Tehran University Medical Journal

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Esophageal cancer is one of the most common malignancies in our country. Patients often seek medical advice in advanced and inoperable stages or with cervical esophageal cancer, in which operation is accompanied by sever morbidity. In this conditions many of them cannot tolerate chemo-radiation, or refuse it. Therefore radiotherapy is applied as a single modality in palliation of many patients with esophageal cancer. One of the palliative radio therapeutic methods is application of 5000 CGY in 20 fractions (Long Course) but considering the great number of our patients and limited capacity of radiotherapy centers, as well as emphasis of literature on palliation with 4000 CGY in 13 fractions (short course), we decided to compare these two methods (which are both used in our departments). In this retrospective analytic study, the files of 283 patients with esophageal cancer referred to cancer institute of Imam Khomeini Hospital from 1989-1999 were studied. Patients were between 27-97 years old (mean age=58.3) and most of them were male (53.7 percent). The mean length of lesion was 8.5 cm. The most common site of lesion was middle third at esophagus (48.1 percent) and the most common pathology was squamous cell carcinoma (99.6 percent). Fifty-four percent of patients were hot tea drinkers habitually. From the mentioned variables, only length of lesion had significant relationship with overall survival (P=0.04). Thirty-eight of 283 patients were excluded from analytic study because of incomplete follow-up. The number of patients had been treated by long course (5000 CGY in 20 fractions) was 137 and the remainder (108 patients) by short course (4000 CGY in 13 fractions). No significant difference was seen statistically between these two groups in overall and dysphagia-free survival (Kaplan-Meyer test). Also total dosage of spinal cord is lower in the short course. Thus regarding to less required time in short course and comparable palliation and survival between two methods, the short course policy is more preferable in esophageal cancer patients.

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Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

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Background and Aim: Tuberculosis is one the major health care problems in developing countries. Miliary tuberculosis is induced by blood dissemination of multiple tubercle bacilli, the paramount importance of accurate diagnosis of military tuberculosis is because of its dismal outcome if untreated and the chance of cure if diagnosis happens early in the course of the disorder. In this study we describe the demographic and risk factors related to military tuberculosis, which enables us to control and reduce the incidence of military tuberculosis. This ultimately reduces the mortality and morbidity consistent with this disorder.

Materials and Methods: we conducted a retrospective case control study, which compares 28 patients with military tuberculosis and 56 patients with pulmonary tuberculosis as control. We reviewed all the patients&apos documents registered between years 1994-2004, after extracting raw data we analyzed them with chi-square and Fisher exact tests.

Results and Conclusion: We found that HIV (P< 0.05) infection and lack of BCG vaccination (P< 0.05) increases the number of military tuberculosis among our patients. In addition we did not find any other significant risk factor.

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Background: The purpose of this study was to identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuver (CRM).

Methods: This interventional study was conducted on 58 patients (14 males, 44 females, mean age 48.12+13.22) referred to the Vertigo Rehabilitation Clinic of the Rehabilitation School of Tehran University of Medical Sciences from 2002 to 2004. All patients were treated with CRM. According to the treatment efficacy the patients were allocated in three groups: completely treated, partially treated, and not treated. The effect of factors including age, sex, etiology, duration of BPPV, unilateral or bilateral disease, number of maneuvers, and number of sessions on outcome in patients was evaluated.

Results: Forty-nine patients (84.5%) were completely cured. Age, sex, etiology, and duration did not significantly affect the treatment outcome. Unilateral BPPV can be treated significantly better than bilateral BPPV. Forty-seven patients who were completely treated needed 1 session and thirty-seven of them required 2 maneuvers.

Conclusion: CRM is significantly effective for BPPV treatment. Treating unilateral BPPV is expected to be easier. As most of the patients will be cured by 1 or 2 maneuvers or in 1 session, patients who required more sessions or more maneuvers may not be completely treated.

