1 Bahar, Tabestan 1384 Spring, Summer 2005 6 1,2 158 HOSSEIN NOUGH, MD, MEHRAN KARIMI*, MD, HASHEM SEZAVAR**, MD, ALI KHODADADI, MD AND JAFAR AHMADI, MD LIPID FACTORS ARE CURRENTLY CONSIDERED TO BE THE MAIN AGENT RESPONSIBLE FOR CARDIOVASCULAR RISK IN YOUNG INDIVIDUALS. SEVERAL EPIDEMIOLOGICAL STUDIES HAVE SHOWN THAT ATHEROSCLEROSIS BEGINS IN CHILDHOOD. THEREFORE, THERE IS A GENERAL CONSENSUS THAT THE EARLIER THE CONTROL BEGINS, THE BETTER THE RESULTS WILL BE. NOW THERE ARE MANY CONTROVERSIES REGARDING THE EARLY DIAGNOSIS OF HYPERLIPIDEMIA IN CHILDREN. THE AIM OF THIS STUDY WAS TO EVALUATE SERUM LIPID LEVELS IN CHILDREN WHOSE PARENTS SUFFER FROM PREMATURE CORONARY ARTERY DISEASE (CAD). IN THIS CROSS SECTIONAL STUDY, 76 CHILDREN BETWEEN 2-10 YEARS OLD (38 CHILDREN, WHOSE PARENTS HAD PREMATURE CAD, AND 38 HEALTHY, AGE AND SEXMATCHED CONTROLS, WHOSE PARENTS DID NOT HAVE PREMATURE CAD) WERE STUDIED. THE HEIGHT, WEIGHT AND BODY MASS INDICES WERE SIMILAR IN BOTH GROUPS. SERUM LIPID LEVELS [TOTAL CHOLESTEROL, TRIGLYCERIDE, HIGH DENSITY LIPOPROTEIN (HDL) AND LOW DENSITY LIPOPROTEIN (LDL)] WERE MEASURED AFTER 10 HOURS FASTING FOR 2 TIMES, ONE WEEK APART, AND THE MEAN OF THE TWO VALUES WAS CONSIDERED AS THE AMOUNT OF EACH VARIABLE. DATA WERE ANALYZED WITH EPI 6, AND P<0.05 WAS CONSIDERED AS SIGNIFICANT. RESULTS SHOWED THAT MEAN TOTAL CHOLESTEROL AND LDL WERE 167±20 AND 135±30MG/DL IN THE CASE GROUP AND 121±20MG/DL AND 101±20MG/DL IN THE CONTROL GROUP AND THAT THESE DIFFERENCES WERE SIGNIFICANT STATISTICALLY. THERE WERE NO DIFFERENCES BETWEEN THE TWO GROUPS FOR TRIGLYCERIDES AND HDL. IN THE CASE GROUP, SIX CASES HAD LDL LEVELS GREATER THAN 160MG/DL, WHILE THERE WERE NO SUCH CASES IN THE CONTROL GROUP. We Therefore Concluded That Total Cholesterol And LDL Levels Were Higher In Children Of Parents With Premature CAD. This Necessitates Evaluation Of Serum Lipid Levels In Children Of Parents With Premature CAD (Iranian Heart Journal 2005; 6 (1,2): 6-10). LIPID LEVEL ■ CHILDREN ■ PREMATURE CORONARY ARTERY DISEASE 159 F. Jalali, MD and K. O. Hajian-Tilaki, PhD Hyperlipidemia is an important cause of coronary artery diseases. Linseed contains large amounts of omega-3 fatty acids, and it has a major role in lowering serum lipid levels. This study evaluated the effect of linseed powder in patients who did not respond to regular diet regimens. We conducted an interventional study (before and after) of 56 patients with hyperlipidemia that had not responded to a 3-month regular diet and had serum levels of total cholesterol >240 or TG>300 or LDL>160 or HDL<30 (mg/dl). We prepared the dose of 6 gr/day of linseed powder in the form of a biscuit and gave it to the patients for 3 months plus their regular diet regimen. The serum levels of lipids were measured before and after the 3-month intervention program. The data were analyzed using SPSS software with paired t-test The mean (±SD) of serum level of total cholesterol before treatment was 258 (±55.59) mg/dl and afterwards was 232.05 (±41.47) mg/dl (P=0.0001). The mean serum triglyceride level before and after treatment was 289.92 (±126.57) mg/dl, and 225.07 (±82.58), respectively (P=0.0001). Also, the mean serum LDL decreased from 173.82 (±52.87) to 141.12 (±39.94) mg/dl (P=0.0001). However, no significant difference on HDL levels was found before and after intervention (43.89 (±25.66) vs. 43.53 (±13.84), P=0.85). Overall, the linseed powder regimen for 3 months decreased the total cholesterol by 10.2%, serum triglyceride by 22.33% and LDL cholesterol level by 18.8%. HDL level increased by 1.45%. Linseed powder plus regular diet decreased the lipoprotein levels significantly. Thus, we recommend roughly 6 gr. daily consumption of linseed as a compliment of regular diet regimen in lowering the level of serum lipids (Iranian Heart Journal 2005; 6 (1,2): 37-42). hyperlipidemia ■ linseed ■ cholesterol ■ triglyceride■ LDL■ HDL■ diet 160 Ali Esmaeili Nadimi, MD; Jafar Ahmadi, MDand Mehrnoush Mehrabian, MD DRY COUGHS ARE THE MOST COMMON ADVERSE EFFECT AND LIMITING FACTOR OF ALL ANGIOTENSIN CONVERTING-ENZYME INHIBITORS (ACEI). PROSTAGLANDINS HAVE BEEN PINPOINTED AS PLAYING AN IMPORTANT ROLE IN THE GENESIS OF THIS PROBLEM. THE SUBJECTS WERE 32 PATIENTS, WHO HAD DEVELOPED ACEIINDUCED COUGHS.THEY WERE RANDOMIZED TO A DAILY DOSE OF 500 MG ASPIRIN OR PLACEBO FOR A TREATMENT PERIOD OF 4 WEEKS.THE MEANS OF COUGH SEVERITY BEFORE AND EACH WEEK FOR 4 WEEKS WERE COMPARED IN THE TWO GROUPS. MEANS OF COUGH SEVERITY IN THE ASPIRIN AND PLACEBO GROUPS BEFORE AND AT THE END OF THE FIRST WEEK OF TREATMENT DID NOT SHOW ANY SIGNIFICANT DIFFERENCE. AFTER THE SECOND, THIRD AND FOURTH WEEKS, THE COUGH SEVERITY SCORE WAS SIGNIFICANTLY REDUCED IN THE ASPIRIN GROUP (P<0.001). 