Tehran University Medical Journal

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Parasitic infections, especially opportunistic ones are important problems of immune deficient patients. These groups of patients can encompass a broad spectrum of cancer patients. Patients receiving immune suppressive chemotherapeutic agents and those who receive radiotherapy. This group of patients has much more susceptibility to infections and suffers more complications. The objective of this study is to determine the incidence of intestinal parasitic infestations in patients receiving immune suppressive anti-cancer agents. Stool sample of 261 patients under treatment with chemotherapeutic agents were collected and sent to parasitologic laboratory of Shahid Beheshti medical school. Every sample was evaluated with direct smears formalin and ether concentration technique, shitter dilution, zeil-nelson strip stain, culture on strip of filtration paper according to Hadamvory method and on agar plates. Thus, the incidence of intestinal parasitic infestations was evaluated. In this study 34% (89 samples) of patients, who had receive immunosuppressive medicine, had intestinal parasitic infestation. 31.4% of patients with intestinal parasitic infestation were under 20 years of age, 31.6% were between 21-50 years and 36.5% were above 51 years old. Statistical method did not show significant difference between the incidence of intestinal parasitic infestation and the 2 variables of age and sex. The rate of intestinal parasitic infestations in cancer patients with 1-4 courses of treatment was 34.5% and after more than 5 courses was 33.6%. Statistical analysis with X² test did reveal significant differences. Considering the above studies, we recommend: 1) Stool exam of all chemotherapy patients for intestinal parasites before chemotherapy treatment. 2) Five to seven stool exam is necessary for high-risk group. In other patients one stool examination is enough. 3) Repeated stool examination is recommended during chemotherapy. 4) More specific method is needed for detection of high-risk patients and suspected cases.

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Background: The oncoplastic surgery has been revolutionized breast conservative surgery. The aim of our study was to represent the cosmetic outcome of oncoplastic breast surgery in Iran and to evaluate its determinants.

Methods: Fifty eight patients with unilateral breast neoplasm operated with single surgeon in Imam Khomeini Hospital, Tehran, Iran. Three view photographs were obtained pre and post operatively and were put in separate PowerPoint slides. The photographs were evaluated by six health related professionals. They scored the cosmetic outcome with modified questionnaire containing general and specific questions. Weighted kappa used for intra and inters rater reliability and ANOVA was used for analyzing cosmetic outcome determinants.

Results: Generally, 72.2% of the photographs got the excellent or good score in a single breast evaluation part. Its items breast size, nipple deviation and scar quality scored 94.2, 67.9 and 88.8 respectively. "In comparison with contra-lateral breast" part shape asymmetry, need for surgery of contra lateral breast and size asymmetry scored 68.9, 75.8 and 69% respectively. Tumor size greater than two cm had poorer outcome (p=0.039) upper outer quadrant tumor had the worst and upper inner quadrant tumors had the best outcomes (p<0.0001). Patient with 50 to 60 years of age had the poorest outcomes (p<0.0001). Weighted kappa for inter and intra rater kappa was 0.12 and 0.58 respectively.

Conclusions: Acceptable cosmetic outcome is obtained in the first experience of oncoplastic breast surgery in Iran. Long term monitoring of oncologic and cosmetic outcomes in greater numbers of patients is recommended.