Tehran University Medical Journal

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Background: Cervical cancer is the second leading cause of cancer death among women. In this cancer, the effects of prevention, early diagnosis and treatment more than other cancers decrease the mortality rate. In 1970 human papilloma virus (HPV) was introduction as major etiologic factor of cervical cancer. Different studies throughout the world revealed strong correlation between HPV and cancerous & precancerous changes in epithelial cells. Since cell culture and serological methods can not recognize the virus and its subtypes, the importance of the molecular methods including polymerase chain reaction (PCR) in early and definite diagnosis of virus is obvious.

Methods: In this study, after patient selection using the related protocol and completion of the questionnaires, 100 samples from cancer lesions of cervix selected. Then DNA extraction from paraffin blocks performed using standard method. Multiplex PCR with two pairs of primer (one as internal control) performed and the PCR product run on 8% polyacrylamid gel.

Results: The results showed that 73% of the tissues were infected by HPV.

Conclusion: This finding confirm the previous results based of correlation between HPV,and cervical cancer.

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Background: Endometrial cancer is the most common malignancy of genital system which is commonly seen after menopause. Rises in the age of marriage non-surgical methods, using systemic progestins, have been evaluated to treat the young patients with well-differentiated endometrial cancer who wish to preserve their fertility.
Methods: Twenty one infertile patients with stage Ia well-differentiated endometrial adenocarcinoma were enrolled in a quasi-experimental study. The treatment initiated with 160mg/d of megestrol acetate then continued with 320mg/d for non-responsive cases. Patients follow up with FD&C and hysteroscopy. Patients divided in two groups on the basis of response to therapy and persistent. The responsive patients were introduced to IVF group and evaluated for later fertility and birth of alive newborns for three years.
Results: This study showed a response rate of 85.71% and 14.29% undergoing TAH. The mean duration of treatment was 5.85±2.00 month. The response to therapy was observed in 27.78% with dose of 160mg/d and the remaining patients with 320mg/d. Pregnancy occurred in 27.78%, 2 of which ended up in a term delivery and the others ended before term. Recurrence happened in 16.67% that 66.67% of them experienced remission again.
Conclusion: Use of 320mg/d seems to be associated with a better therapeutic response. Serious complications were not observed with this dose. Furthermore, continuance of the drug for three month following a normal pathology report was decreased the rate of recurrence.

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 Background: Uterine sarcomas are malignant mesenchymal neoplasms that represent three to five percent of all uterine tumors, and are classified into three major groups: 1) mixed mullerian sarcoma 2) endometrial stromal sarcoma 3) leiomyosarcoma. The purpose of this study is to determine the association of different prognostic factors with patient survival and tumor relapse.
Methods: Twenty-seven patients with a previous diagnosis of uterine sarcoma were entered into this survival study. Inclusion criteria were presence of primary uterine tumor, confirmation of previous diagnosis in pathologic reassessment and availability for follow-up. We evaluated the association of overall and disease-free survival with eight factors, including FIGO stage, lymph node status, mitotic count per 10 high-power fields, vascular status, age, histology of sarcoma, myometrial depth of invasion and size of tumor.
Results: The median age of our patients was 47 years, ranging from 18 to 73 years, and median time of follow-up was 28 months, ranging from 1 to 114 months. Five-year survival was 61% and the mean time of overall survival was 78 months, with a 95% confidence interval, ranging from 56 to 100 months. LSS histology type, in contrast to other subtypes, and a mitotic count of 0-9, in contrast to 20 and more, were two factors that significantly related to relapse of tumor (p<0.05). The three factors related to survival were FIGO stage (p=0.0039), mitotic count (p=0.0005) and LSS histology type in contrast to other subtypes (p< 0.05). Relapse occurred mostly in the pelvic region or lung.
Conclusion: From our findings and a review of other reports, the FIGO stage is associated with survival, although other factors discussed in the literature are controversial. Some factors had been reported to have significant association only within a restricted histological subgroup. However, due to the limitation of our number of cases in each subgroup, we could not make such an analysis. Future studies with adequate numbers of samples are recommended.

