TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2009 | Volume:66 | Issue:12|Papers Count:17

The response of living tissues to the surgical trauma is associated with varying degrees of tissue repair and involves two distinct processes including replacement and regeneration. Replacement results in scar tissue formation instead of restoration of the normal architecture. However, regeneration leads to restoration of the original architecture leaving no sign of injury. Anti-proliferative agents are used to inhibit tissue responses to surgical trauma. Among them mitomycin- C and 5- FU had gained increasing applications in ophthalmic surgeries, including filtering glaucoma surgeries, laser vision correction with excimer laser by ablative surface refractive surgery, reconstructive surgeries for ocular surface disorders and removal of neoplastic tissues and secondary operations on nasolacrimal ducts. In this review article, the various aspects of applications of these agents including their mechanism of action, function, mode of application and complications in different ophthalmology fields are discussed.

Background: Vascular endothelial growth factor (VEGF) has mitogenic effect for endothelial cells and is an important mediator of tumor expansion, metastasis and angiogenesis in vivo. Isosorbide dinitrate, as a nitric oxide donor, has been widely used in treatment of many cardiovascular diseases such as congestive heart failure and acute coronary syndromes. Furthermore this drug was found to have inhibitory effect on angiogenesis, tumor growth and metastasis in vivo. In the present study we evaluated the isosorbide effect on the VEGF production using some human leukemic cell lines. Methods: Human leukemic MOLT-4, JURKAT and U937 cells were cultured in complete RPMI medium. The cells at the exponential growth phase were then incubated with different concentrations of Isosorbide (4´10-7 -4´10-4 M) in the presence or absence of PMA (25ng/ml) for 24 hours. The VEGF concentrations in the culture supernatants were measured by enzyme immunoassay kits (R&D systems) according to the manufacturer’s instructions.Results: The level of VEGF produced by the human leukemic cell lines which was treated with different concentrations of isosorbide, did not show any significant difference with untreated control cells. Conclusions: The results of this study showed that isosorbide had no significant effect on VEGF production. Our findings suggest that anti-angiogenesis effect of isosorbide could be mediated through VEGF-independent mechanism(s). Further studies are warranted to determine definite isosorbide effect on VEGF and other angiogenic factors production in patients as well as animal models.

Background: Pi-GST and Mu-GST are subclasses of glutathione S-transferase that present on human sperm surface and play an important role against oxidative stress. Therefore, any defects in the enzyme activity may be associated with male infertility.In this study the polymorphisms of GSTM1 and GSTP1 in association with enzyme activity and sperm parameters were studied.Methods: This case-control study involved 95 men with oligoastenoteratozoospermia and 26 controls with normozoospermia. Semen analyses were carried out according to WHO guidelines. Blood DNA was extracted using salting out procedures. GSTM1 and GSTP1 polymorphisms gene were determined through PCR-RFLP and multiplex PCR, respectively. Finally, Glutathione S-transferase activity was measured.Results: Frequencies of GSTM1 null genotype in oligoastenoteratospermic and normospermic groups were 52.1% and 53.8% respectively. There were no statistically significant differences in sperm parameters and enzyme activity between GSTM1 null and positive genotypes in two groups. There were no statistically significant differences in glutathione S-transferase activity between oligoastenoteratospermia and normospermic groups (p>0.05). All the 121 men in this study had Ile/Ile genotypes at 105 codon of GSTP1. Frequency of normal homozygote (114Ala/Ala), heterozygote (114Ala/Val) and mutant homozygote (114Val/Val) genotypes in oligoastenoteratospermic group were 81.1%, 17.9% and 1.1% respectively but in the control group they were 88.5%, 11.5% and null.Conclusions: Total glutathione S-transferase activity and sperm parameters were not affected by deficient Glutathione S-transferase activity in GSTM1 null genotype. Compensate activity of other sperm surface glutathione S-transferase isozymes, like GSTP1, may justify the cause.

Background: Treatment of cervical carcinoma is routinely performed with Low Dose Rate (LDR) brachytherapy, but Brachytherapy in our department is done with Medium Dose Rate (MDR) due to the technical characteristics of the machine available here.Thus we decided to evaluate the results of this treatment in our department in a prospective study.Methods: Between March 2006 and July 2008, 140 patients with histologic diagnosis of cervical carcinoma referred to Tehran Cancer Institute; were treated with external beam radiotherapy (44-64 Gy to whole pelvis) and MDR brachytherapy (8-30 Gy to Point A) with a dose rate of 2.2±0.3 Gy/h.Results: 121 patients were followed up for a median time of 18 months (range: 9-39 m). There were 11% (6/54) local recurrence for surgery and adjuvant radiotherapy group; 25% (16/65) for radical radiotherapy group, and 19% (23/121) for all patients. Rectal and bladder complications incidence for all patients were 10% (12/121) and 13% (16/121) respectively. High grade complication was shown only in one patient in radical radiotherapy group. In this study 3-years disease free survival and overall survival were 73% and 92% respectively, and disease stage (p=0.007) and overall treatment time (p=0.05) were the significant factors affecting disease free survival.Conclusions: Results of this series suggest that the use of external beam radiotherapy and MDR brachytherapy with about 20% dose reduction in comparison with LDR can be an acceptable technique with regard to local control and complications.