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Background: The standard treatment for high-grade astrocytoma (grades 3 and 4) is surgery followed by radiotherapy (post-op RT). Adjuvant chemotherapy increases disease-free survival (DFS) and overall survival (OS). There are several drugs used for this purpose, each of which have shown benefits and shortcomings. The superiority of combination therapies such as PVC (procarbazine, CCNU and vincristine) over single agents such as BCNU (carmustine) and CCNU (lumostin) has not been definitively established. Single agent CCNU could be a very convenient treatment, as it only involves oral prescription every six weeks. Thus, in this study, we compare CCNU alone with PCV to establish any potential superiority with regard to DFS and OS.
Methods: From 2003-2006, patients with high-grade astrocytoma who had undergone surgery and radiotherapy in the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were randomized to CCNU alone or PCV. Chemotherapy was repeated every six weeks for six cycles. Six weeks after the end of sixth cycle, a CT scan was performed. New neurologic signs and symptoms or increases in the previous signs and symptoms and/or new masses in imaging and/or growth of the residual tumor (> 25%) and/or enhancement of any inactive mass from the previous imaging was considered a recurrence. DFS was considered to be the duration from the end of RT to the date of recurrence or last follow-up. OS was taken as the duration from the end of RT to date of death or last follow-up.
Results: After informed consent, of the 70 patients included in this study, 38 were treated with PCV and 32 were treated with CCNU. The mean age was 44 years, ranging from 16 to 78 years, and 51 of the patients were male. Nineteen patients had grade 3 anaplastic astrocytoma and 51 patients had grade 4 glioblastoma multiforme. There were no significant differences with regard to patient age, gender and pathology between the CCNU and PCV groups. DFS and OS were 26 and 27 months, respectively, in the CCNU group and 29 and 34 months, respectively, in the PCV group. By log-rank test, the difference between CCNU and PCV was not statistically significant with regard to the length of DFS and OS.
Conclusion: Although no significant differences were found, a trend toward better survival could be seen in patients treated with PCV. Further studies with more patients and longer follow-up are needed to definitively resolve this issue.

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Background: Nephrotic syndrome is one of the most remarkable diseases in childhood. The majority of patients have prompt response to corticosteroids.

Methods: In this study, we retrospectively evaluate the outcome of patients with steroid-responsive nephritic syndrome. Medical records from January 1996 to September 2006 were reviewed to identify all children with steroid sensitive nephrotic syndrome at the Pediatric Medical Center, Tehran, Iran. Initial steroid therapy was 60 mg/m² per day for four weeks. Levamisole, a steroid-sparing agent, was prescribed at a dose of 2.5 mg/kg on alternate days in conjunction with alternate-day prednisolone. If no benefit was observed by three months, levamisole was discontinued and immunosuppressive therapy with cyclophosphamide at a dose of 3 mg/kg daily for 8 weeks, or cyclosporin A at a dose of 3-5 mg/kg was prescribed.  

Result: Of 745 children with steroid sensitive nephrotic syndrome, 63.1% of patients were male. The most common causes were minimal change disease (98/324, 30.2%) and focal segmental glomerulosclerosis (81/324, 25%). At presentation, microscopic hematuria was found in 22.6% of the patients. During follow-up, 9.2% had no relapse at any time, while 15.8% were frequent relapsers. The remission period ranged from 3.5 to 168 months. At the last follow-up, 57.6% of the patients were in remission, 37.7% relapsed and 29 children developed chronic renal failure. The outcome of nephrotic syndrome was not associated with age or gender. The end clinical status of patients correlated with duration of remission, number of subsequent relapses and response to cytotoxic agents.

Conclusions: Steroid-responsive nephrotic syndrome in children should be followed over a long period, especially patients with early relapse. Relapse was seen in more than 90% of patients. Documentation of histopathology by renal biopsy may be helpful to identify those at increased risk for a poor outcome.

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Background: Although postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach, curative surgery occurs in less than 50% of nonmetastatic gastric cancers. A regimen of docetaxel, cisplatin and infusional fluorouracil improves survival of patients with incurable locally-advanced gastric adenocarcinoma. So we assessed the perioperative regimen of docetaxel, cisplatin and infusions 5FU (TCF) and postoperative chemoradiotherapy to improve outcomes in patients with potentially resectable gastric adenocarcinoma.

Methods: Between March 2005 and March 2008, we 100 enrolled patients with stage II to IV (M0) adenocarcinoma of the stomach who had not been treated previously. Treatment consisted of three preoperative and one postoperative cycles of TCF followed by chemoradiotherapy. The primary end point was overall survival. The secondary end points were progression-free survival and toxicity of treatment.

