Complete improvement in a patient with multiple irreversible defects of the left ventricle on 99m technetium-sestamibi SPECT after percutaneous coronary intervention.

99mTc-sestamibi has been investigated as a potential viability marker; initial studies have shown good concordance between 201Tl and 99mTc-sestamibi activities in both viable and nonviable myocardium. However, assessment of myocardial viability by 99mTc-sestamibi remains controversial for tissue recovery after revascularization. Here, we present a patient with several regions of severely diminished and irreversible (defect persisting in both early and delay images of each set scanning) defects on initial scan which were dissolved completely on the follow up scan after an intervention. In a 75 year-old Asian woman with acute myocardial infarction who received thrombolytic therapy and subjected to percutaneous coronary angiography (PCI) on day 28 after acute myocardial infarction(MI), resting 99mTc-sestamibi SPECT was applied on day 4 (initial scan) and 138 (follow up scan) after acute MI at 30 and 180 min after injection of tracer (740 MBq); Two-dimensional echocardiography was carried out at the same time. On the initial image set, there was irreversible defects in the apex, anteroapical, inferoapical, anteroseptal, septal and also anterior walls, while the follow up image was normal in all regions.The angiography intervention showed just significant stenosis on left anterior descending (LAD) vessel (95%). This may highlight the failure of 99mTc-sestamibi as a marker of myocardial viability and also mandate further validating of the procedure with follow up scan or other modalities for myocardial viability investigation.

Impact of body mass index versus physical activity and calorie intake on assisted reproduction outcomes.

OBJECTIVE: To measure the effect of body mass index (BMI) versus calorie intake and physical activity (PA) on the outcomes of assisted reproductive technologies (ART). STUDY DESIGN: A prospective study was performed on 236 infertile women who underwent in vitro fertilization. BMI, level of PA and calorie intake were assessed at study entry, and associations between these variables and ART outcomes were analyzed. Participants were divided into four groups based on BMI and PA: normal BMI/inactive, normal BMI/active, overweight/inactive and overweight/active. RESULTS: BMI, adjusted for age, level of PA, calorie intake and aetiology of infertility, was not associated with the number of oocytes retrieved, fertilization rate, cleavage rate, number of embryos, number of high-quality embryos or pregnancy rate. For women aged <36 years, the number of oocytes retrieved and the number of embryos decreased with increasing BMI, independent of calorie intake and PA. The fertilization rate, cleavage rate, number of high-quality embryos and pregnancy rate were not associated with BMI. The number of oocytes retrieved was significantly higher in women of normal weight compared with overweight women, regardless of the level of PA. CONCLUSIONS: Age has a strong negative effect on ART parameters. Increased BMI, independent of calorie intake and PA, has an adverse effect on the number of oocytes retrieved in women aged <36 years, but does not affect the number of high-quality embryos or the success of the treatment cycle.

Standardized breast cancer mortality rate compared to the general female population of Iran.

INTRODUCTION: Breast cancer is the most common cancer in women. Improvements of early diagnosis modalities have led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to the normal female population. MATERIALS AND METHODS: The follow up data of a cohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986 to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups and the 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranian women was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancer patients were calculated using the ratio of the mortality rate in breast cancer patients over the general female population. RESULTS: The mean age of breast cancer patients at diagnosis time was 45.9 (±10.5) years ranging from 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. The SMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5- 8.2), 6.55 (95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively. CONCLUSION: Results showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy to improve breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survival rates of different centres may shed more light on mortality patterns of breast cancer.

Effect of oral carbohydrate intake on labor progress: randomized controlled trial.

BACKGROUND: Lack of information regarding biochemical changes in women during labor and its outcomes on maternal and neonatal health still is an unanswered question. This study aims to explore the effectiveness of oral carbohydrate intake during labor on the duration of the active phase and other maternal and neonatal outcomes. METHODS: A parallel prospective randomized controlled trial, conducted at the University Affiliated Teaching Hospital in Gonabad. Totally, 190 women were randomly assigned to an intervention (N=87) or control (N=90) group. Inclusion criteria were low-risk women with singleton cephalic presentation; and cervical dilatation 3-4 cm. Randomization was used by random number generator on every day. Odd numbers was used for intervention and even numbers for control group. Intervention was based on the preferences between: 3 medium dates plus 110 ml water; 3 dates plus 110 ml light tea without sugar; or 110 ml orange juice. The protocol is only run once but women ate and drank gradually before second stage of labor. Control group were fasted as routine practice. Neither participants nor care givers or staff could be blinded to group allocation. Differences between duration of the active phase of labor were assessed as primary outcome measure. RESULTS: There was significant difference in the length of second stage of labor (P <.05). The effect size for this variable was 0.48. There were no significant differences in other maternal and neonatal outcomes. CONCLUSIONS: Oral intake of carbohydrate was an effective method for shortening the duration of second stage of labor in low-risk women.