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Background: Tumor diathesis (TD) refers to the granular proteinaceous precipitates on the slide surface of cytologic (Pap) smears. Found in the background of smears from some, but not all, invasive carcinoma cases, TD is present in the majority of smears from large cell nonkeratinizing carcinoma. It is more pronounced than keratinizing SCC also is almost always present in small cell carcinoma.  Smears from patients with adenocarcinoma are frequently associated with dense inflammatory and fresh blood exudates and less often there is a recognizable tumor diathesis.

Methods: To determine the prevalence of TD in cervicovaginal smears from patients with uterine cervix carcinoma, cytologic smears and histologic slides of 46 patients with histologically-confirmed uterine cervix carcinoma were reviewed for the presence or absence of TD, red blood cells and neutrophils on cytologic smears, as well as depth of invasion, histologic types and grade of differentiation of tumor on histologic slides.

Results: TD was identified in 28 smears (60.9%), 18 patients with squamous cell carcinoma (62.1%), seven patients with adenocarcinoma (58.3%), two patients with adenosquamous carcinoma (66.7%) and one patient with endometrial carcinoma that involved the uterine cervix. TD was seen in smears from four (33.3%) patients with uterine cervix carcinoma with invasion <5 mm and 17 (65.4%) carcinomas with invasion >5mm. However, some of the patients with invasive carcinoma lacked TD on the cytologic smears. Red blood cells were identified on 16 (34.8%) smears.

Conclusions: Although TD is the hallmark of invasive carcinoma of the cervix on cytological smears, there have been few studies performed on it. We found that tumors with greater depth of invasion and reduced differentiation are associated with TD cytologic smears. TD was absent in some cases, particularly in micro-invasive carcinoma. This study reinforced what has been recognized from other studies.

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Background: Tuberculosis is still one of the most important causes of mortality and morbidity in many countries and is the second only to human immunodeficiency virus as a cause of death worldwide resulting from a single infectious agent. In 1993, the World Health Organization declared tuberculosis a global public health emergency. Conven-tional methods for the diagnosis of Mycobacterium tuberculosis (MTB) infections are time consuming, as MTB culture requires 3-8 weeks for growth. To determine the sensitivity of polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC), we have evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in adults with new cases of pulmonary and extra-pulmonary tuberculosis. Setting: Department of Infectious disease of Imam Khomeini Hospital, 2004- 2005, Tehran, Iran.

Methods: In this cross-sectional study, we evaluated MTB DNA extracted from 3ml citrated peripheral blood samples from 95 adults with new cases of pulmonary and extra-pulmonary tuberculosis. DNA extraction was performed using a commercial PCR kit with IS1081 primers. For prevention of cross contamination and reduction of false positives, all steps were performed under laminar hood.

Results: The 95 patients, 59 of whom were male, had a mean age 44.44 years (SD±20.26) 69 cases had pulmonary and 26 had extra-pulmonary tuberculosis. PCR was positive in 32 (33.7%) patients and negative in 63 (66.3%) cases. The overall sensitivity and accuracy of the PCR assay was 44.1% for pulmonary, 19.2% for extra-pulmonary and 10% for disseminated tuberculosis, respectively.

Conclusion: The low sensitivity of the IS1081 primer MTB-PCR assay on PBMC may pose problems for the rapid diagnosis of tuberculosis. However, further studies are needed to confirm this technique as an alternative test for the diagnosis of tuberculosis.

