Tehran University Medical Journal

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Many years ago the treatment of sarcoma was radiotherapy up to 2000-4000 rad. This treatment was very complicated, due to producing neoplasm after radiotherapy. By this method of treatment of osteosarcoma, the rate of survival became about 20% (two years). The second method of treatment was chemotherapy for a period of 2-5 weeks that amputation was performed afterwards. By chemotherapy, the rate of being alive reached up to 25-27% (five years). Right now, the best treatment for sarcoma is limb salvage. In our report, the chance of being alive in chondrosarcoma was about four years. This was nearly the same as that of the other institutes in the world especially in America, Europe, and Japan. The rate of recurrence was also more than that from different parts of the world. The survival rate in osteosarcomatic patients was about two years less for males the females, and it was more in tall people than short ones. The survival rate of the patients with giant cell tumor was more than osteosarcoma up to five years, and it has no recurrence or metastasis

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A 30 years old female presented with dyspenea, tachycardia and post sternal pain of one year ago in ECG and echocardiography pericardial effusion is suggested there was a large mass M.20×12×5 cm in mediastinum in thymic zone and thymus was not present. The mass was well circumbscribed and encapsulated without invasion to other viscera. The pathology reported as a thymolipoma

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Ito cell (Fat Storing Cell=FSC) is one of the cells which forms the liver sinusoidal wall it also forms the connective tissue of the liver. The cell was first identified in 1963 by a scientist named Ito. It will get damaged due to the plasma fat increase which is resulted from a diet of corn oil 10% and fish oil 10% the damage wil be in form of fat storing cell. The FSC morphology may represent the damage to the liver tissue. The biopsy of an infant's liver reveals that, Ito cell has a very small cell body which contains a core in the middle occupying 2/3 of the area of cytoplasm its basal cytoplasm is hollow and very clear. This study indicated that not only the ultrastructure of Ito cell is circular and three dimensional, but also its presence may show the damage to the liver tissue.

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Association of Helicobacter pylori with pathogenesis of gastrointestinal disorders (including gastritis in children with special endoscopic anteronodular) have significant importance in prognosis of infection resulting from this bacteria in children. However, in this research it was found that there is significant and clear correlation between nodular anteritis (in endoscopy) and active presence of lymphoid follicle (in histology findings with replacement of H.pylori) was noticed in children. In this research 14 persons (34.1%) out of total patients were positive. The average age of positive H.pylori patients was clearly higher than negative H.pylori patients. So increase of possible infection occurrence together with increase of age in children was confirmed. Meanwhile, there is significant relationship between presence of bacteria and clinical symptoms particularly epigastric pain, vomiting, and nausea. One of the other results of this study was confirming the relationship between history of gastrointestinal disorders in immediate family members and infection resulting from H.pylori in patients.

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Different opinions exit in histological typing of bone cysts. Epidermoid cysts are very rare as the small numbers of published cases indicate. They arises following preceding trauma exclusively in distal phalanges and skull. The roentgenogram shows a round osteolytic resion with no trabecular pattern. We observed 2 cases of epidermoid cyst of finger in Imam Khomeini hospital central path department the patients were young workers complaining from local pain several months after trauma. Bone curettage was performed.

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The autopsies, which have been performed within the last 50 years, have revealed that real prevalence of prostatic carcinoma is more frequent than clinical one. The real prevalence of prostatic carcinoma, is prevalence combination of carcinomas which have been revealed clinically (They have been confirmed by autopsy or by operation) and the prostatic latent carcinomas are those, which are found in autopsy or randomly in the biopsies taken for hyperplasia. But they have no clinical syndromes. In order to review prevalence of prostatic latent carcinoma in Iran, all prostatic lesions (Including hyperplasia or carcinoma) were studied in Imam Khomeini medical complex during 10 years (1981-91), in university Jihad center and medical center of Iran within 2 years and in Yazd faculty of medicine within 3 years (1981-84). The total cases were 1110 among which 1085 cases were selected upon reviewing for statistical analysis. At first all lamellas were studied, then the ratio of adenocarcinoma to total prostatic lesions were analyzed and types of carcinoma and their percentage in total cases were identified. Finally the prostatic latent carcinoma and its percentage in total malignancy cases were presented

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The newborn who is born before terms is a candidate for the development of idiopathic respiratory distress syndrome. The intense hypoxia and acidosis that ensue as the consequence of inadequate alveolar-capillary exchange of oxygen and carbon dioxid may prove fatal antenatal steroid therapy can affect RDS (Respiratory Distress Syndrom) and its complications. The newborn before 34 weeks have a significantly lowered incidence of RDS and neonatal mortality from RDS with antenatal steroid therapy. In a retrospective study we compared 37 preterm infants whose mothers had received corticosteroids to 29 similar but untreated infants. The study showed that antenatal steroid therapy reduced neonatal mortality from RDS more than reducing the incidence of RDS and further it was concluded that this beneficial effect was more significant in female fetus than male fetus, but it was not significant statistically

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The laparoscopic findings of 32 patients with chronic pelvic pain were compared with findings of 62 pain free women who were candidates for laparoscopic tubal sterilization. The most common findings, normal pelvis, was found in 50% of patients and 80.6% of controls that was statistically significant (P<0.01). There was no significant difference with pelvic adhesions, polycystic ovaries, pelvic relaxation between study and comparison group.

