TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2003 | Volume:61 | Issue:2|Papers Count:14

Introduction: Dispersed neuroendocrine system (D.N.S) consists of a wide variety of cells that are present in the central and peripheral nervous system and in many classic endocrine organs and different tissues such as respiratory and gastrointestinal tracts, skin, prostate, breast and also their neoplasm show neuroendocrine differentiation by electron microscopy, immunohistochemistry or biochemical techniques. Materials and Methods: The present study has been carried out by case-series method in order to evaluating the characteristics of all types of neuroendocrine carcinoma: different anatomical locations during 5 years period in immunohistochemistry department of cancer institute. Results: The diagnosis of 109 cases of neuroendocrine carcinoma consisting of neuroendocrine carcinoma, small cell carcinoma, medullary carcinoma of thyroid, carcinoid tumor and merkel cell carcinoma are confirmed that among them the most common diagnosis was related to neuroendocrine carcinoma (50.5 percent ). The most prevalent age group was 40-49 years and male to female distribution were 56 percent and 44 percent respectively. Anatomical distribution of tumor show that about 30 percent of cases were metastatic carcinoma, 30 percent in thyroid, respiratory tract and head and neck region and remainder in a variety of tissues. In over 50 percent of cases one of endocrinoid patterns as trabecular, organoid or mixed of them were seen. Conclusion: Immunohistochemically N.S.E (Neuron Specific Enolase) show high sensitivity with 96 percent positive reaction and more specific endocrine markers as chromogranin A in 80 percent and synaptophysin only in 24 percent because of lesser application of the latter. Also epithelial markers such as cytokeratin and E.M.A. (Epithelial Membrane Antigen) were positive in 69 percent and 74 percent respectively. Mean survival rate of all neuroendocrine carcinoma reached to 4.8 years with lowest survival of 4.3 years among small cell carcinoma and highest in merkel cell carcinoma with 5.5 years.

Background: Opioids are increasingly being recognized as the primary treatment fog cancer pain management. Optimal treatment of cancer pain involves assessing its characteristics, considering different management strategies, evaluating side effects and adverse drug reactions and establishing the most appropriate therapeutic regimen. This study was designed to review the current status of pain management for advanced cancer cases using opioid analgesics. Materials and Methods: A questionnaire was used to collect data on demographics, disease characteristics, and opioids use indicators in 700 cases of advanced cancer patients. Results: A total of 700 cancer cases, 42 percent females and 58 percent males, between 17 - 80 years age range (Mean age of 57.25) were studied retrospectively. Cancers of breast (21 percent), colorectal (12 percent), lung (7 percent), stomach (7 percent ) and bone either primary or metastatic (6 percent ) in women and stomach (17 percent ), lung (12 percent ), colorectal (11 percent ), prostate (9 percent ), and bone (8 percent ) in men were the most common causes of opioids prescription in study gr6up respectively. Advanced primary cancer (in 52 percent), bone metastasis (in 32 percent), and treatment complications (in 7 percent ) were considered as physical basis for pain in patients. Morphine (by injection), Opium (by oral intake) and methadone (injection and/or oral) were the most common opioids prescribed. Using equianalgesic conversion chart, the daily dosages and therapeutics schedules of morphine administration were as follows: 43 percent received 21-30 mg. in 2-4 divided doses27 percent received >30 mg. in 3-5 divided doses 21 percent received 11-20 mg. in 2-3 divided doses9 percent received 5-10 mg. in 1-2 divided doses Conclusion: Pain management of cancer patients is not adequate and opioid use is not rational. New educational and managerial strategies are needed to optimize cancer pain treatment in routine medical practice. To overcome current barriers, WHO stepwise model for cancer pain control and palliative care is recommended. Publishing Standard Treatment Guidelines for different levels of health care system is another recommended approach to optimize cancer pain.

Arthrofibrosis continue to be a difficult complication of operative procedures of trauma about the knee. We present our experience in 8 cases of arthroscopic Arthrolysis between 1997 and 2001. in 3 Cases the etiology was prior Knee ligament surgery and 5 cases had sustained fractures about the knee. Technique begins with the liberation of the adhesions of suprapatellar Pouch, continues down both gutters , and ends with a cleaning of the notch where necessary. The result obtained are very satisfactory, with an average increase in the arc of mobility of 61 degrees.

Introduction: Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients. Materials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age ≥12 years), neutropenic (PMN ≤1000) patients with fever (Temperature, oral ≥ 38.5c) in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A) and; Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B). Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever) were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result). Results: During a twelve months period of study, a total of 57 patients (I7female, 40male) were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent), the treatment was effective, compared to 15 of 29 (51.7 percent) in groups B. The duration of fever after initiation of treatment was 37.9± 17 hours in arm A and 40.1±20 h in arm B. Blood and/or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B). Conclusion: Cefriaxon monotherapy is at least equally effective in low risk neutropenic patients with fever compared to combination of ceftazidim plus amikacin at a decreased cost and probably (expected) less adverse side effects in our patients.

