39 2228-7043 Iran University of Medical Sciences 1756 Gynecology RUOTURE OF SPLENIC ARTERY ANEURYSM DURING PREGNANCY: A CASE REPORT Akbarian Abdorasoul Mehdizadeh Abolfazl Arjomandi Fatemeh Alaghebandan Reza 1 3 2000 6 4 271 274 09 11 2011 Spontaneous rupture of splenic artery aneurysm (SAA) during pregnancy is a rare event with catastrophic consequences. The risk of rupture, generally given as 3% to 5%, rises in pregnancy up to over 20%, with a 70% maternal and 95% fetal mortality rate. Review of the literature reveals that more than 100 cases of ruptured SAAs in pregnancy have been reported. However, mother and fetus have survived in only 13 of these cases. This paper describes a case of SM rupture during pregnancy, reporting survival of the mother. A 27-year-old primigravid at 31 st week of gestation was admitted because of acute severe epigastric pain, nausea and vomiting. Physical examination showed that she was in a hypovolemic preshock state with tenderness on abdominal palpation in the epigastrium and left upper quadrant. From the obstetrical point of view there was no bleeding and no uterine contraction, but fetus showed severe bradycardia. She immediately underwent an emergency laparotomy, SM was resected and splenectomy was performed but unfortunately, fetus did not survive. The patient recovered with no complication, however, further evaluation revealed esophageal varices due to portal hypertension.
1748 Laboratory Sciences GROUP B STREPTOCOCCI COLONIZATION IN PREGNANT WOMEN IN LABOR Pirooz Tahereh Farsi Shahla Foroohesh Tehrani Homa 1 3 2000 6 4 275 280 08 11 2011 Nowadays, group B streptococcus (GBS) is considered an important agent in early-onset infection in newborn infants. This is often transmitted to the child from the birth canal. Neonatal infection depends on degree of colonization of mother's vagina in labor. This study was conducted at two obstetrical teaching hospitals in Tehran (Shahid Akbarabadi and Mirza Kuchak Khan). Specimens were obtained from 200 women in labor befor rupture of membranes and directly inoculated into Todd-Hewith broth (THB) and selective Todd-Hewith broth (STHB) and incubated at 37'C and for 24 hours. Isolated strains were identified using conventional bacteriological methods. Then the degree of colonization was determined in positive GBS cultures. The results showed that the use of STHB increases the yield of positive GBS cultures. 17% of women were colonized with GBS. Degree of colonization in GBS carriers was determined. Colonization was light in 21%, moderate in 26%, heavy in 21% and very heavy in 32% of carriers (53% heavy and very heavy). These findings show that the risk of neonatal sepsis, due to transmission of GBS from the birth canal, should be considered seriously. 1747 Orthopedic SHOULDER PAIN: TWO YEARS EXPERIENCE IN SHOULDER SURGERY CLINIC OF SHOHADA-YE 7TH TIR HOSPITAL Khorsandi Ali Akbar 1 3 2000 6 4 281 289 08 11 2011 In this retrospective study, 82 patients who admitted to shoulder surgery clinic of shohada-ye 7th Tit Hospital from March 1995 to March 1997 were analyzed. Of these patients, 42 were male and 40 were female. The ages of male patients ranged from 25 to 75 years and of female patients from 25 to 65 years. The mean age of males was 49.19 and females was 45.97 years. Right shoulder was affected in the majority of patients. Referrals were more in spring and summer, but patients believed that cold can aggravate pain. The etiology was unknown but they have mentioned history of trauma, car accident, diabetes, occupational problems and .... In present study, subacromial bursitis was the most common cause of shoulder pain. of 82 patients, 46 (56%) were improved by proper medica) ther,apye i.e. administration of nonsteroidal anti-inflammatory drugs, physiotherapy based on Neer's protocol ana in some cases, especially in those older than 40 years, subacromial corticosteroid injection. 14 cases (18%) who did not respond to medical therapy, refused to be followed up. 22 cases (26%) underwent surgical therapy. Of these latter cases, 11 were male and 11 were female and all had received medical therapy before operation. Complete physical examination, different laboratory tests and radiography - three views - were performed for all cases. Arthrography, MRI, CT scanning and ultrasonography were performed depending on the case. Of these 22 cases, 5 cases (3 females and 2 males) underwentpreoperative diagnostic arthroscopy for definite diagnosis. Torn labrums were removed by arthroscope in 2 of these latter 5 cases. The results of surgical operations were good and excellent in 80% of cases. So, it can be concluded that surgical operation is a good approach for those patients who are not responsive to medical therapy. 