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Objective: Hydatidosis is one of the most prevalent zoonoses in Iran. Because there is no effective medical therapy, surgery remains the principal mode of treatment. Methods: In this retrospective study, 24 patients were operated for hydatid disease between March 1991 and March 1996 in three medical centers of Babol University of Medical Sciences, and the results were analyzed. Findings: 117 cases (70.8%) were operated in Shahid Beheshti hospital. There were 12 men (50%) and 12 women (50%). Most patients (33.3%) were in 41-60 years age group. 16 cases (66.6%) were from rural areas. The results indicated that the highest percentage of infection was among the housewives (37.5%). Liver was the most affected organ (41.6%). A case of bilateral hydatid lung disease is reported. Conclusion: In conclusion, local as well as national programs, community participation, health education, epidemiological and serological studies especially in high risk groups are necessary for hydatidosis control.

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Objective: Ovarian cysts rarely develop in female fetuses and they may be accidentally detected in a routine ultrasonography performed for evaluation of the fetal health condition during pregnancy. The formation of ovarian cyst in fetus accompanies severe stimulation of maternal and placental hormones. Case: A 25 years old women in her first pregnancy that had a fetus with two cysts in ovary detected by ultrasonography. 4.5 months after delivery, these cysts were resolved spontaneously without any complications. Conclusion: We can follow this patient with bilateral ovarian cysts with conservative treatment (Without surgery) and we recommend surgical management in an emergency situation (i.e. rupture or torsion of the cysts).

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Background and Objective: The objective of this study was determination of the frequency of hirsutism among female students and its relationship with menstrual abnormality, acne, androgenetic alopecia, hypertrichosis and familial history of hirsutism. Methods: This cross-sectional and descriptive study was done by using questionnaires. Data was analyzed by Chi-square test. Findings: From all of 607 female students, 462 filled in questionnaires, that 31.6% of them had hirsutism. 306 (67%) were between 20-23 years old. Menstrual abnormality, acne, androgenic alopecia, hypertrichosis and familial history of hirsutism were seen in 38%, 49%, 34%, 28% and 28% of persons respectively that there was a relationship between the frequency of hirsutism and these subjects. Conclusion: With regard to a relationship between hirsutism and menstrual abnormality, acne, androgenic alopecia, hypertrichosis, familial history of hirsutism, after idiopathic and racial reasons must pay attention to polycystic ovary syndrome.

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Background and Objective: Polycystic ovary syndrome (PCO_s) has been studied for years but the most intriguing issue of PCO_s that is causal factors affecting on ovarian function are still unknown. Neuroendocrine drug therapies, which affect on ovarian and adrenal function, are currently used for treating patients with PCO_s. Methods: This controlled clinical trial was done on 60 patients with PCO_s referred to Mirza Koochak Khan hospital in Tehran during 2000-2001. Hormonal tests and the degree of hirsutism (Freeman-Galloway score) and medium diameter of ovaries were monitored by abdominal sonography at third day of the first menstruation during 6-month treatment. Patients were randomly divided into two groups (Each group 30 persons). First and second groups were treated with OCP_LD and OCP_LD with GnRH agonist, respectively. Findings: Both therapeutical regimens were effective in reducing androgen levels, Freeman Galloway score and medium ovarian diameters during 6-month treatment. However, this reduction in second group in comparison to first group was significantly more. This reduction of plasma testosterone, androstenedione, LH/FSH, medium diameters of ovaries and hirsutism in second group was significantly more than first group. Conclusion: According to the obtained data, it could be concluded that efficacy of the combined regimen (GnRH_agonist+OCP_LD) is higher than OCP_LD alone in treatment of patients with PCO_s.

