سال:1381 | دوره: | شماره: |تعداد مقالات:12

Frozen section and touch imprint cytology are important diagnostic procedures for surgeons during operation and must be accurate if the patient is to receive maximum benefit. To assess the accuracy of intraoperative pathologic consultation including frozen section and touch imprint cytology during a five year period (1995- 2000), a retrospective survey of 1000 consecutive cases of frozen sections performed by the staff pathologists of Shiraz Medical School and 211 touch imprint cytology cases related to some of these sections were studied focusing on accuracy. Also some 462 cases of frozen sections related to the 1000 samples were reviewed by the staff pathologists without complete clinical data and without any data from the surgeon to determine the importance of the surgeon pathologist relationship. The gold standard method for comparing the results of frozen section and cytology was permanent tissue diagnosis. The overall accuracy of frozen section for the 1000 cases was 93.6%. The accuracy of cytology was 93.1%. Also the accuracy of 462 frozen sections which were reviewed without clinical data was 85%. In conclusion, frozen section diagnosis is a highly accurate method. Touch imprint cytology is also a specific method and can be used in areas where facilities of frozen section studies are not available. The frozen section method achieves its highest accuracy when there is cooperation between the surgeon and pathologist and when used in combination with touch imprint cytology.      

During a 6 year period from September 1992 to September 1998, 165 children with a final diagnosis of Henoch-Schon1ein purpura (HSP) were managed and followed in our center. There were 87 (52%) boys and 78 (48%) girls, with age ranges of 1-16 years and mean age of 7.8 years. Forty-one percent of the patients had evidence of preceding upper respiratory tract infection (URI). The main clinical features were: skin eruption in 100%, GI symptoms in 79.5%, joint problems in 59.5% and renal involvement in 26.5% of cases. Thrombocytosis in 31% and increased ESR in 55% of cases were the main significant laboratory findings. Abdominal sonography was done in 58 cases with GI symptoms, and was abnormal in 28 cases (48%): free peritoneal fluid in 26%, thickened bowel wall in 14%, ileus in 5% and intussusception in 3%. Sixty percent of the patients received prednisolone for GI problems or renal involvement. Nine percent of the cases had relapse and there was no death. It was concluded that: a) There is no significant sex difference in children with HSP in this area. b) The age of children with HSP in this area is the same as those in eastern countries, but relatively higher than that reported in western countries. c) Abdominal sonography can be a helpful means of diagnosis in patients with GI manifestations of HSP before skin eruption. d) The morbidity and mortality of HSP is very low if the disease is diagnosed in its early stages and managed properly.          

In order to identify left ventricular diastolic function in patients with betathalassemia major and normal systolic function by noninvasive M-mode and Doppler echocardiography, an analytic study was designed in a university hospital in Sari. We have studied 44 patients (23 men and 21 women), mean age 15.48±t2.l6 (range 12 to 20) and 43 age and sex matched control subjects. Peak flow velocity in early diastole increased in patients compared with controls (98±14vs. 86±13 cm/sec; p<0.0001), rate of deceleration of flow velocity was also increased (778±142 vs. 592±193 cm/sec2 and 2.24±0.51vs. 1.73±0.36, respectively; p<0.0001).Peak flow velocity during atrial contraction was not significantly different in patients and normal control subjects. Doppler diastolic indices had no correlation with age, serum ferritin levels and cumulative blood transfused in thalassemic patients. We concluded that left ventricular diastolic flow indices identified noninvasively by Doppler echocardiography in patients with thalassemia major are altered in an early phase, when systolic function is normal.       

High blood pressure control (HBPC) is a common goal of WHO and the world hypertension league (WHL). The two important strategies in HBPC are identifying cardiovascular (CVD) risk factors and planning to modify controllable factors. This study was accomplished to determine the CVD risk factors in high blood pressure (HBP) patients of the rural population, residing in the Babol region, north of Iran, in the year 2000.This study was a cross-sectional research. 150hypertensivepatients were selected by cluster random sampling method. The data were collected with two questionnaires (demographic characters and behavioral habits questionnaire and Eschpel Burger's anxiety record) and laboratory tests. The data analysis has indicated that the rate of most risk factors such as cholesterol level, body mass index, anxiety score and other factors is highly elevated. The results demonstrated that the rates of CVD risk factors were higher in Iranian hypertensive patients compared to other countries. Probably, because of this, the maximum rate of achievement of high blood pressure control was only 18.4%.      

