Tehran University Medical Journal

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In this research 600 staff of an educational office (distric seven) were being studied before and after they were educated about breast self-examination. Necessary information was gathered before and after they were educated through questionnaires. The result of the study showed that the average scores of their awareness before and after they were educated was 42.3 and 44.2, respectively. Hence, there was a significant difference because of the education of self-examination women's breasts (P<0.0001). There was no difference between family members nor between those who had different marital status, concerning the awareness of breast self-examination. However, there was a large difference between the educational level of women who were studied and the educational level of their spouses, according to their knowledge concerned about monthly breast self-examination (P=0.04).

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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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Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000.

Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing.

Results: From the cases, 64 patients (32 percent) referred without delay and 136 patients (68 percent) referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004), lower education level (P=0.002), and lower economic status (P=0.001). The frequency rate of single were lower among them (P=0.001), fewer percent were residual of big cities (P=0.01) and they had less rate of available physician (P=0.004). 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001). 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E) (P=0.002) and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01). 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference.

Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late.

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Background: Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. Central lung distance (CLD), the distance from the chest wall to the edge of the field at the central axis, is an indicator of lung volume within the radiotherapy fields. In this study, we aim to detect the relationship between CLD and pulmonary function tests.

Methods: In this study we included 50 patients with breast cancer receiving postoperative adjuvant radiotherapy at Imam Hossein Hospital, Tehran, Iran. The patients received radiotherapy with a total dose of 4800-5000 cGy. For all patients, the central lung distances were measured using simulation of tangential fields, in addition to determination of pulmonary function, including force vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) determined before radiotherapy, one month and three months after radiotherapy.

Results: There is no significant statistical difference between the FEV1 and FVC values before radiotherapy and those measured one month after radiotherapy however there was a significant statistical decrease in the FEV1 and FVC before radiotherapy and those measured three months after radiotherapy (P<0.001 and P<0.006, respectively). There is a positive statistical correlation between the change in the FEV1 three months after therapy and the CLD (r=0.71, p<0.01) and that of the FVC three months after therapy and the CLD (r=0.59, p<0.01). Linear regression for the prediction of FEV1 and FVC three months after radiotherapy was designed according to the CLD, FEV1 and FVC values before radiotherapy.

Conclusions: Three months after breast radiotherapy, the FEV1 and FVC values decrease, and the CLD is a proper predictor of these changes.

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Background: Nonlethal genetic damage is the basis for carcinogenesis. As various gene aberrations accumulate, malignant tumors are formed, regardless of whether the genetic damage is subtle or large enough to be distinguished in a karyotype. The study of chromosomal changes in tumor cells is important in the identification of oncogenes and tumor suppressor genes by molecular cloning of genes in the vicinity of chromosomal aberrations. Furthermore, some specific aberrations can be of great diagnostic and prognostic value. Comparative genomic hybridization (CGH) is used to screen the entire genome for the detection and/or location chromosomal copy number changes.

Methods: In this study, frozen sections of 20 primary breast tumors diagnosed as invasive ductal carcinoma from the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were studied by CGH to detect chromosomal aberrations. We compared histopathological and immunohistochemical findings.

Results: Hybridization in four of the cases was not optimal for CGH analysis and they were excluded from the study. DNA copy number changes were detected in 12 (75%) of the remaining 16 cases. Twenty-one instances of chromosomal aberrations were detected in total, including: +1q, +17q, +8q, +20q, -13q, -11q, -22q, -1p, -16q, -8p. The most frequent were +1q, +17q, +8q, -13q, similar to other studies. In three cases, we detected -13q, which is associated with axillary lymph node metastasis and was reported in one previous study. The mean numbers of chromosomal aberrations per tumor in metastatic and nonmetastatic tumors was 1.5 and 1, respectively. No other association between detected chromosomal aberrations and histopathological and immunohistochemical findings were seen.

Conclusion: Since intermediately to widely invasive carcinomas are more likely to have chromosomal aberrations, CGH can be a valuable prognostic tool. Furthermore, CGH can be used to detect targeting molecules within novel amplifications which holds the potential for a new therapeutic approach for intractable cancer.

