CONTAINING MYCOBACTERIUM VACCAE AND THEIR USE IN THE CHILDREN OF LEPROSY PATIENTS IN IRAN GHAZI SAIDI KIUMARS L. STANFORD JOHN A. STANFORD CYNTHIA DOWLATI YAHYA From the Dept. of Pathobiology, School of Public Health, Tehran Universily of Medical Sciences, Tehran 'Dept. of Medical Microbiology, School of Pathology, University of London Medical School, London WIP 7LD 'Dept. of Medical Microbiology, School of Pathology, University of London Medical School, London WIP 7LD the lranian Leprosy Organization, Tehran, lslamic Republic of Iran. 1 8 1994 8 2 87 91 20 10 2012 The policy of vaccinating children who live with leprosy patients, and who have responses to leprosin A of2rnrn or less, with BCG+killed Mycobacterium vaccae if they lack a BCG scar, or with killed M. vaccae alone if they have a BCG scar, has been followed over 3-4 years in two centers in Iran. Judged on the basis of skin test conversion to leprosin positivity, the policy has been highly successful. A way in which the vaccines may work is discussed, and supported by differences in apparent efficacy between the two study centers. 1383 Internal Medicine THE EFFICIENCY OF A MALARIA SCREENING PROGRAM AMONG AFGHAN REFUGEES IN KERMAN, ISLAMIC REPUBLIC OF IRAN KESHAVARZ-VALIAN HOSSEIN JANGHORBANI MOHSEN From the Medical School, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran. 1 8 1994 8 2 81 85 20 10 2012 Evaluation of a malaria screening program was carried out in two screened Afghan refugee camps in Bardsir and Rafsanjan and compared to non-screened Afghan refugees within Kerman, as well as refugees with malaria diagnosed by Communicable Disease Control (CDC) Laboratories in Kennan and Rafsanjan, by parasitological blood examinations. The study involved 456 residents of two refugee camps and random samples of 512 refugees in the Kerman Bus Tenninal and 1300 persons referred to Kerman and Rafsanjan CDC laboratories, aged from 1 to 70 years. Malaria was found in 403 (l7.H%) of the persons examined. Plasmodium vivax was identified in XS.I %, Plasmodiumfalciparum in 13.6% and mixed infection due to both of these species was found in 1.3% of the cases. The prevalence of parasitemia in screened camps was 4 times lower than non-screened active cases detected. A comparison of age-specific rates of malaria in screened and non-screened Afghan refugees indicated that screening programs are highly effective. The Afghan refugees bring high infection loads with them from outside and cause an out break of the infection, particularly in areas of [ran where malaria is under control. Therefore, malaria control in Afghan refugees in Iran should be primarily based on curative as well as preventive measures. 1382 Oncology SALVAGE CHEMO THERAPY WITH CYCLOPHOSPHAMIDE, DOXORUBICIN, AND CISPLATIN (CAP) IN ADVANCED BREAST CANCER AZARM TALEB From the Division of Hematology /Medical Oncology. Seyyed-al Shohada Hospital, Isfahan University of Medical Sciences. Isfahan, Islamic Republic of Iran. 1 8 1994 8 2 75 80 20 10 2012 Twenty-one patients with advanced breast cancer (7 premenopausal and 14 postmenopausal women) were treated with a combination of cyclophosphamide, doxorubicin, and cisplatin (CAP). The median age of the patients was 43 years (range 36-61). This therapy was repeated every 3 weeks. Nine patients (group 1) received CAP as primary therapy for metastatic breast cancer, and twelve patients (group 2) received CAP as a second-line therapeutic agent. Of the 12 (57%) patients who responded, six (29%) had complete response (CR). The median disease-free survival (DFS) was 8 months. The response rate was highest for metastases in the pleura (83%) and lymph nodes (81 %), followed by skin (64%), liver and breast (55%). The overall response rate was higher in previously untreated patients than in those previously treated (89% versus 33%, p<O.O I). Complete response rates of 44% and 17%, and median DFS of 10.5 and 3 months respectively, were observed in the two groups of patients. The therapy was well tolerated, myelosuppression being the doselimiting toxicity. The most frequent nonhematological toxicities were nausea, vomiting (100%), mucositis and stomatitis (38%), but these were rarely severe. Total alopecia occurred in only two patients. There were no toxic deaths or cardiotoxicity. Severe anemia occurred more frequently in group 2 patients. The present study suggests a role for CAP combination chemotherapy in the management of advanced breast cancer. 1381 General COCHLEAR IMPLANTATION IN IRAN FARHADI M DANESHI A IMAMJOMEH H From the EN.T. DeptRasuI Akram Medical Complex, Iran University of Medical Sciences, Tehran, Islamic Republic of lran. From the EN.T. Dept RasuI Akram Medical Complex, Iran University of Medical Sciences, Tehran, Islamic Republic of lran. Dept. of Audiology, RasuI Akram Medical Complex, Iran University of Medical Sciences, Tehran, Islamic Republic of lran. 1 8 1994 8 2 71 74 20 10 2012 Cochlear implantation has become an increasingly common procedure in the rehabilitation of selected cases of profound deafness.' Patients should have profound total bilateral sensorineural hearing loss. Sound is transformed into small electric currents which stimulate the auditory nerves in the cochlea and generate the hearing sensation. The nucleus cochlear implant is the result of more than 20 years of research and development and has been used in more than 9000 patients worldwide to date.' After two years of research in order to provide the cochlear implant in the Farsi (Persian) language, three out of 54 post lingual totally deaf patients up to now have undergone the cochlear implant operation with a 22-channel mini-system through a Lehnhardt incision, mastoidectomy, facial recess, and cochleostomy procedure.3-4 One month following the implant, these patients were undergoing speech education and auditory training by using innovative rehabilitation techniques for deaf people in the Persian language. This report deals with presenting three cases implanted by a cochlear implantation team in [ran and the results of rehabilitation following implant.