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The amount of stainable Iron in the bone marrow is frequently used as a means of assessing Iron stores. In our study marrow Iron assessed in needle biopsy sections and simultaneously obtained aspirated smears from 75 patients. Significantly different amounts of stainable Iron were observed in needle biopsy and aspirated smears in 53.3% of the specimen. The usual difference consisted of significantly less stainable Iron in needle biopsy sections as compared to the aspirated smears (49.3%). In according to this study, in comparison of needle biopsy section to aspirated smears (As a golden test), sensitivity and specificity were 88 and 64 percent, respectively. Also, positive and negative predictive values were 56.5 and 91%, respectively. It can be appreciated that marrow assessment of Iron content may be associated with distinct differences between the needle biopsy specimens, and the aspirated smears, and could lead to diagnostic error, although, with some limitations and cautions biopsy specimen can be used for Iron assessment.

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Adenomas of the extrahepatic biliary tuce are rare and common bile duct adenomas are rare too. They may be pessile or pedunculated our patient was a 60 years old lady who presented with RUQ pain and jaundice so with impression of cholangitic under weat laparotomy, cholecystectomy, CBD explouation and choledochoduodestomy. During CBD exploration a 0.5×0.5 cm of CBD identified that excised. Histopathology confirmed the diagnosis of CBD adenoma and the patient discharged 6 days later with no complication.

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Ehler-Danlos syndrome is rare disorder of collagen metabolism, characterized by skin fragility and hyperlaxity, hypermobility of joint. Type I collagen or III collagen is metabolically disordered. Our case report is 27 years old Turkaman male referred top dermatology clinic 5th Azar Hospital for disability, echymose and papyraceus scar. After clinicopathologic evaluation, the diagnosed case proved to be Ehler-Danlos.

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Hemangiomas are benign tumors, which considered being in distance between hamartomas and true neoplasms. Most of the hemangiomas arise in head and neck region and the others grow is trunk and extremities. Hemangiomas of the uterine cervix are rare. They are usually harmless and appear as dark red or purple mass. Our case is a 35 years old patient suffering from intermittent vaginal bleeding and had a well-defined polypoid mass in vaginal examination. The natural history of cervical hemangioma is regression and involution. Biopsy must be undertaken with circumspection because serious bleeding can occur.

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Cutaneous metastasis from carcinoma of the larynx are very rare. We observed a 75-year-old male patient with squamous cell carcinoma of the larynx who developed a subcutaneous nodule as an abscess presentation in the buttock. It was found to be a metastatic squamous cell carcinoma of the laryngeal cancer, histopathologically. The skin manifestations proceeded laryngeal metastases by 18 months after laryngectomy and radical neck dissection. After 3 months, the patient died. Cutaneous metastasis of laryngeal carcinoma should be considered in all patients with previous laryngeal carcinoma representing with cutaneous lesion.

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Background & Objective: Preeclampsia is a common complications of pregnancy it’s about 5-7% in pregnants and it may complicate mother or fetus which ends with death. The purpose of this study was to determine the value of the protein/creatinine ratio in prediction of 24-hour urine total among women with suspected preeclampsia. Materials & Methods: 60 women who were evaluated for suspected preeclampsia at ?24 weeks of gestation were studied prospectively in Deziani Hospital Gorgan. There was no concurrent or preexisting systemic disease. They were undergoing a 24-hour urine collection for the determination of proteinuria. A single voided urine specimen was obtained after completion of the 24-hour urine collection and analyzed for the P/C ratio. Results: The random urinary protein to creatinine ratios is strongly associated with the 24-hour total protein excretion (P<0.05, R=0.75). The best cut off of 0.5 yields a sensitivity of 47% and a specificity of 100%. Conclusion: The random urinary protein to creatinine ratio could replace the 24-hour urine collection as a simple, faster more useful method for the diagnosis of significant proteinuria.