Results: A total of 100 patients participated, 83 of whom received neoadjuvant and 17 received adjuvant chemotherapy. Seventy-five patients underwent at least D₀ gastrectomy. After chemotherapy, tumor stages were significantly lower than before beginning the protocol. Out of 100 patients, 44 had stage IV before chemotherapy versus 15 after the treatment. Three patients showed complete pathologic response. The median survival time was 25 months.

Conclusion: Docetaxel, cisplatin and 5FU combination chemotherapy is an active preoperative treatment in locally advanced gastric cancer. Perioperative chemoradio-therapy should be considered as an option to lengthen patient survival.

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Background: Treatment of cervical carcinoma is routinely performed with Low Dose Rate (LDR) brachytherapy, but Brachytherapy in our department is done with Medium Dose Rate (MDR) due to the technical characteristics of the machine available here. Thus we decided to evaluate the results of this treatment in our department in a prospective study.

Methods: Between March 2006 and July 2008, 140 patients with histologic diagnosis of cervical carcinoma referred to Tehran Cancer Institute were treated with external beam radiotherapy (44-64 Gy to whole pelvis) and MDR brachytherapy (8-30 Gy to Point A) with a dose rate of 2.2±0.3 Gy/h.

Results: 121 patients were followed up for a median time of 18 months (range: 9-39 m). There were 11%(6/54) local recurrence for surgery and adjuvant radiotherapy group 25%(16/65) for radical radiotherapy group, and 19%(23/121) for all patients. Rectal and bladder complications incidence for all patients were 10%(12/121) and 13%(16/121) respectively. High grade complication was shown only in one patient in radical radiotherapy group. In this study 3-years disease free survival and overall survival were 73% and 92% respectively, and disease stage (p=0.007) and overall treatment time (p=0.05) were the significant factors affecting disease free survival.

Conclusions: Results of this series suggest that the use of external beam radiotherapy and MDR brachytherapy with about 20% dose reduction in comparison with LDR can be an acceptable technique with regard to local control and complications.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast conservative therapy is associated with similar outcomes in comparison with mastectomy. The aim of this study is assessment of local recurrence rate and related risk factors in patients who have been treated with radiotherapy after conservative surgery for breast cancer.

Methods: This is a cohort study which data of all breast cancer patients who have visited in follow up clinic in radiation oncology department of cancer institute of Imam Khomeini Hospital complex in Tehran, Iran, during years 2007-2009 were collected. All of the patients were investigated for local recurrence and the possible risk factors.

Results: Two hundred and seventy seven patients have entered the study and all have followed for at least one year since data entry. Median follow-up time from the start of radiotherapy were 35 months (12-148 mo). We had seven cases (2.5%) with local recurrences (2.5%) which most of them occurred in first year after treatment. Because of low rate of recurrence none of the variables such as margin and nodal status has significant correlation with local recurrence which this should be due to small number of patient and short time of follow up.

Conclusions: At median follow up of 35 months from the beginning of radiation therapy, local recurrence rate was 2.5% which is similar to the literature. We recommend to follow a larger group of patients for longer times to estimate recurrence risk after breast conservative therapy.

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Background: Pedicular screws are currently the gold standard of internal fixation of spinal column. Pedicular screws have their own complications, however the surgeon should be aware of morphometery of pedicles, as well as the anatomy of surrounding neural structures to minimize these risks. No national study has ever examined the physical characteristics of lumbar pedicles and this study is unique for this purpose.Methods: This study covers the patients undergoing lumbar spinal CT-scanning due to variable causes. 25 vertebrae were selected in either gender, 18 years or older and EFilm computer software was employed to measure different diameters of pedicle and the results were analyzed with p≤0.05 regarded as significant.Results: L5 pedicle was the widest (16.8 mm), while L1 was the narrowest (8.25 mm).this figure was 8.82, 10.48 and 12.86 mm for L2, L3, L4 respectively. Longitudinal depth of pedicle was 47.98, 48.68, 50.42, 48.32 and 47.8 mm for L1, L2, L3, L4, L5 respectively.Statistically significant differences were found between some dimensions detected in our study and similar studies. Conclusions: The advantages of pedicular screws and rods to stabilize spinal column are well known. To avoid neurological complications, an understanding of anatomy and pedicle orientation is mandatory. The shape and diameters of pedicles are different base on races. Some differences were found in our study regarding pedicle dimensions.

