TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2010 | Volume:68 | Issue:7|Papers Count:12

Background: In the recent years, concerns have been raised about the incidence of reproductive disorders in human populations. The present study was aimed to determine the effects of maternal exposure to Di 2 ethylhexylphthalate (DEHP) on postnatal development of ovary in Wistar rat off springs.Methods: Forty female Wistar rats were randomly divided in four equal experiment groups, an oil vehicle group and three DEHP-treated groups that received 10, 100 and 500 mg/kg/day Di 2 ethylhexylphthalate by gavage during lactation, respectively. The ovaries of pups were removed at 60 days of postnatal development, their weights recorded and fixed in Bouin's solution, subsequently6 mm serial paraffin sections were stained with haematoxylin-eosin, the structural changes of ovarian follicles and corpora lutea were studied.Results: There was no significant difference on mean body weights of off springs among different groups. However, the mean of ovary weight was decreased significantly (p=0.037) in 500 mg/kg/day DEHP group. Significant decreases were seen in mean number of primary follicles (p=0.012) and mean number and diameter of secondary (p=0.023 and p=0.012, respectively) and antral (p=0.025 and p=0.018, respectively) follicles in high dose DEHP-treated group compared to sham group. Also, mean number of corpora lutea decreased significantly (p=0.023) at 60 days of age in ovary of offspring in500 mg/kg/day DEHP group. Moreover, significant increases were seen in number of atretic follicles in moderate (p=0.012) and high (p=0.036) DEHP treated groups.Conclusion: Present study showed that maternal exposure to Di 2 ethylhexylphthalate during lactation affects postnatal development of ovary in offspring Wistar rats and reduces their fertility and reproductive efficiency at puberty.

Background: Studies of the association between post operative AF and Plasma level of NT- Pro BNP have reported conflicting findings. The aim of the present study was evaluation of the association between post coronary bypass graft-Atrial Fibrillation (AF)and Plasma level of NT- Pro BNP as an independent risk factor of AF development in patients undergoing coronary artery bypass graft.Methods: In a cohort study, 79 patients with sinus rhythm who admitted in Imam Khomeini Hospital in Tehran, Iran, during February2009 and February 2010 for CABG are included the study and followed for developing post operative AF rhythm.Results: Post operative AF was found in 17.7% of patients. The peak time from the operation to the first AF episode was in second post op day  [in ten patients (71.4%)].The serum level of Pro BNP in patients with AF was significantly higher (1624±647 versus221±238 pg/ml, p<0.0001). Increased age, Increased LA size and high plasma level of Pro BNP were associated with increased risk for post op AF. After adjustment of risk factors, plasma level of Pro BNP was the most important risk factor with odds ratio of 15.34 with CI 95% 1.77-132.95 and then LA diameter with odds ratio of 6.11 with CI 95% 0.99-37.42was independently correlated with post op AF. Correlation between plasma level of Pro BNP with age and LA size was seen too (LA size r=0.0281, p=0.012). Between age and Pro BNP (r=0.337, p=0.002). The best cut off point for plasma Pro BNP as a predictor of post op AF was 854 pg/ml.Conclusion: Increased level of preoperative Pro BNP levels could be an independent predictor of post operative Atrial Fibrillation.

Background: Colorectal cancer is the third common cancer world wide and the forth in Iran. Neoadjuvant chemo radiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluate the efficacy a cox-2 inhibitor on pathologic response, sphincter preservation and acute toxicity during neoadjuvant chemo radiation.Methods: Thirty-six patients that have adenocarcinoma of rectum was enrolled (up to 15cm of anal verge). The patients were undergone Endometrial Ultrasound (EUS), abdomino-pelvic and chestCT for staging. Then received neoadjuvant concurrent chemo radiation (xeloda825 mg/m2 bid in combination with celecoxib 100 mg qid and 50-50.4 Gy/25-28 f). Surgery was done 4-8 weeks after chemo radiation. During the chemo radiation the patients was observed for the probable complication one year.Tumor regression grade was reported.Results: From 36 surgery patients, Total Mesorectal Excision (TME) was done in 30 patients. Pathologic complete response was seen in eight of 30 patients (26.7%). Tumor regression grade was calculated in three and five grade system: in three grade system 17 patients had grade 1 (60.7%), eight patients had grade 2 (28.6%) and three patients had grade 3 (10.7%). In five grade system of tumor regression eight patients had grade 1 (28.6%), nine patients had grade 2 (32.1%), eight patients grade 3 (28.6%), three patients had grade 4 (10.7%). T down staging was 43.3%. N down staging was 30.8%. No patient had skin reaction or cardio-vascular complication.Conclusion: Based on our study results, Celecoxib in combination with neoadjuvant chemo radiation is safe and is associated with low complications. This combination can promote pathologic complete response, TRG and T and N down staging in Rectal adenocarcinoma.