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Background and Objective: The aim of this study was to assess the follicular response in induction of ovulation with the of low dose human menopausal gonadotropin (HMG) in patients with clomiphene citrate resistant PCOs. Methods: This semi-experimental study was performed on 12 patients with clomiphene citrate resistant PCOs in Fatemeh Zahra infertility center. Induction ovulation was started with 37.5 (IU) of HMG daily and then was increased by 75IU according to follicular response. Patients were exactly monitored by vaginal sonography. Findings: Eight patients showed suitable follicular response to induction, of whom 2 conceived. In 4 patients, their cycles had cancelled because no follicular response was observed in spite of increasing dose to 75IU until midcycle. Ovarian hyperstimulation syndrome (OHSS) was not observed in any of them. Conclusion: Administration of low dose HMG can be used successfully to stimulate follicular growth in patients with clomiphene citrate resistant PCOs.

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Background and Objective: Regarding prospective effects and cross immunity between some species of parasites, obtained antigens of a parasite can be used to prevent other parasitic diseases and adjuvant of this effect can be increased. The aim of this study was to evaluate the effect of hydatid cyst components in prevention of H.Nana in rat. Methods: 40 rats with the same sex and age were selected after gaining confidence in nonexistence of any parasitic disease. They were divided into 2 groups and each group were divided into 4 subgroups. In one group, antigen of fluid, protoscolex, germinal layer were injected respectively and in the other group, these antigenic materials were used with an adjuvant. Control group was considered for both groups. The immunization was performed by multiple injection. One week after injection of antigenic materials, H.Nana eggs were received orally by rats. After observation of H.Nana in stool of rats in control group, blood sample was taken from all rats. Different biochemical tests and immunological and parasitological tests were performed on sera and stool samples, respectively. Findings: Different protein measurements especially gammaglobulin indicated that membrane of hydatid cyst had the strongest antigenic effect in comparison to 2 other parts of cyst and hydatid cyst fluid showed the weakest one. Conclusion: Stool test in control group and exposing egg showed that this group was infected. It was not seen any exposing egg in rats that immunized with different hydatid cyst components. Statistical and biochemical results demonstrated that this effect increased by using adjuvant with different hydatid cyst components and its results showed that immune effect would be increased after injection of adjuvant.

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Background and Objective: Homocysteine is an amino acid with a free thiol (Sulphydryl) group and is an intermediate formed during the metabolism of methionine to cysteine. Measurement of total plasma Homocysteine may be of value in several clinical conditions including homocysteinuria, atherosclerosis, thrombophilia and folate/vitamin B12 deficiency. The purpose of this study was to measure total plasma Homocysteine using RP-HPLC with fluorescence detection method. Methods: Total plasma Homocysteine was measured with reverse-phase HPLC with fluorescence detection after reduction of Homocysteine with tris (2-carboxyetile) phosphine (TCEP) and derivatization of plasma thiols with ammonium 7-fluorobenzo-2-oxa 1,3-diazole-4-sulfonate (SBD-F). Findings: The limit of detection for Homocysteine was 0.2 µmol/l. The within day coefficient of variation (CV) was 2.67% to 4.56% and the between day coefficient of variation was 5.43% to 8.17%. The mean recovery of Homocysteine was 93% to 103.4%. Conclusion: The results show that the HPLC method with fluorescence detection for measurement of total plasma Homocysteine, is sensitive (The limit of detection 0.2 µmol/l), accurate (CV between 2.67% and 8.17%) and it has acceptable recovery (93% to 103.4%). Therefore, it is confident method especially for investigate application.