Scintigraphic parameters with emphasis on perfusion appraisal in rest 99mTc-sestamibi SPECT in the recovery of myocardial function after thrombolytic therapy in patients with ST elevation myocardial infarction (STEMI).

INTRODUCTION: This study was performed to determine the clinical application of rest 99mTc-sestamibi in the assessment of viability and functional improvement of the left ventricle (LV) myocardium in the post-thrombolytic therapy of acute myocardial infarction (AMI). MATERIAL AND METHODS: In 37 patients with AMI who received thrombolytic therapy, 2-dimensional (2D) echocardiography, as well as the resting redistribution of 99mTc-sestamibi, was investigated, both within 1 week and 3-5 months after AMI. The predictive capacity of the perfusion percentage for myocardial function recovery was evaluated. Also, the capacities of the possible variables in the prediction of recovery of myocardial function resulting from a change in LV ejection fraction (EF) were evaluated using stepwise multiple regression analysis. RESULTS: Thirty-seven patients (30 men and 7 women; mean age: 58±14 years) with AMI were enrolled in the study. Redistribution was observed in 35 and 50 segments of the initial and follow-up scans, respectively. In addition, 146 segments with reverse redistribution (RR), both in the initial scan (118 segments) and the follow-up scan (86 segments), were also observed. An apparent difference in wall motion scores was seen between the initial and follow-up echocardiographs (p<0.001). Furthermore, using the optimal cut-off point of perfusion percentage in each image set, sensitivity as well as specificity and likelihood ratio (LR) for the improvement of regional wall motion after 3-5 months were defined. CONCLUSION: These data showed that redistribution and reverse redistribution of 99mTc-sestamibi post thrombolytic therapy can be used as a marker of viability to predict the recovery of segmental wall motion abnormality (stunning), as well as the improvement of segmental perfusion uptake. This study also demonstrates that the resting 99mTc-sestamibi SPECT can be used for an approximate assessment of LV function status and can predict the recovery of jeopardized myocardium function after thrombolytic therapy.

Coenzyme Q10 improves seminal oxidative defense but does not affect on semen parameters in idiopathic oligoasthenoteratozoospermia: a randomized double-blind, placebo controlled trial.

BACKGROUND: Several lines of evidence show the implication of oxidative stress in the etiology of male infertility. Recently, the role of coenzyme Q10 (CoQ10) in the prevention and treatment of disease has been intensively probed. However, definitive efficacy studies in oligoasthenoteratozoospermia (OAT) have not been completed yet. AIM: To evaluate the effect of CoQ10 supplementation on semen parameters in idiopathic OAT (iOAT). MATERIAL/SUBJECTS AND METHODS: A double-blind placebo controlled clinical trial was carried out. A total of 47 infertile men with iOAT were randomly assigned to receive 200 mg CoQ10 daily or placebo during a 12- week period. Semen parameters were determined using microscopic evaluation according to World Health Organization guidelines. Lipid peroxidation was assessed by measuring the concentration of plasma malondialdehyde. We evaluated the total antioxidant capacity of seminal plasma. To compare variables between and within the 2 groups we used independent t-test and Paired t-test. RESULTS: The trial showed non-significant changes in semen parameters of CoQ10 group. However, concentrations of thiobarbituric acid-reactive substances were significantly (p<0.05) reduced in serum of treated groups compared with the control. Furthermore, total antioxidant capacity of seminal plasma significantly increased in the CoQ10 group (p<0.05). CONCLUSION: Our results provide further evidence suggesting that CoQ10 supplementation is associated with alleviating oxidative stress, although it does not show any significant effects on sperm concentration, motility and morphology. It may be suggested that CoQ10 could be taken as an adjunct therapy in cases of OAT. Further studies are needed to draw a final conclusion.

Assessment of moderate to severe abdominal blood loss using peripheral to central blood oxygen saturation.

