MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:49 | Issue:91|Papers Count:25

Introduction: Intravesical chemotherapy or immunotherapy is the main point in treatment of superficial transitional cell carcinoma of bladder after performing TURBT1. But these methods have some limitations in terms of therapeutic response and the rate of complications. This study was performed to evaluate the complication rate, response to treatment and relapse of TCC2 after mixed chemotherapy with Thiotepa and Mitomycine C in comparison with immunotherapy by BCG. Materials and Methods: In this clinical trial a total of 140 patients who admitted in urology department of Ghaem and Musa- Ebne -Jafar Hospital due to superficial TCC, were divided into 4 groups of 35. After TURBT, patients in first group were treated by Thiotepa, on second & third group we used monotherapy with Mitomycine C, BCG, respectively. So in the last group mixed therapy with Thiotepa plus Mitomycine C was performed.All patients in each group were followed by physical exam, lab tests (CBC, U/A) and cystoscopy every 3 months for the first 2 years, and then every 6 months until the end of study. CBC tests were performed before and after 8 weeks of every of therapy. Then gathering data was analyzed through statistical methods.Results: In this study, maximum prevalence rate of TCC was in 7 and 8 decades with an average of 66 years old. In patients there was 3.5% TIs, 43.5% stage Ta and 53% stage T1 Tumors were mostly seen in the lateral walls and the base of bladder (94%). In the group which treated with intravesical BCG, the recurrence rate of carcinoma was apparently lower than other groups and the remission's time was longer. The highest incidence rate of acute cystitis was seen in BCG-Therapy group, while in the mixed therapy group was lowest. Hematologic and allergic side-effects were significantly lower with mixed therapy in comparison with monotherapy methods.Conclusions: Rate of recurrence in BCG-therapy is lower but its complications, especially acute cystitis, is common. Administration of mixed therapy has been successful in reducing complications (both systemic and local); but the therapeutic response was like the monotherapy treatment.

Introduction: Diuretic renal scan is preferred noninvasive investigation in evaluating upper urinary tract function and assessing upper tract dilatation or obstruction. There are several protocols for diuretic renal scan which are named according to timing of diuretic adminstration before, after or at the same time of radiopharmaceutical injection. Timing of diuretic administration is not universally standardized in renography. In the present study we compared F- 15, F+20 diuretic renography protocols in patient with upper urinary tract dilatation.Material and Methods: From Feb 2004 to Nov 2005, 21 patients were referred with flank pain and pyelocalyceal system dilatation without ureteral dilatation in ultrasonography and after history taking, physical exams and radiological studies such as IVP, retrograde pyelogram, serum creatinin measurement and urine analysis, F-15 and F+20 diuretic renal scans were performed. The pharmaceutical drug in this study was TC-EC (Ethylene dicysteine). Renal function data, curves and renograms were recorded and patients were undergone conservative or surgical therapy and followed up with physical exams and IVP or diuretic renal scan after 3-6 months and then we compared results with two diuretic renal scan protocols.We used marginal homogeneity test to compare renograms and paired t-student tests to compare renal function in two protocols.Results: Among 21 cases, 15 were male and 6 were female. Mean age was 16.3:1:25years. Left pyelocalyceal system dilatation was reported in 15 cases and right side dilation was seen in 6 cases. Chief complain of patients was flank pain. Ultrasound showed pyeloca1yceal dilatation without uretral dilatation. IVP findings included delayed pyelogram and pyelocalyceal dilatation without seeing the ureter. Of all renal diuretic scans, 52.2 percent of patients had obstruction pattern in F-15 and F+20 protocols.Results were equivocal in 23.3% ofF+20 scans whereas they had complete obstructive pattern in F-15 scans.14% had normal pattern in F+20 and F-15 scans. 9.5% had nonobstructive pattern in F+20 but equivocal or obstructive pattern in F-15 scans. Obstructions were diagnosed in 52.2% of patient by F+20 scan and in 75.5% by F-15 scan. Renal split function didn't change in F-15 and F+20 diuretic renogram protocols.Conclusion: According to. the equivocal results of F+20 diuretic renal scans, F-15 can reduce equivocal results of F+20 diuretic renal scans. Of course we recommend future investigations to approve or disapprove this hypothesis.

