فهرست مطالب

Archives of Iranian Medicine
Volume:16 Issue: 11, Nov 2013

  • تاریخ انتشار: 1392/08/11
  • تعداد عناوین: 17
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  • Zygomatic Bone Metastasis as an Initial Presentation of Hepatocellular Carcinoma
    Nada Tomanovic, Aleksandar Krstic, Dimitrije Brasanac, Milovan Dimitrijevic, Tatjana Terzic, Ivan Boricic Page 11
    Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blood or through lymphatic dissemination, most comonly to the lungs, abdominal lymph nodes, and bones. Metastases to the bones of the head and neck region, however, are extremely uncommon. A 70-year-old male was presented with a mass in the left zygomatic region. After the incisional biopsy, the histopathologic and immunohistochemical analysis confirmed a metastasis of hepatocellular carcinoma. An abdominal computerized tomography (CT) scan revealed a large primary tumor in the right liver lobe. To the best of our knowledge, this is the second case of an isolated zygomatic metastasis as an initial presentation of hepatocellular carcinoma. We also reviewed the literature regarding clinical and histopathologic characteristics of hepatocellular carcinoma that produced metastases to the zygomatic bone and the maxilla.
    Keywords: Hepatocellular carcinoma, immunohistochemistry, maxilla, metastasis, zygomatic bone
  • Parastoo Saniee, Farideh Siavoshi, Gholamreza Nikbakht Broujeni, Mahmood Khormali, Abdolfatah Sarrafnejad, Reza Malekzadeh Page 624
    Background
    Human gastric epithelium and immunocytes have been recognized as the sole specialized eukaryotic cells that host Helicobacter pylori (H. pylori). The aim of this study was to provide further evidence for our previous proposal regarding the occurrence of H.pylori inside the yeast vacuole, verifying the viability of the intravacuolar H.pylori by western blotting.
    Methods
    Light microscopy and polymerase chain reaction (PCR) were used for primary detection of nonculturable H.pylori in 11 Candida yeasts (six oral and five gastric). Boiling was used for extraction of proteins from yeasts and the control H.pylori. Western blot analysis was recruited to assess the occurrence of H.pylori-specific proteins in protein pool of yeasts, using IgY-Hp raised in hens and IgG1-Hp raised in mice.
    Results
    The fast-moving bacterium-like bodies (BLBs) were identified as H.pylori by amplification of H.pylori 16S rRNA, ureAB, vacA s1, and ahpC genes from the whole DNA of yeasts. Analysis of the sequenced products of 16S rRNA gene amplified from the yeast and H.pylori isolates of patient #2 showed 100 % homology with the corresponding sequences of the reference H. pylori strains in GenBank. According to published data, it was plausible to assign the H.pylori-specific proteins, detected by western blot analysis, as thiol peroxidase (21 kDa), peroxiredoxin (AhpC) (26 kDa), urease-A subunit (UreA) (32 kDa), vacuolating cytotoxin A (VacA) small subunit (36 kDa), and VacA large subunit (56 kDa).
    Conclusion
    Results of this study show that inside yeast, H.pylori expresses proteins and is viable. These proteins appear to serve as powerful tools to help H.pylori to establish in the vacuole of yeast where it can reach nutrients and multiply. The intimate relationship between H.pylori and Candida yeast which began long time ago, could have led to the establishment of H.pylori inside the yeast vacuole before invading human cells.
    Keywords: Candida yeast, H.pylori, immunodetection, proteins, vacuole
  • Liangshuo Hu, Bo Wang, Xuemin Liu, Yi Lv Page 631
    Background
    The morbidity of unsuspected gallbladder carcinoma (UGC) has increased. This study was aimed to explore the factors which may influence the therapeutic strategies and prognosis of UCG. Additionally, long-term prognosis of laparoscopic and open surgeries of UGC was comparatively investigated.
    Methods
    Thirty-eight cases of UGC were enrolled in this study. Statistical analysis of survival was performed using the Kaplan–Meier test and the results were examined using the log-rank test.
