Tehran University Medical Journal

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Background: Mediastinum includes the vital organs like the heart the major respiratory passages and the major vessels due to this vicinity, the masses of this area with malignant or benign etiology or cause systemic diseases such as metastatic malignancies or granulomatous reactions can be potentially fatal.

Materials and Methods: According to the priority of the problem, a ten years comprehensive retrospectively study of mediastinal masses in children was conducted In children medical Center (Tehran University) from the points of view of incidence, clinical manifestations and diagnostic and treating ways. Results &

Conclusion: In our study there were 34 patients from 1992-2002 who were reviewed. No differences between boys and girls with mediastinal masses were observrd. The most prevalence age for mediastinal tumors was form 5-10 years (38%). The most prevalent sign was fever (53%) and the most common symptom was coughing (44.4%). Basesd on this research, mediastinal masses have been the most prevalent finding in chest radiography (53.8%). CT-Scan with double contrast was recognized as the most common and easiest ways for diagnosing masses. Anterior masses were the most common finding in our study (41.7%). Most of these masses were removed by surgery and the most common operation in our patients was thoracotomy and removing the masses (61.7%). Lymphoma was the most common masses (35.2%) and masses with neural orgins occupy the second grade. According to available documents and with regard to mean follow up of patients in 3.2 years the rate of survival was 54%.

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Background: As increase of cytokines (like IL-1 , IL-6 , IL-8 and TNF- ) in platelet concentrates (PCs) during storage are involved in Febrile Non Hemolytic Transfusion Reactions (FNHTRs) after Platelet transfusion, the aim of this study was the survey of these cytokines level in PCs produced in Tehran Blood Center. Materials and Methods: This study proposed to determine if WBC reduction in PCs by pre-storage leuckodepletion filters reduced the levels of these cytokines during storage uo 3 days. Each of the PCs (n = 54) was prepared from single random donor (RD) by Platelet-Rich-Plasma (PRP), then were divided in four groups: 1- unfiltered non-irradiated RD-PCs (n= 13) 2- unfiltered and -irradiated RD-PCs (n=16) 3 - filtered non-irradiated RD-PCs (n=14) 4-filtered and -irradiated RD-PCs (n = 11). Cytokines levels in PCs supernatants were measured by ELISA kits according manufacture‘s instructions. Results: Our results showed : IL-8 was increased in unfiltered non-irradiated and IL-18 in -irradiated RD-PCs but not in the filtered RD-PCs in day 3 . Compared to unfiltered PCs in filtered units, pre-storage filtration prevented a rise in the IL-8 and TNF-  in day 3 of storage .The concentration of IL-1 was lower than the minimal detectable concentration by the kits used for this purpose. IL-6 was detected only in 7 units of all filtered PCs in day 3. Conclusion: These data indicate that pre-storage leuko-reduction of PCs can prevent accumulation of IL-6, IL-8 and TNF-  during storage.

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Background: Many of hospital acquired infections that cause so much morbidity and mortality and have great economical burden are transmitted via contaminated hands of health care workers (HCW).Prevalence of these infections can decrease up to 30% with hygienic measures. In this study we assessed the prevalence of careers and microbial spectrum of HCW,s hand and relation between detergent used for washing and reduction of microbial load of HCW, s hand.

Materials and Methods: This study was done in two part: Descriptive part (cross sectional) and analytical part (before –after). Cases were Consist of all staff Working in wards of center of pediatrics hospital (Including attends, residents, interns, nurses and workers). In first part ,we assess hand microbial spectrum and contamination load of 72 staff and in second part, we assessed and compared hand microbial spectrum and load before and after of washing with four detergent : plain soap (60 staff ), liquid soap (60 staff ) , betadin scrub in ward (60 staff ) and betadin scrub in operating room manner (26 staff).

Results: %87.5 of personnel had positive cultures-.The most prevalent bacteria were staph. epidermidis (%79.4), staph. oreus (%42.9), klebsiella (%12.7), E-coli (%12.7). The rate of reduction or negative cultures in groups used betadin were greater than the first two group (P-value <0/05).Thirty staff (10 with plain soap,10 with liquid soap and 10 with operating room betadin scrub ) dried their hands after washing. Forty percent of first, fifty percent of second and ninety percent of third group have negative culture after drying. Also 11 samples were drawn from faucets that all of them were positive.

