Acta Medica Iranica
Volume:44 Issue: 1, Jan-Feb 2006

Optimal management of low lying locally advanced rectal cancer remains a major challenge. This study was performed to evaluate the impact of preoperative external radiation therapy combined with systemic chemotherapy on sphincter preservation and local control in locally advanced low lying (<5 cm from anal verge) rectal cancer. A total of 25 consecutive patients with biopsy proven locally advanced low lying rectal cancer were treated with preoperative 5FU (750 mg/m²/day, first and fifth week of radiation) and external beam radiation (45 GY in 25 fractions over 5 weeks) followed by radical resection. Surgery was performed 4-6 weeks after the end of chemoradiation. There was no major acute toxicity following chemoradiation and all patients completed their scheduled preoperative therapy. A complete pathologic response to preoperative chemoradiation was confirmed in 3 patients (12%). The pathologic tumor stages in the remaining patients were: T3N0 (n = 4, 18%), T3N1 (n = 3,14%), T4N0 (n = 9, 41%), and T4N1 (n = 6, 27%). Eighteen patients (72%) had a sphincter saving surgical procedure but sphincter was finally preserved in 16 patients (64%). A perfect continence was achieved in 85% of cases. There were 2 (8%) perioperative mortality and 9 (36%) perioperative morbidity. In 3 (12%) patients a reoperation was required. At a median follow up of 27 months, local recurrence was observed in 1 patient (4.3%) and distant metastases in 5 patients (21.7%). It seems that preoperative chemoradiation for locally advanced rectal cancer may provide higher rate of sphincter preservation.

There is a continuing need to identify new agents that are active in ovarian cancer. Etoposide is a derivative of the plant alkaloid epipodophyllotoxin. The availability of etoposide in oral preparation allows prolonged administration by the oral route. In this study, activity and toxicity of etoposide in women with recurrent ovarian cancer are described from a case series of women with recurrent ovarian cancer who had measurable disease. All patients had prior platinum-based chemotherapy and developed progressive disease. Oral etoposide was given as 50 mg/day for 21 days every 4 weeks until progression of disease or prohibitive toxicity. From December 1999 to January 2004, 32 patients were enrolled in this study. Thirty patients received a total of 133 cycles of etoposide. Median age of patients was 49 years (range, 19 to 75). The median number of etoposide cycles was 4 (range, 1 to 12). There were 5 partial responses (16.6%). The mean response duration was 4.8 months (range, 3.5 to 6); median progression-free interval was 7 months (range, 3 to 13) and median survival time was 12.5 months (range, 1.3 to 36). The major toxicity was leukopenia. One patient required red blood cell transfusions and the main non-hematologic toxicity was nausea and vomiting. There were no treatment-related mortalities. Although etoposide appears to exhibit modest activity in recurrent ovarian cancer after platinum-based therapy, response and survival durations are short.

It has been shown recently that loud clicks evoke myogenic potentials in the tonically contracting sternocleidomastoid muscles. Studies have suggested that these potentials are of vestibular origin, especially of the saccule and inferior vestibular nerve. A pilot study was undertaken in our hospital to record vestibular evoked myogenic potentials (VEMP) for the first time in Iran. Eighteen healthy volunteers (32 ears) without history of otologic or vestibular disorders were subjected to the VEMP test. Twenty-one patients (26 ears) with unilateral (6 patients) and bilateral (5 patients) high frequency sensorineural hearing loss with unknown etiology, acoustic neuroma (1 patient), Meniere’s disease (4 patients) and unilateral low frequency sensorineural hearing loss without vestibular complaint (5 patients) were also enrolled in this study. VEMP response to clicks was obtained from 84.4% of ears of healthy subjects. These subjects demonstrated short latency waves to click stimuli during tonic neck flexor activation. Mean latencies of first positive (p13) and first negative (n23) potentials in healthy subjects were 12.45 ± 1.9 ms and 20.8 ± 3.5 ms, respectively. Median latencies of these two potentials were 12.1 and 19.3 ms, respectively. We could record VEMP in 5 patients with unilateral and all patients with high and low frequency sensorineural hearing loss without vestibular complaint. In the patient with acoustic neuroma VEMP was absent on the affected side. This technique may offer a new method to evaluate otolith and sacculocollic pathways in human.

Clinical and histopathological features of basal cell carcinoma (BCC) may differ according to the type of carcinogen involved. BCC arising from radiotherapy treatment has high incidence and its clinical and histopathological features may be different from BCCs caused by other carcinogens. The aim of our study was to investigate any possible association between specific histopathological or clinical features and chronic radiation dermatitis as the cause of BCC. In this study, 87 patients with previous history of radiotherapy on the site of BCC (exposed) were selected as group A and matched with 87 other patients with BCC without such a history as group B (unexposed). The two groups were compared based on certain clinical features such as size, number and location of the tumors and also based on the histopathological features. In the exposed group, the most frequent histopathological type was pigmented solid type (73.5%), while in the unexposed group solid type (66.7%) was the most frequent feature. Multiple tumors were found in 86.2% of the exposed patients, while just 12.6% of the unexposed patients had multiple tumors. In the unexposed group, the face was the most frequent location (94.3%) and the mean size was 1 cm in diameter, while in the exposed group the most frequent location was the scalp and the mean size was 0.5 cm. BCCs arising on a background of radiation dermatitis are usually of pigmented solid type, multiple, smaller in size and normally are seen on the areas exposed to X-ray therapy.

