Tehran University Medical Journal

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Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems In this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined.
Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient <150 torr or urine output <0.5 ml/kg/hr in the setting of IAH. Data were gathered on all patients with IAH and ACS.
Results: We evaluated some 353 patients, consisting of 165 elective laparatomies and 188 emergency cases, including 28 trauma patients. The incidence of IAH and ACS was 2 and 1 per cent (7 and 3 patients, respectively). The mean IAP of these seven patients was 29.8 cm H2O. No elevated IAP was observed after elective laparotomy (165 patients), nor in emergency cases with temporary abdominal wall closure (29 patients). APACHE II score, PAP and worst base deficit were significantly higher in patients with elevated IAP. None of the three patients with ACS underwent decompressive laparotomy. The mortality rate for patients with elevated IAP was 85%, significantly higher than the total study population.
Conclusion: IAH is a rare disease of the rarity of IAH, routine measurement of IAP is necessary only in high-risk patients. Prophylactic temporary abdominal wall closure may prevent IAH and ACS in high-risk patients. Patients with elevated IAP have dismal outcomes. Critical care practitioners should become familiar with different aspects of IAH and ACS, including decompressive laparotomy.

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Background: Transitional Cell Carcinoma (TCC) is the most common type of urinary bladder cancer. Cyclooxygenase-2 (COX-2), a key enzyme in prostaglandins biosynthesis, has been introduced as a new candidate for targeted therapy in this cancer. In this study, we investigated the expression of COX-2 in urinary bladder TCCs and its relationship with clinicopathological parameters such as tumor grade and stage.

Methods: This cross-sectional study was performed in the Pathology department of Sina Hospital in Tehran, Iran during 2006-2011. Pathology reports of patients with definite diagnosis of urinary bladder TCCs who had undergone Transurethral Resection (TUR) were reviewed and 40 cases were selected. Subsequently, COX-2 expression was assessed immunohistochemically by the examination of paraffin embedded tissue blocks. Staining in more than 5% of tumor cells was considered as positive expression.

Results: COX-2 was expressed in 52.5% of the patients. High-grade tumors revealed a higher (87.5%) COX-2 expression versus other grades of the lesions and there was a statistically significant difference in COX-2 expression between them (P<0.001). Patients' age was also related to the expression of this marker (P=0.03). In contrast, this marker did not correlate with other characteristics including gender, lymphatic invasion or tumor stage. In addition, perineurial or vascular invasions were not detected in any of the patients.

Conclusion: COX-2 expression was seen in more than half of our patients and it had a marked relation to tumor differentiation. Accordingly, this molecule may be a useful tumor marker in the assessment of urinary bladder cancers.

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Background: Despite advances in the vaccinology and chemotherapy in the past century, tuberculosis is still responsible for two million deaths every year. Emergence of multi-drug resistant strain and coinfection of TB-HIV make it a serious concern. Treatment and control of tuberculosis is a great health burden in every community. Active tuberculosis in children has very severe consequences especially those who are under 5-years-old, therefore vaccine indication should be taken. Bacille Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has been used for providing immunity or protection against tuberculosis (TB). In addition, BCG provides relative protection against leprosy and Buruli ulcer, it also can be used for treatment of bladder cancer. BCG is the most widely administered vaccine around the world. It has been given to over three billion individuals over the past decades. At first it was developed in 1908 at the Pasteur Institute in Lille by Albert Calmette and Camille Guérin. In fact BCG is a strain of Mycobacterium bovis that bear deletion in its genome following too long subculture in special media. Deletion in region of deletion 1 (RD1), a specific region of Mycobacterium bovis genome, has decreased pathogenicity of BCG strain. Following culture of BCG on different media since 1921 make genetic variation in the BCG strains that have specific characteristics. BCG should begin given to only immune-competent individuals and should not be administered to immunocompromised people. This vaccine is not effective in people formerly infected or sensitized with environmental mycobacteria. Previous meta-analysis studies indicate that BCG has variable range of protection from 0 to 80 percent against pulmonary TB, but is very effective against severe disseminated forms such as meningitis and miliary form of TB. Despite many research and develop new generation vaccine against TB, BCG vaccine still remains as the only effective vaccine because many efforts to replace it with better ones were unsuccessful.