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Many studies have investigated the variations in the anatomy of each segment of the cerebral arterial circle while a few have addressed the variations of the cerebral arterial circle as a whole.Thirty brains of recently deceased Iranian infants and fetuses were dissected. The dissection process was filmed and digitized so as to be readily available for further studies. The variations of the circle as a whole and segmental variations were evaluated.Variants with uni- and bilateral hypoplasia of posterior communicating arteries (PcoAs) were the most common in our study, similar to previous works. No aplasia of the precommunicating part of the anterior cerebral artery (A1), the precommunicating part of the posterior cerebral artery (P1) and anterior communicating artery was seen. Hypoplasia of the right and left PcoA was observed in 8 and 5 cases, respectively. Aplasia of the right PcoA was found in 16.6% and of the left PcoA in 3.3%.In this study, we confirmed the previously described finding that the symmetrical, circular configuration of the circulus arteriosus cerebri is present in only about 42.1%. The main differences between the fetal and adult disposition are the diameter of the PcoA and the circular part of the posterior cerebral artery. According to previous studies, the fetal brain older than 4 months has anatomical characteristics very similar to the adult's circle; our finding was mostly similar to adult samples as most samples were from infants, not fetuses.

The bladder exstrophy and classic epispadias represent a spectrum of congenital anomalies with different degrees of anterior midline defect. Although the anomaly usually occurs sporadically there are some cases indicative of a strong genetic component. We present the clinical data of two siblings with bladder exstrophy and epispadias complex (BEEC), who were the product of consanguineous union. All previous reports of familial BEEC in the literature have been reviewed.

Background To find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005. Methods We included 140 children born with MMC and who were referred for management, surgery and treatment of complications associated with it. The ultrasound reports were examined. Data on sex, age, location of MMC, time of prenatal ultrasound and the trimester in which the diagnosis was made along with the results of the diagnosis (MMC, hydrocephalus, or both), were collected. Results Among the studied patients, 136 (97.1%) cases had prenatal ultrasound, amongst those, 58 (42.6%) sonographic evaluations were diagnostic for hydrocephalus and/or MMC. The prenatal ultrasound was positive for MMC in 16 (11.8%), hydrocephalus in 25 (18.4%) and both MMC and hydrocephalus in 17 (12.5%) cases. Among all cases with prenatal diagnosis of MMC, 3.4% were detected in the first, 31% in the second and 65.5% in the third trimester. Thoracic/thoracolumbar lesions were found prenatally in 40% of cases, which is significantly higher than the detection rate of other locations including cervical/cervicothoracic and lumbar/lumbosacral/sacral regions diagnosed only in 0% and 21% of cases respectively. Conclusion There is a large difference between the detection rate of our population (24.3%) compared to others (68%). Pregnant women should have an ultrasound at 20–22 week for detection of congenital anomalies including MMC.

Objectives To determine the time-dependent regeneration of different cellular components in the bladder acellular matrix graft (BAMG) and the involvement of hematopoietic stem cells in BAMG vascular regeneration. Methods and Materials Thirty-three male Sprague Dawley rats underwent partial cystectomy and the acellular matrices were grafted to the remaining host bladder. At 4, 7, 14, 30, 60, 90, and 180 d after grafting, animals were sacrificed and their bladders were excised and paraffin-embedded. Tissue sections were stained for determination of CD3, CD20, CD34, CD31, CD68, smooth muscle cell (SMC) α-actin, and neurofilament protein as well as elastin fibers and collagen typing. Cystometric evaluation of grafted bladders was also performed 3 mo after procedure. Results In acellular matrices, there was no expression of cellular markers and type-1 collagen fibers were predominant. One month after surgery, all grafted matrices were completely lined with urothelium. Polymorphonuclear cells and lymphocytes densely infiltrated BAMG during the first 2 wk after grafting; however the inflammation resolved by the first post-surgical mo. CD34+ endothelial progenitor cells (EPCs) were found in all grafts 4 d after surgery. The number of CD34+ cells increased continuously and peaked 2 mo after grafting. The increment in number of CD31+ microvessels in grafted matrices followed that of CD34+ cells and reached 144.5% of control values at third post-surgical mo. The mean number of CD34+ and CD31+ cells returned to control ranges by 6 mo after grafting. Expression of SMC α-actin was first visualized on day 4 and α-actin intensity reached to control values 6 mo after grafting. Neural elements appeared 1 wk after grafting and just 60% of normal intensity was achieved by the sixth post-surgical mo; however complete nerve bundles were found in all grafted matrices after 1 mo. Cystometric studies revealed higher bladder capacity and compliance but lower maximum intravesical pressure in grafted bladders in comparison with controls, 3 mo after surgery. Conclusions Our results demonstrate the effective cellular regeneration in BAMG and propose a considerable role for the CD34+ EPCs in the neo-vasculogenesis of the grafts.

