Tehran University Medical Journal

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The changes that occur in all of the motor unit recruitment following the central and peripheral lesions of motor nerves can be effective on individual's disability. Following the low back pain (L.B.P) with any known cause, the effective role of muscles in providing postural or dynamic stability will be reduced. Today in rehabilitation of these patients, except of medical treatment for reduction of pain, a great attention is given to assess the motor control and its efficiency in order to prevent reappearance of the disease symptoms. The aim of this research is to determine the amount of changes in motor planning at motor control level in order to provide an appropriate setting for movement of lumbar spine following postural responses and peripheral stimulation.
Materials and Methods: Ten healthy women (24.3+2.32 year) and five women with L.B.P (27.34+4.67 years) without any structural disorder of lumbar spine have participated in this study. The test stages included flexion and extension in sagital plan with/ without external hearing stimulation in the 30 degree of flexion and 10 degree of extension, with 5 repetition. By measuring the amount of individual's reactions and computation of range of motion (R.O.M), the velocity, torque and delay time for showing any reaction prior to reaching stimulation point and its post time as well as comparing them with each other in both groups and also comparing these two groups.
Results: There are a significant differences between R.O.M changes, velocity and torque in similar times before and after hearing stimulation in both types of movement (P<0.05). In such a way the said values before hearing the external stimulation was much greater than after hearing the external stimulations and appearance of postural responses (P<0.05). Also in comparing with the conditions that external stimulation and postural response imposing was loosed, the time of appearance the postural response has shown a meaningful reduction (P<0.05). The group consisted of patients with L.B.P in compare with normal group, during the period that the movement were without any external stimulation , has shown no significant difference, while in stages with external stimulation and occurrence of postural responses, the R.O.M , time , velocity and torque have shown a significant difference (P<0.05). In healthy cases the percentage of functional performance reduction following external stimulation was more than the patients (P<0.05). This shows that the patients with history of L.B.P will have problems in setting up motor planning or in feedworward process.

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Background: Low back pain (LBP) is a one of the most common symptoms of vertebral column diseases. Spinal muscles have a outstanding role in maintaining vertebral column function in daily life. But proper function and motion of hip and knee joints also has an important role in performing smooth, fine and nonstressed movements of lumbar spin. Where as accurate and fine motions of hip and knee joints in cooperate with lumbar spin can improve translation and summation of forces and increase performance of movements. The aim of this research is to indicate the amount of interventions of lower limb joints on lumbar spin function in patients with LBP, and attention to physical treatment (PT) of them.

Materials and Methods: Fifty females with LBP due to osteoarthritis ( OA) of lumbar spin participated in this study and divided in two groups randomly with similar number of cases: a) ordinary treatment or control group and b) complementary treatment group. Patients in control group treated by routine PT approach ( superficial heat, ultrasound, TENS, forward flexion and back extension exercises ) and patients in complementary or test group received routine treatment similar to control group and also strength and stretching exercises of hip and knee joint muscles ( latisimous dorsi, gluteous maximus, iliopsoas, quadriceps and hamstring ) bilaterally. Range of motion (ROM) of lumbar, hip and keen joints by valid goniametere and pain of lumbar in motions at all of axis by visual analog scale measured before, after five and ten sessions of treatments in both groups.

Results: In control group with non parametric tests there was not significant difference of MMT of muscles and ROMs of hip and knee joints. Lumbar pain in motion after ten sessions of PT in this group reduced significantly ( P< 0.05 ). Increase of lumbar motion in all of axis after PT was significant at this patients ( P< 0.05 ). In second group that received complementary treatments ROM of joints, lumbar pain had significant differences between onset of treatments and five and ten sessions later ( P< 0.05 ), but there was not significant findings in MMT of muscles. There were significant differences between percentages of reduce of pain and increase of ROM in comparison of two groups ( P< 0.05 ). Where as patients that received ordinary PT and strength and stretching of muscles around of hip and knee indicated better recovery signs.

Conclusion: Reduce of lumbar pain with improve of motion and flexibility of muscles such as quadriceps, hamstring, gluteus maximus, iliopsoas and latisimous dorsi in a complete physical therapy approach indicate there are a great correlation between lumbar pain and functionality of lower limb joints. Therefore concentration to flexibility and extensibility of muscles of lower limbs is a basis aim in treatment of patients with lumbar OA.