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BACKGROUND AND OBJECTIVE: Nowadays, besides the ordinary staining, a variety of cell markers and immunohistochemistry methods are incorporated for distinction between neoplasms. But in the current situation, due to the high cost of most of these methods, cheaper and simpler way like silver nitrate staining should be sought for analyzing the nucleolar organizer dots. Therefore, this study was conducted to evaluate the distinction capability of silver nitrate within the benign and malignant neoplasms of the salivary glands.
METHODS: Silver nitrate staining was carried out for nucleolar organizer regions in 22 cases of the most common benign neoplasms of the salivary glands, namely pleomorphic adenoma, and 22 cases of common malignant neoplasms of salivary glands, consisting of 11 adenoid cystic carcinoma and 11 mucoepidermoid carcinoma cases. Twenty-two cases of normal salivary glands of the peripheral regions of the same samples were analyzed.
FINDINGS: The mean dots occurrences for normal salivary glands, pleomorphic adenoma, adenoid cystic carcinoma and mucoepidermoid carcinoma were 1.67±0.2, 2.32±0.39, 3.92±1.11 and 3.25±0.78 (for malignancies was 3.58±1), respectively. There were significant differences among benign and malignant, malignant and normal, and benign and normal groups (p<0.05).
CONCLUSION: This study purposed that the use of silver nitrate staining method is suitable for distinction of the benign and malignant neoplasms of salivary glands.

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BACKGROUND AND OBJECTIVE: Gallbladder torsion is a rare condition of acute abdomen that can lead to acute cholecystitis and gallbladder gangrene. Preoperative diagnosis of this condition is usually difficult and in the most cases, diagnosis achieved at the operation. The preferred treatment is emergent surgery. Considering this condition in the diagnosis of acute abdomen and acute cholecystitis, makes it possible to prevent its dangerous complications such as gallbladder perforation, peritonitis and mortality.
CASE: A 82 year old man with symptoms of acute cholecystitis presented to Shahid Beheshti hospital, Babol, Iran in summer 2004. Sonography of gallbladder showed cholecystitis due to stone. The patient had fever and with clinical diagnosis of empyema, he was operated for cholecystectomy. Diagnosis of gallbladder torsion was made during operation.
CONCLUSION: Gallbladder torsion must be considered in the differential diagnosis of acute abdomen and cholecystitis in old patients in order to prevent from its complications and mortalily.

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BACKGROUND AND OBJECTIVE: Clomiphene citrate is the first–line treatment in patients with ovulatory dysfunction, but it may be associated with side effects for example multiple follicles, multiple pregnancy and adverse effects on endometrial growth. Nowadays, it is considered to use letrozole for induction ovulation. The aim of this study was to compare letrozole with clomiphene citrate for ovulation induction, in patients with polycystic ovarian syndrome (PCOs).
METHODS: This clinical trial study was performed on 107 PCOs patients. They divided into two groups. Group one received 100mg clomiphene citrate (n=57) and group two received 5mg letrozole (n=50) daily on days 3-7 of their menstrual cycle. Human chorionic gonadotrplin (hCG) at a dose of 10000IU was administered when at least one mature follicle was observed. A single IUI was performed 34 hours later. Then size and number of mature follicles, ovulation rate, endometrial thickness and pregnancy rate was measured.
FINDINGS: The number and the size of mature follicles were similar between two groups. The pregnancy rate in letrozole was 6% higher than clomiphene group (20% vs. 14%) that did not show significant difference. Endometrial thickness in letrozole and clomiphene citrate group was 64% and 64.9%, respectively. 86% of patients developed mature follicle in letrozole group who all of them showed ovulation, but in 72% of patients in clomiphene citrate group was developed mature follicles.
CONCLUSION: Letrozole may be an acceptable alternative to clomiphene citrate for ovulation induction and pregnancy rate in PCOs patients.

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BACKGROUND AND OBJECTIVE: The term middle lobe syndrome identified with recurrent right middle lobe atelectasis or lingual that resulted from bronchectasis, TB, malignancy, etc. This syndrome was characterized by chronic cough, hemoptysis and repeated respiratory infection. In this report, hydatid cyst is very rare cause of this disease.
CASE: A 71-year-old man was presented with cough contain bloody sputum but he did not have fever and dyspnea, also sputum BK (Kochs bacillus) smear was negative. The patient repeatedly treated with different antibiotics but not cured. CT scan showed the consolidation in right middle lobe. Fiberoptic bronchoscopy revealed inflammation and erythema in right middle lobe and right lower lobe division. Since the patient did not respond to medical therapy, with diagnosis middle lobe syndrome was operated. Pathology report revealed hydatid cyst.
CONCLUSION: Hydatid cyst as one of the etiologic factors of middle lobe syndrome especially in endemic area should be considered and surgery is the only treatment for this disease.