Background: The postmortem diagnosis of early myocardial infarction is a perplexing affair in forensic pathology. The routine evaluations of autopsied hearts including macroscopic examination and study of H&E stained sections are often not contributory. Some other methods like electron microscopy need sophisticated equipments which are not available in all pathology laboratories.Methods: In an attempt to find a more reliable and less labor- intensive method, we have studied the diagnostic value of cardiac troponin- T by an optimized immunohistochemical method on 67 autopsied hearts in Legal Medicine Organization of Iran. The cases were divided into three groups: the positive group composed of cases with the definite diagnosis of myocardial infarction (MI) as the cause of death; the noncardiac death group; and finally the suspicious group which consisted of cases with high probability of early myocardial infarction, however without definite evidence of MI on the routine histopathologic studies. In stained sections, the degree of troponin T depletion was scored.Results: With our proposed cut off, this test showed positive results in 19 out of 22 cases in MI group (86.4%), none of the 17 cases of non-cardiac death (100% specificity), and 15 out of 28 cases of suspicious group (53.6%). Conclusions: This relatively easy method may increase the sensitivity of routine histopathologic methods in postmortem detection of early myocardial infarction.Additionally, this method does not require a particular preparation and can be done very easily on the archival paraffin blocks available in pathology departments whenever further evaluation is deemed necessary by the pathologist.

Background: The papanicolaou (pap) smear has been used to screen cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional pap smear. Ideally, these new tests will increase the early detection of meaningful pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results.Methods: In this prospective study the result of Liquid- based cytology smears (Liquid prep method) compared with conventional pap smears in terms of adequacy and ASC diagnosis in 289 patients in pathology department of mirza kochak khan hospital (Tehran, 2005– 2006). The smears were interpreted based on Bethesda system 2001. Results: In conventional pap smear method, the number of occasions of unsatisfactory smear was 24(5%). In Liquid- based cytology method 66 (22.8%) smears were unsatisfactory, In which difference between unsatisfactory groups were statistically significant (p<0.05), Also ASC diagnosis in conventional method 5(1.8%) as compared with Liquid- based cytology 6(2.1%), was not statistically significant (p>0.05). Conclusions: There was no significant difference between two methods in term of ASC diagnosis but in conventional method adequacy of specimen was significantly better as compared with this Liquid- based cytology method.

Background: The usage of pericardium of patient himself, for support of anastomosis lines may carry benefits in patients undergoing aortic valve replacement with pulmonary autograft (Ross). The aim of the present study was to compare the short term results of aortic valve replacement with pulmonary autograft with routine and offered methods.Methods: In a non-randomized clinical trial, 64 patients who referred to cardiac surgery ward of Imam Khomeini hospital Tehran Iran from December 2002 to December 2006 for aortic valve replacement with pulmonary autograft with two different methods. In the first two years of this study all of the patients were operated with routine procedure (group A, n=28) and during the next two years, all of them were operated with authors' offered method in which the patient`s pericardium was used for support of anastomosis lines (group B, n=36). Some of clinical parameters and outcome were compared between two groups. Results: There were no significant differences between mean of age, sex, pathology, preoperative and postoperative EF in two groups. In group B, the mean pump time was significantly lower than group A (144.09±26 vs. 179.64±25 min). The mean Cross-clamp time was significantly lower in group B (118.5±22 vs. 136.93±19 min) Need for blood transfusion in ICU was significantly lower in group B (35.71% vs. 68.57%). Mean ICU Stay and Postoperative Hospital Stay were significantly lower in group B (1.3±0.3 vs. 1.9±0.7 and 5.2±0.9 vs. 5.9±1.5 days respectively). Overall mortality was four death (6.25%) which was not significant between two groups.Conclusions: The usage of patient's pericardium for support of anastomosis lines in patients undergoing aortic root replacement with pulmonary autograft carry advantages to routine procedure and its utilization is advocated in other centers.

Background: Since the systemic steroids are introduced in Pemphigus Vulgaris treatment, the prognosis of disease improved significantly. This study was designed to evaluate determining factors in the prognosis of pemphigus vulgaris in Iranian patients. Methods: In this study, 119 patients with documented pemphigus vulgaris who had presented to Razi Hospital from 2001 until 2003 were included. These patients had presented for the first time and treated with prednisolone and Azathioprine. Morality rate, minor and major relapses and duration of first remission had been defined as prognostic criteria and correlation between them and other demographic variables and disease characteristics were investigated.Results: The majority of patients (84.1%) were followed for more than one year. The major recurrence and minor recurrence occurred in 28(23.5%) and 65(54.6%) of patients respectively, no case of mortality was observed. In patients who received treatment six months or less after onset of disease the frequency of major recurrence was less than the others. 18(17.8%) vs. 12(41.4%), (p=0.009). Duration of primary remission more than one year was detected in most of the patients (64.7%). In patients with less than 10 initial cutaneous lesions, period of primary remission was longer than the other patients.(p=0.009). Shorter duration of primary remission were noted in older patients (age>50) in comparison with younger patients (age £50, p=0.04).Conclusions: Male gender, old age, interval more than 6 months between onsets of symptoms to initial treatment and more than 10 skin lesions on admission, are associated with poor prognosis of pemphigus vulgaris.