1744 Gynecology STRUMA OVARII WITH PSEUDO-MEIGS' SYNDROME: A CASE REPORT Derakhshan Jahangir 1 3 2000 6 4 290 296 08 11 2011 Teratoma is one of the commonest ovarian tumors. Struma ovarii is a rare cystic teratoma which is predominantly composed of thyroid tissue. Sometimes, this tumor is accompanied by ascites and hydrothorax which suggests Meigs' syndrome. In this paper, a case of struma ovarii and serous cystadenoma in one oval}' and agenesis of contralateral ovary with hypoplasia of Fallopian tube and pseudo-Meigs' syndrome. 1743 Dermatology REPORT OF 200 ZONA PATIENTS Rasi Abbas 1 3 2000 6 4 297 301 08 11 2011 This study was performed to determine age, sex, site and side of involvement in patients with herpes zoster. For this purpose, all patients of dermatology clinic of Firuzabadi Hospital in Thehran who presented with painful grouped vesiculobullous lesions with a dermatomal distribution on an erythematous base for the first time, in whom no predisposing factor could be detected, and had a clinical course compatible with herpes zoster (at least of two weeks duration) were considered as herpes zoster cases after three follow up visits with weekly intervals from the first visit and were included in this study. 200 cases of herpes zoster were found (1.18% of dermatology clinic cases) from August 22, 1996 through December 21, 1998. The ages of patients ranged from 9 to 90 years and the mean age of involvement (mean ± Sf) was 41.89 ± 1.37 years. 65% of the patients were 50 years old or younger and 35% were younger than 30 years. This shows that in this study the age of involvement is significantly lower than other series. There was no significant difference between mean ages of males and females. The most common involved dermatomes were thoracic (33%), lumbosacral (30.5%), cervical (20%) and trigeminal (16%). There was a single case (0.5%) of disseminated herpes zoster. In this study, the most common involved dermatomes were thoracic, but the frequencies of involvement of these dermatomes were lower than what reported in other series (53-55%). The frequency of involvement of lumbosacral dermatome was higher than other series (11 %). The mean age of trigeminal involvement was significantly higher than the mean age of the patients with thoracic involvement (difference of two means = 12.98 years and P = 0.011). There were no significant differences between the sites and the sides (right or left) of involvement in males and females as well as between different age groups. There were no significant differences between the right or left side lesions, comparing different dermatomal involvements. 1742 Internal Medicine VANCOMYCIN-RESISTANT ENTEROCOCCI IN HOSPITALIZED PATIENTS Soltani Arabshahi Kamran Foroohesh Tehrani Homa Mahmood Arabi Seyed Mehdi 1 3 2000 6 4 302 309 08 11 2011 The enterococci are gram positive microorganisms. Currently they are considered as one of the most important causes of mortality in hospitalized patients. Enterococci are the 4th cause of nosocomial infections. The importance of enterococci is due to the ability of these bacteria in developing resistance to a wide range of antibiotics. The other contributory factor is the potency of transmitting resistance to other microorganisms and their role as a reservoir for spreading resistance. In this study, gastrointestinal colonization with vancomycin - resistant enterococci in hospitalized patients has been investigated. Stools or rectal swabs have been collected from 300 hospitalized patients and 100 controls. Enterococci were isolated in 290 of hospitalized patients and all of controls. The isolated enterococci were tested by "disk diffusion" for resistance to vancomycin and penicillin. All controls were sensitive to vancomycin, whereas in hospitalized patients 2 cases were considered as resistant and 22 cases seemed suspicious. By using serial dilution, sensitivity test was performed to determine minimal inhibitory concentration (MIC) for confirming resistance. 