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Background: Cervical cancer is one of the most common cancers in women.Conization of the cervix is one of the best diagnostic and therapeutic modality in preinvasive lesion of the cervix.

Methods: In this retrospective study we have evaluated the indications,complications, cytopathologic results, diagnostic and therapeutic value of 44 patients who underwent cervical conization.

Results: Age of the study group ranged from 18 to 75 (mean=43.18, SD=±11.4), and their parity ranged from 0 to 10 (mean 4-5, SD=±2-3). Ten cases (22.7%) were menopauses. The main indication was inability to visualize the entire T.zone (19 cases/43.2%) that was more prevalent in menopauses (50%/5cases in menopauses and 41.2% /14 cases in premenopauses). Bleeding occurred in 2 cases (4.5%) and urinary infection in 1 case (2.3%). The most common histologic result after conization was mild dysplasia in 23 cases (52.3%). The most common colposcopic biopsy result was moderate dysplasia in 16 cases (36.4%).The most common pap smear result was HSIL in 16 cases (36.4%). Two cases (4.5%) had invasive cancer in colposcopic- biopsy: one of them had ASCUS in the pap and another one had HSIL. Four cases (9.1%) had invasive cancer in histologic report: one of which had ASCUS on the pap and the others had HSIL.

Conclusion: Pap smear in screening of cervical cancer are not reliable and colposcopy is more acceptable in LSIL and ASCUS. Gynecologists should develop the skill to perform an accurate knife conization because the classical indications for conization continue to be valid and it has a low complication rate.

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Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma
Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1) Cisplatin and continuous infusion of 5FU and Epirubicin (ECF), and 2) Cisplatin and continuous infusion of 5FU with Docetaxel (TCF). Reduction in tumor mass, overall survival (OS), time to progression (TTP), and safety were measured outcome.
Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass) was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002) and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0) resection had done in two of ECF and six of TCF tumors (p=0.015). Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups.
Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

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Background: Adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass graft (CABG). This study was designed to evaluate the effect of ascorbic acid as an adjunct to beta-blockers in prevention of post-CABG atrial fibrillation
Methods: Patients who were more than 50 years old and scheduled to undergo CABG were included if they were treated with beta-blockers at least 1 week before surgery. Patients with previous history of atrial fibrillation, AV block, heart rate <50 /min, end-stage renal disease, severe pulmonary or liver disease and those who were taking digoxin or class I and III anti-arrhythmics or had pacemakers were not included. Ascorbic acid group were prescribed 2 gm of ascorbic acid, the night before the surgery, and 1 gm twice daily for 5 days after surgery. Beta blockers continued in both group after surgery. Telemetry monitoring was performed in ICU and Holter monitoring was performed for 4 days.
Results: Fifty patients completed the study as ascorbic acid and 50 as control group. The population was 60.19 ± 7.14 years old and 67% were male. The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in control group (odds ratio=0.119, 95% confidence interval: 0.025 to 0.558, P=0.002)
Conclusion: Ascorbic acid is well-tolerated, relatively safe and seems effective. Therefore it can be prescribed as an adjunct to beta-blockers for prophylaxis of post-CABG atrial fibrillation.

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Background: Human Cytomegalovirus (HCMV) infections are a significant challenge in patients with Hematopoietic Cell Transplant (HCT). Acute Graft vs. Host (GVHD) is recognized as a predisposing factor for increased incidence of HCMV reactivation. Availability of rapid and accurate tests for HCMV detection in HCT recipients is of foremost importance in developing countries, such as Iran.
Methods: A total of 201 peripheral blood leukocyte (PBL) and plasma specimens from 26 allogeneic HCT recipients were examined for HCMV DNA by polymerase chain reaction (PCR) assay. Densitometric analysis of 257bp PCR products from clinical samples and 101-106 "cloned plasmid" per µg DNA containing a HCMV specific fragment were analyzed using LabWorks software (v3.0.02). Optical density of amplicons was plotted, and calculated HCMV viral loads were compared with the patients' antigenemia results.
Results: HCMV viral loads ranged between <102 to 1.35×102 copies per µg DNA among 7 HCT patients. In addition, 14 episodes of positive antigenemia assay in 7 patients in which peak HCMV load were compared with GVHD grade II-IV patients. Significant correlation was also detected between HCMV DNA load in PBL and plasma samples, as well as HCMV DNA load in PBL samples and antigenemia results. Receiver–Operating Characteristic analysis determined that 2,200 HCMV copies in PBL samples as the threshold value for initiation of Ganciclovir therapy.
Conclusion: This report shows that rapid and sensitive assays, like quantitative PCR, are extremely valuable for detection of active HCMV infection, and life-threatening HCMV disease in HCT recipients during the post transplant period. Furthermore, high HCMV DNA load among GVHD grade II-IV patients confirms the high risk of HCMV reactivation among these HCT recipients. Tests such as quantitative PCR also helps physicians initiate timely preemptive therapy and for a shorter period, which may lead to better clinical outcome in HCMV-infected transplant patients.

