Tehran University Medical Journal

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The evaluate the diagnostic value of image guided Fine Needle Aspiration (FNA) in breast lesions, the cytologic results of 401 patients were studied. All patients had either unpalpable masses or lesions who were hardly possible to localize by palpation and FNA was performed by single radiologist under ultrasound guide in all cases. The cytologic results were divided into four categories (inconclusive, benign, suspicious and malignant. Pathologic results were also divided into two categories (benign, malignant) and additional statistical analysis was conducted to find te cut-off point between benign and malignant cytologic results. Following cytologic results were obtained: 7.98 percent inconclusive, 67.83 percent benign, 10.97 percent suspicious, 13.22 percent malignant. Of the patients undergone breast operation after image guided FNA, the surgical pathology of 128 cases were found. In this study the sensitivity, specificity and accuracy of image guided FNA were calculated as 94.34 percent, 82.67 percent and 87.5 percent respectively. Person's coefficient analysis revealed significant correlations between FNA diagnosis and surgical pathology (P<0.001, r=0.66). Thus, image guided FNA of breast lesions can be a reliable substitute for the excisional biopsy breast operation in many patients.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cyclooxygenase 2 is a key enzyme which converts arachidonic acid into prostaglandins. Cyclooxygenase 2 is triggered by inflammatory stimuli, such as cytokines. Its expression increases in tumors and Alzheimer's disease and ovarian hyperstimulation syndrome. Polycystic ovarian syndrome is a heterogeneous disease characterized by pathological angiogenesis and chronic anovulation. In the present study, the probable role of cyclooxygenase 2 in Wistar rats with polycystic ovarian syndrome was investigated.
Methods:  Thirty female Wistar rats (170-200 gr) were equally divided into three groups: 2 mg estradiol valerate was intramuscularly administered to each rat in the experiment group or group 1 the rats in group 2 were regarded as the sham group and received sesame oil injections and group 3 or the control group received no injections. After 60 days of treatment, animals were anaesthetized with chloroform and killed by decapitation. Ovaries were collected for histological and immunohistochemical evaluations. All the experiments were repeated three times.
Results:  Morphologically, ovaries from the control group exhibited follicles in various stages of development and many fresh corpus luteum. In estradiol valerate group small follicles in early development were observed in addition to follicles showing evidence of atresia and many large cysts with thickened theca cell layer. Corpus luteum was rare or absent in group 2. The immunohistochemical analysis for cyclooxygenase 2 expression showed an increased expression of cyclooxygenase 2 enzyme in group 1.
Conclusion: The results suggested the involvement of cyclooxygenase 2 in the progression to polycystic ovarian syndrome in a rat model.

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Background: Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA) which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome.

Methods: This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS), clinical outcome (based on range of motion), morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups.

Results: Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0.05) however, group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0.05). Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups.

Conclusion: Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty.

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Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL) reconstruction.
Methods: Fifty patients (male and 18-45 years old) with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft) and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC) questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.
Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the difference)
Conclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient), it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex and with long duration of follow up.

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Background: Wrist arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients. Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic wrist pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic wrist arthroscopy. All patients were evaluated by wrist range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal wrist ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated. Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in wrist range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional wrist score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009). 82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of wrist arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory. Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

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Background: Polycystic ovary syndrome (PCOS) that occurs with chronic lack of ovulation, systemic inflammation and hyperandrogenism is manifested most common endocrine disorder in women of reproductive age. Ziziphora tenuior L. due to possess its Pulegone, flavenoid and anthocyanin has anti-inflammatory and anti-oxidant activity. This study investigates the modulating effects of Ziziphora tenuior L. extract by its anti-inflammatory properties on hormonal profile and the improvement of tissue symptoms of estradiol valerate- induced PCOS. Methods: In this experimental study that established in Laboratory,s Animal Center and Cellular And Molecular Research Laboratory, Kharazmi University, Karaj, from October 2012 to November 2013, 144 female adult Wistar rats divided into three groups of control (without injection), estradiol valerate- induced polycystic ovarian syndrome (2 mg/rat estradiol valerate, subcutaneously) and Ziziphora tenuior L. extract-treated groups. After induction of the syndrome within 60 days, experimental groups were injected 100, 150 and 200 mg/kg bw Ziziphora tenuior L. extract for 10 consecutive days intraperitoneally. The animals were anesthetized by chloroform. Their ovaries and blood serum was harvested to hormonal analysis and histomorphometric studies. Data using of one-way ANOVA test and P< 0.05 was considered significant level. Results: The ovarian sections in PCOS group exhibited a significant reduction in thickness granulosa layer (82%), number of corpus luteums (54%), appearance of some cysts (79%) and increased CRP serum level (68%) compared with the control group, while the histological changes in Ziziphora tenuior L. extract-treated ovaries did not have significant difference compared with control (P= 142). The decrease of LH, estradiol, and testosteron was significant in Ziziphora tenuior L. extract-treated groups compared with the estradiol valerate- induced PCOS. Conclusion: It seems that Ziziphora tenuior L. extract may improve functional and endocrine disturbances of estradiol valerate- induced PCOS and modulate the hormone level by anti-inflammatory effects. Ziziphora tenuior L. extract also starts the ovulation process again in polycystic ovary syndrome group.

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