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In a retrospective study, type, origin and relative frequency of pelvic masses during 3 years period in shariati hospital were studied. Ovarian mass was the most common pelvic mass with relative frequency of 88% including neoplastic 58% and non neoplastic 30%. Corpus luteom cyst was the most common cyst in non neoplastic group and serous cystadenoma was the most common in neoplastic group. The most frequent mass in malignant series was serous cystadenocarcinoma. Non ovarian masses was 6% and metastatic masses was 2% of ovarian masses. The average age was 42 years in neoplastic group excluding dermoid cyst which was 33 years and the average age was 32 years in non neoplastic group.

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Fine-needle aspiration biopsy for the diagnosis of breast lesions has been used for more than six decades and has been established as an effective procedure in Europe for many years. In order to evaluate the accuracy of fine-needle aspiration with histopathologic confirmation, a retrospective study was performed in Iranian Center for Breast Cancer, using a computer database over one year period. All women who had had fine-needle aspiration breast biopsy with histopathologic diagnosis included open excisional biopsy or mastectomy specimen. A total of 49 patients fulfilled the criteria. The test had a 93% sensitivity, 73% specificity, 65% positive predictive value, and 95% negative predictive value. Fine-needle aspiration is a sensitive test that Van be useful as an adjuct in the diagnosis of breast cancer.

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In this paper we report a case of jejunal atresia that was detected pre-nataly. Polyhydramnios and multiple dilated bowel loops in the lower part of fetal abdomen in ulterasonography helped us to diagnose this abnormality. Post-natal barium enema showed it and also it was confirmed by laparotomy confirmed it. Pre-natal diagnosis is important in these cases to facilitate delivery in centers where expert team of specialists are available to allow optimal neonatal care.

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The nervous system has an important and vital role in the human body, but unfortunately the repairment of damaged nervous tissue is very slowly. For a long time, the scientists have been involved in finding ways to speed up this process. Radiation of low power He-Ne laser has been suggested to as a way to improve this issue. In this study, 20 rats were divided randomly into control and case groups. The sciatic nerves of all these rats were damaged under general anesthesia and sterile conditions. The day of surgery was considered as the day zero. Rats of case group received every day laser radiation (?=65 mm). At 27th day rats were killed by ether and the sciatic nerve was studied histologically. Data was analysed and the difference was significant. In the case group the repairment was faster. We concluded that low power He-Ne laser radiation on crushed sciatic nerve of the rats has accelerated the nerve repairment process.

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Breast cancer is a major cause of mortality in women due to malignant diseases and is the most prevalent type of cancer in western countries. According to investigations which has been done in Iran so far, the prevalence of disease in our country is also very high, therefore complete attention to clinical and pathological findings of this disease would be extremely essential. In this study, the direct relationship between axillary lymph node involvement and the aggressiveness of invasive ductal carcinoma has been brought into consideration. This study is a case series of 90 patients which all of them have had radical mastectomy because of breast cancer and all their samples has been referred to the center of pathology of Imam hospital. Based on modified Bloom-Richardson grading, all the samples have been graded. The study of all lymph node samples related to above cases has also been conducted along with the main study. The most frequent ages of disease was 31 to 40 and left breast had most involvement. From all cases, 12.2% were in grade I with 27.2% lymph node involvement, 66.7% grade II with 73.4% lymph node involvement and 21.1% in grade III with 100% lymph node involvement (P=0.00008). Based on statistical analysis we concluded that the axillary lymph node involvement in breast cancer is strongly associated with the aggressiveness of invasive ductal carcinoma. This important point should not be neglected in planning for treatment of this kind of disease.

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Background and Aim: Tuberculous pleural effusion occurs in 30% of patients with tuberculosis (TB). Rapid diagnosis of a tuberculous pleural effusion would greatly facilitate the management of many patients. The purpose of this study was to determine sensitivity, specificity, and predictive values of clinical, laboratory, radiographic findings in patients with tuberculous pleural effusion.

Materials and Methods: The cross sectional study was performed between august 2002 and March 2004 at a referral teaching hospital. Major clinical, laboratory, and radiographic findings were evaluated in 88 cases of pleural effusion, 33 with confirmed TB pleural effusion (TBPE) and 55 with a diagnosis other than TB (NTBPE).