500mg aspirin once daily can suppress or abolish ACEI-induced coughs, and this finding proposes alternative therapeutic approaches for ACEI-related coughs (Iranian Heart Journal 2005; 6 (1,2): 17-19). aspirin ■ coughs ■ angiotensin-converting enzyme ihibitor 161 Rezayat Parvizi, MD, Mohammad Rahbani, MD, Susan Hassanzadeh Salmasi, PhD and Maliheh Safavi, MSc Microalbuminuria is a diagnostic tool for screening patients at risk of developing nephropathy. It is also known that patients with microalbuminuria have a greater incidence of cardiovascular events and early mortality. In this study, reliability of the microalbuminuria as an indicator of a risk of progressive cardiovascular disorders was tested by detection of the relationship between microalbuminuria and extension of atherosclerotic coronary lesions. The subjects for this study were 228 patients with angiographically confirmed coronary atherosclerotic lesions and mean of age 60 years; they were referred to Madani Hospital Tabriz, Iran. Age and sex-matched apparently healthy individuals (n=114) were used as the control group for a comparative study. The levels of glucose and creatinine and that of post-prandial glucose were determined in venous blood samples by standard methods. The immunoturbidimetric method was employed in the measurement of microalbuminuria A direct relationship between microalbuminuria and extension of atherosclerotic coronary lesions was noticed (P = 0.009). The increased albumin / creatinine ratio was markedly correlated with fasting blood sugar, systolic and diastolic blood pressure (P<0.05). The presented results indicate the existence of significant correlation between extent of atherosclerotic lesions and microalbuminuria. The relationship between diabetes and microalbuminuria was meaningful. These facts may contribute to the higher cardiovascular risk in diabetic patients. An association between hypertension and microalbuminuria was noticed. The result suggests that although risk factors such as hypertension and diabetes are known to cause cardiovascular disease, microalbuminuria may in fact be a contributor indicator of cardiovascular events (Iranian Heart Journal 2005; 6 (1,2): 20-25). microalbuminuria atherosclerosis 162 Majid Maleki, MD, Peiman Malek Marzban, MD, S. Zahra Ojaghi Haghighi, MD and F. Noohi, MD Coronary artery bypass grafting (CABG) is a common surgical procedure performed in the world. Coronary artery disease (CAD) has become prevalent in Iran, and the aim of this study is to assess the effects of CABG on LV systolic and diastolic function indices. We also attempted to disclose the CABG effect on the myocardial performance (Tei) index. 50 patients were enrolled in this study, all of whom were given instructions about the research program. They were admitted to our center electively for CABG; the first echocardiography was taken just prior to surgery, and the second TTE was performed between 1 and 43 weeks after surgery (mean=11 weeks). CABG had dramatic effects on the patients, as their mean left ventricular ejection fraction (LVEF) rose from 48.88% to 52.54% (P<0.001). It was more obvious in patients with preoperative LVEF less than 40%, Tei index<0.49, male gender and those with complete revascularization. LVEF had no change in the case of incomplete revascularization. MPI (Tei) decreased significantly after CABG from 0.4992 to 0.4462 (P=0.001), which was more pronounced in those whose preoperative Tei index was equal or more than 0.49 and in patients with triple vessel or left main CAD. Diastolic function recovery had a timedependent manner with no change or even deterioration