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Background&Objective: Consultation prior to blood donation and screening tests of common blood born diseases such as Hepatitis B,C and AIDS are very important issue in blood quality assurance, therefore we decided to compare frequency of such diseases in blood donors and outpatients admitted in the blood transfusion centers. Materials&Methods: For this purpose the initial tests including HBsAg, HCVAb, and HIVAb were performed on all blood donors and outpatients' blood samples in Gorgan transfusion center by ELIZA methods during 2003 and confirmatory tests including neutralization for HBsAg, RIBA for HCVAb and Western blot for HIVAb performed in condition where ELIZA report was positive. Results: The blood donor in this study had the following positive results: HbsAg 2.5%, HCVAb 3%, HIV 0.35%. The same indeces for the out patients were positive as follow: 13%, 8.3% and 2.04% respectively. The other finding from this investigation indicate that the blood donors positive cases with the ELISA technique were confirmed by Western blot 92%, 20.1% nad 0% for HBSAg, HCVAb, as HIV respectively. The confimatory results of the positive out patient's cases were as follow, 97%, 47% and 60% for HBSAg, HCVAb and HIV respectivley. Conclusion: This study reveals frequency of Hepatitis B and C and AIDS among outpatients which considered being high risk group are more than the blood donors. We conclude that the measurement of HBSAg by ELIAZ methodes in comparision to the HCV and HIV are more accurate.

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The patient was 58 years old lady, admitted due to recurrent right temporal cystic mass, with no previous histopathologic study. On physical examination, a 3*3 cm mobile, cystic mass was present with no other positive finding. Skull CT scanning revealed multilocular cystic lesion of right temporal soft tissue, without involvement of orbit, sinuses and temporal bone. Chest radiography and abdoman sonography was reported to be normal. She undergone operation of cyst evaluation and open underwent draiwage. She dishcharged after 3 days and no recurrence happened in one year follow up. Histopathologic study of the cyst contents, confimed the diagnosis of hydotid cyst. Hydatical cystis, most commonly involves the liver, then lungs and varely striated muscles may be involved at larval stage of edinococcus granulosus and rare edinococcus multilocularis, only in 3% of hydotid disease. Parasite spreads in hematogenous manner. Peritoneal, spleaic, mediastinal, renal, bone, heart, brain, muscular. Arterial, seminal vesicle involvement rarely happens. Preop sonography, CT scanning and MRI and serologic ELISA testing helps diagnosis. New method of FNA and cylologic study as noted by thial, et al may be diagnostic. Appropriate theropy is cysto-peri cystectomy or evacuation. Mebeandazole or albendazole orally as adjunct therapy before and after operation, specially when surgery is impossible may be valuable.

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A 70- years old female referred with left upper quadrant pain since about 72 hours prior to hospital admission. In physical examination the patient was pale, hypotensive, tachycardiac and a vague left upper quadrant (LUQ) mass palpated. LUQ mass and free intraperitoneal fluid declared by ultrasound investigation there was no history of abdominal trauma and with impression of intraabdominal bleeding of unknown origin the patient underwent laparotomy. A huge fundal gastric mass identified with surrounding rupturea retroperitoneal hematoma and intraperitoneal hemorrhage. No intragatric penetration or hemorrhage was seen, so complete excision of the mass with safe margin was done with subsequent splenectomy. She had an uneventful post operative course and was discharged at the 7th post- op day. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma.

