Tehran University Medical Journal

---

Parasitic infections, especially opportunistic ones are important problems of immune deficient patients. These groups of patients can encompass a broad spectrum of cancer patients. Patients receiving immune suppressive chemotherapeutic agents and those who receive radiotherapy. This group of patients has much more susceptibility to infections and suffers more complications. The objective of this study is to determine the incidence of intestinal parasitic infestations in patients receiving immune suppressive anti-cancer agents. Stool sample of 261 patients under treatment with chemotherapeutic agents were collected and sent to parasitologic laboratory of Shahid Beheshti medical school. Every sample was evaluated with direct smears formalin and ether concentration technique, shitter dilution, zeil-nelson strip stain, culture on strip of filtration paper according to Hadamvory method and on agar plates. Thus, the incidence of intestinal parasitic infestations was evaluated. In this study 34% (89 samples) of patients, who had receive immunosuppressive medicine, had intestinal parasitic infestation. 31.4% of patients with intestinal parasitic infestation were under 20 years of age, 31.6% were between 21-50 years and 36.5% were above 51 years old. Statistical method did not show significant difference between the incidence of intestinal parasitic infestation and the 2 variables of age and sex. The rate of intestinal parasitic infestations in cancer patients with 1-4 courses of treatment was 34.5% and after more than 5 courses was 33.6%. Statistical analysis with X² test did reveal significant differences. Considering the above studies, we recommend: 1) Stool exam of all chemotherapy patients for intestinal parasites before chemotherapy treatment. 2) Five to seven stool exam is necessary for high-risk group. In other patients one stool examination is enough. 3) Repeated stool examination is recommended during chemotherapy. 4) More specific method is needed for detection of high-risk patients and suspected cases.

---

Background: Radioactive synoviorthesis by injection of safe radioisotopes into the joints affected to chronic arthritis is accounted as a novel method to treat haemophilic arthropathy. The main goal of this therapy would be decrease in frequency of hemarthrosis and consumption of coagulation factors. In this study we assessed the effect of radioactive synoviorthesis on the frequency of hemarthrosis, factor consumption and other related parameters.

Methods: In an interventional study in Imam Khomeini Hospital in Tehran, Iran, after meeting of inclusion criteria and taking written consent, colloid 32p radiosynovectomy was performed for 56 joints with haemophilic arthropathy. After local anesthesia of injection site, one mci of 32P for large joints (knee) and 0.5 mci for small joints (ankle and elbow) was injected, respectively. Half of these doses were considered for children (age <12 years).

Results: The mean of age was 16.78 year old (Range: 2.5-36 SD: 7.46) and 98.2% of cases were male. Injected were knee 80.35%, ankle 12.5%, and elbow 7%. The mean of follow-up was 43.63 months (range: 3-102) that at the end, the result was 62% decrease in frequency of hemarthrosis (p=0.0001) and 84% decrease in factor consumption (p=0.0001). However, the involvement of other (non injected) joints during follow-up could lower the decrease of mean of total factor consumption.

Conclusions: Radioactive synoviorthesis can be a cost-effective alternative to decrease hemarthrosis and factor consumption in haemophilic arthropathy.