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Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.

Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.

Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.

Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.

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Background: Burns are a major cause of death and disability worldwide. Today biological dressings have become an integral part of modern burn care. Using this method, in otherwise healthy young adults, the size of burn relative to the total body surface area (TBSA) correlating with a 50% mortality rate has increased from 30% to 80%. Due to a lack of experience and an interest in using biological dressings in Iran, as a developing country, the aim of this study was to compare patient outcome using the biological dressing vs. conventional treatment in patients with massive burns.

Methods: In this clinical trial study, 118 burn patients (30 to 75% TBSA) were enrolled. The patients were divided in two groups. Those in the conventional treatment group had not accepted treatment with a biological dressing.  The second group agreed to treatment with biological dressing, a pig skin xenograft known as Xenoderm. Significant differences were evaluated using the unpaired Student's t test, the Mann-Whitney U test and the χ2 test. 

Results: Mortality rates in the conventional treatment group (n=53) and biological dressing group (n=65) were 35% (19) and 10.8% (7), respectively (p=0.001). Excluding those patients who died, the mean hospital stay was 31.3 days in the conventional treatment group versus 18.2 days in the biological dressing group (p=0.0005), and number of dressings was 22.1 versus 9.9 (p=0.0005), respectively. Three patients in the conventional treatment group were transferred to a tertiary-care hospital after three weeks of treatment. The most commonly burned areas were the upper limb, lower limb and trunk.

Conclusions: The results of this study indicate that biological dressings give a better outcome and decrease the hospital stay and the number of dressings. A randomized clinical trial is warranted.

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Background: Myeloperoxidase (MPO), an iron-containing protein, is found in the azurophilic granules of neutrophils (PMNs), and catalyzes the conversion of hydrogen peroxide and chloride ions (Cl) into hypochlorous acid, which plays an important role in oxygen-dependent bacterial killing. The enzyme was first isolated in 1941, and deficiency of MPO was first described in 1954. Fewer than 5% of patients with MPO deficiency contract severe infections, which are usually fungal infections in diabetes mellitus (DM) patients. Besides the disorder in antifungal activity, diminished rate of bacterial (S. aureus) killing, and carcinogenesis, it seems that MPO deficiency is also related to atherosclerosis, degenerative neurologic diseases, as well as other disorders. In this study, we compared the levels of the MPO enzyme in the peripheral neutrophils of infected and non-infected DM patients at Imam Khomeini Hospital during 2005-2006. We compared these two groups the prevalence of MPO deficiency in each group, in order to then determine any correlations this may have with infection.

Methods: In this case-control study, 50 patients were in the infected group (case group) and 50 were in the control group. Patients were chosen using simple sampling methods. Data was gathered from blood samples, using a qualitative test to determine MPO deficiency (Kaplow stain), laboratory results (BUN, Cr, PMN, HbA1c), interviews and completion of a questionnaires, as well as hospital records. Data were analyzed with SPSS software using T test and chi-square test, with a confidence index of 0.05.

Results: In spite of differences seen in stained slides, the MPO enzyme was positive in all of the patients, and no differences were seen between the two groups.

The average patient age and the duration of DM in the case group were more than those of the control group. No statistical differences in the type of DM and glycosylated hemoglobin (HbA1c) levels were found between the two groups. Body mass indexes (BMI) and PMN counts were higher in the case group. The most prevalent infections were in the skin and soft tissue, bones and joints, as well as chronic respiratory infections (TB), pneumonia, urinary infections, CNS infections, gastrointestinal and intra-abdominal infections, mucormycosis, and sepsis.

Conclusions: We found no correlation between MPO enzyme deficiency and age, sex, type or duration of DM, HbA1c levels and BMI.