during the first few days after CABG, but after 4 weeks nearly half of the patients had normal diastolic function. History of systemic hypertension and old age (>60 years old) are both associated with more preoperative diastolic dysfunction and are negative predictors for diastolic function recovery after CABG. Isovolumetric relaxation time (IVRT), E-wave deceleration time (EDT), peak E-wave velocity (PEV) and peak A-wave velocity (PA) all show significant improvement after CABG. There was no mortality in our series CABG has important positive and significant effects on many LV systolic and diastolic indices including LVEF, LVESV, IVRT, PEV, PAV and EDT as well as on the myocardial performance (Tei) index (Iranian Heart Journal 2005; 6 (1,2): 26-30). coronary artery bypass surgery Ë myocardial function Ë ejection fraction 163 Aliakbar Khoshkhonejad, MD; Ahmad Mohebi, MD* and Farkhondeh Raiessadat, MD Results of studies seeking for the association between periodontal diseases and coronary artery disease (CAD) are significantly inconsistent. Such inconsistency has been attributed to the varying definitions for CAD and whether or not adjustment for common risk factors has been performed. The main objective of this study was to investigate the association between angiographically- defined CAD and periodontal diseases. Fifty-eight patients, who referred to Shaheed Rajaie Cardiovascular Medical Center, were recruited into a case-control design study. They were examined for periodontal indices such as the papillary bleeding index (PBI), probing depth (PD), plaque index (PI) and clinical periodontal attachment level (AL). The subjects were classified as having CAD (CAD+) if they had at least 50% stenosis in at least one major epicardial artery. Thirty-nine patients (67.2%) were CAD+ and 19(32.8%) were CAD- .CAD+ patients were more likely to be male than female (90.3% versus 40.7%, p=0.000) and of older ages (55±2.7 versus 40.6±4.8, p=0.000). Among periodontal parameters, no significant association was found between the mean of PBI, PD and CAD. On the other hand, there was a significant association between the amount of AL, PI, number of missing teeth and CAD. There was also correlation between the amount of AL and the number of vessels involved (r=0.428). The results of this study remained unchanged after adjustment for CAD risk factors, performing multilogistic regression analysis. The observation showed a significant relationship between angiographicallydefined CAD and periodontal diseases, which can emphasize the importance of early diagnosis and complete treatment of periodontal infections, particularly in CAD susceptible individuals (Iranian Heart Journal 2005; 6 (1,2): 31-36). periodontal diseases■ coronary artery disease 164 Mahmood Meraji, MD; Noor Mohammad Noori, MD; Semira Mehralizadeh, MD and Yousof Aarabi, MD The aim of this study was to report the results of using PDA occluders (coil occluder and Amplatzer device), which has continued since December 1999 at the pediatric department of Rajaee Heart Center. Between December 1999 and September 2002, 193 cases of PDA were admitted at the pediatric ward. Seventy cases underwent transcatheter occlusion of PDA by the detachable coil occluder, and in 53 cases PDA was occluded by the Amplatzer device. Successful coil placement was accomplished in 68 cases. Two cases of intravascular hemolysis were observed due to residual shunt .In one of them, acute tubular necrosis ensued, and peritoneal dialysis was performed. However, after surgical PDA closure, the renal performance was recovered eventually. Also, two cases of coil detachment to the LPA were observed with no long-term sequala on pulmonary function. Fifty-two of the 53 Amplatzer occlusions were successful. Only one failure was observed due to the small size of the Amplatzer in comparison to the duct diameter. Retrograde and antegrade transcatheter closure of the PDA by the detachable coil occluder and Amplatzer device has been performed successfully in our department. The problem that we face has been PDA sizing and also the retrieval of detached coils (Iranian Heart Journal 2005; 6 (1,2): 43-47). Patent ductus arteriosus ■ transcatheter occlusion ■coil occluder ■ Amplatzer device 165 M. Chinikar, MD1 and M. Maddah, PhD2 Whether atrio-ventricular plane displacement (AVPD) in echocardiography findings may help to diagnose ischemic heart disease (IHD) in the presence of normal systolic function is not clear. This study aimed to assess the relationship between AVPD and ischemic heart disease (IHD) in a group of IHD patients. One hundred two outpatients (65 male and 37 female) aged 58.9±11.4 were examined for IHD by echocardiography, stress test and angiography, and 61 patients were found to have IHD. Echocardiographic findings, including AVPD, LVEF and RWMA, were compared in normal and IHD patients. Comparison of echocardiography findings in the ischemic patients to the normal subjects showed that the subjects with IHD had significantly lower AVPD, LVEF and higher RWMA. Results of a logistic regression analysis indicated that AVPD was an independent predictor of IHD (OR=0.61, 95%CI= 0.46-0.79). These data suggested that low AVPD was associated with increased risk of IHD. AVPD may help diagnose IHD when more sophisticated techniques are not available and/or applicable (Iranian Heart Journal 2005; 6 (1,2): 48-51). AVPD ■ echocardiography ■ IHD 166 M. H. Soltani, MD; M. Sadr, MD; M. Rafee, MD; M. Imami, MD; M. Motafakker, MD; A. Andishmand, MD and M. Nemayandeh, MD. The purpose of this study was to assess frequency, risk factors, complications and mortality rate of young patients with acute myocardial infarction (AMI), in Yazd. From a database of 815 consecutive patients admitted to Yazd hospitals with AMI between 2001 and 2002, we compared care, risk factors, complications and outcome of patients, divided into two age groups: £ 45 years, (young) and >45 years (old). Risk factors, type of AMI, management, complications and hospital outcomes of the 2 groups were evaluated. The young patients represented 11.6% of all cases, and 10% of these individuals were female. Smoking (60.2% vs. 33.6%, P. value=0.000), positive family history (40.2% vs. 28.6%, P. value=0.017) and obesity (25% vs. 13.9% P. value=0.022) were more common in the young group. Diabetes mellitus (24.1% vs. 46.9%, P. value=0.000) and hypertension (15.1% vs. 43.3%, P. value=0.000) were more common in the old patients. Young male patients had less in-hospital mortality (1.2% vs. 9.1%, P. value=0.005) than old male patients, but in the females the difference of mortality between young and old was not significant (10% vs. 19.9%, P. value=0.3). In this study, about one-tenth of the patients with AMI were £ 45 years old. Smoking, obesity and positive family history were more common in the young patients, and overall mortality rate was low in the young (Iranian Heart Journal 2005; 6 (1,2): 52-54). Yazd ■acute myocardial infarction ■ young 167 Sima Rafiian, MD and Abdolrazagh Kiani,* MD A number of publications has shown a relation between increased QT dispersion and death from a cardiac cause. However, there are no published data on the value of QT interval dispersion after openheart surgery in the pediatric age group. Three electrocardiograms (pre-operation, on the day of operation and the second day post-operation) were obtained from 18 children (11 males, 7 females), three to 14 years of age. Measurements were carried out from standard 12- lead ECGs recorded at a speed of 25 mm/s at rest. The QT and preceding RR intervals of at least one sinus beat (range one to three) were measured in a range of nine to 12 leads, and the mean QT and RR intervals were calculated. The corrected QT interval was calculated by Bazett’s method (QTc = QT/√RR). QT intervals were measured from the onset of the QRS complex to the end of the T wave. Dispersion of the QT and QTc were defined by the difference between the maximum and minimum QT and QTc intervals occurring in any of the 12 leads. The mean QT dispersion in patients before surgery was 53 ± 22 ms, 72±31 ms on the day of operation and 65±27 one day after operation, and mean QTc dispersion before surgery was 62±22 ms, 95±27 ms on the day of operation and 97±41 ms on the day after operation. There was a significant increase in mean QT and QTc immediately