Introduction: Circumcision is the most common surgical procedure. As same as other superficial operations, they cause not only severe postoperative pain but also are accounted a severe intraoperative stimulation. There are many anesthetic techniques for circumcision. It seems supplementary penile block to general anesthesia is the best approach. Our aim in this study is to evaluate the efficacy of sub pubic approach to dorsal penile nerve block in relieving postoperative pain. Material and Methods: This descriptive study was done in Dr Sheikh Pediatric Hospital during summer of 2004. Sub pubic approach to dorsal penile nerve block was evaluated in 60 boys. Two injections were performed with plain Bupivacaine 0.5%, 0.1 ml/kg in each side (total 0.2 ml/kg) at puncture sites, which had been marked before, just 0.5 to 1 cm blow pubic symphisis and lateral to midline in the supine position. Postoperative pain was evaluated with two methods, FLACC and Wong & Baker, and parental report up to 24 hours after general anesthesia. Collected data was analyzed by using descriptive and analytical statistics.Results: Two cases (3.3%) were excluded. Two patients (3.4%) experienced moderate pain postoperatively. Others (96.5%) were completely pain free up to 24 hours after procedure. No complications occurred. There was no relationship between needle length and patients' age. Conclusion: According to this and previous studies, although there is little experience, this technique is the most successful and safe approach for intra and postoperative long (up to 24h) pain relief that with some experience is also very easy.

Introduction: Renal anemia is one of the most frequently observed complications in patients undergoing chronic hemodialysis (HD). Reduced red blood cell survival due to oxidative damage is one of causes of anemia in these patients. Vitamin E (alpha - tocopherol) is a natural biological antioxidant, which protects red cells from these effects of reactive oxygen metabolites and could be useful as a collateral therapy for anemia in HD patients. The aim of the present study was to investigate the potential beneficial effect of anti oxidant vitamin E supplementation (oral) on renal anemia and to find out whether this improvement mechanism is attributable to the enhanced hematopoietic function or to prolonged RBC life Material and methods: This clinical trial study included (8 cases with mean age 14±2.9 years and 7 controls with mean age 14±2.7 years) stable children on chronic hemodialysis, at hemodialysis center in Sheikh Children Hospital- Mashhad. At the time of entry, there was no evidence of iron deficiency or history of blood transfusion. All of children (case and control) received subcutaneous erythropoietin (EPO) 120±80 u/kg/BW/week, Folic acid 1 mg/day and Iron 1-2 mg/kg/day. Oral vitamin E 200 u/day for 3 months was prescribed to cases only. Laboratory parameters determined at the beginning of the study were: Iron, Ferritin, Transferrin, Total Iron binding capacity, Hemoglobin (Hb), Hematocrit, Reticulocyte count and peripheral blood smear. Hb and HCT were checked every month during the study and the results were compared to those obtained earlier.Results: Prescription of oral vitamin E for 3 months resulted in significantly higher levels of Hb and Hct in cases compared to those in controls (11.4±1.7 vs. 10.1±1.9Hb and 35.3±5vs. 31.3± 6 Htc, P< 0.05).Conclusion: Antioxidant vitamin E supplementation improves renal anemia by decrease of oxidative stress and RBC life span in hemodialysis patients.

Introduction: Although new treatments have prolonged survival and improved quality of life in the patients with major Thalassemia, endocrine complications especially hypogonadotropic hypogonadism still occur. The objective of this study is to determine prevalence and risk factors of hypogonadism in 47 patients with major Thalassemia.Material and Methods: 47 patients with Thalassemia major aged 14 years and older were studied. Those who had any other problems were omitted from this study. Serum level of LH, FSH, Testosterone, Estradiol were measured and correlation with parameters including duration of transfusion, duration and dose of Desferal treatment, Ferreting level and pertinent clinical findings was evaluated and compared in groups of patients with and without hypogonadism. Results: Short stature and underweight was seen in 68/1% of patients. Mean hight was 151 ± 10.2 and mean of weight was 43.5 ± 8.4 . Hypogonadotropic hypogonadism was seen in 63/8 %. The prevalence of hypogonadism was more in males than females (p= 0.025). No significant correlation was found between duration of transfusion, duration and dose of Desferal treatment and Ferretin level with hypogonadism.Conclusion: Endocrine complications of Major Thalassemia is frequent and factors other than iron overload including zinc deficiency or genetic differences may influence susceptibility to hypogonadism.

