مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و یکم شماره 12 (پیاپی 156، اسفند 1392)

Colorectal Cancer (CRC) is the third common cancer in the world. One of the pathways in colorectal tumor genesis is Microsatellite Instability (MSI+). MSI is detected in about 15% of all colorectal cancers. Colorectal tumors with MSI have dis-tinctive features compared with Microsatellite Stable (MSS) tumors. Due to the high percentage of MSI+ in patients with CRC in Iran، screening of this type of CRC is im-perative. In current study، two markers (BAT-26 and BAT-25) were used to determine an appropriate screening technique with high sensitivity and specificity to diagnose MSI status in patients with CRC. Allelic variation in two markers (BAT-26 and BAT-25) was analyzed in tis-sues and sera of 44 normal volunteers and tumor and matched normal mucosal tissues as well as sera of 44 patients with sporadic colorectal cancer by Real Time PCR (Hy-bridization probe) and High-Performance Liquid Chromatography (HPLC) techniques. The sensitivity and specificity of Real Time PCR and HPLC compared with sequencing as gold standard. The data were statistically analyzed using Student’s t-test and 2 or fisher exact test، where applicable with (P<0. 05). Receiver-operating-characteristic (ROC) curves were used to evaluate the sensitivity and specificity. The sensitivity and specificity of BAT-26 with Real Time PCR method (Hy-bridization probe) were 100% in comparison with gold standard method. Whereas the sensitivity and specificity of BAT-26 and BAT-25 with HPLC were 83%، 100% and 50%، 97%، respectively. Neither HPLC nor Real time PCR could detect circulating DNA with MSI property in sera. The sensitivity and specificity of real time PCR in MSI detection is the same as sequencing method and more than HPLC. BAT-26 marker is more sensitive than BAT-25 and MSI detection with Real time PCR could be considered as an accu-rate method to diagnose MSI in CRC tissues not sera.

Varicocele is a dilated vein of the pampiniform plexus that cause to det-rimental time-dependent effects so this study describes the effect of varicocele on the level of IL-6 and interferon gamma in serum and testis tissue، number of sertoli and spermatogonia cells، seminiferous tubules diameter and sperm activity in immature rats. Thirty six immature rats، 5-6 weeks aged were investigated in this study. The sham groups underwent sham operation and varicocele groups underwent partial liga-tion of the renal vein. Serum، testis and sperm samples were collected at 9، 11، and 13 weeks after induction of varicocele or sham operation to evaluate histological parame-ters (seminiferous tubules diameter، number of sertoli and spermatogonia cells)، per-centage of sperm motility and viability and levels of cytokines. Testicular morphology was evaluated. Varicocele significantly caused an increase in serum and testis IL-6 and inter-feron gamma، compared to related sham groups and previous varicocele groups (P<0. 05). Varicocele significantly caused decreases in sertoli cells and spermatogonia cells number with increasing varicocele time، compared to related sham groups and previous varicocele groups (P<0. 05). In the evaluation of seminiferous tubules diameter external، internal and epithelium diameter were decreased compared to sham related groups and previous varicocele groups. In all varicocele groups، all kind of sperm motility and viability decreased compared to the related sham-operated groups (P<0. 05). Varicocele had deteriorating effects on testis tissue because our observations in varicocele groups demonstrated that the external، internal and germinal epithelium height was reduced by the time and in the evaluation of testicular cells، sertoli and spermatogonia cells number were decreased by the time compared to sham related groups and previous varicocele groups. This study suggests varicocele had a detrimental time-dependent effect on cytokines levels and decrease in sertoli and spermatogonia cells number، seminiferous tubules diameter and sperm indices.