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Background: Cervical cancer is the second most common cancer of the women worldwide. It is also an important cause of cancer-related mortality in women, after breast cancer. Nearly half million of new cases are identified yearly. The incidence rate in developing countries is greater than the developed countries. Epidemiologic studies have shown that the association of genital human papilloma virus (HPV) with cervical cancer is strong, independent of other risk factors, and consistent in several countries. The aim of this study was to determine the frequency of HPV in patients with high grade cervical intraepithelial neoplasia (CINIII, CIN II) and squamous cell carcinoma (SCC) of cervix.
Methods: Hundred specimens from patients with SCC and CINIII, CIN II, confirmed by histological review, referring to Mirza Koochak Khan Hospital from 1999-2004 were enrolled in a cross sectional study. Polymerase chain reaction was utilized for identification and typing of HPV DNA. To increase the sensitivity of HPV detection, nested PCRs were performed using MY09/MY11 as outer and GP5/GP6 as inner primers.
Results: It was possible to extract 77 of 100 specimens that HPV DNA was detected in 47 of 77 specimens. Infection with HPV was present in 32 specimens (86.5%) among SCC patients and in 15 specimens (37.5%) among CINIII, CIN II patients. The most frequent HPV types in SCC patients were HPV 16 and 18 (59.38%) and then 33 (34.38%) and in CINIII, CIN II patients was 16 (53.33%) and 18 (40%). the most frequent co-infection in both groups was HPV 16 and 18 which was present in 40.62% and 26.7% of cases respectively.
Conclusions: The most frequent HPV types in patients with SCC and CINIII, CIN II was 16 and 18 that is identical to many other countries infection pattern.

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Background: Poisoning is one of the major causes of seizure in emergency medicine. Because of the varying availability of drugs in different areas and insufficient control of the sale of some dangerous industrial substances, the causes of seizure in poisoned patients may be differ in our society. In this study, we examine the causes of seizures in poisoned patients in Iran, and their outcomes.
Methods: This retrospective and analytical-descriptive study investigated the sex, age, type of poison, presence and type of seizure, seizure treatment and outcome from the records of 2,220 hospitalized poison victims from 2001 to 2003 in poison emergency departments in Noor Hospital. Data was analyzed by one-way analysis of variance and chi square tests using SPSS.
Results: Of the 2,220 patient records examined, 66 patients developed seizure. Seizure was more common in men (33 patients), and most common in the 15-40 year age group (28 patients). The most common causes of seizure were tricyclic antidepressants (TCA) (39.7%), organophosphates (17.5%), carbamazepine (7.9%) and organochlorines (6.3%). However, status epilepticus was more common in organochlorine (25%), organophosphate, TCA (18.75%), and carbamazepine (12.5%) poisoning. There was a negative relationship between age and type of seizures. Seizure was not related to previous history of seizure. Midazolam alone (25%) was the most effective drug for controlling seizures. Death occurred in six patients with or without renal complication. The mortality rate among poisoned patients with seizure was 37.5%.
Conclusion: The incidence of seizure in our study reflects the availability of certain drugs and toxins that require more steadfast control. Midazolam, with its low side effects, may be the drug of choice for the treatment of status epilepticus in poisoning.

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Background: Endometrial carcinoma is the most common malignancy of the female genital tract. Different molecular alterations have been described in endometrioid endometrial carcinoma that, the most frequently altered gene is mutations of PTEN. Up to 50-83% of endometrioid carcinoma reveal altered PTEN characterized by loss of expression. In endometrial hyperplasia, which are precursors of endometrioid carcinoma, loss of PTEN expression is 30-63%.
Methods: Immunohistochemical staining was performed on 90 cases of endometrial curettage including: 30 proliferative endometrium, 30 hyperplastic endometrium and 30 endometroid carcinoma. Immunohistochemical specimens were graded semiquatitatively by considering the percentage of staining with two cut-point 10% & 50% on the whole section for each specimen.
Results: loss of PTEN expression was observed 0%, 0%, 30% of 51.7% in proliferative, simple hyperplasia, complex hyperplasia and endometrioid carcinoma respectively with cut-point 10% and 0%, 5.3%, 30%, 52.2% in endometrioid carcinoma respectively with cut-point 50%. Also there was no difference in PTEN expression between atypical complex hyperplasia and endometrioid carcinoma but there was significant difference between simple hyperplasia and proliferative with endometrioid carcinoma & atypical complex hyperplasia.
Conclusion: These results show loss of PTEN expression in endmetrioid carcinoma and no differences between endometrioid carcinoma and atypical complex hyperplasia. Therefore, assessment of PTEN expression by negative immunostaining and matched with routine hematoxylin and eosin stained can be a new tool for diagnosis of endometrioid carcinoma.