Background: Betamethason Causes adrenal suppression in woman at risk of preterm delivery. Materials and Methods: An interventional study was done on 25 women at risk of pre-term delivery. Betamethason course (12-mg-im q 24 hr for 2 doses) was prescribed for 2 consecutive weeks. ACTH Stimulation test was done one week after each Betamethason injection. (1st between 30-31 w and the 2nd one week later. Serum Cortisol levels were measured before betamethason administration and then before and 30 minutes after ACTH Stimulation test.Results: All Subjects had normal baseline cortisol level. Mean baseline serum cortisol levels decreased with each ACTH stimulation test from 24.32±0.77 µg/dl before Betamethason) to 7.33±1.73 µg/dl (one week after the second course of Betamethasone) (p<0.0001). The mean stimulated cortisol levels also decreased from 23.93±1.44, µg/dl (befor Betamethason) to 19.53±2.69 (one week after the second course of Betamethasone) (P<0.007), compared with initial ACTH stimulation test. Laboratory evidence of adrenal suppression (Cortisol < 6 µg/dl) observed in three patients one week after the first course of betamathasone injection and in 15 patienst after the second course. No sign or symptom of Addisonian Crisis occurred antepartum or intrapartum.Conclusion: Antenatal administration of Betamethasone caused measurable adrenal suppression in women at risk of preterm delivery.The number of women with adrenal suppression increased each week that antenatal betamethason was repeated.

Background: Early diagnosis, treatment, investigation and follow up of children with urinary tract infection (UTI) are needed to minimize renal scarring. The aims of this study were 1) to evaluate the ability of DMSA scintigraphy, ultrasound and biological parameters in detecting renal parenchymal involvement in children with acute pyelonephritis (APN) 2) to assess the relation between renal parenchymal changes and creatinine clearance 3) to determine the incidence of renal scarring after APN.Materials and Methods: We prospectively studied 54 children (median age 4.02± 3.41 range 1 month to 12 years) with first time symptomaticUTI. All patients had DMSA scan and ultrasonography within 5 days of admission. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), was measured at the time of infection, and voiding cystourethrography was performed in all children within 10 days. When scintigraphy showed renal parenchymal changes, repeat DMSA scan was done at least 3 months after initial infection. Results: Changes on the DMSA scan were found in 93/108 (85.5 percent ) renal units in 54 children during acute pyelonephritis. Among 42 children who had underwent repeat scintigraphy , renal scars were found in 9 of 16 (56.25 percent ) renal units in 8 infants under 1 year ,23 of 32 (71.87 percent ) in 16 children aged 1-5 years, and 33 of 36(91 percent ) in 18 patients older than 5 years. Ultrasonography showed renal changes in 20 of 108 (18.5 percent ) kidneys. Reflux was seen in 21 of 108 (19.44 percent ) renal units. The sensitivity of ESR, CRP, WBC, and ultrasonography was 78.5 percent , 64.5 percent , 69.9 percent , 18.5 percent respectively, and the specificity of them was 40 percent , 33.3 percent , 13.3 percent , 80 percent respectively. There was a positive correlation between renal parenchymal involvement and creatinine clearance level (p<0.001). We found no difference between groups with or without scars with respect to levels of ESR, CRP, and WBC. Conclusion: The present study suggest that DMSA scan may be a more reliable method of investigation than ultrasonography and biological parameters for identifying children at risk of permanent renal lesion. Additionally we found positive correlation between renal parenchymal change and creatinine clearance level. In order to detect persistent changes, it is suggested that DMSA scintigraphy should be performed at least three months after UTI.

Introduction: There are few studies of eyelid s neoplasm in Asia which in comparison of references are some differences. Materials and Methods: For this reason the retrospective study in 1103 patients which are referred to Farabi Hospital in 10 years period of 1988-1998 was performed. Epidemiological and histopathologic details were sough. Results: 44 percent of the neoplasm were benign and 56 percent were malignant. The most prevalent benign neoplasm of eyelid respectively were Nevus (37.7 percent) hamartoma (19.6 percent ) and papilloma (15.9 percent ) and malignant neoplasm of eyelid respectively were basal cell carcinoma (78.7 percent ), squamous cell carcinoma (11.8 percent ) and melanoma (2.4 percent ). The mean age in benign neoplasm was 36 years and in malignant ones 57 years. In benign tumors the most prevalent anatomical site respectively were upper eyelid, lower eyelid and inner canthus. But in malignant tumors it was occurred most frequently in upper eyelid in comparison to lower eyelid in addition occurrence of malignant tumors was prevalent in left but in benign neoplasm right and left eyelid were involved equally.