PURPOSE: There are various definitions and monitoring modalities for hemodynamic status. Each of them has its own advantages and shortcomings. A new hemodynamic index is proposed in this study. This index can be calculated by placing the measured hemoglobin saturation in a formula. Blood samples for this measurement are taken from arterial, antecubital and central venous blood. MATERIAL AND METHODS: We calculated this index in three different groups undergoing laparatomy. The control group consisted of patients who underwent elective surgery. The case group with acute internal abdominal bleeding was divided into two groups. Those with more than 20 ml/kg of blood in their abdominal cavity were designated as the severe case group, while those bleeding less were categorized as moderate. Blood samples were taken from ten patients in each group in stable and unstable conditions. RESULTS: This index differed significantly between dissimilar hemodynamic conditions. The pre-anesthesia value of this index in the control group showed a mean +/- SD of 8.5 +/- 3.2 vs. 1.6 +/- 0.4 in the moderate case group vs. 0.7 +/- 0.08 in the case group with severe hemodynamic changes (p < .001). The index approximated to the control values as the circumstances improved. After compensation for volume loss, pre-extubation values were not significantly different. These were 9.6 +/- 2 in the control group vs. 8 +/- 2 in the case group with moderate hemodynamic change vs. 8 +/- 1.8 in the severe case group. The likelihood ratio of bleeding increased as this index decreased. CONCLUSION: As the hemodynamic condition deteriorates, this index decreases significantly. This index is an accurate indicator for predicting hemodynamic changes compared to some other modalities. Further investigations are needed into the prognostic and therapeutic advantages of this index.

Morphological pattern and frequency of intracranial tumors in children.

BACKGROUND: Brain tumors are the second most common neoplasm in children. Pattern of primary brain tumors in children has not been reported in Iran. Brain tumors have been the subject of controversy both with respect to pattern of occurrence and to potential causes. OBJECTIVE: To determine the age, sex, location, and histologic diagnosis of intracranial tumors in children less than 15 years of age. MATERIALS AND METHODS: A retrospective study of 619 children who were admitted to the neurosurgical center between 1978 and 2003 was performed. Charts were reviewed to extract information about demographics, location, and histopathological diagnosis of tumors. All patients entered into this study had pathologically proven brain tumor. The frequency distribution of brain tumors by age and sex, location, and histopathology was calculated. RESULTS: The male-female ratio, 58.1 to 41.9%, vary significantly (p<0.05). The mean age of the patients at time of diagnosis was 8.8 years (SD=3.9). Fifty-one percent of brain tumors were located in supratentorial, and 49.0% in the infratentorial region. In supratentorial region, 57.0% of the tumors were in the hemispheric. In infratentorial region, 68% of the tumors were in the midline. The mixed five most common histological diagnoses in patients were astrocytoma (40.4%), followed by medulloblastoma (18.4%), ependymoma (10.5%), craniopharyngioma (8.8%), and meningioma (4.2%). Most of the brain tumor types (85%) occurred in children between 5 to 15 years of age. Astrocytoma occurred mostly in children aged 5-15 years (87%). CONCLUSION: Males were affected more than females. A significant male predominance was observed in craniopharyngioma and medulloblastoma. Astrocytoma was the first most common brain tumor in all age groups. Certain tumor types show a predilection for the certain period of life.

Reproductive characteristics and the risk of breast cancer--a case-control study in Iran.

Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women is growing. The patients are relatively younger than their western counterparts. The present hospital based case-control study was designed to determine roles of reproductive factors for breast cancer among women in Iran. Conducted at a teaching hospital in Tehran, Iran, in 2004, the study covered a total of 303 cases of breast cancer and 303 healthy controls. Cases were identified through the Oncology Department of a university hospital and controls were collected from other wards or out-patient clinics at the same hospital. Control subjects were matched to patients for age. Informed consent was obtained from all cases and controls then demographic and reproductive factors were ascertained by in-person interview using a constructed questionnaire. Odds ratios and their 95% confidence intervals for breast cancer were derived using logistic regression analysis. The mean +/-SD ages of cases and controls were 48.8 +/- 9.8 and 50.2 +/- 11.1 years, respectively, (range 24-84). The final model for multiple analysis indicated that never married, post menopause, age at first live birth, number of live births, use of oral contraceptive pills, and history of chest X-rays between adolescence and 30 yrs of age, were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration were not significant risk factors.