Results: The sensitivity of culture of pleural effusion and tissue were 3% and 9.1% respectively. The mean of adenosine deaminase (ADA) values in TBPE was 36.7 U/L (±18.72), and the mean in the NTBPE was 28.2 U/L (±17.0). Both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were 55%. The sensitivity of PCR was 3% with specificity of 12.7% (positive predictive value, 50% negative predictive value, 70%). Younger age (p<0.024), positive history of exposure to TB patient (p<0.02), and the combination of fever, weight loss and sweating (p<0.01), were associated with tuberculous pleural effusion. There were also significant association between Positive sputum smear (p<0.001), positive sputum culture (p<0.006), positive pleural biopsy (p<0.001), pleural LDH>200 (p<0.005), pleural lymphocytes>50% (p<0.015) and TBPE.

Conclusions: In our region with a high incidence of tuberculosis, the most frequent cause of exudative pleural effusion is tuberculosis. We suggest that the diagnostic planning of pleural effusion should be determined in each region with a view to the adoption of regionally optimized diagnostic and therapeutic facilities.

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Background: Germ cell aplasia (G.C.A) is one of the most important testicular causes of infertility and azospermia.In this condition the seminiferous tubules are only lined by a single layer of sertoli cell. In some cases, there is focal area with spermatogenic activity.
Methods: We studied infertile men with G.C.A referred to Jahade Daneshgahi of Iran during 1381-82, retrospectively. All the cases had more than one biopsy of one testis.
Results: In 11.6٪ of 320 cases, comparison of multiple biopsy sites of a testis revealed: when one site showed G.C.A, another site revealed areas with spermatogenic activity. Considering the cases who showed germ cells in both sites, 15.3٪ of cases multiple biopsy sites appeared to have focal spermatogenesis, better maturation of germ cells or higher scoring area for urologic operation.
Conclusion: According to new techniques in treatment of infertility with ICSI (intra cytoplasmic sperm injection) in which fertility is possible with one spermatozoa or even spermatid (after recovery), biopsy of multiple sites instead of only one site is highly recommended in azospermic patient.

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Background: Aluminum salts are common adjuvants in human and animal vaccine preparations. The two adjuvants aluminum phosphate and aluminum hydroxide show acceptable immunoadjuvant properties with many antigens. These two salts have different physicochemical characteristics that make each one suitable for certain antigens. The surface antigen of Hepatitis B (HBsAg) has several antigenic epitopes that bind to aluminum adjuvants by a ligand exchange mechanism. Although HBV vaccines using an aluminum hydroxide adjuvant are available, higher antigenicity is needed for the subgroup of people who do not respond sufficiently to the currently available vaccines.
Methods: A solution of recombinant HBsAg for making different formulations of vaccines with aluminum phosphate (Adju-Phos®) and aluminum hydroxide (Alhydrogel®) adjuvants was obtained from Darupakhsh Pharmaceutical Company. The total protein content, antigenicity, and purity of HBsAg solution were determined using BCA, ELISA, and SDS-PAGE methods, respectively. The different formulations were prepared in the lab and administered i.p. to two test groups of Balb/C mice and a third test group received the Engerix vaccine, which is currently available on the market and uses an aluminum hydroxide adjuvant. The control group of animals received the solution without antigen. After 28 days, heart blood samples were collected and serum was separated to determine the antibody titer against HBsAg using an ELISA kit.
Results: This study shows that the vaccine formulated with aluminum phosphate exerted more immunogenicity than both the aluminum hydroxide laboratory formulation and the Engerix vaccines.
Conclusion: Although the results of our study indicate higher immunogenic properties of the vaccine formulated with the aluminum phosphate adjuvant, complementary experiments are needed to further evaluate the biological properties with respect to effectiveness, adverse effects, product stability and finally possibility for manufacturing and distribution of this new formulation as a Hepatitis B vaccine.

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Background: It is well known that, at the time of the initial presentation of patients with non-small cell lung cancer, N-status is very important in accurate staging and avoiding inappropriate surgical procedures. Also, if mediastinal lymph node metastasis (N2) of non-small cell lung cancer (stage IIIA) is present, neoadjuvant (preoperative) chemora-diotherapy is indicated therefore a quick and accurate N-status determination is critical before thoracotomy. We compared the usefulness and accuracy of touch imprint and frozen section analysis for this purpose.

Methods: During 2006, fifty eight mediastinal lymph node specimens from 27 patients with lung cancer were excised. After touch imprint preparation, half of each lymph node was sent for frozen section and finally permanent histology.

Results: Frozen section and touch imprint had only one and two false negative results, respectively, but neither had false positive reports. The sensitivity, specificity and accuracy of the frozen section evaluation was 95.5%, 100% and 98.2%, respectively, and those of touch imprint were, 90.9%, 100% and 96.4%. The differences in the sensitivity, specificity and accuracy between the two methods were not significant (p>0.05).