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Background&Objective: The presence of single or multiple nodules within the thyroid gland is a common clinical problem. It is immposible to differentiate benign and malignant follicular neoplasms in cytologic examinations.Estimation of risk of malignancy in thyroid nodules who are cytologically assumped to be follicular neoplasm has a critical importance.The aim of this research is evaluation of diagnostic value of thyroid FNA in follicular neoplasm. Materials&Methods: This survey was done on 476 patients with thyroid nodule whome were biopsied in a 7 years period (in 5th Azar hospital, Gorgan). Standard aspirations and biopsies techniques performed and nessassary smears prepared. Wet-fixed smear glass slides are placed immediately in alcohol (70%) 7-10 slides from the aspiration. The patients with cytologic report whome considered follicular neoplasm followed total thyroidectomy or lobectomy. Results: From 476 patients for thyroid nodules 412 cases(86.5%) are suitable for cytologic evaluation which 312 cases(77.9%) of them were benign and 14 cases(3.3%) were malignant.The rest(77 cases)reported to have follicular neoplsm, this patients also undergone thyroid surgery.The result of histological findings appeared in 32 cases(57.1%) follicular adenoma,15 cases(26.7%) non-neoplastic nodules,5 cases(8.9%) follicular carcinoma and 4 cases(7.1%)follicular type of papillary carcinoma. Conclusion: 9 cases (16%) found malignant among cases which cytologic reports considered as “follicular neoplasms” and subsequently undergone thyroid surgery (consist of follicular carcinoma and follicular type of papillary carcinoma), confirme the importance of histopathologic study of follicular lesions for differentiation between malignant and benign lesions.

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Hydatidiform mole with a coexistent fetus is a rare occurrence with an incidence of 1 per 22000-100000 pregnancies. It is associated with persistant gestational trophoblastic tumor. Hence an early and correct diagnosis is imperative to plan subsequent management of such patients. We report a case of primigravida who presented with vaginal bleeding and severe nausae and vomiting. Expectant management was carried out for her pregnancy with finally ended in abortion.

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Background&Objective: Hepatitis B, is a common kind of viral hepatitis. Vaccination is the most secure way of prevention for the health care worker. The present study was designed to survey the seropositivity of Gorgan teaching hospitals. Materials&Methods: This descriptive and cross-sectional study was done on 300 medical and official personals at 3 hospitals in Gorgan in 2003. with using 3ml of pripheral blood, sampling assay was performed to determine HBs-Ab and HBs Ag. Questionnaire form concerning demographic information, vaccination status and risk factors were compeleted for participants. Statistical analysis was done by means of SPSS soft ware with confidence interval equal to 95%. Results: 13% of individuals were not be vaccinated and 74.6% of them were vaccinated completely. There were statistically significant differences between HBs Ag and vaccination status ,individual’s age , the last vaccination time, occupation and use of glove (p<0.05). Furthermore, 1% of samples (one female, two males) were HBs Ag –positive. These three Persons has 10 years at service and were vaccinated compeletely were HBs –Ab neagtive. Conclusion: As a result of vaccination project, vaccination coverage of emplyees and immunologic status of them were satisfactory. Because of repetitive encountering of under considertion individuals with hepaptitis virus, 2% of unvaccinated subject had been infected but fortunately were be cured. Concomitant reduction in probability of immunity was being occurred after vaccination with the passing time and considering the importance of booster dose injection.

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Granuloma faciale is an uncommon cutaneous lesion characterized by asymptomatic skin nodules and plaques without any systemic presentation. The lesions mainly seen in middle aged males. We report an uncommon presentation (multiple cutaneous lesions) in trunk,upper arm and face)of a 32 years old male.

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Background & Objective: Rubella vaccine is prepared with live virus thus if it injects during abstinence period, it can cause fetal risks. The aim of study was to evaluate rubella IGM among infants of women who were vaccinated against rubella during 3 months pre-or post-conception (abstinence period). Materials & Methods: This cohort study was done on 253 mothers, including 116 mothers as cases and 137 mothers as controls. The case group inadvertently had received MR vaccine (RA27/3) during abstinence period. The control group selected randomly from similar delivery center that admitted for delivery. The background and confounding factors was matched between the control and case groups. In both groups after delivery, cord rubella IGM was measured by ELISA for serological diagnosis of infant infection. Data was analyzed by Chi-square and T-student tests. Results: The findings showed that the number of positive IGM infant was similar in both groups (One positive IGM in each group). In spite of no significant difference between the case and the control groups, the maximum theoretical risk in this study was 4.392% (RR=1.091 95% CI=0.271-4.392). Conclusion: Although no significant difference was found from the point of infants with an IgM+ serology in two groups, according to the risk ratio obtained in this study, we still recommend vaccination should be avoided during abstinence period.