A study of cancer patterns among inpatients of public hospitals in Iran.

Cancer is becoming an increasingly important cause of premature mortality in developing countries as their populations expand and their lifestyle becomes westernized. The aim of this study was to determine the frequency distribution of various neoplasms among Iranian inpatients, their demographic status and length of stay involved in hospitals during 2000-2002. Records of 17447 inpatients who were hospitalized with malignant tumors in Iranian public hospitals during 2000-2002 were studied. The neoplasms had been coded and classified according to International Classification of Diseases, 10th Revision (ICD-10). The frequency distribution of cancer patients was evaluated by age, sex, place of residence and the length of stay at hospital. There were 9470 male patients (54.3%) and 7977 females (45.7%). The mean +/- sd age was 51.2+/-20.6 with a median of 55 years. The average for females (49.4+/-19.2 yrs) was significantly lower than that for males (52.8+/-21.7 yrs) (p<0.001). The five most common cancer sites were the digestive organs (27.6%) followed by lymphoid and haematopoitic tissues (21.4%), breast (10.2%), respiratory and intrathoracic organs (8.8%) and skin (6%). These accounted for 74% of all malignancies. Some 31% of women's cancers were found in breast or genital organs compared to only 7.6% for males. The male/female ratio was 1.19 with the highest being 2.85 for respiratory organs and the lowest being 0.04 for breast. Mean age of male patients with cancer of the digestive organs, respiratory and intrathoracic organs and skin was significantly lower than that of females (p<0.001). The median length of stay of patients in hospitals each time they were admitted was 6 days. Of the cancer patients, 77.7% lived in urban areas which include only 64.5% of the population. Rural patients with skin cancer accounted for 32.1%. In conclusion, the results of this study carry important implications for future health planning strategies and provide a baseline for further studies on the evaluation of malignancies in Iran.

Brainstem origin of preganglionic cardiac motoneurons in the muskrat.

The muskrat, and aquatic rodent with a brisk and reliable diving response, shows a remarkable bradycardia after nasal stimulation. However, the medullary origin of cardiac preganglionic motoneurons is unknown in this species. We injected fat pads near the base of the heart of muskrats with a WGA-HRP solution to label retrogradely preganglionic parasympathetic neurons that project to the cardiac plexi. Results showed that the preponderance of labeled neurons was in ventrolateral parts of the medulla from 1.5 mm caudal to the obex to 2.0 mm rostral. Eighty-nine percent of the labeled neurons were located bilaterally in the external formation of the nucleus ambiguus, 5.6% were in the lateral extreme of the dorsal motor nucleus of the vagus nerve and 5.3% were found in the intermediate area in between these two nuclei. Although controversy still exists concerning the medullary origin of preganglionic cardiac motoneurons, our results from muskrats agree with those from most other species where preganglionic cardiac motoneurons were located just ventral to the nucleus ambiguus.

Trigeminally-mediated alteration of cardiorespiratory rhythms during nasal application of carbon dioxide in the rat.

Stimulation of the upper respiratory tract with air-borne irritants can result in dramatic alterations of cardiorespiratory rhythms that include apnea, bradycardia and selective peripheral vasoconstriction. Since carbon dioxide can stimulate receptors in the nasal passages, we wanted to determine if this odorless gas can induce the same autonomic changes as air-borne irritants. Passing 100% carbon dioxide through the nasal passages of rats anesthetized with chloralose-urethane produced apnea, a vagally-mediated bradycardia and a sympathetically-mediated increase in mean arterial blood pressure. Application of atropine blocked the bradycardia without affecting respiratory or blood pressure changes, while injection of prazosin eliminated blood pressure responses but did not affect heart rate or apnea. There were no significant autonomic responses to nasal application of 10, 25 or 50% carbon dioxide. The responses were mediated through the trigeminal innervation of the nasal mucosa since they could be blocked when the anesthetic procaine was applied to the nasal cavity. We conclude that these cardiorespiratory responses are due to stimulation of trigeminal nociceptors located within the nasal mucosa.

A medullary dorsal horn relay for the cardiorespiratory responses evoked by stimulation of the nasal mucosa in the muskrat Ondatra zibethicus: evidence for excitatory amino acid transmission.