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Background: Radiation to some parts of the heart is unavoidable in the therapeutic course of primary tumors in many kinds of cancer, including breast cancer. The aim of this study was to assess the frequency of acute and subacute cardiac complications following radiotherapy in patients with left breast cancer.
Methods: In this study, we enrolled 53 patients with left breast cancer who underwent mastectomy or lumpectomy between September 2005 and September 2006 in Imam Khomeini Hospital Complex, and subsequently underwent chemotherapy with anthracyclines (<450mg/m²) and Endoxan plus taxane/fFluorouracil followed by radiotherapy. In all patients, electrocardiography and echocardiography were performed before initiation of radiotherapy, immediately after radiotherapy and again three and six months later to check for radiotherapy-induced cardiac complications such as pericardial effusion, valvular lesions, left ventricular dysfunction, conduction system disturbances and other variables.
Results: Thirty-nine patients completed the follow-up period. Among these, 10 (25.6%) patients experienced cardiac complications following radiotherapy. Among these, mild pericardial effusion in seven (53.85%) patients, mild mitral regurgitation in three cases (23.08%) and Right Bundle Branch Block (RBBB) in two cases (15.38%) were the most common complications. We found no correlation between cardiac complication and tumor dose, dose fraction and type of chemotherapy protocol. We noted no cases of new or more serious complications, such as cardiomyopathies or coronary artery disease, nor any changes in ejection fraction by the end of the follow-up period.

Conclusion: In patients with left breast cancer, acute and subacute cardiac complications following radiotherapy are not serious and have no clinical significance. Further studies are needed for more assessments in this area.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Giardia lamblia is one of the most prevalent protozoa infections of the human small intestine. Although anyone can be infected by Giardia, women and children are more susceptible. Giardia infection can cause malnutrition, diarrhea and indigestion of fat. In this study, the effect of breast-feeding on the prevalence of Giardia among children is investigated.

Methods: A total of 482 children, aged 6 to 24 months, from the urban areas of Semnan, Damghan and Garmsar in Iran, were enrolled in this survey. Each mother underwent an interview and filled out a questionnaire that included mother's age, family size, birth order of the child, age and sex of the child and type of milk consumed, among other variables. Then, each mother was given a sample container with 30cc of phenol alcohol formaldehyde (PAF) and an applicator for sampling her child's stool. Each mother was trained to consecutively sample her child's stool for three days, to put the stool into the provided container using the applicator and to shake it until the sample and liquid appeared homogenous. The sample was examined using the direct method, using formalin-ether and thionine. Data was analyzed using the c² test and logistic regression using SPSS version 11.5.
Results: The mean age of the children was 13.6(±5.6) months. Of these children, 45.6% were girls. The prevalence of G. lamblia infection was 8.5%. There was a significant relationship between Giardia and the age of the child, education level of the mother and type of milk the child consumed (p<0.05), such that children who had not consumed their mothers' milk were more likely to be infected compared to those who had been breast fed (OR=2.38, 95% CI: 1.13-5.03, P=0.023).
Conclusions: Results show that breast-feeding is a safer method of feeding with regard to Giardia infection. Therefore, mothers should be educated to breast-feed their children and not use other types of milk or milk substitutes. This important issue must be considered by policy makers for education and subsidy programs.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Seroma formation, or the subcutaneous collection of fluid, is a common problem after surgery for the breast cancer. It may lead to wound-related complications and also can delay adjuvant therapy. The aim of this study was to investigate the effect of various clinical and therapeutic variables on seroma formation.
Methods: A prospective cross sectional study of patients who underwent surgical therapy for breast cancer was carried out. Modified radical mastectomy was performed on 67 patients (65%) and 28 patients (27.2%) underwent breast conservative surgery. Simple extended mastectomy was done for the remaining 8 patients (7.8%). Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. All of the patients followed for 4 weeks after surgery.
Results:  A total of 103 patients with breast cancer were studied. The mean age of the patients was 48.3 years (25-82). Seroma occurred in 27 (26.2%) patients. There was statistically significant relation between age and seroma formation after breast cancer surgery (p=0.005), while other factors studied was found to be significantly ineffective. In addition, there was not any relation between seroma formation and drain duration. However, two factors including type of the operation and level of lymphatic dissection was considerable with confidence interval up to 90%, but it was not statistically significant with confidence interval >95% (p=0.068 and 0.063 respectively).
Conclusion: These findings suggest that the age is a predicting factor for seroma formation in breast cancer patients, while other factors do not significantly affect that.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Detection rate of Ductal Carcinoma Insitu of the breast (DCIS) have increased rapidly over the past decade, which is generally attributed to the widespread use of screening mammography. The aim of this study was to evaluate the prevalence of ductal carcinoma in situ in patients who had been referred to Tehran university medical centers.
Methods: In a retrospective study, medical records of the patients with diagnosis of breast cancer in 3 teaching hospitals of Tehran University of Medical Sciences (Cancer Institute, Sina and Shariati Hospitals between 1994-2003) were reviewed and records with ductal carcinoma in situ were selected and analyzed.
Results: Between 2244 medical records of breast cancer 23 patients had DCIS (1.02%). Mean age was 47.3 years just one patient had been detected by screening mammography and others had clinical symptoms. 48% of patients had mass with mean size of 3.3cm. All had undergone open biopsy (four incisional, 19 excisional). Treatment included 65.2% modified radical mastectomy, 30.4% lumpectomy with axillary dissections and 3.8% lumpectomy alone. Nine patients had radiotherapy after surgery and ten took tamoxifen as hormonal therapy. Two patients (8.6%) in lumpectomy group had recurrence in follow ups. Median follow up time was 84 months.
Conclusion: This study shows that the Prevalence of early stages of breast cancer especially ductal carcinoma in situ is extremely low. (DCIS was 1.02 in comparison with 15-30% in western countries). These findings indicate the need for increasing public information about breast cancer in Iran and improving screening programs of breast cancer.