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Background: Local recurrence in Nasopharyngeal Carcinoma (NPC) presents is a major challenge. Patients experience substantial morbidity as well as poor survival if no further treatment is offered. Residual or recurrent nasopharyngeal carcinoma is usually managed by chemotherapy, stereotactic radiosurgery, external beam radiation therapy (EBRT), interstitial, and intracavitary brachytherapy or salvage surgery. This case presents the treatment of two consecutive localized recurrences of NPC.

Case presentation: The patient was a 59-year-old man who underwent a course of radical external-beam radiotherapy for a primary NPC in 1999, then another course of external radiation in 2004 for his first recurrence, and finally a course of brachytherapy for the second recurrence in 2005. The patient is well now in 2010, with no signs of disease five years after the third radiotherapy.

Conclusion: Our experience of re-irradiation for this twice recurrent nasopharyngeal carcinoma has been promising with encouraging tumor control and acceptable treatment-related toxicity profile. This case indicates the efficacy of definitive re-irradiation for regional recurrence and the necessity for long-term observation for the salvageable early-stage local failure.

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Background: The current standard of adjuvant management for gastric cancer after curative resection based on the results of intergroup 0116 is concurrent chemoradiation. Current guidelines for designing these challenging fields still include two-dimensional simulation with simple AP-PA parallel opposed design. However, the implementation of radiotherapy (RT) remains a concern. Our objective was to compare three-dimensional (3D) techniques to the more commonly used AP-PA technique.
Methods: A total of 24 patients with stages II-IV adenocarcinoma of the stomach were treated with adjuvant postoperative chemoradiation with simple AP-PA technique, using Cobalt-60. Total radiation dose was 50.4Gy. Landmark-based fields were simulated to assess PTV coverage. For each patient, three additional radiotherapy treatment plans were generated using three-dimensional (3D) technique. The four treatment plans were then compared for target volume coverage and dose to normal tissues (liver, spinal cord, kidneys) using dose volume histogram (DVH) analysis.
Results: The three-dimensional planning techniques provided 10% superior PTV coverage compared to conventional AP-PA fields (p<0.001). Comparative DVHs for the right kidney, left kidney and spinal cord demonstrate lower radiation doses using the 3D planning techniques (p<0.0001), the liver dose is higher (p=0.03), but is still well below liver tolerance.
Conclusion: Despite the department protocol using conventional planning, 3D radiotherapy provides 10% superior PTV coverage. It is associated with reduced radiation doses to the kidneys and spinal cord compared to AP-PA techniques with the potential to reduce treatment toxicity.

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Background: Gastric cancer is an important health problem across the world. Chemotherapy in combination with local treatment is the standard treatment for locally advanced gastroesophageal junction (EGJ) cancers. The purpose of this study was to evaluate response and tolerability to neoadjuvant regimen combining epirobicin, oxaliplatin and capecitabin (EOX) in locoregionally advanced gastric cancer.
Methods: We recruited 28 patients with histologically confirmed advanced gastric or EGJ adenocarcinoma in this study performed in the Cancer Institute of Imam Khomeini Hospital in Tehran, Iran in 2010-2011. Staging workup included chest and abdominal computed tomography (CT) scans, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), measurement of carcinoembryonic antigen (CEA), complete blood cell count (CBC), and liver and renal function tests. After three treatment cycles with EOX regimen, we evaluated response to the neoadjuvant chemotherapy by performing endoscopic ultrasonography (EUS) and chest and abdominal CT scans.
Results: The mean age of the patients was 56.64±11.08 years (ranging from 37 to 78 years). Most patients were classified as having stage III (98.8%) cancer before chemotherapy while most were classified as stage II (57.14%) after the treatment. Only 28.5% of tumors were resectable before chemotherapy, but 82.1% of them were resectable upon the treatment. 75% of tumors were downstaged after chemotherapy.
Conclusion: Regarding the acceptable response and downstaging of tumors and low toxicity of EOX regimen in locoregionally advanced gastric cancer, evaluation of this regimen as a neoadjuvant chemotherapy in larger phase III clinical trials in Iranian patients would be both necessary and logical.