Introduction: In conventional treatment of Pemphigus Vulgaris use of adjuvant and initial dose of Corticosteroid affect the healing of lesions in patients. The aim of this study is to evaluate the epidemiology and clinical features of Pemphigus Vulgaris patients and to compare the criteria of response to treatment in various initial doses of Prednisolon and also to study the effect of Immuran as an adjuvant.Material and Methods: In this retrospective study on Pemphigus Vulgaris patients admitted in Qaem hospital in Mashhad during the past 10 years, 63 patients were included and epidemiologic parameters, clinical features, treatment agents and criteria of response to their treatment (time of stopping the development of new lesions, time of onset of healing, time of tapering dose of steroids) were studied.Results: The average dose of Steroid and Immuran was 1.15±0.47 mg/kg/day and 2.2±0.9 mglkg/day, respectively. The average time of stopping the development of new lesions was 10.49±8.7 days, starting healing lesions, 10.75±7.86days and tapering the dose of steroid was 3.75±2.35days.Use of Immuran in treatment of patients had a statistical relation (p=0.048) with the time of tapering dose of Steroids, although it had no such relation with the first and the second criteria of healing (p=0.312 and p=0.1) respectively. On the other hand, initial dose of Immuran in  mg/kg/day had no statistical relation with three criteria (P values were 0.328, 0.136, 0.467 respectively), whereas initial dose of Preadnisolon showed statistical relation with the onset time of healing (p=0.000) but not with time of tapering or stopping new lesions. (P>0.05) Conclusion: No relation between the time of tapering of Steroid and the other twp objective criteria of response (the time of stopping new lesions and the onset time of healing), may be due to individual decision for tapering the dose of Steroid.And probably use of Immuran as an adjuvant, has related only with onset of Steroid tapering (but not two other objective criteria)

Introduction: Despite many studies, the base of formation of hyperplasia and malignancy is unknown. Prostate cancer is the second most common malignancy in men all over the world. The extracellular matrix (ECM) contains a number of macromolecules that may influence normal and neoplastic growth of tissues.The pericellular glycosaminoglycan chondroitin sulfate (GAG/Ch.s) has been ascribed roles in cell-cell adhesion, cellular matrix adhesion, cellular migration and embryological morphogenesis. In this research changes of concentration of ch.s in BPH and prostate adenocarcinoma studied. Material and Methods: Formalin-fixed samples of BPH and adenocarcinoma were taken from patients by surgery (prostatectomy). According to their histological characteristics (with H-E staining), samples were confirmed as BPH or prostate cancer by a pathologist. All samples were fixed in PBS-formalin, processed in standard laboratory protocols, and embedded in paraffin wax. Samples were sectioned in each 5 µm. Then critical electrolyte concentration (CEC) alcian blue staining (ph=5.8) was performed. Results: The concentration of GAG/chondroitin sulfate in ECM was significantly higher in denocarcinoma as compared to BPH especially in the stromal-epithelial interface. In BPH, luminal surfaces were moderately stained of ch.s but poorly stained of the adjacent fibromuscular stromal tissues or were not stained at all In adenocarcinoma chs revealed an intense pricellular-staining pattern, the most intense staining was observed in the base membrane.  Conclusion: Changes of concentration of GAG/ ch.s between BPH and adenocarcinoma were totally different (and specific). The increased ch.s may be a response or requirement for epithelial growth or cell division. Therefore, the intensity of GAG/Ch.s in prostate stroma may be a useful biomarker of disease progression in prostate cancer.

