Tehran University Medical Journal
Year:2010 | Volume:68 | Issue:4|Papers Count:11

Background: JAK2 is a nonreceptor tyrosine kinase that plays a major role in myeloid disorders. This mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. In this study we compared the amplification refractory mutation (ARMS) assay and allele- specific (ASPCR) to evaluate JAK2V617F mutation patients with non-CML myeloproliferative neoplasms (MPNS).Methods: In this experimental study we evaluated JAK2 mutation in 58 patients with a known or suspected diagnosis of a myeloproliferative neoplasm by simple randomized sampling. The mutation was detected by ARMS-PCR and AS-PCR in patients. In order to verify the methods, amplified products from some patients were sequenced.Results: The JAK2 V617F mutation was detected in 86.6% (26/30) of patients with polycythemia vera and 61.5% (8/13) of patients with idiopathic myelofibrosis by ARMSPCR and AS-PCR.46.6% (7.15) of essential thrombocythemia patients were positive using ARMS- PCR method while 53% (8.15) of then were positive when AS- PCR were used. The mutation was confirmed by sequencing.Conclusions: The incidence of JAK2 mutation using above PCR methods is similar to previous studies. The different results may depend on the molecular technique used.

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.

Background: Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate.Methods: In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 mg/4h, vaginal) (n=37) or misoprostol (400 mg/4h, vaginal) plus hyoscine (20 mg IV) (n=37). Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding, decline in hemoglobin more than 3 g/dl, need for blood transfusion and failure of treatment according to the failure of induction of labor or cervical opening in 24 hours after starting treatment and the total duration of hospitalization were compared between groups.Results: There were no significant differences between groups regarding the rate of side effects like nausea, abdominal pain and vaginal bleeding. In misoprostol plus hyoscine group, the success rate in abortion was significantly higher (40.5% vs.18.9%, p=0.04) and total duration of hospitalization were significantly lower (1.16±0.41 vs. 1.42±0.45 days, p=0.01). There was no case of fever, need for blood transfusion or significant vaginal bleeding in both groups.Conclusions: Adding 20 mg hyoscine via IV rout to vaginal misoprostol will raise the success rate in induction of abortion, and decreases the total duration of hospitalization without adding adverse effects.

Background: Esophageal cancer is one of the most lethal diseases in the world. It has a high prevalence in Iran, especially in the Northern provinces. The main treatment of esophageal cancer is surgery. There are two common surgical procedures for its treatment, Transhiatal esophagectomy and transthoracic esophagectomy. The aim of this study was to compare the results of above methods in esophageal cancer.Methods: This cross-sectional study was done on patients with pathologic diagnosis of esophageal cancer that referred to surgery ward of Shahid Beheshti Hospital, in Babol, Iran in 2002-2008. Patients according to the location of tumor and physical status were undergone transhiatal or transthoracic esophagectomy. Demographic and surgical findings were recorded. The patients were matched according to age, sex, weight loss, serum albumin level and hemoglobin concentration in two groups.Results: Fifty nine percent of patients were under transhiatal esophagectomy and 41% were under transthoracic esophagectomy (n=166). Morbidity did not show significant difference (p=0.636) between transhiatal (42.9%) and transthoracic (47.1%) methods. Duration of surgery (min) in transhiatal method (180.7±35.1) was significantly (p<0.0001) lower than the transthoracic one (226.7±54.2). Duration of admission (days) did not show significant difference (p=0.44) between transhiatal esophagectomy (8±4.9) and the other method (8.5±1.6). Mortality in 30 days after surgery did not show significant difference (p=0.489) between two groups (4.1% against 7.4%).Conclusions: Based on our study, duration of surgery in transhiatal esophagectomy was lower than transthoracic method. Other parameters include morbidity, mortality, and duration of admission had not significant difference between two groups.

Background: Shoulder hemiarthroplasty is one of the established methods for management of proximal humerus fractures particularly in the types with more displacement so that fixation is not possible. Successful treatment is a challenge for shoulder surgeons especially in elderly patients. The aim of this study is to investigate the functional results and prognostic factors on shoulder hemiarthroplasty.Methods: Thirty nine patients operated by one shoulder surgeon in Imam Khomeini and Shariati Hospital in Tehran, Iran, from October 2005 to February 2009 were included in this study and followed postoperatively for at least one year. Mean (±SD) age was 49.7±14.3 years. Functional results were measured by constant score and pain was scored using visual analogue score. The relationship between factors such as age, injury to surgery interval, radiographic parameters and functional results were assessed.Results: Mean (±SD) constant score was 61.9±20.2. The age and injury to surgery interval showed a reverse correlation with constant score (p<0.05). There was a significant correlation between constant score and acromiohumeral interval (r=0.53) and head to tuberusity distance (-0.59). Median VAS score was 4.5 (interquartile range: 2-5.2) that had a direct correlation with age (r=0.38) and injury to surgery interval (r=0.55) (p<0.05).Conclusions: Shoulder hemiarthroplasty should be performed in minimal delay from injury and this operation should be performed by an experienced shoulder surgeon to create the best anatomic position of prostheses. Careful rehabilitation particularly in older patients is very important to improve results.