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Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.
Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions) with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions) and a subsequent electron boost.
Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.
Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.

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Background: Bone is one of the most common sites of metastatic disease in malignancies. Many of the cases are asymptomatic and may be diagnosed in primary or secondary follow-up, but in symptomatic cases pain is the prominent symptom which is mostly exaggerated at nights. The improved survival of cancer patients with bony metastases in recent years, specially in breast and prostate cancer, has given a greater importance to the careful choice of treatments in this setting. This can lead to a better quality of life, lower treatment cost, prevention of disabilities, less delay in primary cancer therapies, and decrease of life-threatening events for the patients. Here we review the metastatic disease of the bone and its treatments, with emphasis on local and systemic radiation therapy. Current literature about bone metastasis and its treatments was reviewed through a search of available databases on internet for papers published in 1995-2013. Special attention was given to the research trials and studies performed by the authors on this setting. Treatment of bone metastases consist of analgesics, radiotherapy, surgery and bisphosphonates. Control of bone metastases is a challenging process, necessitating a multi-disciplinary approach and teamwork between the treating physicians. Radiotherapy is the most useful modality for this purpose in oncology, given both as a local and systemic therapy. We hope that this review would be able to help in choosing the best treatment option for this common palliative situation in Iranian cancer patients.

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Background: Colorectal carcinoma is a common malignancy, in treatment of which pelvic radiotherapy plays an important role. But this may lead to azospermia. We designed a study to determine the delivered dose to the testis with thermoluminescence dosimetry (TLD) and compare it to the dose calculated by the Three-dimensional planning software. Methods: We measured the testicular doses by TLD the TLDs were fixed to the scrotum in six points anteriorly and posteriorly in two random fractions of the radiation course. All patients received a 50-50.4 Gy radiation dose to the pelvis in a prone position with standard fractionation and 3-dimensional planning, through three or four fields. The average dose of the TLD measurements was compared to the average of 6 relevant point doses calculated by the planning software. Results: In 33 patients with a mean age of 56 years, the mean testis dose of radiation measured by TLD was 3.77 Gy, equal to 7.5% of the total prescribed dose. The mean of point doses calculated by the 3-dimensional planning software was 4.11 Gy, equal to 8.1% of the total prescribed dose. A significant relationship was seen between the position of the inferior edge of the fields and the mean testis dose (P= 0.04). Also body mass index (BMI) was inversely related with the testicular dose (P= 0.049). Conclusion: In this study, the mean testis dose of radiation was 3.77 Gy, similar to the dose calculated by the planning software (4.11 Gy). This dose could be significantly harmful for spermatogenesis, though low doses of scattered radiation to the testis in fractionated radiotherapy might be followed with better recovery. Based on above findings, careful attention to testicular dose in radiotherapy of rectal cancer for the males desiring continued fertility seems to be required.

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Background: Currently, there are many techniques to measure subcutaneous body fat but these methods have many limitations. In this study, we tried to provide a clustering algorithm to measure the thickness of subcutaneous fat in thermography images. Methods: For the detection of subcutaneous adipose tissue in the midline area (from pubis to the xiphoid process), imaging takes place in the right or left lateral sides of the concerned person and to detect this tissue at the left and right flank (from ribs to the iliac crest), imaging takes place from the front. This study was done on 100 subjects (50 female, 50 male) of patients referred to the Shahid Mobini Hospital of Sabzevar since April 2013/4 to December, 2013 and the thickness of their subcutaneous fat in midline abdomen from pubis to the xiphoid process and flank from ribs to the iliac crest were measured based on thermal model and using K-Means and Fuzzy c-means (FCM) clustering methods and also recursive connected components algorithm. Results: Subcutaneous fat tissue can quickly appear in the thermogram as an area of low temperature and since in the thermal images, temperature is characterized by the color, as a result, subcutaneous fat tissue must have lower levels of color (temperature) relative to internal body tissues. All the measurements based-on thermal images to determine the maximum thickness of subcutaneous fat were compared with ultrasound. The results of our method were similar to the results of ultrasound method done by a radiologist, with the acceptable approximation. Conclusion: The method presented in this paper is considered as a noninvasive and cost-effective method to measure the thickness of subcutaneous body fat.