Calcium channel blockers have an important role in treatment of various cardiovascular diseases including hypertension، angina pectoris and cardiac arrhythmias، so study of cardiovascular effects of derivatives of these drugs are useful. Nifedipine is one of these drugs that used widely to treat hypertension and other cardiovascular diseases. The aim of the present study was to evaluate the central effects of synthesized dihydropyridine derivatives on systolic blood pressure and heart rate of rats and comparison to nifedipine. Sixty four male rats، after induction of anesthesia and intracerebral ventricu-lar cannulation using stereotaxis method، were divided into eight equal groups. One week after the stereotaxis surgery، the systolic blood pressure and heart rate were eval-uated in times 15 to 60 minutes after intracerebral ventricular injection of DMSO (di-methylsulfoxide) and nifedipine in doses of 80 to 320 microgram/rat and also three synthesized dihydropyridine derivatives (A، B and C) in dose of 240 microgram/rat. Effects of these drugs on systolic blood pressure and heart rate were analyzed using two way repeated measure ANOVA statistical test، followed by Bonferroni posthoc test. All data were considered significant at P<0. 05. The inhibitory effects of derivative B on systolic blood pressure and heart rate in dose of 240 microgram/rat in times of 15 and 30 minutes after injection were more potent than nifedipine (P<0. 001)، while A and C derivatives showed weaker inhibitory properties، compared with nifedipine. Also the inhibitory effects of derivative B on heart rate in dose of 240 microgram/rat were stronger than nifedipine in times of 15 to 60 minutes after injection (P<0. 05). Novel dihydropyridine derivatives can possess more potent and stable in-hibitory effects on systolic blood pressure and heart rate، and some part of these properties at least، can be attributed to their direct inhibitory effects on brain neurons.

Many drugs have been abused by patients for headache management. Celecoxib has not been abuse widely as a pain relief drug for headache. The aim of this study was comparison between celecoxib and prednisolone in bridge stage therapy following medication overuse headache. A double-blind randomized clinical trial was done in patients admitted to a private headache clinic in Tehran، Iran at 2012. Patients were selected with 18- 65 years old and 15 days headache per month at least. Prednisone was administered as a 75 mg/day، 50 mg/day، 30 mg/day، 25 mg/day and 10 mg/day dose، in 3 days interval. Celecoxib was administered as a 100mg dose three times per day (first 5 days)، twice per day (second 5 days) and one time per day (third 5 days). Headache time، headache intensity، headache duration، analgesic consumption due to severe headache and drug side effects was assessed. We used the visual analog scale to determine the severity of the pain. One hundred and three patients were enrolled in two groups: celecoxib (53 cases) and prednisolone (50 cases). Twenty and one men and eighty and one women with a mean age of 33. 62±9. 65 years participated in the study. The maximum fre-quency for headache time in the celecoxib group was 1-4 hours (19 cases) and more than four hours (19 cases). In the prednisolone group the maximum frequency for headache time was more than 4 hours (28 cases) (P=0. 149). The frequency of side effects of prednisolone and celecoxib groups were 42% and 18. 9%، respectively (Relative Risk=2. 2، P=0. 011). The most common side effects in both groups were weakness and lethargy. Considering the positive effect of both drugs in reducing patients'' head-ache during withdrawal، celecoxib compared with prednisolone has better efficacy and fewer side effects.

Atrial fibrillation is the most common arrhythmia after cardiac surgery. Vitamin C as an antioxidant has an important role in reducing the incidence of postop-erative atrial fibrillation. The present study aimed at administrating vitamin C as a way to reduce the incidence of post-CABG atrial fibrillation. In this double-blind، parallel clinical trial، 170 patients with coronary artery disease who underwent CABG surgery، by using a table of random numbers are di-vided into intervention and control groups to receive placebo or vitamin C. The clinical and surgical characteristics of the patients in the two groups were similar. The interven-tion group received 2 mg of vitamin C intravenously، the night before surgery. This drug followed by 500 mg، twice a day for five days after surgery. On the other hand patients in the control group received placebo (normal saline intravenously). After operation two groups were compared regarding Important outcomes such as postoperative arrhythmia، ICU stay and hospital stay. One hundred eighteen men and fifty two women with a mean age of 59. 1±9. 8 years were enrolled in the study in two vitamin C and placebo groups (each consisting of 85 patients). The incidence of postoperative atrial fibrillation was 12. 9% in the vita-min C group and 29. 4% in the control group (P=0. 009). ICU stay in the vitamin C group were 2. 5±1. 4 days versus 3. 0±1. 6 days in controls (P=0. 035) and hospital stay in the vitamin C group were 6. 6±1. 5 days versus 8. 2±2. 3 days in controls (P<0. 001). Vitamin C is relatively safe، inexpensive، well tolerated and has a low complication. According to the 44% reduction in the incidence of atrial fibrillation in vitamin C patients undergoing coronary artery bypass grafting surgery، this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