4 of 22 suspicious cases and 2 confirmed resistant cases had an MIG higher than 64 mg/L, and thus were considered resistant. In this study, the results reveal a resistance rate of 2.07% in hospitalized patients which is compatible with European studies. 1741 Anatomy EFFECTS OF PHENTOLAMINE ON THE DAMAGE CAUSED BY ANTINEOPLASTIC DRUG 5-FLUOROURACIL IN THE EPITHELIUM OF THE SMALL INTESTINE OF RAT Shariati Tabandeh Koochmeshgi Jalal 1 3 2000 6 4 310 314 08 11 2011 Toxicity of antineoplastic agents to the gastrointestinal epithelium is one of the major factors that limit dose and duration of administration of these drugs in cancer chemotherapy. This toxicity is probably due to the rapid rate of epithelial cell proliferation in the gastrointestinal tract. We proposed that selective reduction of the rate of cell proliferation in this tissue, at the time of chemotherapy, may protect it from chemotherapy-induced damage. Several agents are known to reduce the rate of cell proliferation in the epithelium of small intestine. In this study, one of these agents - phentolamine - was investigated. Phentolamine is an adrenoceptor blocking agent. Twenty four female Wistar rats weighing between 150 to 200 grams were randomly divided into four groups, six each. Rats in two of these groups received an intraperitoneal injection of phentolamine (20 mg/kg) at 10:30, a single intraperitoneal injection of 5-f1uorouracil (350 mg/kg, and 500 mg/kg respectively) at 12:00, and another injection of phentolamine (20 mg/kg) at 13:00. Rats in the remaining two groups received injections of distilled water at 10:30 and 13:00 and a single injection of 5-f1uorouracil (350 mg/kg, and 500 mg/kg respectively) at 12:00. Half of the rats in each group were sacrificed in midday in the third day after injection and the other half in the fifth day. Samples were obtained from small intestine, 7 to 13 centimeters distal to pyloric sphincter and eight hematoxylin-eosin stained microscopic sections were prepard from each rat. Only those villi which were sectioned in their entire longitudinal axes were studied. Individual villus columns were selected randomly and their cells counted under light microscope. Results show that phentolamine significantly prevents villus shortening in the epithelium of small intestine. 1740 Pediatric Disease UPPER GASTROINTESTINAL ENDOSCOPY IN CHILDREN: SIX MONTHS EXPERIENCE IN HAZRATE ALI ASGHAR CHILDREN'S HOSPITAL Nakhaei Shahrbanoo 1 3 2000 6 4 315 318 08 11 2011 In this descriptive study, 54 children with upper gastrointestinal complaints were seen in gastroenterology clinic of Hazrat-e Aliasghar Children's Hospital in Tehran and endoscopic findings were reviewed. In these children the most common complaint was chronic abdominal pain (78%) and the most common endoscopic finding was nodularity in antrum (39%). Gastritis was the most common finding (43.5%) in 23 patients with positive urease test. Rate of infection with Helicobacter pylori was directly related to age, but was not related to sex. 1739 Orthopedic Surgery TREATMENT OF NON:union: FEMORAL NECK FRACTURE BY VALGUS OSTEOTOMY Noroozi Masood Alami Harandi Bahador 1 3 2000 6 4 319 325 08 11 2011 Non:::union::: of femoral neck fracture in young patients is still a big problem, specially in developing countries. Between 1980 and 1998 we performed 27 cases of valgusizing osteotomy to fix non:::union::: of femoral neck fracture on patient of 17 to 74 years old with an average of 45 years. Majority of the patients had displaced fracture of femoral neck and had under gone surgery but most were faced implant failure Almost all of the patients were suffering from pain and limitation of motion so that they were not able to walk without support. Average Neck-shaft angle was 105(80-130) with average shorthening of 2.5cm. After valgusizing osteotoms 24 of 27 cases healed between 3-10 months (average 5 months) two had implant failure, 5 patient had mild A Vascular Necrosis. at time of stUdy which was not symptomatic. pain and limitation of motion improved remakably so that majority of the patients didn't have to use crutches and shorthening was reduced to an average of 1 cm. We reached to the conclusion that valgusizing osteotomy of proximal of femur is a good porcedure for non:::union::: offemroal neck fracture in young patients, because it is an easy operation to perform with relatively good result.