Cervical myelomeningocele (cMMC) is a rare disease. Only a few series have been published regarding cMMC. Different issues regarding the etiology, classification, clinical, surgical, and pathological aspects of cMMC are still a matter of conflict.Sixteen children operated on for cMMC between July 2000 and 2003 were followed by the neurosurgical service at Children's Hospital Medical Center in Tehran. The patients were followed up for 2 to 5 years (median, 3 yr).The studied patients were nine boys and seven girls, ages 1 day to 4 months. Neurological examination was normal in all but two patients. All children had a normal anal fold, could void spontaneously, and showed no evidence of gross orthopedic deformity. We found eight patients with hydrocephalus, four patients with Chiari II malformation, two patients with syringomyelia, one patient with diastematomyelia at the level of cervical hemimyelomeningocele, and one patient with associated sacral myeloschisis. A thorough urological evaluation was planned for 13 patients, which confirmed bladder dysfunction in 10 (71%) patients. All infants had midline lesions, which consisted of a protruding sac from the back of neck, covered with purplish rudimentary or dysplastic skin at the dome. All patients underwent surgical resection of the sac and intradural exploration to release any adhesion and to exclude other associated anomalies.Cervical myelomeningocele differs structurally and clinically from myelomeningocele in distal areas and has a more favorable outcome. We think that some trivial neurological deficits in cMMC are caused by the late and limited neurulation abnormality during its development. We advise thorough preoperative evaluation of the brain, spinal column, and urinary system. Intradural exploration to release any potential adhesion bands as well as correcting associated anomalies is recommended in all cMMC operations.

Background Young people are of particular importance in state policies against Acquired Immunodeficiency Syndrome (AIDS). We intended to assess the knowledge and attitude of high school students regarding AIDS in Iran. Methods Through a cluster-sampling, 4641 students from 52 high schools in Tehran were assessed by anonymous questionnaires in February 2002. Results The students identified television as their most important source of information about AIDS. Only a few students answered all the knowledge questions correctly, and there were many misconceptions about the routes of transmission. Mosquito bites (33%), public swimming pools (21%), and public toilets (20%) were incorrectly identified as routes of transmission. 46% believed that Human Immunodeficiency Virus positive (HIV positive) students should not attend ordinary schools. Most of the students wanted to know more about AIDS. In this study knowledge level was associated with students' attitudes and discipline (p < 0.001). Conclusion Although the knowledge level seems to be moderately high, misconceptions about the routes of transmission were common. There was a substantial intolerant attitude towards AIDS and HIV positive patients. We recommend that strategies for AIDS risk reduction in adolescents be developed in Iranian high schools.

P 0.39). Time to catheter expulsion was shorter in the Traction Group (1.9 1.5 vs 3.2 2.1 hours, P .001). Change in Bishop and pain scores, cesarean delivery rates, clinical amnionitis, and other maternal morbidities were similar (Table). Subset analyses of those with vaginal delivery, nulliparas, and multiparas revealed similar results. CONCLUSION: Traction on the intracervical Foley catheter during preinduction cervical ripening shortens the time to spontaneous catheter expulsion but does not affect other labor outcomes.