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BACKGROUND AND OBJECTIVE: Ki67 is proliferation marker in proliferative cells and P53 is a tumor suppressor gene. Meanwhile the cause of high recurrence of keratocyst is unknown. The purpose of this study was to evaluate immunostaining reaction of Ki67 (proliferation marker) and P53 (tumor suppressor gene) in different and all layers of odontogenic keratocyst (OKC).
METHODS: This descriptive study was performed on 20 paraffinized blocks. From parafinized blocks, 3-µm section was cutted and then IHC was done for Ki67, P53 markers with anti Ki67 antibody and anti P53 antibody. Nucleus of epithelial cells was immunostained in different layers of OKC in 1000 epithelial cells, in 10 HPF (high power field) were counted and compared to each other.
FINDINGS: Immunostained nucleus of epithelial cells with Ki67 in basal, intermediate and surface layers and all lining epithelium of OKC were 14.3±4.4%, 41.4±12.8%, 0, 18.5±6.1%, respectively. Mean of nucleus immunoreactive epithelial cells with P53 in basal, intermediate, surface layers and all lining epithelium of OKC were 11.7±3.2%, 23.9±7.6%, 0, 11.8±3.6%, respectively. Mean of immunostained nucleus of epithelial cells with Ki67 and P53 markers was statistically significant in different layers of epithelium of OKC (p<0.0001). There was a significant relationship between mean of nucleus immunoreactive epithelial cells with Ki67 and P53 in intermediate layer of OKC.
CONCLUSION: According to the results, high immunoreactivity with Ki67 and P53 markers in intermediate layers compared to basal, surface and in all lining epithelium of OKC showed exclusion of epithelial cells from normal cell cycle and tendency to recurrence and aggressive behavior in OKC. Also, high expression of Ki67 and P53 in intermediate layers could be used to differentiate aggressive of odontogenic cysts from other odontogenic cysts.

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BACKGROUND AND OBJECTIVE: Nasolacrimal duct obstruction is treated with different methods of surgery. The purpose of this study was to compare the external dacryocystorhinostomy (EX-DCR) procedure with and without silicone intubation and complications caused by these two procedures.
METHODS: This study was performed on patients who underwent external DCR with or without silicone tube in Shahid Beheshti hospital of Babol, Iran during 1997-2006. Age, sex, duration of follow-up, probable cause of obstruction, and complications during and after operation were assessed. The success in operation with the decrease in epiphora and purulent discharge was evaluated.
FINDINGS: Of 300 patients, 220 patients (73.3%) were female and 80(26.7%) were male. The age of patients was 44.5±22 years. The most common complaints of patients were epiphora in 165(55%) and the most common factor was acute and chronic dacryocystitis in 135(45%). Regarding DCR method, success rate was 95.3% with silicone intubation and 88.7% without silicone intubation (p=0.054). The most frequent complication of DCR was recurrence of epiphora (8%) and unusual scar (2.7%). No major complication occurred during operation.
CONCLUSION: EX-DCR is a relatively easy technique with a success rate of more than 90% with few complications. This procedure is recommended to use in most ophthalmic centers.

