Tehran University Medical Journal

Background: The knee is the most commonly injured joint. The internal components of the knee include the meniscuses, the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL). Magnetic resonance imaging (MRI) is now used widely because of its high accuracy and noninvasiveness. Our objective was to diagnose internal knee component injuries by MRI and compare its diagnostic value with that of arthroscopic surgery.
Methods: This process research study was carried out between May 2004 and September 2006 on 90 randomly selected patients admitted to the orthopedic ward of Baghiatollah Hospital, Tehran, Iran. Each patient had arthroscopic surgery after undergoing MRI by an expert radiologist.
Results: Out of 90 patients, 81 were male and nine were female. The mean age was 31.6 years (range: 17-71). Among patients with normal ACL as shown by MRI, 42.4% were shown by arthroscopy to have a ruptured ACL. The sensitivity and specificity of MRI in ACL abnormalities were 73% and 77%, respectively. Only 1.3% of the patients with normal PCL by MRI showed PCL rupture upon arthroscopic examination. The evaluation of the lateral meniscus by MRI had a sensitivity and specificity of 40% and 94%, respectively. Likewise, in the medial meniscus, sensitivity and specificity by MRI was 70% and 98%, respectively.
Conclusion: According to our study, considerable differences exist between MRI reports and arthroscopic findings in the diagnosis of internal knee injuries. We therefore conclude that sole reliance on MRI reports is not reasonable for making treatment decisions and MRI should be used as just one of the diagnostic tools, in conjunction with other methods, such as physical examination and arthroscopy.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Flexor tendon injury is one of the unanswered problems in reconstructive surgery of the hand. Although pull out method is one of the best reconstructive approaches but still is controversial. Surgeons prefer immobilization to prevent laceration at the site of the suture but it may cause adhesion and lead to surgical failure. The aim of this study was to perform a new surgical method to achieve a tendon repair without these problems.
Methods: In this case-series study, 80 fingers with flexor tendon impairment selected and divided into four groups (tendon laceration & avulsion, tendon graft reconstructed in 1 & 2 stages) then patients were surgically treated by the new technique. The most important aspect of the technique is the placement of the suture in the direction of strength therefore, following any tension the suture would be tighter and this point help us to mobilize the injured tendon immediately after the surgery then we analyzed the results depends on the patient's group.
Results: The pull out and surgical (functional) results were evaluated. 97% of the pull out results were good and 3% were poor and surgical results were 23.9% excellent, 52.2% good, 17.9% fair and 6% poor.
Conclusion: Depend on the acceptable results, immobilization in these patients is unnecessary & active and passive range of motion would be gradually increased as soon as possible. However biomechanical studies would be beneficial to evaluate this suture influence and designing future studies to compare this technique with old methods would be essential.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Diffuse large B Cell lymphoma (DLBCL) is the most common subtype of non-Hogkin lymphoma (NHL). We performed a retrospective study of patients with de novo DLBCL treated in the Medical Oncology department of Cancer Institute of Iran, Tehran to assess the clinicopathologic and immunohistochemistry correlation and prognosis of the patients.
Methods: World Health Organization (WHO) classification was used to reexamine 1470 biopsy specimens related to the years 1985-2006. After excluding five cases of T Cell large cell lymphoma, 50 Patients diagnosed as DLBCL.
Results: Median age of the patients was 45.5(20-85) years: 60% were male and 30% had primary extranodal disease. The most common extranodal sites were bone, gastrointestinal tract and Head and neck areas. The most common stages were stage II (32%), stage III (32%), stage IV (20%) and stage I (16%) retrospectively and 33% had B-symptoms. All of The Patients received chemotherapy (83% CHOP regimen) and 46% treated by radiotherapy after chemotherapy. With a mean follow up time of 32 months, median survival time was 34 (95% CI 24-40) months. Prognostic factors for survival were tumor stage, B-symptoms and early relapse (less than 6 months).
Conclusions: Our data showed the importance of Immunohistochemistry method in diagnosis of DLBCL. Although DLBCL is potentially curable with CHOP chemotherapy protocol, addition of monoclonal antibody (Anti CD20) and finding new prognostic factors to predict early relapse are clearly needed in Iran.

Background: Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). Methods: This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Results: Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Conclusion: Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.

Background: Metformin has been suggested as anti-cancer in retrospective studies. We design a prospective controlled study about metformin efficacy in the window time between biopsy and definite surgery with changes of Ki-67 as the primary endpoint.

Methods: The primary cohort had composed of 50 pathologically diagnosed invasive breast cancers, accrued in Medical Oncology Department of Iran Cancer Institute from February to November 2014. Patients neither had indication of neoadjuvant chemotherapy, nor involved with diabetes mellitus. They followed during the time period of biopsy and definitive surgery with taking tests on pathology specimens for ER, PgR, HER-2/neu and Ki-67 index. We checked fasting insulin and glucose level as well as quality of life and adverse effects in both times in the intervention group. Metformin (1500 mg/day) was prescribed to intervention group from pathology report to the night before surgery.

Results: From 45 patients, 25 had been received metformin for median time of 2.8 weeks. Controlled group included 20 patients who followed in the window time. There were no statistically significant differences between two groups regarding baseline clinical and tumor characteristics such as age, stage, grade, ER, PgR, HER2 status, time and type of surgery. However, immunohistochemistry study showed decrease of median Ki-67 from 35.14 to 29.6% in the intervention group and increase from 24.5 to 30.6 in the control group. Both of these results were statistically significant. Patients tolerated metformin very well, but mild gastrointestinal symptoms were seen in 30% of cases. There was a correlation between metabolic factor of HOMA score (fasting insulin level fasting blood sugar/405) and changes in Ki-67.

Conclusion: In the present study metformin prescription in the short period of time between Biopsy and definite surgery had shown inhibition of breast cancer cell growth. We found relationship between metformin anti-proliferative effect and glucose and insulin metabolism. To find direct apoptotic stimulation of metformin and long-term results of this drug further studies in the adjuvant settings with cooperation of pharmacokinetic groups are recommended.

Background: Anembryonic gestation (blighted ovum) is the most common identifiable pathology in the first trimester of pregnancy, always leads to miscarriage. Early pregnancy failures from blighted ovum are often due to chromosomal abnormalities and a poor quality of sperm or egg. Oxidative stresses as a factor of disturbance balance between the production of free radicals and antioxidant defenses is involved in the pathogenesis of many diseases, including mouth and throat cancer and cardiovascular disease. Catalase is one of the defensive systems against damages caused by oxidative stress in human. The aim of this study was to compare the activity of salivary catalase in women with blighted ovum and women with history of normal pregnancy.

Methods: This case-control study was performed on 34 patient women with blighted ovum and 34 healthy women as a control group. The study was performed in biochemistry laboratory at the University of Guilan from October 2015 to July 2015. The age range was 20-44 years and 18-45 years in patient and control groups, respectively. Unstimulated saliva samples were collected using spitting method. Catalase activity was measured by evaluating the constant rate of hydrogen peroxide decomposition in patient and control groups.

Results: The patient group matched with healthy subjects in average age and having no other diseases history. The biochemical enzymatic assays indicate that the average catalase activities of saliva in patient and control groups were 14.47±3.8 and 16.42±3.48, respectively. Therefore, the catalase activity was significantly reduced in patient group as compared to the control group (P=0.03).

Conclusion: The obtained results suggested that oxidative stress plays an important role in the pathogenesis of blighted ovum. Therefore, determination the activity of other antioxidant enzymes, in addition to catalse, may be used as a marker for diagnosis of blighted ovum. More studies with larger studied-population is recommended to confidently comment on the results of this study.