Tehran University Medical Journal

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Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.
Methods: All infants with cleft lip and palate referred to the Children's Medical Center and Bahramy the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5
Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) was atrial septal defect.
Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.

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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: 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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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: 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 genome of the bacteria has considerable diversity in terms of sequence of nucleotide bases and change over the time. With the advancement of bioinformatics science possibility of the vast comparison to living organisms has risen. During the last two decades many information about genome sequencing of pathogenic and non-pathogenic bacteria have been published. Using this information and to find connections between them and many phenotypic characteristics and behavior of bacteria could be used in many studies. In this study we compared some of the genetic, phenotypic and behavioral properties of archaebacteria and eubacteria. Methods: In this analytical study, genomic Information of 286 species of archaebacteria and 122 species of eubacteria were collected from the NCBI (National Center for Biotechnology Information) site which was conducted in April to June 2015. Mean of gene size, gene number, protein number and C+G content compared in the two groups of archaebacteria and eubacteria. Association of genomic characterization of bacteria with several other characteristics were analyzed using SPSS statistical software version 19 (Chicago, IL, USA). For this purpose, the Pearson correlation coefficient (Pearson), Student’s t-test and ANOVA test (One-way analysis of variance) was used. The P values less than 0.05 was considered as significant level. Results: There was significant association between means discrepancy in two group (P= 0.01). The genome size of eubacteria and archaebacteria have significant association with some of the characteristics of bacteria, such as the C+G content, the number of proteins, genes and habitats of the bacteria (P= 0.01). As well as there was significant association between genome size and features such as number of pseudogene, mobility and type of breathing in eubacteria (P= 0.01) but not in archaebacterial (P˃ 0.05).

Conclusion: Many characteristics of eubacteria and archaebacteria are significantly associated with genomic properties. Comparison genomics of bacteria will help in identification of evolutionary origins as well as differences between different categories of bacterial.

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