after surgery (p<0.001). Although it decreased on the first day after surgery, it remained significantly high as compared to before surgery (p<0.02). QT interval dispersion may increase after open-heart surgery, which may result in death following an arrhythmia. Open-heart surgery may have an independent role in the genesis of QT dispersion prolongation and should be considered as one of the mechanisms of arrhythmia after surgery (Iranian Heart Journal 2005; 6 (1,2): 55-59). QT dispersion ■ open-heart surgery ■ arrhythmia 168 Mahmoud Mohammadzadeh Shabestari, MD; Ali Asghar Dadgar, MD; Tayebeh Bostani Amlashi, MD; Ali Moradi*, MS and Mojtaba Talaei Khoei, MD Carotid endarterectomy is superior to medical management for the prevention of stroke in patients with carotid and vertebral artery stenosis, but stenting with the use of emboli-protection devices is less invasive. We report our results with carotid artery stenting in five patients. Stenting was done in five symptomatic male patients (mean age = 66.8 years), 20% and 40% of whom were diabetic and hypertensive, respectively, and 60% had coronary artery involvement. Indications for stenting were prior stroke in one, vertigo in one and transient ischemic attack in three patients. Stenting with self-expandable stents was technically successful in all the cases. No stroke, restenosis or death occurred. Stenting cerebral arteries are feasible with a high degree of technical success (Iranian Heart Journal 2005; 6 (1,2): 60-63). carotid artery stenosis ■ vertebral artery stenosis ■ stenting ■ stroke ■ prevention 169 Rezvanieh Salehi, MD; Rezayat Parvizi, MD and Susan Hassanzadeh Salmasi, PhD Postoperative atrial fibrillation (AF) is a common complication of coronary artery bypass graft surgery (CABG) and is associated with an increased incidence of other complications and an increased hospital length of stay. Prevention of AF is a reasonable clinical goal. The aim of this study is to determine the predictive value of multiple clinical, hemodynamic and operative variables for the occurrence of postoperative AF. This research is a descriptive study. Patients scheduled for elective CABG between 1997 and 1999 were recruited. The patients underwent holter monitoring for 3 consecutive days. Information was collected by a questionnaire. Statistical analysis was based on the SPSS software and was done through the descriptive statistical method. 200 patients underwent isolated CABG between 2001 and 2003. The patients with a mean age of 55±8 years old underwent holter monitoring for 3 days. AF occurred in 20% of the patients, postoperatively. 30% of the patients converted to sinus rhythm spontaneously, 60% converted with amiodarone and 10% of the patients required electric shock. Beta blockers are the first line of medication for the prevention of postoperative AF. The incidence of AF during the first postoperative week after CABG varies between 5-40%; prolonged mechanical ventilation after CABG significantly increases the incidence of postoperative AF (Iranian Heart Journal 2005; 6 (1,2): 64-67). atrial fibrillation Ë coronary artery bypass surgery 170 Shohreh Rezaie, MD; Ali Mostafaie, PhD; Masoum Ali Masumi, MD; Hamid Rahi, PhD and Mohammad Jafar Rezaie, PhD With respect to the high incidence of rheumatic heart disease (RHD) and the almost identical racial background of the western population of Iran and the importance of investigation on HLA typing as a new research tool, this study was conducted with the aim of better understanding the mechanisms involved The frequencies of class II HLA antigens (DQ, DR) in 35 patients with a diagnosis of RHD were studied and compared with a control group of 36 healthy individuals. An increase was found in the frequency of HLA-DR53 (57.1% in the patient group versus 16.7% in the control group: P=0.00099, RR=6.66), HLA-DR2 (31.4% in the patient group versus 2.8% in the control group: P=0.0037, RR=16.04) and HLA-DR15 (28.6% versus 2.8%: P=0.007, RR=14). The increased frequency of HLA-DQ2 and HLA-DQ5 in the patients compared with the control group was also significant (P<0.05); however, frequency differences for other antigens was not significant. HLA-DR53, HLA-DR2 