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Background: Measuring anxiety level in clinical and non-clinical population needs valid and reliable tool. This research examined the validity and reliability of Beck Anxiety Inventory in Iranian normal population as well as clinically anxious patients.

Methods: First, a two-session course was run to train research workers. After they were sufficiently prepared, they were dispatched to different regions of the city, Tehran, referring to residential places for men and women volunteer to take part in the research. At the end, 1513 respondents were randomly recruited and tested using Beck Anxiety Inventory (BAI). Of this population, 112 respondents were randomly selected and re-tested in order to measure test-retest reliability with a one-month interval time between first and second tests. Meanwhile, 261 clinically anxious patients (from clinics and mental health centers) were tested. In order to measure validity, 150 patients were interviewed by two parallel clinicians and the anxiety level was rated based on a 10-point scale from 0 (the least) to 10 (the most). The two raters were blind to the BAI scores of the patients.    

Results: For data reduction and analysis, the SPSS for Windows-edition 14, was conducted. Findings showed that the Persian version of BAI proved a good reliability (r=0.72, p<0.001), a very good validity (r=0.83, p<0.001), and an excellent internal consistency (Alpha=0.92).

Conclusions: The results support the applicability of BAI in Iranian population and suggest the use of this inventory for clinical and research aims. Persian version of BAI not only can help clinicians in assessment and diagnosis, but also assist researchers to evaluate anxiety level when needed.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Ovarian cancer is the leading cause of death among all gynecologic cancers in developed countries. The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Over than 50% of patients with advanced ovarian cancer will develop recurrent disease. For those patients who have recurrence of disease at least six months after initial therapy, the paclitaxel- platinum combination has been shown to be a superior treatment to platinum monotherapy. However, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. The efficacy and safety of an alternative regimen that dose not show significant neurotoxicity were evaluated by comparing gemcitabin- carboplatin with carboplatin in platinum sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial in Canada and European Organization for research and treatment of Cancer Gynecological Cancer Group. But this study was not done in Iran.
Methods: We performed a study with escalating doses of gemcitabin combined with carboplatin in 21 patients. All patients who were treated in Vali-Asr hospital between 2003- 2005 evaluated. Gemcitabin with dose of 800mg/m² was given on days 1, 8 and 15 followed by one week rest period for a 28 day cycle. Combine with carboplatin with AUC 4 given on day 2. All patients with surgically resected, histologically confirmed epithelial ovarian cancer and who had failed first- line platinum chemotherapy were allocated to this study.
Results: Median age was 49 years (range 23-78 years). Median follow-up was six months (range 4-22). Total of 87 cycles of chemotherapy were administered with median number of four (range 2-6 cycles). Thrombocytopenia (grade I) and leucopenia (grade I) were seen in 4.75% and 9.52% of patients.
Conclusion: Gemcitabin and carboplatin Combination was tolerated in patients with recurrence of ovarian cancer.

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Background: Hydatid cyst is a zoonosis rarely occurred except in endemic areas that capable of making pulmonary cavities fascilating fungus growth within it. Aspergillo-ma is a glob formed by hyphae from saprophyte growth of aspergillous specious in previously performed cavities within pulmonary parenchyma.

Case report: A 28 years old male patient without any comorbidity presented in emergency department with progressive two month dyspnea. Tube thoracostomy is done because of respiratory distress and massive hydropneumothorax. Thoracotomy and lobectomy is performed due to complicated hydatid cyst. Histopathologic investigation reveals hydatid cyst layers with fungal hyphae within it on granulomatous background.

Conclusion: Hydatid cyst with fungal contamination must be mentioned in differentials of dyspnea with lower segment lung cavities, especially in endemic areas. Thoracic CT scan with IV contrast can reveal fungus ball. Surgery is a treatment of choice and capitonage can be a prophylactic measure from secondary fungal infection in hydatid cyst surgery.