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BACKGROUND AND OBJECTIVE: Ovulation disorders are a common cause of infertility in women. A common cause of anovulation is polycystic ovarian syndrome. Anti-estrogens agents such as clomiphene citrate and tamoxifen citrate are used as first line treatment in polycystic ovary syndrome patients. About 25% of patients may resistant to clomiphene. The aim of this study was to compare the rates of ovulation and pregnancy between tamoxifen citrate and clomiphene citrate in polycystic ovary patients.
METHODS: This randomized controlled trial study was performed on 150 polycystic ovary syndrome patients referred to Fatemeh Zahra infertile center and Mehregan hospital in Babol, Iran during 2005 and 2006. Patients randomly divided into two groups and stimulation with clomiphene and tamoxifen on cycle days 2-6 was done. On first cycle, patients were treated with clomiphene (100 mg) and tamoxifen (40 mg) and on the next cycle because of no ovulation or pregnancy patients underwent clomiphene (150mg) and tamoxifen (60mg). Ovulation and pregnancy rates were compared in two groups.
FINDINGS: The rate of ovulation in the tamoxifen 40 mg (TMX) group was 41 of 75 (54.7%) and in the clomiphene citrate 100 mg (CC) group was 40 of 75 (53.3%). The rate of ovulation in the TMX group (60mg) was 60 of 73 (82.2%) and in the CC (150mg) was 44 of 70 (62.9%) (p=0.014). There were 5 pregnancies in the TMX group (6.7%) and 10 pregnancies in the CC group (13.3%) that there was not significant difference between two groups.
CONCLUSION: According to the results of this study, for increasing ovulation rate and pregnancy in polycystic ovary syndrome patients who were resistant to clomiphene, tamoxifen can be used.

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BACKGROUND AND OBJECTIVE: Polycystic ovary syndrome is one of the most common items in endocrine diseases and involved patients are at the risk of diabetes and atherosclerosis and cardiovascular disease. The most common clinical features of PCOS are insulin resistance, hyperandrogenemia, non ovulation and infertility. Since obesity is the most common cause of insulin resistance and hyperandrogenemia, so this study was designed to evaluate the effects of weight reduction and treatment with metformin and flutamide on insulin resistance indices and hyperandrogenism and lipid serum in overweight-obese PCOS patients.
METHODS: This double blind clinical trial study was performed on 40 overweight-obese women with PCOS. After a one month diet, according to a control trial double blind design, the patients were randomly allocated to treatment with placebo, metformin (500mg/TDS) and flutamide (250 mg/BID) for the following 6 months while continuing hypocaloric dieting. At baseline and at the end of the study anthropometric parameters, hirsutism and menses, sex hormones, SHBG, lipid and insulin sensitivity determinations were measured and compared in two groups.
FINDINGS: Metformin (12.2±6.07 kg) has a significant effect in decreasing body weight (p=0.000), BMI (p=0.000), waist circumference (p=0.000) and hip circumference (p=0.000) and hirsutism (p=0.000), total testosterone (p=0.032). Flutamide (6.5±5.1 kg) has effectively decreased body weight (p=0.000), BMI (p=0.000), waist circumference (p=0.000) and waist/hip circumference (p=0.005) and hirsutism (p=0.000), total testosterone
(p =0.024), cholesterol (p=0.011) and LDL levels (p=0.013).
CONCLUSION: The results of this study showed that safe drugs such as metformin and flutamide reduced in anthropometric indices and hirsutism. Metformin has been more effective in reducing weight, BMI, waist and hip circumference rather than flutamide.

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BACKGROUND AND OBJECTIVE: There are no pharmacokinetic data on CC isomers zuclomiphene (Zu) and enclomiphene (En) in patients receiving the drug, mainly women with polycystic ovary disease (PCOS). Thus, the main purpose of this study was to characterize the pharmacokinetics of Zu and En isomers and their intersubject variability, for the first time, in anovular patients with PCOS after a single oral administration of CC.
METHODS: Nine women with infertility and PCOS who referred to the infertility clinic were included in this study. After getting consent of patients and ethical approval from the University ethics committee, they received clomiphene citrate 50 mg on the first day of their menstrual cycle. LH, FSH and prolactin levels were measured before and after medication. Plasma concentrations of Zu and En were measured in the patients from the second day of their menstrual cycle (day 1 of dosing) up to 21 days.
FINDINGS: The mean (± coefficient of variation) of C_max, t_max, and AUC of Zu was 15±41 ng/mL, 7±87 h, and 1289±34 ng/mL.h (AUC0-456 h), and that of En was 15±18 ng/mL, 3±68 h, and 65±35 ng/ml.h (AUC0-72 h), respectively.
CONCLUSION: These parameters appeared to be different for Zu from those reported previously in healthy participant the pharmacokinetic parameters of En in patients with polycystic ovary syndrome were not generally different from the healthy subjects.