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Background: In according to immunomodulatory effect of probiotics and effect of these bacteria on the effectiveness of immune responses, at the present work we proposed the evaluation of oral administration of L.acidophilus on the immune statues in BALB/c mice bearing breast cancer.
Methods: A total of 30 In-bred BALB/c mices aged from six to eight weeks weighting 25-30g were randomly enrolled in our study, in two groups each consist of 15 mices. The L.acidophilus ATCC4356 strain used in this study was inoculated in MRS broth and cultivated for a day at 37°^C under anaerobic conditions, collected by centrifugation and resuspend in Phosphate Buffer Saline (PBS). After preparation of proper amount of these suspensions it was orally administered to the mice with a gastric feeding, Control mices received an equal volume of PBS in duration of study.
Results: Results showed the increase in production of IFnγ (p<0.005), and decrease in production of Th2 cytokines such as IL4 (p=0.347) in the L.acidophilus administered mice in comparison to control group of mice. In addition the proliferation of immune cells in probiotic group was significantly higher than controls, and most importantly probiotic administered mice showed an increase in survival rate of this group compared to control mice (p<0.001).
Conclusion: Results of our study suggested that daily consumption of Lactobacillus acidophilus can regulate immune responses skewed Th1 balance that is needed against tumor, further studies is needed to investigate the other mechanisms of this effect.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common cancer and the second most common cause of death from cancer in women. HER2 is an epidermal growth factor receptor which plays a substantial role in pathogenesis of breast cancer and also a target for new antineoplastic drug Herceptin. This study was conducted for determining the correlation between HER2 overexpression and histopathologic characteristics of breast cancer and also degree of intraobserver and interobserver agreement in scoring of Immnohistochemistry (IHC) slides between pathologists in samples referred to pathology ward.
Methods: This study was conducted as a descriptive cross sectional study. Among the breast cancer samples referred to pathology ward in Shariati Hospital in Tehran, Iran. 140 samples have been selected sequentially using simple non-random sampling method. All the information has been extracted using medical records and pathology reports.
Results: This study showed significant difference between diagnosis and HER2 status (p<0.05). Significant difference observed between lymph node invasion and HER2 status (p<0.05). Positive significant association between the size and tumor grade with HER2 status (r=0.188, p=0.026), Significant difference between histopathologic types with scoring of HER2 (p=0.001). Significant difference between histopathologic types with lymph node invasion (p=0.001). Agreement level of HER-2 scoring was shown to be nearly perfect between two observers (kappa statistic= 0.715) and the same observer (Kappa statistic= 0.78).
Conclusion: We do not recommend IHC and FISH test in invasive lobular carcinoma of breast and uncommon subgroups of breast cancer except in invasive ductal carcinoma and its subgroups.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast conservative therapy is associated with similar outcomes in comparison with mastectomy. The aim of this study is assessment of local recurrence rate and related risk factors in patients who have been treated with radiotherapy after conservative surgery for breast cancer.