Background: A correlation between coronary artery disease (CAD) and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima media thickness (IMT) of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG).Methods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined.Results: There was a significant weak positive correlation between the IMT of common carotid artery (r=0.193, p=0.039) and common femoral artery (r=0.206, p=0.028) with the number of involved carotid vessels, the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease.Conclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD, however, these parameters are not a surrogate for predicting theCAD severity.

Background: Paranasal sinus disease is one of the most common problems of patients that refer to ENT centers. Adding to clinical examination, imaging plays an important role in diagnosis and treatment. Also the imaging of paranasal sinuses is necessary before surgery. Although computed tomography is the modality of choice for these areas, it has some disadvantages which the most important one is its high patient's dose. The aim of this study is the comparison between cone beam volumetric tomography and conventional computed tomography computed tomography, in evaluation of these areas.Methods: In this descriptive-analytic study Coronal computed tomography imaged and cone beam volumetric tomography images were performed for40 patients referred to ENT department of Amir Aelam Hospital in Tehran, Iran. Computed tomography images were observed by general radiologist and cone beam volumetric tomography images by Maxillofacial radiologist and their results' were recorded. Also ENT surgeon recorded her observations during surgery. Data were analyzed using Mc Nemar test with Kappa and weighted Kappa agreement coefficient.Results: No statistical difference was shown between the efficacy of computed tomography and cone beam volumetric tomography in evaluation of paranasal sinuses (p>0.05).Conclusion: As there was not any difference between conventional computed tomography and cone beam volumetric tomography in the assessment of paranasal sinuses and additional advantages of the later, cone beam volumetric tomography is suggested for paranasal sinus imaging before surgery.

Background: Anterior glenohumeral instabilities can be corrected with open and arthroscopic surgery. The purpose of this study was to evaluate retrospectively the surgical outcomes of arthroscopic repair of anterior glenohumeral instabilities with use of suture anchors in a series of patients who were followed for twenty to fifty months.Methods: The results of arthroscopic Bankart repair with use of suture anchors in 30 patients with traumatic recurrent anterior instability of the shoulder were evaluated. At the time of follow-up (mean of thirty-three months), the patients were assessed with two outcome measurement tools (the Rowe score, the Constant score). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated.Results: According to the Rowe scale, 12 patients (40%) had an excellent score, 13 (43%), a good score, 4 (13%), a fair score, and 1 (4%), a poor score. The mean ROWE score was81.8 and the mean CONSTANT score was 85.5. Overall, the rate of postoperative recurrence of instability was10% (two dislocations, one subluxation).The mean delay to recurrence was 20 months. Loss of external rotation in regard to uninvolved extremity was less than10 degrees in 30% and more than 10 degrees in 10% of patients. The average number of anchors used was 3.2 which follow-up radiographs showed all of them in the osseous glenoid without pullout. In preoperative studies, shoulder 3D CT scan was not performed routinely. Radiographic signs of degenerative changes were noted in one shoulder.Conclusion: Arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.

Background: CD14 is known as a receptor for bacterial LPS (Lipopolysaccharides) and is followed by inflammatory reactions. This receptor on macrophage surface has a major role for recognition and clearance was happen without inflammatory reaction.Prolonged exposure to microbial products decreases the risk of allergic reactions. This is related to high level of CD14 in blood cells. Although the causes of nasal polyposis is not obviously determined but allergy is a potential risk factor for nasal polyposis.CD14 is in 5q31 chromosomal position and CD14 variants have association with asthma. We try to assay association between CD14 polymorphism and nasal polyposis and severity of this disease.Methods: We had 106 patients with nasal polyps with mean age 41 y old in case group and 87 with mean age 36.7 in control group. We obtained 3 ml whole blood from each patient and then extract DNA by PCR-RFLP method and determined variant genotypes of CD14. Although there is no previous study in this field, the results of this pilot study shown in more detailed below.Results: There is significant relationship between C allele (CC+CT) in comparison withTT (p=0.03, odds ratio=1.87, CI 95% (0.99–3.55)) and nasal polyposis. Furthermore another significant relationship had been shown between asthmatic patients and C allele (CC) in comparison with (CT+TT). (p=0.01, odds ratio=3.8, CI (0.99- 13.9). In asthmatic patients withC allele of CD14 incidence of nasal polyposis increased.Conclusion: Based on the results of this study, C allele of CD14 could play a role in nasal polyposis.