Conclusion: Prevalence of careers is high among HCWS and drying of hands can an important role in hospital infection rate. Faucets have heavy contamination and can transmit bacteria to hands after washing. For theses reasons education and of staff to correct hand washing and drying before every contact with patients and used of faucets without direct hand touching can play a great role in lowering hospital infections.

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Background: Chang in the serum K+ level may increase perioperative morbidity and mortality in kidney transplant recipients. Thus this research was done with the aim of evaluated of K+ change in kidney transplant recipients. Hence the following study was carried to evaluate the fluctuation of potassium ion in the kidney transplant recipient patients.

Materials and Methods: In a simple randomized clinical trial the serum K+ level was assessed in 40 kidney transplant candidates as following interval, pretransplantation, during renal art, anastomosis, after diuresis and post transplantation period. After hydration with 5 ml/kg normal saline all patient were undergone general anesthesia identically. They were premedicated fentanyl (2µg/kg), induction was performed by thiopental sodium (5 mg/kg). Tracheal intubation was facifitated with atracurium (0.6 mg/kg). Anesthesia was maintained with N2O + O2 50%, halothane 0.1% and fentonyl 1 µg/kg every 30 min.

Results: The least mean K+ level was during anastomosis (ie. 3.5±0.24 mmol/L) and showed a decrease in the serum K+ level compared to preoperative period (mean 4.4±0.48 mmol) (P< 0.001). The maximum serum K+ level detected preoperatively and postoperatively were 5 (mmol/ L) and 4.7 (mmol/L) respectively.

Conclusion: Despite the above results we inferred that range of serum K+ level was maintained within normal. Therefore with suitable pereoprative assessment hyperkalemia is a rare occurrence in transplant recipients.

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Background: Medical education is inherently stressful and demanding to deal with various stressors, which may cause impaired judgment, reduced concentration, lack of self-steam, increased anxiety and depression.

Materials and Methods: A cross sectional study was conducted on 250 medical students from 6 month period to graduation in medical college of Tehran university of Medical sciences in order to assess their anxiety and practice of health behaviors and also the relation between the two variables and some other related factors..

Results: The results of study show that of 6.6% medical students suffer from severe state and 4.9% from trait anxiety. The finding of this study shows that 83.3% of girls and 84.6% of boys have practicing risky health behaviors. No statistical relationships found between, anxiety and practicing health behaviors. The relation between anxiety and health satisfaction was Statistically significant mental and physical (P<0.001).

Conclusion: The information found in this research, can help medical education institute to capitalize an opportunities to help their students in preventing risky behaviors, and different stress management techniques should be taught at medical schools.

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Background: The purpose of this study is to determine the incidence of electrolyte and ABG abnormalities in infants with HPS and also we evaluate other parameters of the study. ‎

Materials and Methods: This descriptive study covers 161 infants with HPS hospitalized in children Medical center of Tehran university underwent surgical repair from march 1996 to march 2002 . ‎

Results & Conclusion: The results indicated that Hypokalemic metabolic alkalosis had occurred in 40% of patients. ‎The sex ratio was 3/1 =M/F and the most time of presentation was between 15t and 5st week and the most presenting sign was vomiting. Clinical icter happened to be found in 15% of patients. The incidence of accompanying anomalies was 9% and olive sign was palpable in 40%. ‎The best way for evaluating and diagnosis was sonography. ‎The mean period to begin postoperative feeding was 30 hours&apos no complication related to option was reported after operation.

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Background: In this study we evaluated the treatment of giant cell tumor (GCT) of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA) cementing.
Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years) 13 females and 7 males were included in the study. Cortical disruption were presented in 7 patients 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 ).
Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months.
Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