Seroepidemiologic studies in developing countries show a high rate of Helicobacter pylori (H. pylori) infections in children, in contrast to developed countries. The aim of this study was to evaluate the prevalence of H. pylori in children and teenagers in Tabriz, northwest of Iran. In this prospective study 44 children and teenagers were randomly selected to study serum IgG against H. pylori using ELISA method. Our results indicated the presence of IgG in 83.5% of test subjects (83.7% in Females and 83.4%in males). In the 2-5 years age group71.7% were IgG positive  and this percentage increased by age, i.e., 95.2% recorded as IgG positive in the 14-18 years age group (p<0.05). Considering the risk factors in relation to H. pylori infection, an increasing number of family members (above 3 persons) showed a statistically significant difference(p<0.05),while other factors such as economical situation of the family, educational level of parents and lack of a private room for children in the family didn't show significant differences (p>0.05). In general, our findings indicate that the prevalence of H. pylori in Tabriz, like other developing countries is high from early age and increases further by age. More studies are needed to clarify the reasons for this high prevalence.      

 We determined the knowledge of parents of 200 pediatric patients for bacterial endocarditis prophylaxis (BEP), using an eight question survey pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patient's cardiac lesion and current medications were verified at the time of admission for diagnostic or interventional cardiac catheterization. Each patient's need for BEP was determined according to American Heart Association (AHA) recommendations. Eighty-one respondents (40-5%) were high school graduates. Only 12 parents (6%) correctly defined endocarditis. One-hundred and fifty-eight parents (77%) knew the name or condition of their child's cardiac problem, one-hundred (50%) of the families had knowledge of BEP, and only 46 parents (23%) knew that antibiotics are needed for prophylaxis at the time of dental procedures. It is concluded that while most parents know the name of their child's heart lesion and current medications, their knowledge of endocarditis and BEP is limited, and for prevention of such a major complication for pediatric patients with heart diseases, intensified education and awareness programs are needed.        

Cystatin C is a 13 KD basic protein that is a member of the cystatin super-family of cysteine protease inhibitors. The cystatin C gene seems to be a house keeping gene, which is compatible with a stable production rate of cystatin C by most cells. This protein is freely filtered through the glomerulus and almost completely reabsorbed and catabolized by proximal tubular cells. Because of these characteristics cystatin C is assumed to be a better marker of glomerular filtration rate than other markers. 115 new cases of renal disease aged between 14 and 88 years and 121 healthy subjects, aged between 11 and 78 years were studied. In all of the subjects serum cystatin C and creatinine were determined and creatinine clearance was determined only in patients. Cystatin C was determined by a particle-enhanced turbidimetric assay and creatinine was measured by Jaffe's method. In addition, to assess the diagnostic efficiency of serum cystatin C in comparison to that of serum creatinine and creatinine clearance in predicting changes in GFR, we performed Tc99m - DTPA clearance on 53 subjects including controls and patients. A linear relationship was found between Tc99m - DTPA clearance and 1/ serum cystatin C (r= 0.712, p-value <0.001), 1/serum creatinine (r= 0.709, pvalue < 0.001) and creatinine clearance (r= 0.777, p- value <0.001). Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.878±0.050 (Mean±SE) for cystatin C, 0.866±0.051 for creatinine and 0.866±0.051 for creatinine clearance. The serum cystatin C reference values (mean±1.96 SD) determined was 0.83 - 0.88 mg/L. A cutoff cystatin C concentration of 0.82 mg/L had 92% sensitivity and 79% specificity for detecting abnormal GFR. There was no significant correlation between cystatin C and age (p- value <0.219) and weight (p- value <0.193). This study demonstrates that serum cystatin C has an increased diagnostic accuracy for reduced GFR when compared with serum creatinine and creatinine clearance. Hence, cystatin C seems to be an alternative for the estimation of GFR.      