Introduction: Hyperlipidemia (HL), especially when started during early childhood will increase the risk of atherosclerosis. It is also a major risk factor for allograft nephropathy and post-transplant HL, so Its treatment is highly suggested.Material and Method: In this study, the effect of oral L- carnitine on the lipid profile of children with end stage renal disease (ESRD) on maintenance hemodialysis (HD) after a 3-month period was evaluated.Results: Twelve out of 15 children (80%) had abnormal lipid profiles at the beginning of the study. HDL-C level increased in all of them following the treatment (P<0.001).No significant change occurred in the level of Triglyceride, Cholesterol, LDL-C, VLDL-C, but the ratio of TG/HDL-C as a major risk factor for cardiovascular disease decreased significantly (P=0.004). Conclusion: Dyslipidemia is common in hemodialysis children. In this study, short term Lcarnitine Administration (3 months) had major effect on HDL-C level increment; a longer administration may affect other components too.

Introduction: Hemarthrosis is the most common sign of severe hemophilia type A in all ages which leads to irreversible complications in joints. These Complications cause morbidity and high expenses that could be decreased by a good organized therapeutic and prophylactic management. There is not any standard quantitative scoring system to evaluate the complications of joints, used in our country systematically and we have not any published data about it. In this study, Petterson and Gilbert's scoring system has been used to evaluate joints status in a cross sectional descriptive analytic manner.Material and Method: Twenty out 32 cases of the severe hemophilia type A patients who came to Ali Asghar hospital in 1381, were included on our study. Based on Petterson & Gilbert's scoring system, knees, ankles and elbows were selected joints. Physical examination was first done by a pediatrician and confirmed by an orthopedic surgeon PA and lateral X-ray of selected joints were reported by a radiologist .All of the above physicians were fix during the study. Finally we  reported our results in tables and charts and analyzed with SPSS (One-way Analysis of Variance, Wilcoxon Matched-Pairs, Kruskal-Wallis).Results: In this study, the most common radiological pathologic finding was osteoporosis (32.5%) and the rarest one was erosion at joint margin (3.3%). In physical examination,  decreasing in range of motion (35%) and instability (0%) was the most common and the rarest pathologies. The most involved joints in radiology and physical exam were right knee (28.7%) and left knee (19.3%) and the rarest one's were left ankle (13.7%) and left elbow (10.6%). The severity of complications (both physically and radiologically) has been related with the titer of inhibitor, but there was not any correlation with age (one-way analysis of variance). There was not any statistically significant difference between radiologic and physical scoring in every joint.Conclusion: Our findings showed that the majority of our patients had at least one joint involvement (85% physically and 75% radiologically).On the other hand, 45% of 120 evaluated joints had radiological problems and 55% of them were physically insult. This high prevalence of morbidity explained the cause of high expenses for treatment of patients in this province. To increase in titer of inhibitor is the main factor for increasing of morbidity. Considering high morbidity in our patients, the statistical similarity between joints complications in different age groups, showed the importance of prophylaxis protocols for them obviously. It seems there is no relation between radiological scoring and physical score, except for left elbow joint (Wilcoxon Matched-pairs, P=0.454). Pain is a good alarm, but it had no effect on scores. Prevalence of involved joints can be dependent on kind of culture.

Introduction: Epidemiological Knowledge about the psychiatric inpatients is critical in treatment plans. In this study we answered the epidemiology of admitted patients in the only psychiatric hospital of Khorasan province, Ebn-e-Sina Hospital in the first half of year 1382.Material and Methods: In this cross-sectional study, a questionnaire was filled for all inpatient during the first half of the year 1382 based on their documents. 889 people were recommended for admission, from which 863 were admitted. Among them, profiles of 810 were accessible. Data were analyzed by SPSS and Excel software.Results: 28% of patients was female and 72% male; aged from 21-40; 73% was urban residents;55% unemployed, 18.5% housewife, and the rest were employed.22% had previous histories of admission, 28% used substance, of witch the most common was opium. 22% of diagnoses was BMD-I, 12% schizophrenia, 9.5% PTSD, and 7.5% substance related disorder, mental retardation and psychiatry problem due to general medical conditions or substances Conclusion: Since the most common reasons of admission were severe psychiatric disorders such as Schizophrenia and Bipolar disorders proper, plans for management of patients seem needed.