for labor induction in women with gestational hypertension or mild preeclampsia at term: an exploratory analysis of the HYPITAT trial Parvin Tajik, Karin van der Tuuk, Corine Koopmans, Henk Groen, Marielle van Pampus, Paul van der Berg, Joris van der Post, Aren van Loon, Christianne de Groot, Anneke Kwee, Anjoke Huisjes, Erik van Beek, Dimitri N. M. Papatsonis, Kitty W.M. Bloemenkamp, Gijs van Unnik, Martina Porath, Robbert Rijnders, Rob Stigter, Karin de Boer, Liesbeth Scheepers, Patrick Bossuyt, Ben Mol Academic Medical Center, Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands, University Medical Center Groningen, Obstetrics and Gynaecology, Groningen, Netherlands, University Medical Center Groningen, Epidemiology, Groningen, Netherlands, University Medical Center Groningen, Obstetrics and Gynecology, Groningen, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, Martini Hospital, Obstetrics and Gynaecology, Groningen, Netherlands, VU Medical Centre, Obstetrics and Gynaecology, Amsterdam, Netherlands, Dutch consortium AMPHIA trial, Netherlands, Gelre Hospital, Department of Obstetrics and Gynaecology, Apeldoorn, Netherlands, St Antonius Hospital, Obstetrics and Gynaecology, Nieuwegein, Netherlands, Amphia Hospital, Obstetrics and Gynaecology, Breda, Netherlands, Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, Netherlands, Diaconessen Hospital, Obstetrics and Gynaecology, Leiden, Netherlands, Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, Netherlands, Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, Den Bosch, Netherlands, Deventer Hospital, Obstetrics and Gynaecology, Deventer, Netherlands, Rijnstate Hospital, Obstetrics and Gynaecology, Arnhem, Netherlands, University Medical Centre Nijmegen, Obstetrics and Gynaecology, Nijmegen, Netherlands OBJECTIVE: Examining whether cervical ripeness should defer obstetricians decision regarding labor induction for women with gestational hypertension or mild preeclampsia at term. STUDY DESIGN: We used the data from the HYPITAT trial (ISRCTN08132825), a multicenter, parallel, and open-label randomized controlled trial in women with a singleton pregnancy at term who had gestational hypertension or mild preeclampsia; in this trial 756 women had been randomized to either labor induction or expectant monitoring. We examined if the presence of an unfavorable cervix (measured by cervical length and Bishop score) would affect the superiority of labor induction compared to expectant monitoring. The primary outcome was the occurrence of a high risk maternal (HR) situation. Secondary outcomes were neonatal outcome and cesarean delivery. All analyses were by intention to treat and were done by using logistic regression. RESULTS: HR situations had occurred in 117 women (31%) in the labor induction group and in 166 women (44%) in the expectant monitoring group. The superiority of labor induction over expectant monitoring in preventing HR situations varied significantly according to cervical length (test for interaction p 0.03). In women with a long cervix ( 40 mm) or a low Bishop score (5). Similarly, the effect of induction on reducing the cesarean section rate was also stronger in women with a long cervix or a low bishop score. CONCLUSION: Against the widely held opinion that labor induction should be introduced when the cervix is ripe, women with gestational hypertension or mild preeclampsia, and with an unfavorable cervix benefit more from labor induction, as compared to expectant monitoring, than women with a ripe cervix. 793 Placental oxidative stress is an important mediator of IL-17 induced hypertension during pregnancy Pushpinder Dhillon, Jeremy Scott, Kedra Wallace, Judith Heath, Janae Moseley, James Martin, Babbette LaMarca University of Mississippi Medical Center, Obstetrics and Gynecology, Jackson, MS OBJECTIVE: New onset hypertension with proteinuria during pregnancy, preeclampsia is vastly becoming is associated with chronic immune activation. Recent studies show that preeclampsia is associated with activation of autoimmune cells, TH17, secreting interleukin-17, an inflammatory cytokine strongly associated with autoimmune diseases. Reactive oxygen species (ROS) is thought to be one important pathophysiological mediator of preeclampsia as well as many chronic immune disorders. The objective of our study was to determine if chronic exposure to IL-17 during pregnancy increases blood pressure by stimulating oxidative stress. STUDY DESIGN: To answer this question four groups of rats were examined: NP (n 20), NP IL-17 (n 7), NP tempol (n 7) (a superoxide dismutase mimetic that scavenges ROS) and NP IL17 Tempol (n 12). On day 14 of gestation miniosmotic pumps infusing IL-17 (150 pg/day) were implanted into NP rats while tempol was administered via the drinking water ad libitum. On day 18 of gestation carotid catheters were inserted and mean arterial pressure (MAP) was recorded, plasma, urine, and tissue were collected for isolation of ROS and detection by chemiluminescent technique. Urinary isoprostane was measured by ELISA. RESULTS: MAP increased from 98 / 3 in NP to 123 / 3 mmHg in IL17 infused NP rats. Urinary isoprostane increased with chronic IL-17 from 1029 / 1 pg/mg/day in NP rats to 3526 / 2 pg/mg/ day in IL-17 infused, p 0.05. Placental ROS was 436 / 4 RLU/ml/ min (n 4) in NP to 702 / 5 (n 5) RLU/ml/min in IL-17 treated rats. Administration of Tempol attenuated the blood pressure increase to IL-17. MAP was 102 / 5 mmHg in Tempol controls and was unchanged in NP IL-17 tempol, 101 / 3 mmHg. Tempol attenuated placental ROS production to 459 / 5 (n 5) RLU/ml/ min in IL17 Tempol, which was no different from Tempol controls, 474 / 5 (n 3) RLU/ml/min CONCLUSION: These data indicate that chronic IL-17 causes placental oxidative stress, which plays an important role in mediating IL-17 induced hypertension during pregnancy.