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Background: Several studies have shown that propolis has antibacterial, antifungal,antiviral and antiparasitic activity. Furthermore propolis has been described to have medicinal usages in some fungal infections like Candidiasis. Our aim is to study the inhibitory effects of alcoholic extract of propolis on Candida spp. and Aspergillus spp.Methods: To determine inhibitory and fatality dose of propolis extract, we prepared serial dilution of the extract including 1/20, 1/40, 1/80, 1/160, 1/320 and 1/640 in 1 ml of liquid medium sabouraud broth. Given numbers of Candida yeasts in 1ml were added to above dilution tubes. Candida and Aspergillus cultures were incubated at 30°C and 25°C respectively for 24-72 hours.Results: We obseved that the concentration of 0.25 g/dl of propolis extract showed an inhibitory and killing effect on more than 50% of the isolates. But there were no inhibitory and killing by the concentrations 0.0312 g/dl and 0.0625 g/dl on Candida isolates. Our findings showed that 0.0312 g/dl of the extract was partially active on Aspergillus fumigatus and dilution of 0.125 g/dl was active on Aspergillus. niger. In the agar dilution method, some changes were observed on morphological features (depends on the extract dilution) as well as quantitative effects of dilution of extract on the colonies.Conclusion: We found that the alcoholic extract of propolis had a prominent antifungal activity and inhibitory effect on Candida and Aspergillus isolates.

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Background: Primary clear cell adenocarcinoma of cervix (CCAC) is usually seen in women with a history of in utero exposure to diethyl acetyl bestrol (DES). We report two cases of clear cell adenocarcinoma of cervix with no history of exposure to DES in embryonic period. Case presentation: The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic lymphadenectomy and for the another one external beam radiotherapy and brachytherapy was performed. There was no any recurrence or metastasis after an 18-24 months follow-up Conclusions: Primary clear cell carcinoma of cervix could be unrelated to HPV infection or exposure to DES during embryonic period and in approach to these patients this subject should be considered.

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Background: JAK2 is a nonreceptor tyrosine kinase that plays a major role in myeloid disorders. This mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. In this study we compared the amplification refractory mutation (ARMS) assay and allele- specific (AS- PCR) to evaluate JAK2V617F mutation patients with non-CML myeloproliferative neoplasms (MPNS). Methods: In this experimental study we evaluated JAK2 mutation in 58 patients with a known or suspected diagnosis of a myeloproliferative neoplasm by simple randomized sampling. The mutation was detected by ARMS-PCR and AS-PCR in patients. In order to verify the methods, amplified products from some patients were sequenced. Results: The JAK2 V617F mutation was detected in 86.6%(26/30) of patients with polycythemia vera and 61.5%(8/13) of patients with idiopathic myelofibrosis by ARMS-PCR and AS-PCR. 46.6%(7.15) of essential thrombocythemia patients were positive using ARMS- PCR method while 53%(8.15) of then were positive when AS- PCR were used. The mutation was confirmed by sequencing. Conclusions: The incidence of JAK2 mutation using above PCR methods is similar to previous studies. The different results may depend on the molecular technique used

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Background: In recent years, consumption of whole-blood for the treatment of patients has decreased but use of biological plasma-derived medicines such as albumin, immunoglobulin and coagulation factors have increased instead. Paying attention to albumin molecular structure is important for its isolation from human plasma. Albumin is a single-chain protein consisting of about 585 amino acids and a molecular weight of 66500 Daltons. Albumin is a stable molecule and it is spherical in shape. There are different methods for human albumin preparation. Considering the large consumption of this biological drug in clinical settings, methods with fewer steps in production line are of big advantage in saving time and manufacturing more products.

Methods: In this project, we prepared human albumin using hollow fiber cartridges in order to omit the rework on fraction V+VI. Human albumin is usually produced by the application of cold ethanol method, where albumin is obtained from fraction V by doing a rework on fraction V+VI to separate fraction V.

Results: In the current work, human albumin was prepared from fraction V+VI by the help of hollow fiber cartridges. With a concentration of 20%, the obtained albumin had 96.5% of monomer and 3.5% of polymer and polymer aggregate.

Conclusion: Comparing the obtained human albumin with a number of commercial human albumin samples by the use of SDS-page, the results were satisfactory regarding the 3.5 percent polymer and aggregate rate for the prepared albumin.

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Background: Bone remodeling has always been the goal of surgeons for a long time. Recently, it was shown that statins that are commonly prescribed for lowering cholesterol also have beneficial effects on bone healing. Therefore, the present study was undertaken to evaluate the probable effects of atorvastatin on osteogenesis in the rat femur.