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Background: Insect stings can cause local or systemic reactions that range from mild to fatal, and are among the most common causes of anaphylaxis. The major allergens of honeybee venom are phospholipase A₂, hyaluronidase, acid phosphatase, allergen C and melitin. Phospholipase and melitin induce hemolysis, rhabdomyolysis and liver damage due to cell membrane breakdown, damage of the vascular endothelium and activation of the inflammatory response. Rhabdomyolysis has been implicated as the cause of acute renal failure in approximately 5-7% of cases. However, bee stings are a rare cause of rhabdomyolysis, and are usually associated with 50 or more stings. It has been reported that more than 250 bee stings are capable of causing death in humans.

Case report: We report two cases of massive honeybee stings (>2000) with rhabdomyolysis, hemolysis and acute renal failure who survived with full recovery, and two cases of >500 honeybee stings who survived without significant complications.

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Background: Chemo-radiotherapy-induced oral mucositis represents a therapeutic challenge frequently encountered in cancer patients. This side effect causes significant morbidity and may delay or interruption of treatment plan, cyclo-oxygenase 2 (COX2) is an inducible enzyme primarily expressed in inflamed and tumoral tissues. COX-2 inhibitors have shown promise to reduce chemoradiation induce toxicities. We conducted a phase III, randomized double blind clinical trial to evaluate the toxicity and efficacy of celecoxib, a selective COX2 inhibitor, administered concurrently with chemoradiation for locally advanced head and neck cancer. Here in we report the first report about the role of COX-2 inhibitor in acute toxicicities.

Methods: Patients with stage III/IV (locally advance) head and neck carcinoma who referred to department of radiation-oncology were eligible. Patients were treated with chemotherapy with cisplatin concurrently with radiation (60-70Gy). Celecoxib (100mg qid) was started at the first day of radiotherapy and was given for a total of 8 weeks. Acute toxicities were evaluated every week by WHO scale.

Results: One hundred twenty two patients were enrolled into the study, (61 patients for each group). In repeated mesurment analysis of variance there is a significant difference in the time of onset of grade II acute toxicities between the two groups The mucositis, dysphagia, epidermitis and oral pain score changed significantly over the typical five weeks in two groups but these changes were more sever in placebo group (p=0.0001). In the analysis of the overall changes in the following laboratory parame-ters: WBC, hemoglobin and platelet showed that these parameters decreased over time in both groups without a significant difference between groups.

Conclusion: The results of these study showed that the use of a COX-2 inhibitor (celecoxib) that is a safe and inexpensive drug may reduce acute toxicities of chemoradiation specially mucositis in head and neck carcinoma.

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Background: The papanicolaou (pap) smear has been used to screen cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional pap smear. Ideally, these new tests will increase the early detection of meaningful pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results.

Methods: In this prospective study the result of Liquid- based cytology smears (Liquid prep method) compared with conventional pap smears in terms of adequacy and ASC diagnosis in 289 patients in pathology department of mirza kochak khan hospital (Tehran, 2005- 2006). The smears were interpreted based on Bethesda system 2001.

Results: In conventional pap smear method, the number of occasions of unsatisfactory smear was 24(5%). In Liquid- based cytology method 66(22.8%) smears were unsatisfactory, In which difference between unsatisfactory groups were statistically significant (p<0.05), Also ASC diagnosis in conventional method 5(1.8%) as compared with Liquid- based cytology 6(2.1%), was not statistically significant (p>0.05).