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Background: This study was designed to compare low-level laser therapy (LLLT) + exercise therapy with LLLT alone and exercise therapy alone, and to determine whether laser therapy is a useful treatment modality for chronic low back pain (LBP).
Materials and Methods: This study was a double-blind placebo-controlled randomized clinical trial. Patients with chronic LBP for at least 12 weeks were included. Visual analogue scale (VAS), Modified Oswestry Disability Questionnaire (MODQ), Schober test, flexion, extension and lateral bending were used to evaluate back pain, disability score and lumbar range of motion. Irradiation was performed with GaAlAs (=810 nm, power density=226 mW/cm2) laser, two times a week, over a period of 6 weeks. Subjects were evaluated before the first treatment, at week 6 and 12 follow-up.
Results: The reduction in pain related to motion was significantly greater in the exercise + LLLT group compared with the exercise alone group (P = 0.004) but was not significant, compared with LLLT alone (P = 0.982). Disability score in LLLT + exercise therapy reduced more than the other two groups, and the difference with exercise alone group was significant (p = 0.03). Comparison of reduction of disability between LLLT alone and exercise therapy alone was not statistically significant. Improvement of lumbar range of motion in patients treated with LLLT + exercise therapy was better than the other two groups significantly, especially by Schober test and Flexion and lateral bending.
Conclusion: This study clearly shows that LLLT alone and especially LLLT combined with exercise can lead to better improvement in chronic LBP.

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Background and Aim: This study was conducted to evaluate the safety and efficacy of Tension-free Tape for the surgical treatment of female stress urinary incontinence.

Materials and Methods: In a prospective open study for pre and post operative, we followed 36 patients at least 1.5 years after surgery (18-28 months) all patients underwent the operation under local anesthesia, allowing the surgeon to check intra-operatively that continence has been obtained.

Results: Mean operation time was 36 minutes (range 20-45 minutes). 32(89%) of the patients was cured according to the protocol, another 3(8.3%) were significantly improved and there was 1(2.7%) failure. Mast of patients (about 91%) were operated on a one day-care basis, which implies that they were released from the hospital the day after the procedure, and no post operative catheterization, defect healing and tape rejection occurred. Pain free recovery time without any analgesic was another benefit. Five patients needed an indwelling catheter for 3 days and two uncomplicated hematoma occurred.

Conclusion: Based on the results, we conclude that Tension-free Vaginal Tape is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence, which allows the majority of the women to be discharged from the clinic the day after the procedure and start their works in the second week.

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Background: Post-transplant erythrocytosis (PTE) is characterized by persistent hematocrit level above 51% that develops in 10-20% of kidney recipients, mostly 2 years after kidney transplantation. PTE is self limited in 25% of the patients but can be persistent in other patients with an increased susceptibility for thrombosis. The purpose of this study was to identify the risk factors for development of PTE in our center

Methods: We selected 45 patients who were transplanted at least 3 months before selection (minimum time required for detection of PTE) and were referred to the kidney transplantation clinic during 5 years (1998-2003) as the case group. At the same time, we considered 2 patients without erythrocytosis as control for each patient in the case group among kidney transplant recipients who were referred to the same clinic during 5 years (1998-2003). In total we had selected 135 patients, 45 patients with erythrocytosis as the case group and 90 patients without erythrocytosis as the control group. Patients who were affected by high hematocrit before transplantation (HC>51%),overt pulmonary disorder, and polycytemia Vera were excluded from this study. We collected basic information by using old charts and complementary information was added through phone conversations and physical examination in the clinic. All the information was entered in the digital questionnaire and was analyzed by the SPSS statistical package.

Results: There was no significant difference between the case and control group for age, history of hypertension, diabetes, pretransplant hematocrit, pretransplant transfusions, function of graft and source of kidney. A significantly higher proportion of PTE patients were male, also the case group had a significantly higher frequency for personal history of polycystic kidney disease , glomerulonephritis and higher frequency of azathioparine, prednisolone and cyclosporine regimen.

Conclusion: PTE is an important complication of kidney transplantation that can be fatal. There are multiple risk factors that should be addressed to prevent this complication.

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Background: Abnormal uterine bleeding (AUB) is a common presenting symptom indicative of abnormal menstrual bleeding patterns that may occur in anovulatory or ovulatory women.There are different ways to diagnose AUB, all requiring much time and energy. The purpose of this study was to evaluate and compare the value of endometrial biopsy, transvaginal ultrasonography with dilation and curettage (D&C) which is the current gold standard procedure.

Methods: A prospective-descriptive study was conducted on fifty patients referred to our center for refractory abnormal uterine bleeding who were candidates for hysterectomy. All patients underwent endometrial biopsy and transvaginal ultrasonography , followed by D&C as a Gold standard procedure in operating room just before surgery.