In order to evaluate the effects of phenytoin on the reproductive system of rats in detail, 60 male rats were divided equally into 6 groups: 1-5 received 10 mg/kg/day phenytoin IP for 1,2,3,4 and 5 weeks, respectively. However, group 5 did not receive any phenytoin for the last 5th week. The control group (group 6) did not receive any treatment. The results revealed that phenytoin does not have any effect on body weight, weight of testes, seminal vesicle and prostate, serum testosterone and sperm count taken from left and right vas deferenses. However, the percentage of total motile sperm and sperm with full and sluggish motility decreased and the percentage of low motile sperm increased in all experimental groups. Nevertheless, phenytoin caused atrophy and hypoplasia in seminiferous tubules and not Leydig cells. These pathological changes were dose-dependent and more pronounced in the left testis. But phenytoin caused more changes in sperm count and motility of the right testis. This phenomenon was discussed in relation to the existence of asymmetrical control by the hypothalamus, and compensation of the left testis. In summary, it could be concluded that phenytoin affected the seminiferous tubules directly and decreased the total number of motile sperm. It was also discussed that these effects are not reversible after termination of injection.      

PSA is a 33-KDa serine protease that is produced predominantly by prostate epithelium. However, it has been shown that about 30-40% of female breast tumors produce PSA and its production is associated with the presence of estrogen and progesterone receptors. We have now developed a new tissue culture system to study PSA production in breast cancer and its association with prognostic factors such as progesterone receptor andc-erbB-2. For this purpose we investigated the ability of PSA production in five different cell lines, including two breast cancer cell lines, SK-Br-3 and MDA-MB-453.The PSA in tissue culture supernatant and cytoplasm of the Sk-Br-3 cell line was detected by western blotting and immunoperoxidase, respectively. Furthermore, we found lower expression of c-erbB-2 in Sk-Br-3 than non-PSA producer breast cancer cell line, MDA-MB- 453. Progesterone receptor was expressed by both PSA-positive and –negative cell lines and only the intensity of staining and the number of positive cells in Sk- Br-3 population was higher than MDA-MB-453.According to our findings PSA can be considered as a good prognostic factor in breast cancer and we suggest that these two cell lines are a good in vitro model to study the relationship of different breast cancer prognostic factors and their regulations.      

A 5-year-old girl was admitted to the hospital with chest pain, fever and dyspnea. Physical examination showed normal heart sounds, diminished pulmonary sounds in the left hemithorax and a normal ECG. On chest X-ray the heart was slightly enlarged with moderate left pleural effusion. CT scan revealed pleural effusion and a hypodense mass at the apex of the heart. A cystic mass was detected by echocardiography as well. The patient was operated as a case of hydatid cyst of the right ventricle. Intraoperatively a pseudoaneurysm of the right ventricle was found. The mass centrally consisted of clots and necrotic tissue and peripherally was composed of fibrosis and calcification. All of these tissues were removed and the communication between the aneurysm and right ventricle was repaired. The diagnosis of tuberculosis was confirmed by culture and microscopic examination. The patient underwent anti-TB treatment for 6 months and remained symptom-free after 4 years. It is believed that local expansion of tuberculous adenitis near the pericardium has caused a TB abscess, which in turn affected the myocardium and destroyed it.      

Autoerythrocyte sensitization syndrome (AES) is a rare purpuric disorder of women characterized by inflammatory and painful ecchymotic lesions unrelated to blood clotting or vascular abnormalities. Gastrointestinal bleeding, hematuria, headache or syncopal attacks may also be observed. Our patient is a 33-year-old woman presenting with recurrent severe painful ecchymotic lesions on both lower extremities associated with headache, palpitation and weakness. The diagnosis of AES was confirmed by skin testing with autologous washed red blood cells. No internal bleeding was detected. She was treated with vitamin C with some success.      

Fungal sinus infections are being recognized with increasing frequency. We report a case with rhinocerebral and chest phaeohyphomycosis infection caused by Cladosporium bantianum in an 18 year old man with Wegener's granulomatosis. The diagnosis was established by histopathological appearance, direct examination, culture and computerized tomography (CT) scan. This case was successfully treated by a combination of surgery and amphotericin B. The present that is of para nasal sinus mycosis due to Cladosporium bantianum is the first that is reported in Iran.