Conclusions: There was no significant difference between two methods in term of ASC diagnosis but in conventional method adequacy of specimen was significantly better as compared with this Liquid- based cytology method.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Coronary Artery Disease (CAD) is a major cause of death worldwide including Iran.  The risk of developing disease in patients without symptoms is assessed in part by factors that are associated with disease. Among these factors family history points to the significance of genetic component in the risk of CAD. The identification of the genetic variants that confer risk for CAD is essential for detecting high-risk individuals, so preventative life style and therapeutic action can be taken before overt disease develops. So far more than 100 genes have been reported with possible role in developing risk for CAD. Matrix- Gla Protein (MGP) is one of these genes that association of its single nucleotide polymorphism (SNP) with CAD has been reported.  Among the polymorphisms, there are two promoter SNPs at position -7 & -138 that their association with CAD has been reported before. Here we investigated the association of these SNPs with CAD in Iranian population.
Methods: 150 cases and 150 controls were selected on the basis of their clinical assessments and angiographic reports. DNA was extracted from blood samples. The genotypes for both SNPs were determined using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method with size fractionation on Polyacrylamide gel.
Results: The comparison of allele & genotype frequencies between patients and controls showed that there is an excess of A allele at position -7 and T allele at position -138 among patients, although these differences were not significant (p<0.2, and p<0.5 respectively).
Conclusions: This study suggests no association of these SNPs with CAD in Iranian population. Confirmation of this finding needs independent repeat of similar studies.
Keywords: Coronary Artery Disease (CAD), Matrix Gla Protein (MGP), Single Nucleotide Polymorphism (SNP).

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Acardiac twin is a rare complication affecting monozygotic twins and is related to the twin reversed atrial perfusion sequence (TRAP). The TRAP sequence involves a pump twin perfusing a recipient twin through vascular anastomosis. Here, we report two cases with different presentations of acardiac twin.
Case report: The first acardiac twin was composed of a healthy fetus and a fetus with proximal of trunk, pelvic and lower limbs without head, neck and arms (acardia acephalus- classic form). The pregnancy was followed with ultrasonography and pregnancy terminated at 29 weeks, because there was abnormal doppler of ductus venosus and non-reassuring NST in pump twin. The second acardiac twin first time was diagnosed at a rotine ultrasonography at 26 weeks gestation as a healthy fetus and an acardia fetus with a hypoplastic lower limb and intestine like organ (amorphic mass). The pregnancy following, normal infant was born with a sac with some loops of the intestine at term. Each two cases were diagnosed at 26 week and each was delivered healthy pump twin.
Conclusion: Acardiac twin has different presentation and here we presented two end of acardia twin presentation with different management and outcome.

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Background: Thyroid transcription factor-1 (TTF-1) is widely used in the diagnosis of lung and thyroid carcinomas. Although there have been reports of TTF-1 immunoreactivity in tumors other than those originating from the lung or thyroid, endocervical and endometrial adenocarcinomas have not been studied in large numbers in this regard.

Methods: Thirteen endocervical adenocarcinomas, 39 endometrioid endometrial adenocarcinomas and four uterine serous carcinomas which had no neuroendocrine component were retrieved, stained by TTF-1 and examined. A semiquantitative grading system was used to evaluate the distribution of TTF-1 staining (0= negative, 1+  5%, 2+= 5% to 25%, 3+= 26% to 50%, 4+= 51% to 75% and 5+  75%). A qualitative system was also used to evaluate the intensity of TTF-1 staining (weak, moderate and strong).

Results: TTF-1 expression was seen in 1 out of 13 (7.7%) endocervical adenocarcinoma samples, showing 1+ distribution rate and weak intensity. The positive sample was moderately differentiated. TTF-1 expression was present in 2 out of 39 (5.1%) endometrioid adenocarcinoma samples (one grade I and the other grade II) with 1+ distribution rate and weak intensity. There was no apparent correlation between the degree of differentiation and TTF-1 positivity in the studied adenocarcinomas. None of the four endometrial serous carcinomas were positive for TTF-1.