Background: Axillary block is used for inducing anesthesia in outpatient hand and forearm surgeries. Few researches have studied hemodynamic and blockade effects of low doses of Epinephrine. The aim of the present study was to compare the duration of analgesia and hemodynamic changes following the injection of high/low epinephrine doses in such surgeries.Methods: The present randomized clinical trial study was conducted on healthy individuals (ASA I-II) who were candidates for hand and forearm surgeries. The patients were randomly divided into three groups. The first two groups were allocated to receive lidocaine with low (0.6mg/cc) and high (5mg/cc) doses of epinephrine whereas lidocaine plus normal saline was injected in the third group. The hemodynamic changes (Mean arterial blood pressure and heart rate) and the occurance of any side-effects along with the duration of analgesia and motor block were recorded. Results: From among the total of 75 patients, 15 cases were excluded due to incomplete blockade or failure needing general anesthesia. The duration of analgesia and the motor block were longer in the high dose epinephrine group, the difference, however, was not statistically significant. Heart rate changes within the groups were significant in the 4th- 7th and 10th minutes. Mean arterial blood pressure changes were only significant in the 4th minute, within the groups.Conclusions: Administering low doses of epinephrine plus lidocaine as a local anesthetic not only provides acceptable analgesia compared to higher doses of the medication, but also is associated with fewer side effects.

Background: Anal surgeries are prevalent, but they didn’t perform as outpatient surgeries because of concerns about postoperative pain. The aim of the present study was to compare the effects of rectal acetaminophen and diclofenac on postoperative analgesia after anal surgeries in adult patients.Methods: In a randomized, double-blinded, placebo-controlled study 60 ASA class I or II scheduled for haemorrhoidectomy, anal fissure or fistula repair, were randomized (with block randomization method) to receive either a single dose of 650 mg rectal acetaminophen (n=20), 100 mg rectal diclofenac (n=20) or placebo suppositories (n=20) after the operation. The severity of pain, time to first request of analgesic agent after administration of suppositories and complications were compared between three groups. Pain scores were evaluated in patients by Visual Analogue Scale (VAS) in 0 (after complete consciousness in recovery), 2, 4, 12 and 24 hours after surgery. The period between administration of the suppositories and the patients’ first request to receive analgesic was compared between groups.Results: Pain scores were lower significantly in rectal diclofenac than the other groups. The period between administration of the suppositories and the patients’ first request to receive analgesic in diclofenac group was 219±73 minutes, was significantly longer compared with placebo (153±47 minutes) and acetaminophen (178±64 minutes) groups. No complications were reported. Conclusions: Diclofenac suppository is more effective than acetaminophen suppository in post hemorrhoidectomy pain management.

Background: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication) makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births.Methods: A cohort study was conducted on 303 primiparous women who had delivered vaginaly and 315 primiparous delivered by elective cesarean section in seven private hospitals in Tehran, employing data of demographic characteristics like age, education, BMI, obstetric history (weight gain in pregnancy, history of pelvic pain and vaginal discharge), stress incontinence history (prepregnancy and during pregnancy) and effect of delivery on sexual satisfaction in several follow-ups until 12 months after delivery.Results: Sexual satisfaction after delivery in vaginal group was significantly more than cesarean group. (76% vs 60%, p<0.0001). There was no relation between pelvic pain & delivery type (in several follow- up).Conclusions: Instead of social conception of have more sexual satisfaction after cesarean delivery, outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. Therefore Request of cesarean section by mother for having more sexual satisfaction after childbirth is not logic.

Background: Leishman Denovani is an obligatory intracellular parasite that is seen such as Leishmanbody or Amustigote in intra reticolo- endothelial system.Leishmanenios is seen as sporadic- endemic or epidemic in many places in the world. In Iran in Fars state and west Azarbayjan is endemic and in other places are in sporadic form and is found in rural areas.Case report: A four year-old girl was admitted with visceral Leishmaniasis and Subsequently developed peritoneal tuberculosis. The patient, who lived in Dashte- Moghan, complained of abdominal pain and distention and weight loss from 1.5 years ago. The titre of IFA test for leishmansis was 1/1280 Leishman body was seen in bone marrow aspiration specimen. Bone marrow culture for leishmania was negative. The specimen of acsities fluid revealed sero- fibrino- purulent exudate with lymphocyic dominancy (over 90%). No response to classic lishmanisis treatment had been started unless the patient treated with anti tuberculoid regimen.Conclusion: The function of the T- helper (Tht) lymphocytes will decrease in Kala-azar disease. This is why there is no skin reaction to Manteaux (PPD) diagnostic test the patient. The patient has been suffering from long-term malnutrition with its consequent immune defect. There were no evidences of cure in our patient during classic Kala-azar therapy. After she received anti tuberculosis therapy she revealed clinical improvement with Glucantim regimen as well.