Introduction: Fiberoptic bronchoscopy has profusely been used in many hospitals recently. Generally, hypoxemia is very common with fiberotic bronchoscopy. Material and Methods: We studied 188 patients under going bronchoscopy of which 106 were male and 82 were female. Their average age was 52.2 ± 17.8 years. Before bronchoscopy, all patients have %Sao2 more than 92% and they were under oxygenation with nasal cannula. %Sao2 was recorded in any segment of airways, BAL and Biopsy.Results: Arterial O2 saturation shortage was significant in Carina- during BAL and Biopsy. Reduction of %Sao2 in female was less than male. In old age patient, reduction of %Sao2 was increased. Conclusion: Hypoxemia is a very common complication during bronchoscopy. Hypoxemia in carina and during BAL and Biopsy is significant. BAL is associated with greater levels of oxygen desaturation than when lavage is not done. Thus we recommend all flexible bronchoscopy patients should have pulse oximetry monitoring.

Introduction: Acute myelopathy is defined as an acute spinal cord dysfunction initiated during less than 2 weeks.Many of these spinal cord dysfunctions are reversible if quickly recognized and treated, on the contrary. If recognized late, irreversible damages are expected.Material and Methods: In this prospective, descriptive, cross - sectional study which done in patients who admitted in neurology emergency of Ghaem hospital (2002 - 2005), we supposed acute myelopathy base on history and Clinical findings for patients with paraparesia or tetraparesia and we completed questionnaire for all them. Based on laboratory findings, X-ray, MRI, Cerebrospinal fluid (CSF) and pathology, etiology of acute myelopathy was definited or was strong probability.Results: From 42 cases with acute myelophathy, 19 cases (45%) had myelitis, 16 cases (37%) was secondary to tumor, 5 cases (12.5%) vascular, 1 case (2.5%) structural (stenosis of spinal cord canal due to klipple fiels), 1case (2.5%) central herniation. Conclusion: Results from this study (like other studies) indicate that non - infectious myelitis is the most common etiology of acute myelopathy but in this study post – infectious myelitis was observed more than MS as the etiologic agent of acute myelopathy; but in other studies, MS was most common agent.

Introduction: Altered thyroid function in patients with non-thyroidal illnesses a usuall finding and These biochemical changes called sick euthyroid syndrome (SES). Our propose from this research is to estimate the relative frequency of SES and prognostic relevance of alteration in thyroid function indices in critically ill patients whom admitted in ICD. Material and Methods: This prospective analytical study was preformed in Imam Reza Hospital intensive care unit patients.A specimen of venous blood was collected within the first. 24 hours of admission for the evaluation of the baseline thyroid function indices and second specimen was collected at the time of patient death or discharge from ICD. T4, T3 (RIA) T3 RD (RIA method), TSH (IRMA) and free T4 (Direct one step RIA) were measured for all patients.Results: There were 29 males and 21 females, with age range of 16 to 83 years and mean age of 44 years (44±21.9). Thirty three patients ( 66%) showed evidence of SES and 17 patients ( 34%) were as non SES group.Mortality rate in SES and non -SES group was 24 and 3 patient respectively (72% vs. 17.6%, P< 0.01) The commonest profile of thyroid indices was isolated low total T3 (type I SES), and then Combined low total T3 & T4.(Type II SES) We found low (T3) (type I) in 51% of patients, and low T3 and T4 (type II) in 49% of them Relative morality rate have not any difference in two groups.Comparison of mean values of thyroid indices between single system and multi system illness groups showed statistical difference in TSH (P= 0.05) and FT4. (P=0.031) Comparison of thyroid indices between two survived and non survived group showed statistical difference in T3 (p = 0.047) and T4 (P=0.036).Predictive value of normal T3 with good outcome measured 82% against 54% for normal T4. Conclusion: Relative frequency of SES in our patients was 66% and in them thyroid hormones have statistical relation with final outcome and severity of underling illness.