and HLA-DR15 may be markers for susceptibility to RHD in our patients. These results could be explained by genetic differences resulting from racial or geographical diversity (Iranian Heart Journal 2005; 6 (1,2): 83-88). RHD ■ HLA Class II antigens ■ Iran 171 A. Hossein Tabatabaei, MD, Hasan Arefi, MD and Amir Hossein Zohrei, MD Nowadays, the pathogenic role of atherosclerosis of the aorta in embolic stroke is well understood. TEE continues to play a prominent role in the evaluation of patients with stroke and finding the source of emboli. TEE shows that the incidence of strokes presumed to have a cardioembolic origin varies from 13-40% and that atherosclerotic Using TEE, we performed a cross-sectional study of the frequency and severity of aortic plaques in 60 patients admitted with ischemic stroke. Major atherosclerotic risk factors and the presence of coronary artery disease and carotid plaques were also surveyed. TEE detected at least one potential source of embolism in 48 patients, aortic plaques in 29, carotid plaques in 11 and cardiac pathologies in 19. Atrial fibrillation and valvular heart diseases (mostly mitral stenosis) were the most prevalent cardiac anomalies. The remaining 12 patients were regarded as cryptogenic cases. Fifty patients had at least one major risk factor of CAD. The majority of the plaques were detected in the arch and ascending aorta; of these 13.7% were complicated (grade III). There was a significant relation between aortic plaques and hypertension, male sex and CAD. Aortic calcification in CXR was strongly predictive of aortic plaques but not a sensitive criterion. Abnormalities are commonly found by TEE in patients with stroke. The results indicate a strong, independent association between atherosclerosis of the aorta and risk of stroke. TEE should be considered in patients after stroke as a routine test and ultimately for prophylaxis and treatment of stroke (Iranian Heart Journal 2005; 6 (1,2): 72-77). transesophageal echocardiography (TEE) Ë atheromatous aortic plaque Ë ischemic stroke. 172 Afsaneh Ranjbar1 and Mehdi Nematbakhsh,2 MD Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) belong to a family of hormones that have structural similarities and some biological actions in common, such as natriuresis and vasodilatation. Previous studies have revealed the presence of ANP and BNP in the sheep atrial extract and ANP in the human atrium. The aim of the present study was to compare the hemodynamic effects of the two atrial extracts on blood pressure and hematocrit in anesthetized rats. Human and sheep atrial extracts were prepared using saline and acid milieu method. The femoral arteries and jugular veins were cannulated for recording blood pressure and drug administration, respectively. To measure the hematocrit, we collected blood samples from the rats’ eyes at the beginning and once again after 45 minutes of extract administration. The rats’ mean arterial blood pressure (MAP) was reduced by the sheep atrial extract (p<0.05), whereas the human atrial extract did not have any significant effect on MAP. The hypotensive effect of the sheep atrial extract was higher than that of the human extract (p<0.05). Both extracts increased the rats’ hematocrit significantly (P<0.05). The obtained results suggest that the difference between the hemodynamic effects of the two extracts could be due to the differences between the ANP and BNP clearance, cardiac output fall and the negative feedback inhibition (Iranian Heart Journal 2005; 6 (1,2): 78-82). ANP ■ BNP■ human ■ sheep ■ atrial extract ■ mean blood pressure ■ hematocrit 173 Rezayat Parvizi, MD; Bahram Sohrabi, MD; Hadi Hakim, MD; Naser Aslanabadi, MD and Jahanbakhsh Samadikhah, MD Spontaneous coronary dissection (SCDis) is a rare entity which has been increasingly reported over the last two decades. About 150 cases were described from 1931 to 2000, of which fewer than 50 cases were in male patients without any evidence of coronary atherosclerosis. We describe a case of SCDis in a 32-year-old man who presented with low-threshold angina and without evidence of coronary atherosclerosis (Iranian Heart Journal 2005; 6 (1,2): 89-92).