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Background: This study investigated compatibility between post chemoradiation magnetic resonance images and histologic findings after operation and chemoradiation in patients with locally advanced rectal cancer.

Methods: In this prospective study, 63 patients referred to Cancer Institute of Emam Khomeini Hospital, Tehran, Iran, from October 2011 to October 2013 with locally advanced rectal cancer receiving neoadjuvant chemoradiation (50.4 Gy external beam radiation with concomitant capecitabine 825 mg/m2 PO twice a day with or without 60 mg/m2 oxaliplatin weekly). Patients had an MRI before chemoradiation and MRI assessment were used to identify Tumor (T) and lymph node (N) staging by an experienced radiologist. Patients were recommended to repeat MRI after surgery but it was not obligatory. Findings of post chemoradiation MRI and histopathologic reports were compared. Downstaging was defined as at least one stage decrease in T or N in histopathologic report comparing to their first MRI, on condition of no sign of disease progression.

Results: 32 patients (50.79%) had T downstaging and 36 of them (57.14%) showed N downstaging: none had disease progression. In this study MRI had an accuracy of 55.5% for rectal tumor (T) restaging after chemoradiation comparing to pathology. MRI sensitivity for T restaging was 33.3% to 83.3%.  There was a higher possibility to have errors in restaging of T1-2 stages. Specificity of MRI for T restaging was higher than its sensitivity, 66.6%. In this study lymph node involvement (N) was determined according to morphology and size. MRI has an accuracy of 42.8% for detecting lymph node involvement. Its sensitivity and specificity for N restaging were 50% and 66.6% respectively. All patients had MRI before chemoradiation, although 21 of them repeated MRI after chemoradiation since it was not mandatory. 19 of these 21 patients underwent surgery.

Conclusion: Although MRI is a suitable imaging for staging locally advanced rectal cancer its use for restaging after chemoradiation is under question. According to this study, MRI accuracy rates for both T and N restaging were below the rates of previous studies.

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Breast cancer is the most common cancer in women and one of the leading of death among them. The high and increasing incidence of the disease and its difficult treatment specifically in advanced stages, imposes hard situations for different countries’ health systems. Body temperature is a natural criteria for the diagnosis of diseases. In recent decades extensive research has been conducted to increase the use of thermal cameras and obtain a close relationship between heat and temperature of the skin's physiology. Thermal imaging (thermography) applies infrared method which is fast, non-invasive, non-contact and flexibile to monitor the temperature of the human body. This paper investigates highly diversified studies implemented before and after the year 2000. And it emphasizes mostly on the newely published articles including: performance and evaluation of thermal imaging, the various aspects of imaging as well as The available technology in this field and its disadvantages in the diagnosis of breast cancer. Thermal imaging has been adopted by researchers in the fields of medicine and biomedical engineering for the diagnosis of breast cancer. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field.  Thermography does not provide information on the structures of the breast morphology, but it provides performance information of temperature and breast tissue vessels. It is assumed that the functional changes occured before the start of the structural changes which is the result of disease or cancer. These days, thermal imaging method has not been established as an applicative method for screening or diagnosing purposes in academic centers. But there are different centers that adopt this method for the diognosis and examining purposes. Thermal imaging is an effective method which is highly facilitative for breast cancer screening (due to the low cost and without harms), also, its impact will increase by combining other methods such as a mammogram and sonography. However, it has not been widely recognizesd as an accepted method for determineing the types of tumors (benign and malignant) and diseases of breast tissue.

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Results: Totally, 75 nurses were recruited from ICU-1 (N=29), ICU-2 (N=18), ICU-3 (N=19), and nephrology (N=9) departments. Type of department and occupation were the influential factors on nursing errors; also, a significant relationship was found between different work shifts and the occurrence of nurses’ errors, mostly seen in the evening work shift (P=0.037). The mean of nurses’ errors in IV drug administration was not correlated with other factors including age, work history, and the number of patients managed by each one. Also, a positive correlation was found between the number of nurses in each work shift and the number of errors (P=0.008). Conclusion: Medication errors in each stage of drug administration may lead to the hazardous clinical outcome or serious side effects such as thrombosis, infection or eventually lead to morbidity or mortality. Therefore, being aware of these errors and establishing observational policies can prevent unpleasant events related to drug administration.