Conclusion: Although some recent studies cast doubt about the specificity of TTF-1 for lung and thyroid carcinoma, our study showed that TTF-1 was negative in endocervical and endometrial adenocarcinomas and established the specificity of TTF-1 for lung and thyroid carcinomas.

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Background: With respect to the importance of hepatitis B vaccination of high-risk groups such as prisoners, this study was performed to assess the comparability of a short-course double-dose vaccination schedule with the standard 3-dose schedule.
Methods : Within a randomized clinical trial, a short-course vaccination (at months 0 and 1) with 20 microgram (double-dose) doses of the vaccine was compared to the standard method of hepatitis B vaccination (at months 0, 1 and 6, with 10-microgram doses) in 100 prisoners in Zahedan city in Iran in 2009. We made sure the sera from all the individuals were negative for markers of previous hepatitis B infection. Subsequently serum from all the participants was tested for anti-HBs antibody 1, 2 and 7 months after the first dose of vaccination.
Results : Seroconversion rates (HBsAb>10 mIU/ml) 1, 2 and 7 months after the first dose of vaccination were similar in the routine (11%, 79% and 94%, respectively) relative to the double-dose group (26%, 95% and 93 %, respectively). The mean values of anti-HBs antibody titers were similar in the 1st and 2nd months for the two groups but it was significantly higher (P=0.002) in the routine dose (514 mIU/ml) versus the double-dose group (130 mIU/mL), in the 7th month.
Conclusion: Demonstrating comparable results with the standard 3-dose schedule, it seems that short-term double-dose vaccination for hepatitis B is a safe and acceptable method for use in high-risk groups such as prisoners.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cancer of uterine cervix is the second cause of death in women in the world and the most common cause in developing countries. Because the majority of women with invasive cervical cancer of the uterine have not previously undergone screening, many clinicians assume that Pap smear has a high degree of accuracy but problems such as false positive and false negative interpretations, as well as interobserver variability have questioned its validity.
Methods : We retrieved 162 positive cervical smears that had been originally interpreted as ASC-US, ASC-H, LSIL, HSIL, SCC, AGC and adenocarcinoma from the cytology archives of Women's Hospital in Tehran, Iran. The slides were rescreened by an experienced pathologist and reclassified in the mentioned categories. All the 162 slides were reviewed by three more pathologists in a blind study using interpretative criteria utilized in their daily routine to evaluate interobserver reproducibility. To increase the level of interobserver agreement, the diagnostic categories were reduced to squamous Vs. glandular abnormalities and invasive (SCC and adenocarcinoma) Vs. non-invasive abnormalities.
Results : The results obtained in this study indicated slight interobserver agreement (k=0.26). The most reproducible category was the invasive category (SCC in addition to adenocarcinoma) and the least agreement was seen for HSIL (k=0.19).
Conclusion: This study showed that reproducibility of cytological interpretation of conventional Pap smears varies among interpretive categories and the overall interobserver agreement is slight. Since convening on the reduction of interobserver discrepancy in Pap smear interpretations necessitates more reliable information of interpretative variability, larger studies need to be undertaken.

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Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy however, mechanisms underlying its pathogenesis remain obscure. Endometrial carcinoma has been classified into two major categories: type I (related to estrogen or endometrioid adenocarcinoma) and type II (unrelated to estrogen). Estrogen is the main trigger for the abnormal proliferation in the endometrial epithelium but progesterone can inhibit this process. The aim of this study was to analyze the expression of estrogen and progesterone receptors in all types of endometrial hyperplasia in comparison to endometrioid adenocarcinoma of endometrium.