Results: Mean age of patients was 46.62 years. Transvaginal utrasonography offered a sensitivity of 70% and specificity of 68% demonstrating the lowest numbers compared to D&C. Endometrial biopsy had a sensitivity of 70% and specificity of 75% that was better than sonography alone.

Conclusion: D&C was the most useful and valuable procedure and addition of endometrial biopsy with transvaginal ultrasonography will not be of high value in diagnosis.

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Background: addiction and drug abuse have many risk factors in community and individual attitude also causes much diversity in community perception and attitude toward addiction.

Methods: in this study we assessed attitude toward an addict in 42 addict men and asked about problems in their community and recreational behaviors. They were residents of a rural area in Babol city. In the control group we assessed the same parameters in 268 non addicts in the same area. All of the addicts have been using opium more than many times a week at least for recent 6 months. Data collected via a semi structured questionnaire through conversation.

Results: There was a significant difference between addicts’ attitude toward toward addiction compare to non-addicts’. Both addicts and non-addicts indicated that the first three community problems in their area were unemployment, lack of recreational facilities and addiction, in respective order. Answering questions about recreational activities, both groups indicated that there were no recreational facilities in the community.

Conclusion: In planning a preventive approach, there is a major role for attitude toward addiction in any community. The conflict seen in this study between addicts’ attitudes toward an addicted person and addiction as a community problem has it’s interesting feature. Recreation and physical and cultural facilities need to pay more attention as indicated by our study participants. This seems to have an important impact in prevention of many community problems as well as addiction.

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Background: Prolonged antiacid and antibiotic usage in gasterointestinal diseases may predispose candidial colonization in GI tract. In order to isolate and diagnose of candida infections in patients with gastritis, duodenitis, gastric ulcer and duodenal ulcer, this study have been planned.

Methods: We studied 300 biopsy specimens of patients referred to hospital, 51.7% of the patients were male and the others were female. The isolated fungi were identified by direct examination and culture of specimens.

Results: Forthy four cases of yeasts were isolated in this investigation. Isolated yeasts have been identified as follows: 26 cases of C.albicance , I case C.tropicalis, 2 cases of C.krusei, and finally 1 case of unknown yeast.

Conclusion: All the patients had a positive history of long lasting antacid taking for gastric ulser or gastritis. Candidiasis must be investigated in patients with gastritis, duodenitis and gastric ulcer, who are refractory to classic therapies and also in patients who have the chronic disease .

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Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications the most important is laryngo-tracheal injuries.                   

Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia.

Results: Fifty-seven patients (44 male mean age, 23.014.7 years) were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%). Head trauma was responsible for most cases of intubation (72.4%). The most common types of tracheal and laryngeal lesions were tracheal (56.9%) and subglottic (55.2%) stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001) but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS). Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%). No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS). Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS).

Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation period were greater in tracheal and subglottic lesions.

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Background: The aim of this study was to determine the level of lipid peroxidation and tissue protein after superior mesenteric artery occlusion tissue damage. The effect of melatonin as anti oxidant and free radical scavenger in prevention of tissue damage, were also evaluated.

Methods: Thity six young male Wisatr-Albino rats (weight: 80-120 gr), were divided equally in 6 group with different concentrations of melatonin (10,20,30 mg/kg) treatment. Group 1was control, group 2 the sham that surgical process was applied until superior mesenteric artery dissection and received vehicle solution only in equally volume by intra muscular route. Group 3 was ischemia- reperfusion (I/R), group 4 was I/R plus melatonin 10 mg/kg, group 5 I/R plus melatonin 20 mg/kg and finally group 6 I/R plus melatonin 30 mg/kg. After laparatomy, a microvascular atraumatic clip was placed across the superior mesenteric artery under general anaesthesia and itbremoved after ischemia for 30 minutes. The first dose of melatonin was applied just beforereperfusion, second dose, after reperfusion and third dose on the second day .On third day rats were killed and their bowels were removed. The level of tissue melandialdehyde (MDA) as index of lipid peroxidation and tissue protein was determined.

Results: The level of tissue MDA were significantly lower in group 4, 5, 6 than group 3 (p<0.05). Tissue protein levels were significantly upper in group 4 than group 3. (p<0.001). There was no significant difference tissue protein level in group 5, 6 than group 3(p>0, 05).