Methods: This is a cohort study which data of all breast cancer patients who have visited in follow up clinic in radiation oncology department of cancer institute of Imam Khomeini Hospital complex in Tehran, Iran, during years 2007-2009 were collected. All of the patients were investigated for local recurrence and the possible risk factors.

Results: Two hundred and seventy seven patients have entered the study and all have followed for at least one year since data entry. Median follow-up time from the start of radiotherapy were 35 months (12-148 mo). We had seven cases (2.5%) with local recurrences (2.5%) which most of them occurred in first year after treatment. Because of low rate of recurrence none of the variables such as margin and nodal status has significant correlation with local recurrence which this should be due to small number of patient and short time of follow up.

Conclusions: At median follow up of 35 months from the beginning of radiation therapy, local recurrence rate was 2.5% which is similar to the literature. We recommend to follow a larger group of patients for longer times to estimate recurrence risk after breast conservative therapy.

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Background: Fever in neutropenic patients is a medical emergency which may happen in patients undergoing chemotherapy. The definition of neutropenia varies from institution to institution but is usually defined as an absolute neutrophil count (ANC) < 500 cells/l or < 1,000 cells/l with a predicted nadir of < 500 cells/l. Bacterial and fungal infections are the most important in neutropenic patients. Viral infections with agents such as herpes simplex virus and cytomegalovirus are common but less than other pathogens. Case presentation: We report a patient with fever & neutropenia following cytomegalovirus infection during chemotherapy course for breast cancer. Conclusion: Although fever and neutropenia after cytomegalovirus infection is not very common but prompt diagnosis and treatment of this disease reduces the mortality and morbidity associated with cytomegalovirus. For this reason, screen testing for CMV infection in high risk patients including patients with cancer and preemptive therapy in patients with viremia, for prevention of CMV disease could be considered as a strategy for prevention of CMV infection.

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Background: The oncoplastic surgery has been revolutionized breast conservative surgery. The aim of our study was to represent the cosmetic outcome of oncoplastic breast surgery in Iran and to evaluate its determinants.

Methods: Fifty eight patients with unilateral breast neoplasm operated with single surgeon in Imam Khomeini Hospital, Tehran, Iran. Three view photographs were obtained pre and post operatively and were put in separate PowerPoint slides. The photographs were evaluated by six health related professionals. They scored the cosmetic outcome with modified questionnaire containing general and specific questions. Weighted kappa used for intra and inters rater reliability and ANOVA was used for analyzing cosmetic outcome determinants.

Results: Generally, 72.2% of the photographs got the excellent or good score in a single breast evaluation part. Its items breast size, nipple deviation and scar quality scored 94.2, 67.9 and 88.8 respectively. "In comparison with contra-lateral breast" part shape asymmetry, need for surgery of contra lateral breast and size asymmetry scored 68.9, 75.8 and 69% respectively. Tumor size greater than two cm had poorer outcome (p=0.039) upper outer quadrant tumor had the worst and upper inner quadrant tumors had the best outcomes (p<0.0001). Patient with 50 to 60 years of age had the poorest outcomes (p<0.0001). Weighted kappa for inter and intra rater kappa was 0.12 and 0.58 respectively.