Stimulation of the upper respiratory tract, including the nasal mucosa, with water, vaporous irritants, or gases, induces a collation of several cardiorespiratory responses including an apnea and bradycardia and often some change in arterial blood pressure. Since the nasal mucosa is innervated by branches of the trigeminal nerve, it implies that some part of the trigeminal system within the central nervous system mediates the autonomic responses induced by nasal stimulation. In the present study, respirations, heart rate and arterial pressure were monitored in muskrats anesthetized with a mixture of chloralose-urethane. We induced a bradycardia and apnea by stimulating the nasal mucosa of muskrats with brief (5 s) transnasal application of vapors of ammonia hydroxide. In an effort to determine the central site where the trigeminal mediation of the cardiorespiratory responses occurs, small nanoliter injections of 2% lidocaine were made bilaterally into the subnucleus caudalis of the spinal trigeminal nucleus (referred to as the medullary dorsal horn) to determine if the responses could be blocked. The responses could be blocked when the lidocaine injections on both sides were placed in the rostral, ventral parts of the medullary dorsal horn, but persisted when the injections were placed elsewhere. Since lidocaine blocks both neurons and fibers of passage, nanoliter injections of kynurenate, a general excitatory amino acid antagonist, were used in a similar paradigm to circumvent the problem of blocking only fibers of passage.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased raphe unit activity in a rat model of endogenous depression.

One theory about the pathogenesis of endogenous depression is that decreased serotonergic (5-HT) neurotransmission is involved in producing the disorder. A key component of brain 5-HT neurotransmission is the discharge rate of 5-HT neurons in the dorsal raphe nucleus (DRN), a major aggregation of 5-HT neurons. We tested the hypothesis that the discharge rate of 5-HT neurons in the DRN was decreased in a new animal (rat) model of human endogenous depression. In this model, rats are treated neonatally with the antidepressant chlorimipramine. When adult, these animals exhibit several behavioral, REM sleep, and treatment response features of the human disorder. We found in a single unit measurements in adult, pentobarbital-anesthetized rats that, compared with 'non-depressed' control rats, the 'depressed' rats had a lower discharge rate of 5-HT neurons in the DRN. This correlation is consistent with the theory that 5-HT neurotransmission is diminished in endogenous depression.

Pharmacological studies in frog sympathetic ganglion: support for the cholinergic monosynaptic hypothesis for slow IPSP mediation.

The slow inhibitory postsynaptic potential (slow IPSP), the slow excitatory postsynaptic potential (slow EPSP), the late slow excitatory postsynaptic potential (late slow EPSP), and the fast excitatory postsynaptic potential/compound action potential (fast EPSP) were recorded from the 9th or 10th paravertebral sympathetic ganglia of bullfrogs (and some Rana pipiens frogs) by the sucrose-gap technique. The adrenergic antagonists phentolamine, dihydroergotamine and propranolol did not show any antagonistic effect on the slow IPSP when used at concentrations of up to 10, 100 and 10 microM, respectively. U-0521 (3',4'-dihydroxy-2-methylpropriophenone, 50 micrograms/ml), a specific inhibitor of catechol-O-methyltransferase, did not show any potentiating effect on the slow IPSP. The cholinesterase inhibitor neostigmine (0.5-1 microM) induced a large increase in the duration and amplitude of slow IPSP. When phentolamine and propranolol at concentrations greater than 10 microM were used the slow IPSP (and all other synaptic potentials) were non-specifically reduced in amplitude by these drugs. The results reported in this paper do not lend any support to the hypothesis that the slow IPSP in frog sympathetic ganglia is mediated by an adrenergic interneuron. The results are consistent with the proposal that the slow IPSP in this ganglion is mediated by a direct action of acetylcholine released from cholinergic preganglionic fibers.

Antagonists discriminate muscarinic excitation and inhibition in sympathetic ganglion.

The effect of muscarinic antagonists was studied on the muscarinic slow IPSP (inhibitory postsynaptic potential) and slow EPSP (excitatory postsynaptic potential) in bullfrog sympathetic ganglia using the sucrose-gap recording method. Pirenzepine, alcuronium and atropine reduced slow IPSP amplitude more than slow EPSP amplitude. The most selective antagonists studied were pancuronium and gallamine which blocked or substantially reduced the slow IPSP without significantly affecting slow EPSP amplitude. The results suggest that the muscarinic inhibitory response may involve a different muscarinic receptor subtype, and/or receptor-ion-channel complex, than the muscarinic excitatory response.