    Results
    The morbidity of UGC was 0.43 %. The cancer stagings were: pT1a (one), pT1b (11), pT2 (14), pT3 (10), pT3N1 (one), and pT4 (one). The median lifespan of the entire cohort was 20.0 ± 6.5 months, one-year survival rate was 44 %, and five-year survival rate was 11 %. One-year recurrence- free survival rate was 44 % and three-year recurrence- free survival rate was 0 %. Twenty-eight patients sustained cancer recurrence and three patients sustained port-site cancer recurrence. The cancer staging (P < 0.01) and radical resection (P < 0.01) were independent factors for both overall and recurrence-free survival. Radical resection improved the prognosis of the patients with pT2 stage UGC (P < 0.05), but no significant impact on the prognosis of the patients with pT1b (P = 0.362) or pT3 stage (P = 0.221) UGC. Survival rates were not significantly affected by the first operation no matter it was laparoscopic surgery or open surgery (P = 0.12).
    Conclusion
    Radical resection surgery is recommended in pT2 stage UGC. There is no difference for the long-term prognosis between laparoscopic surgery (cholecystectomy) and open surgery of UCG.
    Keywords: Laparoscopic cholecystectomy, open cholecystectomy, unsuspected gallbladder carcinoma
  • Ghorban Mohammadzadeh, Abdolrahim Nikzamir, Javad Mohammadi, Sara Pourdashti, Hajeh Shabazian, Seyed, Mahmoud Latifi Page 636
    Background
    Leptin, an adipocyte-derived hormone, has a pivotal role in the regulation of body weight through acting on its specific leptin receptor (LEPR). The 223A/G polymorphism of the LEPR gene is one of the most common polymorphism in all populations. In this study, we aimed to investigate the impact of the 223A/G polymorphism of the LEPR gene on serum levels of leptin in type 2 diabetes mellitus (T2DM) in a sample of Iranian population.
    Materials And Methods
    One hundred and forty-four T2DM patients were screened and compared to 147 healthy controls. The 223A/G LEPR polymorphism was genotyped using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP). The serum levels of leptin were measured.
    Results
    The mean serum levels of leptin in T2DM patients were significantly higher than that of healthy control subjects; 22.90 ng/ml (95 % confidence interval [CI] = 20.79 – 25.23) vs. 8.70 ng/ml (95% CI = 7.87 – 9.63). The genotypes (AA, AG, and GG) distributions of the 223A/G polymorphism were 55.5 %, 41 %, and 3.5 % in T2DM and 54.4 %, 42.2 %, and 3.4% in healthy controls. The results showed no significant differences in the 223A/G LEPR genotype and allele frequencies between T2DM and control subjects (χ2 = 0.043, P = 0.979 and χ2 = 0.003, P = 0.957), respectively. In addition, the serum leptin levels were markedly higher in subjects with GG genotype than those with AG or GG genotype only in T2DM
    Conclusion
    The 223A/G LEPR gene polymorphism is associated with markedly increased serum leptin levels in T2DM. However, no differences were determined in genotype and allele frequencies between T2DM patients and control subjects.
    Keywords: LEPR, PCR, RFLP, T2DM
  • Fereshteh Shahcheraghi, Saman Nobari, Hossein Masoumi Asl, Mohammad Mehdi Aslani Page 642
    Background
    Botulism is a serious neuroparalytic disease caused by toxins of Clostridium botulinum. Botulinum toxin is produced under anaerobic conditions and it is the most dangerous toxin in the world. Rapid diagnosis of botulism is very essential for successful therapy. In this study, we reviewed data of cases of botulism in Iran from April 2004 through March 2010.MATHERIALS AND
    Methods
    From a total of 1140 samples of suspected botulism samples, 477 serum, 294 stool, 111 gastric secretions, and 258 food samples were collected from 21 provinces. These samples belonged to 432 distinct patients. All samples were tested for botulism by mouse bioassay, a gold standard method for detection of botulism.
    Results
    From 1140 received samples, 64 (5.6 %) positive samples of botulism were identified. Of these, 14 (21.8 %) cases had toxin type A, seven (11 %) cases had toxin type B, 22 (34.3 %) cases had toxin type E, and seven (11 %) cases had toxin type AB. The toxin type could not been identified in 14 (21.8 %) cases. The highest positive results were in Gilan, Tehran, Golestan, and Hamedan provinces. Seafoods and locally- made cheese were the most implicated foods in type E and type A botulism, respectively.
    Conclusion
    Accurate and rapid diagnosis of botulism is very important because every case of botulism can be a public health emergency. During the study period, the median number of positive cases per year was 2.7 (range: one to18). Therefore, it is suggested that all clinicians are required to submit the collected samples from patients with botulism symptoms to the botulism reference laboratory for specific diagnosis and confirmation of botulism.