Conclusions: Acceptable cosmetic outcome is obtained in the first experience of oncoplastic breast surgery in Iran. Long term monitoring of oncologic and cosmetic outcomes in greater numbers of patients is recommended.

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Background: Based on the reports, high frequency of special alleles of HLA class II genes might be associated with susceptibility to or protective from a particular cancer. These alleles might vary depending on the geographical region. Here we investigate the association between alleles of HLA class II genes and breast cancer in Iranian women.
Methods: 100 patients with pathologically proved breast cancer who referred to Cancer Institute, Tehran University of Medical Sciences in Tehran, Iran, were divided to two groups based on ages (40 years old and less/ or more than 40 years old) and were randomly selected and compared with a group of 80 healthy blood donor subjects. HLA class II alleles were determined by amplification of DNA with polymerase chain reaction (PCR) method followed by HLA-typing using sequence-specific primer (SSP) for each allele.
Results: The most frequent alleles in the DR and DQ regions in group 1 (40 years old and less) in comparison with control group were HLA-DQA1*0301 (p=0.002) and HLA-DQB1*0302 (p>0.05). In contrast HLA-DQA1*0505 (p=0.004) had significantly lower frequency in this group compared with control group. Patients of group two (more than 40 years old) had a higher frequencies of HLA-DQA1*0301 (p=0.001) and HLA-DRB1*1303 (p=0.02) and a lower frequency of HLA-DQA1*0101 (p=0.002) compared to healthy control.
Conclusion: These findings provide information of a positive and negative association between certain alleles of HLA class II and breast cancer in our population and also might support that the pattern of inheritance in the early and late onset of breast cancer differ substantially.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Aldehyde dehydrogenase 1 (ALDH1) is a marker of normal and malignant human mammary stem cells that has been reported to be associated with poor prognosis. Studies on the detection of ALDH1+ cells can help the treatment of patients with breast cancer. The aim of this study was to determine the activity of ALDH1 in breast cancer and its relationship with the pathological features of the tumors.
Methods:  ALDH1 activity was studied by immunohistochemistry in 121 paraffin-embedded histological samples of breast cancer patients from Department of Pathology of Milad Hospital, Tehran, Iran during 2006-2007. The relationship of ALDH1 with the pathological features of the tumors (size, grade, lymph node metastasis and vascular invasion) was also investigated.
Results:  Eighty-five percent of breast cancer samples expressed ALDH1 in their cytoplasm with a wide range of intensity (weak, moderate and strong), while 18 samples (14.9%) were completely negative. The majority of cases (97.1%) showed ALDH1 positivity in the stroma of tumors which varied from weak (2.9%) to strong (73.5%). ALDH1 H-score (ALDH1% × intensity) of tumor cells varied from 0 to 240 (mean= 80). ALDH1 H-score was ≤80 in 62 (51.2%) and >80 in 59 (48.8%) samples. There was no statistically significant relationship between ALDH1 H-score and age (P=0.358), tumor size (P=0.375), tumor grade (P=0.207), lymph node metastasis (P=0.125) or vascular invasion (P=0.190).
Conclusion: ALDH1 activity was demonstrated in 85.1% of breast cancer samples although its level of expression was not correlated with the pathologic features of breast tumors.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common form of hereditary cancer worldwide and is an important cause of morbidity and mortality. Approximately 5-10% of breast and ovarian cancers are due to the highly penetrating germline mutations in cancer predisposing genes. Two genes, BRCA1 and BRCA2, account for at least half of these cases. The demand for BRCA1 and BRCA2 mutation screening is rapidly increasing as their identification will affect the medical management of people at increased risk for the disease. Therefore, the aim of this study was to investigate BRCA1/2 mutations in 100 high risk Iranian families.
Methods:  One hundred families who met the minimal risk factors for breast/ovarian cancer were screened among the families referred to Kawsar Human Genetics Research Center for the diseases in 2009-2011. The entire coding sequences and each intron/exon boundaries of BRCA1/2 genes were screened for by direct sequencing and MLPA in both patients and the controls.
Results:  In the present study, we could detect the following novel mutations: p.Gly1140Ser, p.Ile26Val, p.Leu1418X, p.Glu23Gln, p.Leu3X, p.Asn1403His, p.Asn1403Asp, p.Lys581X, p.Pro938Arg, p.Thr77Arg, p.Leu6Val, p.Arg7Cys, p.Leu15Ile, p.Ser177Thr, IVS7+83(-TT), IVS8 -70(-CATT), IVS2+9(G>C), IVS1-20(G>A), IVS1-8(A>G), p.Met1Ile, IVS2+24(A>G), IVS5-8 (A>G), IVS2(35-39)TTcctatGAT, IVS13+9 G>C in BRCA1 and p.Glu1391Gly, p. Val1852Ile, IVS6-70(T>G), 1994-1995 (InsA) in BRCA2.
Conclusion: Ten mutations seemed to be pathogenic and the disease-causing mutations were seen in 16% of the families. In addition, from the total number of substitutions and reassortments (42), 80% related to BRCA1 and 20% to mutations in BRCA2 genes.