Purpose To evaluate the efficacy of antioxidant administration starting at the onset of fever detection in reducing renal scars in an animal model of acute pyelonephritis (APN), and comparing the effectiveness of Allopurinol and vitamin E in the prevention of renal scaring. Material and methods Twenty male Wister rats divided to 4 groups. Group 1 to 3 underwent direct inoculation of 0.1 ml of E-coli suspension into the parenchyma of the right kidney. Group 4 received 0.1 ml of saline. Group I were treated with ceftriaxone for 5 days, starting 3 days after bacterial inoculation; group II & III received Allopurinol and vitamin E as soon as animal's body temperature rose above 37°C. followed by the administration of daily ceftriaxone 3 says after inoculation for five days. Six weeks later all rats were sacrificed; both kidneys examined histopathologically for scarring. Renal cell apoptosis index was determined in paraffin embedded kidneys (using TUNEL assay). Results The fever started 4.6±1.3 hours (measured by continues digital rectal thermometer) after inoculation in all rats. Histopathologically, subsequent scar formation had occurred in all rats of the group 1 which didn't receive antioxidant agents. The inflammation and fibrosis was mildest in group 2 and 3 (Allopurinol and Vitamin E); whereas it was significantly lower in group 3 than in group 2 (p Conclusions Initiation of the antioxidant agents following detection of fever can be effective in reducing the severity of scarring in APN. Comparing the total scar scores in experimental groups, vitamin E has more protective effect against renal damage due to APN than Allopurinol.

Background As the voiding habits of Iranian children differs from other children because of some cultural and religious considerations, we aimed to establish normal reference values of urinary flow rates in Iranian children between 7 to 14 years of age. Methods Eight hundred and two uroflowmetry studies were performed on children with no history of a renal, urological, psychological or neurological disorder, between the ages 7 and 14. Five hundred twenty five studies from 192 girls and 335 boys were considered in this study excluding the staccato/interrupted voiding pattern or voided volume less than 20 ml. The voiding volume, the maximum and average urinary flow rates were extensively analyzed. Results The maximal and average urine flow rate nomograms were plotted for both girls and boys. Mean maximum urine flow rate was 19.9 (ml/sec) for boys and 23.5 (ml/sec) for girls with a mean voided volume of 142 (ml) for boys and 147 (ml) for girls. Flow rates showed a close association with voiding volume in both sexes. The maximum and average flow rates were higher in girls than in boys, and they showed a significant increase in flow rates with increasing age, where boys did not. The mean maximum urine flow rates (19.9 ml/sec for boys and 23.5 ml/sec for girls) were found to be higher in this study than other studies. Conclusion Nomograms of maximal and average flow rates of girls and boys are presented in centile form, which can help the physician to evaluate the response to medical or surgical treatment and be useful for the screening of lower urinary tract disturbances in children, for a wide range of voided volumes.