Introduction: Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinoma of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery.Material and Methods: 411 patients underwent cholecystectomy for gallbladder disease in the department of surgery, Imam Reza hospital between 1995 and 2000. Benign polyps were present in 32 gallbladders and malignant polyps in 8 patients.Clinical data, age and sex distribution, symptoms and evaluation of preoperative diagnosis were correlated with the pathology of polyps were reviewed.Results: In 411 patients undergoing cholecystectomy benign polyps were present in 32 gallbladder and malignant polyps in 8. Cholesterol polyps account for most of benign lesions and all malignant lesions were adenocarcinoma. Gallstone coexisted in 50% of malignant lesions. 69% of patients with benign lesions were under 60 years, whereas 75% of malignant lesions were over 60 years. 94% of benign lesions were less than 10 mm in diameter, while 88% of malignant lesions exceeded this size.Conclusions: Most small polypoid lesions of the gallbladder are benign and remain static for years. Age more than 60 years and polyp size more than 10 mm are the most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstone, solitary polyps and symptomatic polyps. Cholecystectomy is the treatment of choice.

Introduction: Carpal Tunnel syndrome is the most common peripheral nerve entrapment, which is due to median nerve compression in carpal tunnel in anterior portion of the wrist. Phalen and Tinel tests are common clinical diagnostic tests. This study assessed sensitivity and specificity of Tine! and Phalen tests. Material & Method: This is a descriptive study of patients who came to electro diagnostic center of Emam Reza hospital of Mashbad during 18months. E.M.G and N.C.V are standard diagnostic tests in the most articles and also our study. This study was done on 771 cases (1223 hands).Data were studied in validity table of clinical tests compare to Para clinical tests.Results: Our finding showed 86% sensitivity and 75% specificity for clinical tests. Most of patients aged 40-50 years. Female to male ratio was 7/1. % 30.5 was severe. % 40 of severe cases had Thenar atrophy. The most symptoms were paresthesia, pain, nocturnal hand paresthesia. There were 6 double crush syndromes.Conclusion: Concordant findings of Phalen and Tinel tests have acceptable sensitivity, specificity, and positive predictive value but we also suggest other tests for exact diagnosis.