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Background: Regarding the immunomodulatory effects of lactobacillus bacteria, this study aimed to evaluate the effect of oral administration of Lactobacillus reuteri, as probiotic bacteria, on natural killer cell cytotoxicity and tumor-specific lymphocyte proliferation in Balb/c mice with breast adenocarcinoma.

Methods: A total of 30 female mice, aged 6- 8 weeks and with a weight of approximately 17- 19 g, were randomly divided into two groups of 15 mice. The case group received Lactobacillus reuteri at a dose of 2.7× 108 bacteria in half a milliliter of sterile phosphate buffer saline (PBS) and the control group only received PBS. The probiotic group received the regimen for two weeks prior to tumor transplantation, as they did for 30 days after transplantation with three-day intervals and durations of seven days. For the evaluation of natural killer cell cytotoxicity and also tumor-specific lymphocyte proliferation response, LDH and BrdU assays were performed respectively according to the manufacturers' instructions.

Results: The study showed that the mice in the case group which were receiving Lactobacillus reuteri had statistically significant differences in the replication of tumor -specific lymphocytes, natural killer cell cytotoxicity and delayed hypersensitivity responses Compared to the mice in the control group.

Conclusion: Daily consumption of probiotics seems to regulate the immune system and consequently it can be helpful in people with cancer. Moreover, consumption of probiotics in healthy individuals can also boost the efficiency of the immune system against a variety of abnormalities.

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Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.
Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions) with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions) and a subsequent electron boost.
Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.
Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.

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Background: Atopic dermatitis (AD) is one of the most common chronic, highly pruritic and inflammatory skin diseases. The exclusive influence of breastfeeding in the prevention of inflammatory diseases is a matter of debate. In this study, we aimed to determine the concentration of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-13 (IL-13) and interleukin-4 (IL-4) cytokines as anti Th2 or anti Th1 cytokines in breast milk and their relationship with atopic dermatitis in breastfed infants.
Methods: This study carried out in Afzalipour Hospital of kerman during one year from 2010 to 2011, we selected 50 breastfed infants with AD as cases and 50 healthy infants without AD or any other allergic disease as the controls. The concentrations of pro- and anti-inflammatory cytokines were measured by ELISA in the mothers' milk. The demographic characteristics were recorded in a data collection form. Moreover, severity of the disease was determined by SCORAD index. T-test and logistic regression were used for assessment of the correlation among study variables.
Results: The concentrations of IFN-γ and IL-13 were significantly higher (respectively, P=0.04, and P=0.02) in the case group. However, logistic regression revealed that only IFN-γ significantly increased the risk for atopic dermatitis (P=0.02). Concentration of TNF-α was similar in the milk from mothers belonging to the two groups.
Conclusion: The results indicate that the concentrations of IFN-γ, IL-13 and IL-4 cytokines are higher in the milk of mothers whose infants have AD. However, the risk for atopic dermatitis increases by 49% by every ten-unit (in pg/mL) increase in the level of IFN-γ.