Conclusion: Frozen section and touch imprint have similarly high accuracies for detecting mediastinal lymph node metastasis in lung cancer. However, since the touch imprint method is more rapid and simple, it maybe method of choice.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The mechanisms by which fetal weight are regulated during pregnancy are poorly understood. The relation between hormones such as leptin and adiponectin and intrautrine growth is still under investigation. The aim of this study was to ascertain whether fetal growth restriction is associated with alterations of leptin and adiponectin  concentrations in venous umbilical cord blood and maternal serum.
Methods: Maternal serum and venous umbilical cord blood leptin and adiponectin concentrations were determined by ELISA after 36 week of gestational age in 22 women with uncomplicated singleton pregnancies with AGA fetuses (group A) and in 22 women with singleton pregnancies complicated by fetal growth restriction but without fetal distress (group B), all with normal body mass index and without history of diabetes, hypertention or maternal cardiac disease.
Results: Venous umbilical cord leptin levels were significantly lower in group B compared with group A (8.1±0.8ng/ml versus 39.45±6.8ng/ml p=0.001). Venous umbilical cord adiponectin levels were also significantly lower in group B compared with group A (28.8±3.5μg/ml versus 43.6±3.7μg/ml p=0.007). Maternal serum leptin and adiponectin did not differ between SGA and AGA groups.maternal BMI, gestational age and maternal age did not differ between these two groups. Neither leptin nor adiponectin correlated with gender difference.
Conclusion: In this study we confirmed that growth restricted fetuses show venous umbilical cord blood leptin and adiponectin concentrations were significantly lower than those in normal fetuses indicating that these two adipokines have an independent role in growth restriction pathogenesis. Maybe in future we can administer recombinant human leptin and adiponectin to growth restricted fetuses for treatment.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Dendritic Cell (DC) is an important antigen-presenting cell that present tumor antigen to CD8⁺ and CD4⁺ T- Lymphocytes and induce specific anti-tumor immunity. In order to induce effective anti-tumor response, an option is increasing the efficiency of antigen presentation of dendritic cells and T cell activation capacity. The aim of the present study was to investigate the effect of dendritic cell maturation with protein components of toxoplasma gondii on cytotoxic T lymphocyte activity and their infiltration in to the tumor.
Methods: For DC generation, bone marrow cells were cultured in the presence of GM-CSF and IL-4 for five days. After that, LPS, protein components and whole extract of toxoplasma gondii were added to the culture media and incubated for another two days for DC maturation. To generate tumor, mices were injected subcutaneously with WEHI-164 cell line. For immunotherapy 10⁶ DCs matured with different compounds were injected around the tumor site. Infiltration of CD8⁺ T cells were determined by flow cytometry and cytotoxic activity was measured by LDH detection kit.
Results: Immunotherapy with DCs treated with protein components of toxoplasma gondii led to a significant increase in the activity of cytotoxic T cells and infiltration of CD8⁺ T cells in to the tumor. Immunotherapy using protein components of toxoplasma gondii significantly improved the survival of the mice compared with other groups (p<0.0001).
Conclusion: Protein components of toxoplasma are able to increase DC capability in induction of CTL-mediated anti-tumor response and increase infiltration of these cells in to the tumor.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Multiple myeloma is a plasma cell dyscrasia characterized by proliferation of plasma cells in bone marrow associated with the production of monoclonal immunoglobulins. In recent years, the use of arsenic trioxide, formerly approved for treatment of acute promyelocytic leukemia has been considered for refractory myeloma treatment. This study was designed and carried out to evaluate the efficacy and possible side effects of ATO on patients with refractory multiple myeloma.

Methods: This study carried out on myeloma patients whose diseases were at least refractory to two standard treatment regimens conducted in Ghazi Tabatabaei Hospital in Tabriz- Iran. Arsenic trioxide was administered as an intravenous infusion at a dose of 0.25 mg/kg/d for 5 d/week during the first two consecutive weeks of each 4-week cycle with two week rest. Patients who completed one 4-weak cycle were evaluated for response to treatment.

Results: Twelve patients with refractory disease to conventional treatment regimens received arsenic trioxide. The response to the treatment assessed based on the amount of serum proteins electrophoresis of the 10 patients. Stable disease observed in four patients (33%), progressive disease in five patients (41.6%), complete response in one (3.8%) and the remaning two patients could not be assessed for response (because of increased liver enzymes after the first week). One patient completed six cycles. Some adverse events such as: increase liver enzymes and serum creatinine, neutropenia, pruritus, nausea, vomiting, lower extremities edema, and noninfectious diarrhea were observed.

Conclusions: The use of arsenic trioxide is promising in treatment of refractory multiple myeloma.