Severity of respiratory infection in children is depended on various fac-tors such as causative organism and the host immunologic response to the organism. Vitamins and micronutrients play an important role in this response with supporting the immune system and therefore، the response to infections. Nutritional deprivations in children، especially vitamins and micronutrients such as zinc، vitamin A and vitamin D are very common in middle east and other countries in Asia، which is due to inappro-priate diet and nutrient loss in recurrent infections. This study aimed to evaluate the se-rum levels of vitamins A، D and zinc in hospitalized children aged six months to five years. This analytic cross-sectional study was performed in 65 children aged six months to five years who were hospitalized in pediatric and surgical wards of Rasul Akram Hospital and Bahrami Hospital in Tehran. All of samples were evaluated ac-cording to WHO cri-teria for acute respiratory infection، and underwent measurement of serum vitamin A، vitamin D and zinc levels by using Atomic، Elisa and spectropho-tometer methods. Serum levels of vitamins A in patients with acute respiratory infection was 0. 27±0. 16 µg/ml and in children without infection was 0. 41±0. 2 µg/ml، that different wasn’t statistically significant (P=0. 4). Serum levels of vitamins D in patients with acute respiratory infection was 35. 37±34. 68 ng/ml and in children without infection was 45. 78±21. 05 ng/ml، that different wasn’t statistically significant (P=0. 1). Serum levels of zinc in patients with acute respiratory infection was 87. 93±23. 34 µg/dl and in chil-dren without infection was 106. 95±23. 70 µg/dl، the difference was statistically signifi-cant (P=0. 002). According to finding in this trial، there is a correlation between lower levels of zinc in serum، and chance of respiratory tract infection in children. Future larger studies could provide the correlation between serum levels of vitamins A & D and chance of respiratory tract infection.

The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. In this study، fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG، were selected by convenience sampling method. Se-quentially، they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups، using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure، brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0. 05 was considered as significant. The mean age of patients was (65. 3±9. 9). The patients included %16 (n. 8) of women and %84 (n. 42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0. 14)، acute renal failure (P=0. 4)، cerebrovascular accidents (P=1) and atrial arrhythmias (P=0. 3)، need to second surgery due to bleeding (P=1)، need to dialysis (P=0. 14)، need to rehospitalization (P=1)، duration of ventilator use (P=0. 4)، duration of need to hospitalization (P=0. 11)، duration of a patients stay in the Intensive Care Unit (P=0. 4) and deep sternal infection (P=0. 7) rates. According the results of this study، prophylactic dialysis، before conduct-ing CABG، does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

Normal vaginal delivery is the best method of delivery. Vaginal delivery is followed by the best pregnancy outcomes. Reducing the rate of cesarean delivery has been a health goal for the United States with economic and social advantages. This study has been conducted with aim of maternal and neonatal outcomes of Normal Vaginal Delivery (NVD) and comparing with cesarean delivery. This descriptive- analytic study was conducted in Ghaem University Hospital in Mashhad during years 2007 until 2013. Five hundred thirty six full term infants aged 3- 14 day، born either by NVD as control group or cesarean delivery as case group par-ticipated in this study. Sampling was a convenient method. The data in questionnaire containing maternal information (maternal age، mode of delivery، maternal weight، du-ration of delivery، duration of maternal hospitalization، let down reflex، breast feeding status) and neonatal information (age، sex، Apgar score، urination frequency and defe-cation frequency) were collected by a researcher. According to the findings of this study، the infant’s age (P=0. 425)، admission weight (P=0. 278)، jaundice access (P=0. 162)، urination frequency (P=0. 165)، maternal weight (P=0. 869) showed no statistically significant difference between two delivery methods. Time of the first breast feeding after childbirth (P=0. 000)، defecation fre-quency (P=0. 000)، maternal age (P=0. 000)، maternal parity (P=0. 003)، duration of de-livery (P=0. 000)، duration of maternal hospitalization (P=0. 025)، feeding position (P=0. 029)، let down reflex (P=0. 012)، mastitis (P=0. 025) and breast problems (P=0. 027) showed statistically significant difference between the groups. It means defecation frequency، duration of maternal hospitalization، Apgar score، mastitis and breast problems were more in cesarean group، but early breast feeding after delivery، duration of delivery، proper breastfeeding position and let down reflex were more in NVD group. The results of this study showed in comparison with cesarean delivery، normal vaginal delivery provides better outcomes in terms of breast problems، breast feeding status، duration of labor and duration of maternal hospitalization for both mother and infant. So، adopting careful instructions in management and administration of deliveries will help the prevalence of making decisions for normal vaginal delivery and the recovery of delivery outcomes.