Methods: This experimental study was conducted on 30 male Sprague-Dawley (SD) rats. The animals were divided randomly into one control and two experiment groups. After induction of anesthesia, a hole of 2 mm in diameter was made in femur width. The control group received physiological serum but the experiment groups one and two, respectively, received 10 and 20 mg/kg/PO of atorvastatin on daily basis. After euthanizing the rats, histopathological and histomorphometrical evaluations of the bones were performed 45 days after the intervention.

Results: In the control group, the defects seemed to be filled with woven bone and bone marrow, depictive of a poor osteogenic activity. In the experiment groups, many osteoblast groupings and young bone trabeculae had been formed and bone trabeculae were more organized. Histomorphometric results, showed that atorvastatin had significantly promoted bone healing in the experiment groups compared with the controls (P<0.001). Moreover, the analysis showed that atorvastatin had more significant effects in group three receiving high doses of the medication in comparison with group two (P<0.001).

Conclusion: The findings of this study showed that atorvastatin is capable of stimulating osteogenesis in rats.

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Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.

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Background: Ovarian mucinous borderline tumors are divided into two morphologic groups: endocervical-like and intestinal type. Most endocervical adenocarcinomas exhibit mucinous and/or endometrioid differentiation, they infrequently metastasize to the ovaries but may simulate primary ovarian tumors (both atypical proliferative or borderline and carcinoma). In patients with mucinous adenocarcinoma in the abdominal cavity, caution should be exercised in interpreting the possible primary site of the tumor on the basis of the immunohistochemical profiles. The presence of human papillomavirus (HPV) DNA is assessed to determine whether the ovarian neoplasms were metastases or primary independent neoplasm. Approximately 90% of endocervical adenocarcinomas are related to high-risk human papillomavirus (hr-HPV) with the remainder being unrelated to HPV. Both types metastasize to the ovaries very infrequently. Ovarian endocervical-type (mullerian) mucinous tumors and tumors composed of a mixture of endocervical-type mucinous, serous endometrioid, squamous, and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and micro invasive types. We report a-36-yr old woman with adenocarcinomas of uterine cervix who also had ovarian mucinous borderline tumor.
Case presentation: The patient presented with abnormal uterine bleeding and lower abdominal pain. She had a history of uterine cervix polyps. Pelvic ultrasound showed a right adnexal mass and a large cervical size. Histological diagnosis in uterine cervix biopsy revealed adenocarcinoma of cervix. Radical hysterectomy type III with bilateral salpingo-oophorectomy was performed. Histological finding in adnexal mass revealed borderline mucinous tissue of ovarian tumor. Testing for HPV DNA in the tumoral tissue was negative. This confirms that the ovarian tumor is not metastatic from endocervical adenocarcinoma.
Conclusion: We conclude that in a patient with tumors that involve two organs, complete diagnostic investigation should be done to distinguish the primary origin. The factors that affect cell proliferation, can probably have synchronous effects on the two similar cells.

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Background: The aim of this study was to minimize edema and ecchymosis following rhinoplasty through a closed drainage system to address concealed hemorrhage.
Methods: This study was designed as a prospective، double blinded, randomized contr-olled study. Fifty one patients who underwent septorhinoplasty were included in this study and divided in two groups. In group A, a closed drainage system was applied in the most dependent posterior septal area following septal harvesting. Concealed bloody secretions were drained out of mouth in a vacutaner tube during three concecutive post operative days. In control group, group B, exactly the same classic rhinoplasty opera-tion by the same surgeon was done as for study group except omitting the closed drainage system. Degree of supra-tip and eyelid edema was evaluated on post operative days through photographic and software image analysis. Edema and ecchymosis rating of eyelids and ecchymosis of paranasal and cheek area done based on photographic analysis by independent plastic surgeons using a defined grading system.
Results: Eyelid ecchymosis was reduced significantly on post operative day 14 in the study group (P=0.03). Ecchymosis of paranasal and check was reduced considerably likewise on days 7 and 14 in group A using Mann-Whitney test (P=0.03). There was no significant deference regarding supra tip edema on post operative days. The same hold true for the eyelids edema.
Conclusion: Significant decrement observed in eyelids ecchymosis on day 14 and para-nasal and cheek ecchymosis on postoperative days 7 and 14 in study group. There were no positive effects regarding supra tip and eyelid edema reduction using closed drainage system to evacuate concealed haemorrhage in posterior septum space. There could be different etio-pathologies for two common morbidities following rhinoplasty that should be addressed separately.