مجله دانشکده پزشکی اصفهان
پیاپی 141 (هفته اول امرداد 1390)

Notwithstanding the fact that Radial keratotomy (RK) is now a neglected surgical method, patients and ophthalmologists are still dealing with its following complications such as hyperopic shift. This study was sought to assess the results and benefits of Photorefractive keratectomy (PRK) in complicated patients who had RK procedure in their clinical history.

This non-controlled clinical trial was carried out on 20 eyes pertaining to 17 patients with history of RK and presenting with significant refractive problems. All patients undergone Wavefront-guided (WG) PRK with Mitomycin-C and were followed for at least three months. Uncorrected distance visual acuity (UDVA), Corrected distance visual acuity (CDVA), total aberration, high order (HO) aberration and complications were compared between the status of patients before and after the procedure.

UDVA was averagely improved about 3 lines (P < 0.001). After the procedure 100% and 50% of subjects had visual acuity of ≥ 4.10 and ≥ 7.10, respectively, while; such frequencies prior to the procedure were about 55% and 0%, respectively. Moreover, 40% and 100% were at the idealistic refraction status of 1 D and 1.75 D, respectively. None of 20 subjects had decline of CDVA. Total aberrations were significantly decreased (P < 0.001) although changes of HO aberrations did not achieve significance level (P = 0.33) Three subjects manifested corneal opacity following PRK (two with grade II and one with grade I).

WG PRK has benefit in most of the cases and our current experience indicates the value of WG PRK in patients with history of RK.

BK virus belongs to the polyomaviridae family. It has been reported that up to 80% of normal population change to seropositive status between 5 and 10 years of age. It has been assumed that the rate of multiple virus isolation is significantly greater in children with acute lymphoblastic leukemia (ALL) than normal population. Considering the scarce data on the presence of urinary excretion of BKV in children with ALL, we studied the urine BKV in newly diagnosed leukemic children comparing with normal population. 62 subjects (31 all cases and 31 controls) were enrolled in the study. Epitelial cells isolated from urine samples were screened for the BKV DNA with PCR method. Positive PCR for urine BK virus was seen in 3 children (9.7%). No positive result for urine BKV was achieved in control group. However, Fisher Exact test did not show any significant difference between two groups (P > 0.05). In addition, there was no significant correlation between BKV positivity and frequency of relapses. Furthermore, the mean time of diagnosis was not different between BKV positive and negative groups. In our study there was not any significant difference between BK viruria in ALL children and control group, no case of BK viruria had been found in control group. To demonstrate the role of BKV in inducing ALL or increasing number of relapses, prospective studies on larger scale of population and evaluating both serum and urine for BKV are recommended.

Patients who suffer from traumatic peripheral nerve injuries receive temporary treatment after referring to hospital. Peripheral nerve repair surgery in some patients is done immediatly after damage but many of them get secondary nerve repair after longer periods of time. In this study we have compared the clinical and electrodiagnostic outcome among primary and secondary nerve repair. Patients with primary or secondary repair of median and ulnar nerves were enrolled in a non-randomized clinical trial prospective study. Information used in this study was collected from patients that passed a surgery to repair the peripheral nerve betwen years 2003 to 2010 in Alzahra and Ayatollah Kashani hospitals of Isfahan, Iran. Patients were followed by clinical and electrodiagnostic examination in the third, sixth, twelfth and eighteenth month after surgery and the outcome of recovery in their hand function (sensory and motor) were evaluated. 122 patients (64 men and 58 female) were enrolled in this study. 56 patients (45.9%) had a primary repair surgery and 66 patients (54.1%) had a secondary repair surgery. The age range were between 7 to 55 years (mean: 24.9 ± 8.9), with the mean of 25.6 ± 7.1 for primary group and 24.4 ± 9.8 for secondary group (P = 0.59). By using the Maan-Whitney test, primary group had better clinical sensory and motor recovery and also improvement in sensory NCV (Nerve conduction velocity) and EMG (Electromyogram) findings compared with secondary group (P < 0.05), but no significant difference was seen in motor NCV between 2 groups (P = 0.1). In this research we studied the result of primary and secondary repair in both median and ulnar nerve injuries. We concluded that clinical and electrodiagnostic outcome in primary nerve repair were better than secondary nerve repair, thus we suggest immediate repair after peripheral nerve injuries, when possible.

The P53 tumor suppressor gene plays important roles in genomic stability. G–to-C at codon 72 in the P53 gene has been associated with increased risk for lung, oral, prostate, breast, colorectal cancers and may be a marker for risk of skin cancer. This project studied the effect of P53 polymorphism on risk of nonmelanoma skin cancers (Squamous and basal cell carcinoma). This case–control study undertook for study of twenty basal cell carcinoma (BCC), twenty squamous cell carcinoma (SCC) and twenty specimens as controls for each cancer specimen in the city of Isfahan, Iran. Different P53 codon 72 genotypes were identified using polymerase chain reaction. In control samples, the frequency of Arg/Arg genotype showed 25% and in BCC specimens showed 60%. The differences in this genotype group between the cases and controls were statistically significant (P = 0.048). The differences in the frequency of heterozygot Arg/Pro and also in the frequency of Pro/Pro genotype between the cases and controls were not statistically significant. OR = 4.5 in BCC cases show that the risk for this disease in persons who have Arg/Arg genotype is about 4.5 times more than normal people. The results of χ2 test showed that in this study there is not statistically significant differences between the SCC specimens and controls for frequency of different genotypes. The present study indicate that P53 codon 72 polymorphism is a genetic predisposing factor for risk of nonmelanoma skin cancers (of BCC type) in Isfahan. However, further studies are needed in order to elucidate the role of P53 codon 72 polymorphism in skin cancer development.