    Keywords: Botulism, Iran, mouse bioassay
  • Ali Aydin, Murat Topal, Kutsi Tuncer, Umut Canbek, Vahit Yildiz, Mehmet Kose Page 647
    Background
    To study the efficacy of extramembranous transfer of the tibialis posterior (posterior tibial) tendon for the treatment of drop foot deformity in children.MATHERIALS AND
    Methods
    This study included 24 patients (11 girls and 13 boys) with drop foot deformity, who underwent tibialis posterior tendon transfer. The mean age was 12.33 years (range: seven to18 years), and the mean follow-up period was 32.54 months (range: 24 – 55 months). Drop foot developed due to different levels of nerve injury associated with trauma or surgical operation in 18 (75 %) patients, and due to meningomyelocele in six (25 %) patients. Tibialis posterior tendon was flipped from the anteromedial aspect of the tibia and transferred to the lateral cuneiform bone. The patients were evaluated via the Stanmore system questionnaire.
    Results
    Evaluating the outcomes by the Stanmore system, poor results in two feet (8.3 %), fair in two feet (8.3 %), good in eight feet (33.3 %), and excellent in 12 (50 %) feet were obtained. All patients were satisfied with the postoperative outcomes. The mean active ankle dorsiflexion was 8.96 degrees (range: zero to 20 degrees).
    Conclusions
    Extramembranous transfer of the tibialis posterior tendon is a quite successful method in retrieving active dorsiflexion of the foot in patients with drop foot deformity. It is a method which eliminates the need for orthosis and enhances the quality of life of patients.
    Keywords: Foot drop, transfer of the posterior tibial tendon, tibialis posterior tendon
  • Parvin Mirmiran, Zahra Bahadoran, Mahdieh Golzarand, Asadolah Rajab, Fereidoun Azizi Page 652
    Background
    Data suggest that sesame seeds have properties beneficial to modulating lipid disorders and decreasing cardiovascular disease (CVD) risk factors. The aim of this study was to investigate the effects of Ardeh, paste of ground unhulled sesame seeds, on lipid profiles and atherogenic lipid parameters.
    Methods
    This randomized clinical trial included 41 patients with type 2 diabetes, who were randomly assigned to one of the two groups: group A (Ardeh 28 g/d, n = 21) and group B (control, n = 20). After an initial two-week washout period, the patients in group A, replaced a part of their usual breakfast with two tablespoon (tbsp) (~ 28 g) Ardeh, while group B patients continued the usual breakfast meal for six weeks; energy content of both breakfast meals was maintained in the same range. Anthropometric measures, blood pressure, serum levels of total cholesterol (TC), triglycerides (TG), LDL-C, HDL-C, and atherogenic index of plasma (AIP; log TG/HDL-C), TC/HDL-C ratio, and LDL/HDL-C ratio were determined at baseline and six weeks later.
    Results
    After six weeks, there were significant decreases in serum TG (15.3 mg/dL) and AIP (39 %) in group A. Moreover, slight decreases in serum TC, LDL-C, and other atherogenic lipid parameters and a mild increase in HDL-C also were observed during Ardeh supplementation. Anthropometric measures and blood pressure were unchanged during the study period in both groups.
    Conclusion
    Ardeh could have favorable effects in decreasing CVD risk factors in type 2 diabetics.
    Keywords: Ardeh_lipid profiles_sesame seeds_type 2 diabetes
  • Fariba Birjandi, Ahmad Gharehbaghian, Alireza Delavari, Negar Rezaie, Mahtab Maghsudlu Page 657
    Background
    Donor selection is still being emphasized, even in the era of sensitive laboratory screening. Therefore, a number of volunteers are deferred from blood donation. This study evaluated the deferral rate in Iran, as well as the frequency of each reason in order to monitor the impact of donor selection process on donor loss.
    Methods
    This study was carried out on data of all volunteers who were deferred from blood donation in Isfahan Blood Transfusion Services between the years 2007 – 2008. The deferral reasons were then classified into “donor safety” and “recipient safety”. The total deferral rates within sociodemographic variables and donor status were compared. Then, the rates of various specific deferral reasons were calculated.
    Results
    Out of 197,757 blood donor volunteers, 50,727 (25.6 %) were deferred from donation; 88.6 % were temporarily deferred whereas 11.4 % were permanently deferred. The deferral rate for females and males was 54.6 % and 24.3 %, respectively. Forty-three percent of the first-time donors, 9 % of the lapsed donors, and 11.9 % of the regular donors were deferred. Sixty-one percent of all deferrals were due to donors'' safety while 31 % were deferred due to recipients’ safety.