Background: Brucellosis is a zoonotic disease of worldwide distribution. Despite its control in many developing countries the disease remains endemic in Iran. The symptoms, signs and laboratory results are variable and nonspecific. This case series study was conducted to determine the liver complications of Brucellosis in Iran. Materials and Methods: We studied 188 patients (108 males and 80 females) with Brucellosis, fulfilled the diagnostic criteria, aged 1-79 years (mean 34.8 years) were registered in Imam Khomeini Hospital, a referral center in Tehran, during the six years (1995-2001). Results: Thirty-four of 188 cases (18.08 percent) had elevated liver enzyme (elevated SGOT only, 6 patients; elevated SGPT only 1 patient; elevation of both transaminases, 27 patients). The prominent symptoms included anorexia (74 cases), weight loss (62 cases), right upper quadrant pain (32 cases), epigastric pain (25 cases) and nausea and vomiting (23 cases). Among the gastrointestinal signs were found in these patients, hepatomegaly was seen in 28 patients. Jaundice and ascitis were present in only 7 and 3 patients, respectively. Other laboratory results showed elevated alkaline phosphatase in 28 cases and abnormal bilirubin in 10 cases. Fifty-seven patients had a focal illness, representing 30.32 percent of all patients. Osteoarticular complications were the most frequent focal forms, being present in 34 cases. Twelve male patients had genitourinary Brucellosis, representing 10.53 percent of focal forms. Also, 5 patients had neurologic complications. Conclusion: In conclusion liver involvement is frequent in Brucellosis, although the rate of this complication in our study was lower than other studies. So, in patients with evidence of overt clinical or laboratory findings compatible with liver disturbance etiologies other than brucellosis should be considered in Iran.

Background: During kidney and other organ transplantation, the organ to be transplanted, must inevitably remain out of the body with little or no blood perfusion at all for a long period of time (ischemia). These events have been suggested to cause the formation of oxygen- derived free radicals (OFR). Reperfusion (reintroduction of blood flow) will further exacerbate the initial damage caused by the ischemic insult and may result in the production of free radicals. The aim of this study was to investigate whether induction of brief periods of renal artery occlusion (ischemic preconditioning, IPC) can provide protection from the effects of a subsequent period of ischemia and reperfusion (IR) in the rat kidney. Materials and Methods: In this regard, 28 white, male rats were randomly and equally divided into four groups: Control (sham- operated), IPC alone, IR alone (30 min ischemia followed by 10 min reperfusion), and IPC- IR. Preconditioning involved the sequential clamping of the right renal artery for 5 min and declamping for 5 min for a total of 3 cycles. To demonstrate the effectiveness of IPC regimen, vitamin E as an endogenous antioxidant and an index of lipid peroxidation was measured by HPLC after its extraction from right renal venous plasma and right renal tissue. Results: Results of this study showed that the amount of vitamin E of renal tissue and venous plasma in the IR group had a significant decrease when compared to the control group (P< 0.0001). Whereas the amount of this vitamin in both renal tissue and venous plasma of the IPC- IR group was significantly higher than that in the IR group (P<0.0001), but did not show any significant difference with the control group. Conclusion: In this study, preconditioning method prevented the reduction of the endogenous antioxidant (Vit. E) in encountering the following sustained ischemic insult. Therefore, we suggest that ischemic preconditioning can be used to protect the Vit. E level of kidney from its subsequent decrease by ischemia and reperfusion.

Background: Since three decade ago, the application of the concept of finite element analysis (EEA) have received a keen interest among dental investigators. In practice the FEA provides detailed stress information regarding to a non-homogenious body such as craniofocal skeletal growth, tooth post ceramo-metal crowns and etc. The aim of this study was the determination of the influence of stress distribution at the cement interface of metal ceramic restoration-dentin. Materials and Methods: An idealized metal-ceramic crown model was developed. The model was divided into very small segments. Various loading conditions was applied to the model. A super sap software was used for analyzing the stress distribution. Results & Conclusion: The results of this study suggest that the higher shear stress was developed in the cervical region by two dimensional methods.

Ilio-sacral screw is a technique for posterior pelvic fixation. In spite of its benefits, it had not performed commonly in Iran because of its difficulties. We changed this technique to insert the screw under CT-Scan guide with lical anesthesia to increase image quality and decrease neurological complications and performed it in two patients. In both cases the screws were inserted in correct position without any complication.