Among patients with end stage renal disease (ESRD), anemia increases the rate of mortality, and low hemoglobin (Hb) levels contribute to an increased rate of hospitalization and shortened survival.The prevalence of left ventricular hypertrophy (LVH) increases as chronic renal progresses and anemia worsens. In fact, as many as 45% of Chronic Renal Dieses patients with Hb levels of < 11.4 g/dl manifest LVH [1] .The clinically ideal threshold Hb for the initiation of erythropoietic agents in , early Chronic Renal has still not been established. This uncertainty is reflected in the differences in the recommended threshold Hb for the initiation of treatment in the United States, and in Europe. In the United States, the threshold is reached when Hb levels decrease to < 109 Idl; in Europe, the threshold is reached when Hb levels drop to < 11g/dl [2]. The main goal of treatment is to reach the recommended target hemoglobin level of> 11/dl [European best practice guidelines (EBPG)] or target hemoglobin level of 11-12 g/dl [the national kidney foundation kidney disease outcomes quality initiative (NKF-K/DOQI)] while also increasing the effectiveness of therapy to optimize the cost :benefit ratio of anemia therapy [3]. To date, no study has found increased mortality with normalized Hb levels in patients with ESRD who do not have heart failure. On the other hand, several investigators have shown multiple benefits from Hb levels of 12 g/dl or greater[4]. In Chronic Renal Disease ,anemia appears earlier in men than in women, yet the recommended threshold Hb level for the initiation of EPO as well as the target to be attained (11-12 g/dl) remains equivalent for both genders[5] .The authors found that the early initiation of EPO in pre-dialysis patients with no severe anemia significantly slowed the progression of Chronic Renal Disease and delayed the initiation of renal replacement therapy[6].Hypo response to EPO is a problem in patients with ESRD. Iron therapy is vigorously advocated for renal anemia management. An analysis of data United States renal data system shows trends in the use of IV iron not explained by clinical indications. With the current pattern of IV iron use in patients with ESRD, the potential exists for excess accumulation of iron in the body [7]. Feldman et al found no statistically significant association between any level of iron administration and mortality, suggesting that confounding may have been responsible for their previous finding of an associated higher mortality [7]. Erythropoietin (EPO) deficiency is the main cause of anemia in uremic patients, but many other factors interfere with erythropoiesis and worsen anemia in hemodialysis (HD) patients. The main ones are GI bleeding, hyperparathyroidism, aluminum toxicity, toxic metabolites and deficiency of iron, foliates and vitamin B12. There is increasing evidence that oxidative stress plays a key role in the genesis and severity of dialysis anemia [8]. Oxidative stress corresponds to an imbalance between the production of reactive oxygen species (ROS), mainly the super oxide anion ,hydroxyl radical and protective mcchanisms. several enzymatic systems can detoxify ROS; Copper/Zink super oxide dismutase catalyses the conversion of super oxide anion to H202. In addition some micronutrients can prevent ROS harmful effects by nonenzymatic modes: reduced glutathione, a-Tocopherol or Vitamin E, which leads to formation of α-Tocopheroxyl radicals [8].Journal of Mashhad University of Medical Sciences No.90, Spring 2006 17 Oxidative stress reduces RBC survival, impairs the effect of EPO, and increases the susceptibility to hemolysis due to inflammatory, infectious and mechanical stimuli. The oxidative stress is enhanced in HD patients because Polymorphonuclear (PMN) leukocytes, activated by the contact with dialysis membranes, produce large amounts of oxygen free radicals [9].All these observations suggest that antioxidants could be useful as a collateral therapy for anemia in HD patients [10]. There is increasing evidence that EPO itself interferes with the oxidative event, but it is still not clear whether it enhances or has a protective effect against the oxidative stress). From these studies it appears that proper control of the oxidative status is essential to optimize treatment with EPO [11].Some encouraging results have been obtained with oral vitamin E, or a vitamin-E modified membrane, and reduce the oxidative stress in plasma and cells and the activation of leukocytes [12].One of the aims of this study is to evaluate the oxidative stress after treatment with oral vitamin E. Therefore, serum level of MDA, Alfa tocopheroxyl, glutathione and SOD in RBC has to be measured. As the level of α -Tocopheroxyl in RBC should be measured, it can not be concluded from this study that treatment with vitamin E significantly increase Hb level. Furthermore the study has not shown any benefit in responsiveness to EPO.It would have been better if some exclusion and inclusion criteria were added. Especially KT/V more than 1.2 is needed in inclusion criteria and hyperparathyroidism and hematologic disorder are needed in exclusion criteria.

Introduction: Deciduoid mesothelioma is an unusual morphologic variant of epithelial mesothelioma that closely simulate peritoneal decidusis, florid mesothelial hyperplasia and peritoneal metastatic carcinoma.Case report: We reported a rare case of epithelial mesothelioma with deciduoid features in a 12 years old girl with abdominal tightness and swelling and weight loss without history of asbestos exposure.CT scan and Sonography showed severe ascitis and multiple masses in peritoneal cavity. In the time of surgery very much fluid was evacuated and a multicystic huge mass occupying the pelvis was resected.In histopathologic examination malignant desiduoid epithelial neoplasm with psammoma bodies was seen which cells were positive for Vimentin, Cytokeratin, EMA, Calretinin.

Introduction: We presented two non-addicted patients with Tricuspid valve endocarditic. The first patient was a 38-year-old diabetic female with; fever chills, anemia, and microscopic hematuria and pyuria that occurred during several weeks. The plain radiography of chest was normal and high resolution computed tomography (HRCT) of chest, was done because of predominant pulmonary symptoms and signs that revealed consolidation and cystic formation in the left parynchyma. Based on these findings in HRCT we decided to start anti-tuberculosis treatment, but no significant response was seen. Tran's Thoracic Echocardiography (TTE) was done and revealed large vegetation of Tricuspid valve. The second patient was a 45 -year-old man who admitted with acute fever and left lower lobe infiltrate and systolic murmur. TTE was normal but Trans Esophageal Echocardiography showed large vegetation on the Tricuspid valve. Staphylococcus aurous grew in 2/3 blood cultures. We suggest that right-sided endocarditic must be considered in any patient with fever and recurrent pulmonary symptoms and signs, with or without abnormal chest X- ray, heart murmur or intravenous drug addiction.