Methods: Forty-seven specimens including 23 cases of histopathologically confirmed hyperplastic endometrium (12 simple hyperplasia, 5 complex hyperplasia without atypia, and 6 complex hyperplasia with atypia) and 24 cases of endometrial carcinoma were studied. Immunohistochemical staining of estrogen and progesterone receptors was performed in paraffin-embedded blocks and expression of estrogen and progesterone receptors were scored according to the proportion of positive staining cells.

Results: Overexpression of progesterone receptors was seen in 18 (75%) out of 24 cases of endometrial carcinoma and 23 (100%) of all types of endometrial hyperplasia. The aforesaid differences were statistically significant (P=0.023). 70.8% of cases with endometrial carcinoma were 3+ for immunohistochemical staining of progesterone receptors as were 85.7% of the cases with endometrial hyperplasia the difference being also statistically significant (P=0.02).

Conclusion: Considering the increased proportion of progesterone receptor expression in all types of hyperplastic endometrium in comparison to endometrial carcinoma, hormonal therapy by progestinal agents is recommended as a treatment of choice.

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Background: Steroid cell tumor is one of the rare ovarian tumors and forms 0.1% of all ovarian tumors, divided to three subgroups. Steroid cell tumor that are not otherwise specified (NOS) are the most common type and represent 60% of steroid cell tumors. One of the most known signs of this tumor is hormonal function, especially androgenic effects of it. Primary treatment consists of eradication of tumor via surgery.
Case presentation: The patient is a 29 years old female with history of poly cystic ovarian syndrome since 10 years ago, who attended to the clinic of General Women Hospital of Tehran in January 2011. In pelvic ultrasonography, there was a 6449mm mass in the right adnexa consisting of homogeneous component. She underwent laparotomy and unilateral salpingoophorectomy was done. Pathological report was steroid cell tumor of ovary.
Conclusion: The aim of this study is reporting one of the rare tumors of ovary and assessment of the correct way of diagnosis and treatment of it.

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Background: Urinary tract infection (UTI) is one of the most common infections in infants and children, especially in their first decade of life. These patients are more susceptible to renal scars and other possible complications like growth retardation, arterial hypertension, proteinuria, isostenuria, and finally chronic renal failure. Trace elements like vitamins and minerals are essential for efficient metabolism and proper function of various body systems namely immune system. In this trial we compared the relation between serum levels of zinc, vitamins A and D in children inflicted with UTI and control group.
Methods: This was a cross-sectional study on 25 patients with UTI admitted to pediatric wards of Rasul Akram Hospital and Bahrami Hospital. They were compared to 40 other patients admitted in surgical wards for elective surgery. Serum levels of zinc, vitamins A and D were measured in both groups.
Results: Seventy two percent of the patients were male and 28% female. The average age was 2.17. Despite the lower levels of vitamins A and D in cases than controls, the difference was not significant (P=0.4 and P=0.9, respectively). However, serum levels of zinc were significantly lower in cases than controls (P<0.05).
Conclusion: Vitamins A and D may play some role in patients’ vulnerability to UTI, but this supposition needs more research on larger samples, considering differences among patients of various age groups and their nutritional status.
According to the study, lower levels of zinc were associated with susceptibility to UTI thence, its administration might be helpful.

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Background: Gestational trophoblastic disease (GTD) is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization (WHO) classification they include: Hydatidiform mole (complete and partial), invasive mole, choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by pre-evacuation ultrasonographic evaluation, laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis, the accurate diagnosis, follow up and recommendations given to patients may differ.
Methods: Consecutive cases with diagnosis of GTD from archive of pathology department of women (Mirza Kochak Khan) hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity, parity, history of previous abortion and gestational trophoblastic disease, the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated.
Results: Out of 220 cases with clinically gestational trophoblastic disease diagnosis, 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole (CM), 84 partial mole (PM), 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy (4.1%) and high degree of concordance between ultrasonography and histological diagnosis is seen.
Conclusion: Ultrasonographic examination accompanied with clinical examination, beside histological assessment as gold standard have high efficacy in diagnosing  complete mole. This study did not show this finding for partial mole.