In advanced stages، Colorectal cancer remains often refractory to classic therapies. In consequence، search for new therapeutic modalities with minimal toxicity is of particular interest in colon cancer management. In this regard، powerful growth-inhibitory effect has been shown for fish-oil derived Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) against cancer cells. In the present study، we evaluated the anti-cancer effect of EPA and DHA (n3-polyunsaturated fatty acids، n3-PUFAs) on the human colorectal cancer cell line (LS174T) on a dose-response and time-course ba-sis. LS174T cells were cultured in RPMI-1640 medium supplemented with 10% fetal bovine serum at 37 ºC in a humidified incubator. Cancer cells were treated to vari-ous concentrations of EPA and DHA (50، 100، 150 µM/L) and incubated for 24-72 hours. Following treatments، dose-response and time-course cytotoxicity using viability and MTT assays were performed. Viability analysis showed that 150 µM/L PUFAs decreased significantly the proliferation of treated cells، as compared to untreated cells. In this regard، cell viabil-ities were found to be %31±%5. 1 and %30±%2. 6 for DHA and EPA respectively. Moreover، treatment of cells with increasing concentrations of EPA and DHA signifi-cantly decreased growth rates in a dose-and time-dependent manner. Following 72 hours treatments with 150 µM/L PUFAs، growth rates were found to be %19±%5. 5 and %20±%5 for DHA and EPA relative to untreated cells respectively. The results of this study indicate that n3-PUFAs decrease cell proliferation and could provide new approaches in malignant tumor therapeutic strategies.

Twin pregnancy with a fetus and a diploid complete mole is not rare، but، the cases of twin pregnancy with a partial mole are rare. Nowadays، the prevalence of these cases has been increased due to the high rate of assisted reproductive techniques in reproductive medicine. The importance of twin pregnancy with a fetus and a diploid complete mole is mainly due to systemic complications such as hypertension and maternal hemorrhage and the possibility of trophoblastic tumor following delivery. Different studies have reported some results about similar cases، but limited case reports are presented in our country. The aim of this study is to report a case with incomplete molar pregnancy concomitant with a live fetus. A 21 yr old woman (G2 ab1) referred to emergency department of Ghaem University Hospital in Mashhad. She complained of scant vaginal bleeding and spotting and a sonography report of a combined molar and normal pregnancy with 15 weeks gestational aged. During hospitalization، the pregnancy complicated with hypertension and proteinuria. Termination of pregnancy was planned at 17th weeks of gestation due to severe preeclampsia. After evacuation of uterus، during follow up visits، -hCG titer raised. Metastasis evaluation was negative. Pathology reports showed patial mole. Then، three doses of methotrexate (50 mg/m2 intra muscular) was administered and finally، according to the monthly follow up، -hCG level was undetectable. The rate of pregnancy complications such as hypertension، hyperthyroidism، and obstetrics hemorrhage and also the risk of Gestational Trophoblastic Neoplasm (GTN) are increasing in incomplete molar pregnancy. Therefore، early diagnosis and timely treatment of molar pregnancy is very important to reduce maternal morbidity and mortality.