    Conclusion
    Blood donors'' deferral rate in Iran was significantly higher than other countries. This may be due to special attention to donor selection procedures. However, revision of the national criteria of donor selection and rigorous adherence to these criteria should be considered. Also, it is emphasized to improve the blood donor retention strategies to boost the regular blood donors’ pool.
    Keywords: Blood donation, blood donor deferral, blood safety
  • Majid Mirsadraee, Ahmad Saffari, Mohammad Sarafraz Yazdi, Mojtaba Meshkat Page 661
    Introduction
    Anthracosis of the lung is the blackening of bronchial tissues which can lead to chronic bronchial obstruction. Many studies have shown association of bronchial anthracosis and tuberculosis. The aim of this study was accumulation of scattered studies and getting the definite conclusion about the association between anthracosis and tuberculosis.MATHERIALS AND
    Methods
    We conducted a systematic search that included studies with sufficient information about the frequency of tuberculosis in anthracosis (anthracofibrosis) patients and non-anthracotic control group. Moreover, tuberculosis should be confirmed by microbiologic (smear or culture) or histopathological methods.
    Results
    Twelve studies (eight studies on anthracofibrosis and four studies on anthracosis as a general term) comprising of 6280 patients was entered into our meta-analysis. The frequency of tuberculosis in all anthracosis patients was 22.5 % (32.3 % for anthracofibrosis and 16.6 % for anthracosis), which was significantly higher than the control group. Determination of risk showed that the cumulated odds ratio of tuberculosis in all studies of anthracosis was 3.16 (95 % CI = 2.49 – 6.85), which revealed significantly higher risk than the control group. The analysis of the subgroups showed that the cumulated odds ratio of tuberculosis in subgroups of anthracofibrosis (3.28; 95 % CI = 2.16 – 9.12) was significantly higher than anthracosis as a general term (2.85; 95 % CI = 1.73 – 6.61).
    Discussion
    The association of tuberculosis with all types of anthracosis of the lung was confirmed and a proper mechanism should be defined.
    Keywords: Anthracofibrosis, anthracosis, tuberculosis, Acid, fast bacilli
  • Hae Joong Cho, Eun Sil Lee, Ji Young Lee, Seong Nam Hong, Yong, Il Ji, Heung Yeol Kim, Ari Kim Page 665
    Background
    Postmenopausal bleeding is a clinically important complaint in general gynecologic practice. The incidence of spontaneous postmenopausal bleeding in the general population is approximately 10% immediately after menopause, and 5 % in all menopausal women.
    Objectives
    The study was aimed to reveal the histopathologic diagnosis of postmenopausal uterine bleeding, and to investigate the correlation between various clinical factors and endometrial carcinoma. We also evaluated the role of endometrial volume calculation in the clinical use for the endometrial histopathologic findings.MATHERIALS AND
    Methods
    In this prospective observational study, we recruited 163 postmenopausal women with abnormal uterine bleeding from January 2008 through December 2010. Women who had hematologic disease, or had nonuterine pelvic diseases were excluded. Clinical characteristics such as age, body mass index (BMI), associated diseases, and previous postmenopausal hormone therapy were checked. They were evaluated by transvaginal ultrasonography and underwent endometrial biopsy for the endometrial histopathologic examination.
    Results
    Among the endometrial histopathologic findings, atrophic endometrium was the most common finding (32.7 %), followed by hyperplastic endometrium (10.4 %), endometrial carcinoma (10.4 %), and endometrial polyp (9.2 %). The prevalence of endometrial hyperplasia and cancer was not significantly different at the 5 mm cut-off thickness of the endometrium, but significantly higher in women with ≥ 3 mL of endometrial volume. However, the incidence of endometrial cancer and hyperplasia in women with endometrial bleeding was not significantly different with or without previous or current hormone therapy.
    Conclusions
    Endometrial biopsy should be performed to exclude endometrial hyperplasia and carcinoma in postmenopausal women with endometrial bleeding to perform proper and prompt treatment, especially in old aged women (> 60 years) and in patients with endometrial volume ≥ 3 mL.