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Background and Objective: Destructive effects of thyroid diseases in pregnancy and fetal frowth is well established subclinical autoimmune thyroid diseases can double the rate of preterm labor, abortion and postpartum thyroiditis. This study was done to compare thyroid function and autoimmunity derangment in goiterous and non-goiterous pregnant women. Materials and Methods: This case – control study was done on 100 healthy and 100 goiterous pregnant women in Dezyani hospital located in Gorgan, Northern Iran during 2005. Five mililiter of blood sample was obtained from each subject to measure thyroid hormones concentration including T3/ T4/ TSH/ T3 RUP and thyroid autoantibodies (Anti Tg/Anti TPO). Thyroid hormone and auto antibodies were measured using IRMA and ELISA techniques. Results: Thyroid volume was enlargel twice and tripl of its orginal size in 34% and 66% goitrious pregnant women respectively. Mean serum TSH in cases and controls were 1.81+/-1.33 microU/ml and 1.84+/-1.4 microU/ml respectively. The mean of Anti TPO and Anti Tg in cases were 373.91+-197.36 U/ml and 248.80+-70.59 U/ml respectively. The same indecs for controls were 79.52+-63.99 U/ml and 248.80+-70.59 U/ml respectively. In pregnant women with goiter 36% had high Anti TPO and 9% had high Anti Tg, but in control group 16% and 4% of controls had elevated Anti TPO and Anti Tg, respectively. Conclusion: According to thyroid function tests there were elevation of antibody in 20% of the healthy subjects and 45% of the goiterous subjects, therefore it is advisable to measure thyriod function tests accompanied with thyriod antibodies in all pergnant women either with or without goiter in order to prevent feto-maternal disorders.

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Background and Objective: Mucocutaneons manifestations are common in hemodialysis patients.The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease (ESRD) patients who are on the maintenance hemodialysis.

Materials and Methods: This cross sectional study was performed on 100 (51 males, 49 females) hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests.

Results: The average age was 49±12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis (78.3%), after that pruritis (39.1%) lentigo (34.8%) skin discoloration (32.6%) leukonychia (32%) thining of nail bed (24%) were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% (p=0.042). Xerosis (p<0.01), scaling (p=0.042), lentigo (p<0.01), folliculitis (p<0.01), idio pathic guttate hypopigmentation (p<0.01) leukonychia (p<0.01) and half and half nail (p<0.01) have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration (p<0.031) and leukonychia (p<0.041). Clubhing and ca-p product also have meaningful correlation (p<0.027). Pruritis (p<0.048) and skin fungal infection (p<0.047) (tinea versi color) also have meaningful correlation with serum ferritin level.

Conclusion: Mucocutaneous manifestation were common in end stage renal disease patients.

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Background and Objective: Urinary tract infection is the most common bacterial infection during pregnancy. The pregnant women seems to be at risk for pyelonephritis and untreated infection. Timely recognition and on-time appropriate treatment of urinary tract infection particularly in pregnant women reduce the related complications. This study was done to assesse Sensitivity of isolated E.coli from pregnant women urine to antibiotics. Materials and Methods: In this descriptive study E.coli isolated from 360 urine samples from pregnant women, were examined, using Eosin Methylene Blue, blood sugar method. Antibiogram diffusion disk Kirby-Bauer was performed to assess the antibiotic response. Results: The persent of sensitivity of Escherichia coli to antibiotics were Co-amoxiclav (5.72%), Ampicillin (8.86%), Amoxicillin (11.87%), Cefazolin (32.12), Cephalexin (36.1%), Gentamicin (40.28%), Co-trimoxazole (48.15%), Nalidixic acid (55.3%), Nitrofurantoin (72.48%) and Ceftriaxone (80.78%). Conclusion: This study showed that there is a high level of E.coli antibiotics resistance toward Amoxicillin and Ampicillin high sensevity is related to Ceftriaxone and Nitrofurantoin in this region.