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BACKGROUND AND OBJECTIVE: Laparoscopic cholecystectomy has been performed for the management of hepatobiliary diseases. Early laparoscopic cholecystectomy (LC) was contraindication for acute cholecystitis (AC). With improvement in operative skills and advances instrumentation, LC is now a common treatment modality for AC. The objective of this study was to compare the outcome of laparoscopic cholecystectomy in acute and chronic cholecystectomy.
METHODS: This retrospective study is comprised of 264 patients with acute (38 cases) or chronic (226 cases) cholecystitis admitted at Babol Medical University hospitals and underwent laparoscopic cholecystectomy from May 2006 to September 2011. Patients were diagnosed into two groups: 1- patients with acute cholecystitis and 2- patients with chronic cholecystitis on the basis of clinical, laboratory, sonographic, surgical and pathological findings. Patients were compared for laparoscopic cholecystectomy results, complications, age, gender, operation duration, early and late postoperative complications, duration of hospital stay, and factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy.
FINDINGS: The mean age of patients was 48.87±13.07 years. From 264 patients underwent LC, 60 (22.7%) were male and 204 (77.3%) were female. Conversion to open surgery in patients with acute cholecystitis was 6 (15.8%) cases and in those with chronic cholecystitis was 9 (4%) cases (p<0.05). Severe adhesion and inflammation were the main reason for conversion to open surgery. Duration of hospital stay was significantly higher in patients with acute cholecystitis (1.6±0.9 days vs. 1.1±0.4) (p<0.05). No significant difference was observed between two groups regarding early postoperative complication. Obstructive jaundice due to the cut of common bile duct was seen in a case with acute cholecystitis and 5 cases had pancreatitis due to retained stone after laparoscopic cholecystectomy in chronic cholecystitis patients.
CONCLUSION: This study showed that LC is an appropriate safe method for treatment of cholecystitis and can be served as the method of choice and first line therapy for cholecystitis.

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ABSTRACT
BACKGROUND AND OBJECTIVE: Vitex agnus castus is used as alternative medicine for treatment of endocrine disorders in women. This study was carried out to evaluate the effect of vitex agnus castus in ovarian histomorphology in rat with induced polycystic ovary syndrome (PCOS).
METHODS: In this study, 48 Sprague Dawley rats (200±20 g & 10 weeks ages) with normal estrous cycles were randomly divided into four groups: Control (received distilled water), Sham, PC and PT. To develop PCOS letrozol was administrated (1mg/kg) by gavage for 28 days to the PC and PT groups. Sham and PT (after induction of PCOS) groups received 365 mg/kg vitex agnus-castus extract orally by gavage for 30 days. At the end of experiment, rats were sacrificed, both of ovaries were dissected out, and prepared section of ovaries stained with Hematoxylin-eosin for histological study.
FINDINGS A significant decrease in number of preantral follicles (PAF), antral follicles (AF) and corpus luteum was observed in PC group compared to other groups, but number of primary follicles did not show significant difference between groups. Diameter of antral follicles, thickness of theca of follicle and tunica albuginea of ovary increased significantly in PC group compared to other groups. However thickness of granulosa layer decrease in PC group compare to other groups. Treatment by vitex agnus castus resulted to increase number of PAF and AF, corpus luteum (6.42±0.64 vs.3±0.18), decrease number of cystic follicles (1.28 ±0.42 vs. 5.66±0.49) and decrease thickness of theca of follicle and tunica albuginea of ovary and increase thickness of granulosa layer of AF.
CONCLUSION: The results of this study showed that vitex agnus castus in administrated dose has positive effect on the condition of ovarian follicles in the experimental PCOS.