Background: Cerebrovascular ischemic accident is the third most common cause of death in community. Management of high-risk patients reduces complications and mortality. Serum lipid profile is one of the most important factors influencing the prognosis.Methods: In this cross sectional study, 123 (58 female and 65 male) patients with acute ischemic stroke, mean aged 65.1±11.16 years, were admitted to Sina Hospital between September2008 and September 2009. The inclusion criteria were age between 40-90 years and ischemic stroke within the anterior or posterior brain blood system. The exclusion criteria were brain tumor or abscess, venous sinus thrombosis, liver disease, renal failure, hypothyroidism or metabolic problems. Serum lipid profile was evaluated during the first 24 hours after stroke and after 12 hours of fasting. Furthermore, the patients' inability was evaluated on the first and fifth day of hospitalization by NIH Stroke Scale (NIHSS).Results: Patients' total serum cholesterol was 189.93±51.46 mg/dl and mean total serum triglycerides was 157.72±72.67 mg/dl. The mean HDL and LDL was 47.70±14.43 and105.98±37 mg/dl, respectively. In the analysis, a significant inverse relationship was found between serum triglyceride levels and fifth day's NIHSS. In addition, age and a history of heart disease had a significant direct relationship with the first day's NIHSS. (p<0.05) Conclusion: The study showed a better prognosis in cases with increased plasma triglyceride levels, after cerebral ischemic stroke. Besides, older age and a history of ischemic heart disease were associated with a worse prognosis.

Background: In the patients with chronic liver disease chronic increase in serum transaminases may remain of undetermined cause despite thorough investigations.Celiac disease (non tropical sprue) has been reported as one of the causes of elevated levels of serum transaminases. The aim of this cross sectional study was to evaluate the frequency of celiac disease among patients with liver disease with chronic unexplained hypertransaminasemia.Methods: One hundred patients with unexplained elevated liver enzymes who referred to gastroenterology and hepatology clinic of Imam Khomeini Hospital in Tehran, Iran from March 2009 to March 2010, and no cause were found for this elevation after initial clinical and paraclinical assessments and tests were enrolled in a cross sectional study.After measurement of Anti t TG IgA antibody in the serum of the patients, the biopsy of second part of duodenum were performed in cases with positive results and were assessed regarding evidences of celiac and finally the diagnosis of celiac diseas was confirmed.Results: The mean age of patients was 39.79±16.77 and 55% of patients were male. The celiac disease was confirmed in 6% of patients (CI: 95%: 2.78- 12.48%). There were no significant differences between frequency of both sexes and means of age, ALT, and AS Tin the study patients.Conclusion: In our study, the frequency of celiac disease among patients with chronic liver disease with unknown elevated liver enzymes was 6% which is near the frequency derived from other studies that has been reported.

Background: Local recurrence in Nasopharyngeal Carcinoma (NPC) presents is a major challenge. Patients experience substantial morbidity as well as poor survival if no further treatment is offered. Residual or recurrent nasopharyngeal carcinoma is usually managed by chemotherapy, stereotactic radiosurgery, external beam radiation therapy (EBRT), interstitial, and intracavitary brachytherapy or salvage surgery. This case presents the treatment of two consecutive localized recurrences of NPC.Case presentation: The patient was a 59-year-old man who underwent a course of radical external-beam radiotherapy for a primary NPC in 1999, then another course of external radiation in 2004 for his first recurrence, and finally a course of brachytherapy for the second recurrence in 2005. The patient is well now in 2010, with no signs of disease five years after the third radiotherapy.Conclusion: Our experience of re-irradiation for this twice recurrent nasopharyngeal carcinoma has been promising with encouraging tumor control and acceptable treatment-related toxicity profile. This case indicates the efficacy of definitive reirradiation for regional recurrence and the necessity for long-term observation for the salvageable early-stage local failure.