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Background and Objective: The prevalence of hepatitis B infection is increasing worldwide. The main way to prevent hepatitis B transmission to newborns can be through accurate detection of HBsAg positive pregnant women and implementation of standard protocol for their infants. Therefore, this study carried out to determine the frequency of HBsAg in pregnant women in Gorgan, Iran. Materials and Methods: This cross sectional study was done on 1553 pregnant women whom attended to Dezyani hospital in Gorgan, North of Iran during 2008-09. Blood samples were taken and tested for HBsAg and HBeAg using ELISA method. Results: HBsAg was found positive in 15 (1%) pregnant women. However, HBeAg were negative in all cases. Seven of these cases (46.7%) were not diagnosed before admission to the hospital for delivery and therefore had not received any immunoprophylaxis or HBIG treatment for their newborns. In contrary, six mothers and their newborns received immunoprophylaxis due to falsely diagnosed HBsAg seropositive. Conclusion: This study showed that the current protocols for dealing with HBsAg seropositivity and case finding among pregnant women in this region should be thoroughly revised. Furthermore, it is suggested that pregnant women during third trimester should be screened for HBsAg.

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Background and Objective: Androgens are among the causative factors in preeclampsia. This study was done to compare the serum androgens and progesterone in preeclampsia and normal pregnancy. Materials and Methods: This case-control study was done on 30 preeclamptic and 30 healthy pregnant women in Gorgan, Iran. Higher or equal to 140/90 mmHg and proteinuria equal or more than +1 in dip stick test in the third trimester of pregnancy were considered as the diagnostic criteria of preeclampsia. Progesterone, free and total testosterone, and dehydroepiandrosterone sulphate (DHEA) were measured by ELISA method. Results: Total testosterone level was 1.8±0.3 ng/ml and 1.3±0.9 ng/ml in cases and controls, respectively. This difference was not significant. Progesterone was lower in cases (95±46.9 ng/ml) than in controls (165.4±75 ng/ml) (P<0.01). Free testosterone and DHEA were 5.6±2.3 ng/ml and 1±0.5 ng/ml in cases, respectively which was significantly higher than the controls (3.2±1.5 ng/ml and 0.7±0.4 ng/ml, respectively) (P<0.045). Conclusion: Serum level of free testosterone, DHEA and progesterone increased and reduced respectivley in preeclampsia.

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Background and Objective: Rheumatoid arthritis (RA) is a systemic and chronic disease. Anticitrulinated anticyclic antibody (Anti-CCP) and rheumatoid factor (RF) are applied for the diagnosis of rheumatoid arthritis. This study was designed to evaluate the diagnostic value of anticitrulinated cyclic antibody and rheumatoid factor in rheumatoid arthritis patients. Materials and Methods: This laboratory study was done on 238 affected RF patients and 152 RF symptom free subjects in Gorgan, Iran. Anti-CCP and RF were measured by ELISA and Latex agglutination. Results: Out of 238 patients with rheumatoid arthritis Anti-CCP test was positive in 196 patients, and the sensivity was 82%. In control group, Anti-CCP was positive in 5 cases, and the specificity for RA was 96%. RF test was positive in 206 patients and sensitivity for RF in rheumatoid factor was 86%. In control group, RF was positive in 28 cases and specificity was 81%. Positive RF and Anti-CCP (simultaneously) showed sensitivity as 89%. Conclusion: The specificity of CCP is higher than RF and therefore can be substituted as diagnosis of rheumatoid factor.