Background: Some complications of pregnancy such as abortion, gestational diabetes mellitus, preeclampsia, and preterm delivery are more common among women with polycystic ovary syndrome (PCOS). Recently it has been reported that metformin treatment during pregnancy reduces pregnancy complications, so this study was conducted to demonstrate the possible effects of metformin on the uteroplacental circulation and pregnancy complications.Methods: Seventy pregnant women with polycystic ovary syndrome (PCOS) from 1386 to 1388 were enrolled in a randomized, double-blind, placebo-controlled trial of metformin during pregnancy in Shariati hospital. Doppler ultrasound examinations of the uterine arteries and umbilical artery were performed at 12th and 20th weeks of gestation. All patients were followed up to the end of pregnancy, then the effect of metformin on the uteroplacental circulation was evaluated by the comparison of the pulsatility index (PI) of uterine arteries and prevalence of obstetric complications between two groups.Results: The mean reduction of PI in metformin group from 12th to 20th weeks of gestation was 0.38 versus 0.16 in placebo group (p=0.016). Gestational diabetes mellitus, pre-eclampsia and preterm delivery, were more common in pregnant women in placebo group but the difference was not statistically significant.Conclusions: Metformin treatment in pregnancy accompanied with reduced uterine artery impedance between 12 and 20 weeks of gestation but this reduction showed no effect on the pregnancy complications such as preterm delivery, preeclampsia and gestational diabetes.

Background: Patients with chronic renal disease, if not treated appropriately, will be usually terminated into an irreversible stage known as End Stage Renal Disease (ESRD), the final stage of kidney disease. End stage renal disease patients cannot excrete the appropriately potassium ion through the kidney. Among the crystalloid solutions, normal saline is devoid of potassium; so it is used in a widespread manner in renal transplant patients. High doses of this solution may cause hyperchloremic metabolic acidosis that is accompanied by extracellular potassium shift and impaired splanchnic perfusion. The aim of this study was to assess the effects of two types of solutions, normal saline vs. lactated ringer in these patients during the perioperative period.Methods: In a double blind clinical trial, 108 patients were randomly assigned in two groups (54 in each), while were assimilated regarding all aspects except for the type of the crystalloid solution. Age, weight, duration of the surgery, total volume of the infused crystalloid, central venous pressure and sex were all assessed.Results: The two groups were the same regarding the results gained for pre- and postoperative parameters. Follow up assessments did not show any difference between the two groups regarding above variables.Conclusions: The results of this study demonstrated that both of the crystalloid solutions assessed, normal saline and lactated ringer solution, are safe for using in patients undergoing surgical operation and there is not a risk of hyperkalemia in renal transplant patients receiving lactated ringer. This study was performed on live kidney transplants and the results were not applicable to cadaver transplants.

Background: Cutaneous Leishmaniasis is endemic in plenty of Iranian provinces. This study aimed to determine the epidemiological status of the cutaneous Leishmaniasis outbreak, isolation and identification of the parasite using a PCR method in burden rural areas of Gonbad-e-Qabus County, north Iran.Methods: Data was collected on the prevalence of scars and ulcers over a period of three months among 6990 inhabitants of five villages around Gonbad-e-Qabus county, north Iran, during 2006-2007. Cultured promastigotes were identified using PCR technique. ITS1 and ITS2 of Non Coding Transcribed region at ribosomal DNA of 46 Leishmania isolates were amplified and the PCR products were separated by electrophoresis in 1.5% agarose gel (200 mA, 140 V), visualized by staining with ethidium bromide, and photographed. To confirm the PCR findings, six Leishmanis isolates were injected individually into two BALB/c mice.Results: Among 6990 inhabitants of the five villages, 62.9% had scars and 0.5% had active lesions. The most highly infected age group was 0-10 years and nobody was infected in individuals more than fifty years of age. Individuals 11 to 20 years of age were the most highly infected age group. The results showed that from 46 isolates, all (100%) were L. major in comparison to reference strains and all of them could produce ulcer at the base tail of BALB/c mice, 4-12 weeks after inoculation.Conclusions: According to this study, cutaneous Leishmaniasis due to Leishmania major is endemic in Gonbad-e-Qabus county, north Iran. The results were confirmed by active lesions induced in BALB/c mice.

Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous.Case presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT-scan was performed and shows a fragment of catheter in the sub-laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic.Conclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT-scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.