Conclusion: These results suggest that melatonin 10 mg/kg has antioxidant effect in prevention of inducing tissue damage during SMA occlusion in rat intestine.

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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: The objective of this study was to investigate the relationship between glucose-6-phosphate dehydrogenase inhibition in macrophages treated with 6-Aminonicotinamide, the amount of nitric oxide (NO) production and the resistance of infected macrophages against Leishmania major infection.
Methods: Peritoneal macrophages of BALB/c mice were isolated and treated with different concentrations (1.25, 2.5, 5, 10 mM) of 6-aminonicotinamide. After 24 hours, the viability of treated macrophages was measured by MTT assay at 540 nm. G6PD activity was measured in the cell extracts 24 hours later. Macrophages were then infected with leishmanial amastigotes and after 18 hours NO production was determined using Griess-reagent. In order to study the inhibition of macrophage activity, 5 mM concentration of 6-AN was used and number of leishmanial amastigotes was recorded in these cells from day 1 to7.
Results: Different concentrations of 6-AN were shown to cause a significant increase in cell death and decrease in G6PD activity and NO production in macrophages. Also, the number of amastigotes in macrophages was increased significantly (p < 0.05).
Conclusion: The concentration of 6-aminonicotinamide and G6PD activity affect the viability of BALB/c mice peritoneal macrophages through production of NO. Inhibition of G6PD activity leads to decreased leishmani-cidal activity of mouse peritoneal macrophages.

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Background: Staphylococcus aureus (SA (is an important cause of nosocomial and community-acquired infections. The emergence of antibiotic resistance, especially in methicillin-resistant SA (MRSA) strains, has caused difficulties in treatment of such infections. The determination of antibiotic resistance patterns, particularly domestic patterns of Iran, is essential for appropriate treatment of MRSA infections and proper infection control measures in our country.
Methods: The antibiotic resistance of 338 SA isolates from various clinical specimens was determined by disk agar diffusion (DAD), minimum inhibitory concentration (MIC) and polymerase chain reaction (PCR) methods.
Results: Using the DAD method, 47% (160/338) of the SA isolates were resistant to oxacillin, and only 6% (20/338) were resistant to vancomycin. By PCR, 48% (162/338) of the isolates had the mecA gene. The MIC of oxacillin in 93% of isolates was higher than 256µg/mL. The MRSA isolates, showed a high resistant to gentamicin (40.5%), erythromycin (40%), and ciprofloxacin (38%). However, only a few of the SA isolates showed a high resistance to vancomycin (5%) or erythromycin (3.5%).
Conclusion: The results of this study can provide guidance for physicians toward a more appropriate treatment of SA infections in Iran, thereby preventing the emergence of further antibiotic resistance among SA. Our results also revealed the need for further investigations using a higher number of specimens representing a wider variety of locations to determine the antibiotic resistance patterns in our state more precisely.

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Background: Cerebral metastases from choriocarcinoma are poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable gynecological malignancy, failure rate among “high-risk” patients is still high despite the use of aggressive multidrug regimens.
case: A 27 year old woman (G4P2Ab1) presented with hemiplegia due to brain metastases of choriocarcinoma one year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin-etoposide and cisplatinum (EMA-EP) regimen combined with whole brain irradiation. She delivered a term healthy child two years after termination of treatment. Conclusion: Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis. Methods: In a descriptive study from February to April 2005, two hundred sixty six consecutive pregnant women referring to a university hospital were asked to answer a questionnaire containing questions their sexual status and some demographic data. In 122 cases the answers of the spouses was collected also. The answers were compared in divided groups according to age range, duration of marriage, parity and educational status.
Results: Fifty five percent of men and fifty eight percent of women had a negative attitude about sexual relations during pregnancy, and 60% of men and 75% of women presented incorrect knowledge about sexuality during pregnancy. Main reasons for decreased sexual relations in pregnancy were mentioned to be dysparaunia, and the fear of trauma to the baby, abortion, membrane rapture, preterm labor and infection.
Conclusion: As couples’ knowledge and attitudes about sexuality affect their general sexual behavior during pregnancy it is crucial to provide proper consultation regarding sexual relations in prenatal care services.

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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.