    Keywords: Endometrial biopsy, endometrial cancer, endometrial volume, menopause, postmenopausal bleeding
  • Masoud Solaymani, Dodaran, Mohammad Vasei, Mustafa Ghanei Page 671
    Background
    Iranian Registry of Clinical Trials (IRCT) commenced its activities as a member of WHO registry network on fourth of December 2008. We explored the progress it has made within its first four years both in terms of quantity of registrations as well as its timeliness. MATHERIALS AND
    Methods
    We downloaded all the approved trial records until 22nd of September 2012 from the registry website. The number of registrations per calendar year was calculated and plotted over time. We assessed the timing of the registrations by categorizing them according to the date of registration in relation to the start date of recruitment into prospective, borderline prospective, borderline retrospective, and retrospective. We looked at the trends of timeliness of the registrations over time both according to registration year and the year that the recruitment had started.
    Results
    There were 3145 valid registrations in IRCT until 22nd of September 2012. The number of trials increased steadily over the years from 26 in the last three months of 2008 and 182 in 2009 to 771 and 1138 in 2010 and 2011 respectively and is expected to reach 1310 in 2012. Among the 182 registrations that took place in 2009, only 16 % were prospective or borderline prospective while this figure was doubled in 2012. When we categorized registrations according to the year of recruitment, the increasing trend was more marked from 5 % and 15 % in 2009 and 2010 to 27 % and 62 % in 2011 and 2012.
    Conclusion
    IRCT has made an outstanding progress within four years from its establishment both in terms of quantity and timeliness. Registration movement has succeeded in getting the message across to the research community and clinical trial registration has now become an integral part of research sphere in Iran.
  • Firoozeh Ahmadi, Deena Moinian, Prichehr Pouransari, Zohreh Rashidi, Hadieh Haghighi Page 679
    Implantation of an embryo within the scar of a previous cesarean delivery is one of the rare forms of ectopic pregnancy (EP). There are two types of such pregnancies: type 1, in which the embryo starts to progress towards the uterine cavity and may result in live birth despite the high risk of a hemorrhage occurring during birth, and type 2, which consists of pregnancies in which the embryo is embedded deep within the cesarean scar (CS) and grows towards the bladder and abdominal cavity, which is very dangerous and needs to be terminated immediately.There are very few cases in the literature reporting live birth as a result of such pregnancies. Here, we present a 41-year-old single gravid woman who had been treated for infertility at our institute and had eventually conceived through embryonic transfer freezing. At six weeks, a transvaginal scan showed the presence of an EP within the CS but despite this finding the pregnancy was continued to term.
    Keywords: Ectopic pregnancy, cesarean scar, cesarean section
  • Umberto Volta, Kamran Rostami, Francesco Tovoli, Giacomo Caio, Chiara Masi, Eugenio Ruggeri, Giulia Cacciari, Bon Isabella, Roberto De Giorgio Page 683
    Celiac disease (CD) is a small intestine immune-mediated disorder triggered by gluten ingestion in genetically predisposed patients. This condition can also affect many extraintestinal tissues, including the liver.We report a patient presenting with a marked increase of transaminases at diagnosis of CD. The immune markers for autoimmune hepatitis (AIH) were negative. Following a few months of a strict gluten-free diet (GFD), aminotransferase levels decreased significantly (< 2.5x U/L). The response to GFD suggested that the liver damage was due to a gluten-dependent celiac hepatitis, the most common liver abnormality in CD. Despite the fact that the patient never stopped the GFD, yet, in a few months, the aminotransferase levels raise again to high values (> 50x U/L). At this time, the liver autoantibodies turned to be positive thus confirming the development of a type 1 AIH. The hepatic damage progressed to a late onset liver failure requiring liver transplantation.
    Keywords: Antinuclear antibodies, antismooth muscle antibodies, autoimmune hepatitis, celiac disease, liver transplantation
  • Ali Akbar Esmailiejah, Naser Kamalian, Mohammadreza Abbasian Page 686
    Gorham’s disease is a rare musculoskeletal disease of unknown etiology characterized by progressive osteolysis and massive bone destruction. Here, we report an extremely rare case of Gorham’s disease involving two far sites in the lumbar spine and trochanteric region, gradually resulting in paraplegia. The patient underwent cord decompression and chemotherapy, and resumed her normal life; she was followed up for nearly five years.
    Keywords: Femur, Gorham's disease, paraplegia, spine
  • Atieh Rahmati, Ramin Shakeri, Soheila Aminimoghaddam, Hossein Ajhdarkosh Page 691
  • Kemal Ekici, Beytullah Cakal, Sinem Deniz Cakal, Alpaslan Mayadagli Page 693
  • Emre Yalcinkaya, Murat Celik, Baris Bugan Page 695