Malaria has reemerged in northern borderline of Iran after the collapse of former Soviet Union. There have been several reports of malaria epidemics in Azerbaijan and Ardebil provinces of Iran. The Anopheles maculipennis complex is assumed to play an important role in malaria transmission in these regions. For the first time in Iran, a diagnostic character in 4th instar larvae, i.e. seta 2 (antepalmate hair) in the tergum of 4th and 5th segments of abdomen was used to differentiate An. sacharovi from An. maculipennis s.l. A total of 149 larval samples from 17 different locations of Iran were examined by light microscope. It was found that the mean number of seta 2 branches in An. sacharovi was 36.84 ± 1.94 whereas it was 16.52 ± 5.05 for An. maculipennis s.l. It seems that this character can be added to the national identification key of larval stage of Iranian anopheline mosquitoes.

The role of education in improving quality of life of patients with chronic renal failure has been emphasized by many studies. This survey was performed to assess the effect of a confined program of home-care on the health status of patients who were receiving hemodialysis. In this research, 37 patients afflicted by chronic renal insufficiency were chosen and put into two categories randomly, 19 patients as patients group and 18 patients as control group. At the start of therapy, the patients’ health condition was assessed and recorded. For the patients group a confined program of home-care, containing four visits per month (one session every week) was performed. No intervention was performed for the control group. After the complete performance of home-care programs, the health condition of both groups were assessed and recorded again. The results of the research showed that after the home-care program, weight gain, nausea, vomiting, headache, bone pain, weakness and fatigue and itching decreased and general condition and levels of BUN, creatinine, potassium and phosphorus of the blood improved in cases compared to the controls (P < 0.05); the mean values of blood pressure, pulse and temperature, sodium, calcium and hematocrit level were not significantly changed. It is concluded that home-care program as an effective and beneficial method can be applied in chronic diseases such as chronic renal insufficiency and for patients who are under the hemodialysis treatment.

In spite of being histologically benign, sacrococcygeal teratoma (SCT) may recur either as a benign or malignant tumor. A total of 26 patients with benign neonatal SCTs were treated in Taleghanee and Mofid medical centers from 1986 to 2000. Investigations included radiography,abdominal ultrasound and computed tomography (CT) scan and measurement of tumor marker (α-fetoprotein). Initial surgical removal of the SCT (including the coccyx) was carried out during the first two weeks of life. One patient died on the first day of life following tumor rupture due to hemorrhagic shock before undergoing surgical intervention. Eight children had recurrences. Two were benign and six malignant teratomas, the latter having been benign on histology of the primary tumor. Five patients with malignant lesions required abdominosacral excision, two had a preliminary colostomy and chemotherapy followed by excision of the residual tumor and colostomy closure at a later stage, but in last one tumor was excised at the sacrococcygeal area. The overall follow-up ranged from 3 months to 13 years. There have been no complaints of functional neurological deficits after the operation. We conclude that SCT, although histologically benign, has an alarming potential to recur either as a benign or malignant tumor during the first 3 years of life,therefore, a close follow up for at least 3 years (physical examination serum α-fetoprotein and diagnostic imaging) is recommended for all patients who have undergone excision of SCT.

Unintentional drug intoxication is still a major cause of morbidity and mortality in young children. In order to study the epidemiological pattern of childhood drug poisoning in Golestan province, all cases diagnosed with poisoning from 1997 to 2002 in the only pediatric hospital in province were recruited. During this period 563 cases of poisoned children were hospitalized in Taleqani hospital, of these 305 cases were due to drug poisoning. Opium was responsible for more than half of the poisoning cases, and 91% of deaths, among drug intoxicated children. Metoclopramide, benzodiazepines, tricyclic antidepressants and anticonvulsants were among the other frequent causes of poisoning. Neurological symptoms were the most prominent symptoms of poisoning and more than 80% of cases showed some neurological symptoms. Mortality rate among the cases was 3.6% and of total of 11 deaths, 10 were poisoned with opium. About 61% of cases were hospitalized between 24-48 hrs. Most of the poisoning cases in young children were unintentional and in many cases, their parents played a critical role in their intoxication. This role specially is crucial in infants and children under one year of age. Parents in Golestan province use opium widely for symptomatic treatment of routine illnesses in their young children and overdose of opium may cause severe intoxication and even death of the child.

Aldose reductase is a critical enzyme in the polyol pathway that plays an important role in diabetes mellitus. Inhibition of the activity of this enzyme can prevent cataract in diabetic patients’lenses. In this study the inhibitory effect of two flavonoids, quercetin and naringin, in the activity of aldose reductase in streptozotocin-induced diabetic and healthy rats were investigated. Thirty male rats were divided in six groups. The first, second and third group were healthy rats that received water,quercetin and naringin, respectively. The fourth, fifth and sixth groups were streptozocin-induced diabetic rats that received water, quercetin and naringin, respectively. These rats were fed orally in a definite dose from each substance for 12 days. After this period rats were scarified and their lenses were separated and homogenized. The activity of aldose reductase was measured in each homogenized sample separately. The effect of feeding of these substances in blood sugar was also determined. Aldose reductase activity was reduced 73 and 69 percent in diabetic rats fed by quercetin and naringin, respectively, and the difference compared to control group was significant. In healthy rats this reduction was 63 and 59 percent, respectively, and the difference was significant compared to those who did not receive flavonoids. It was concluded that these substances were effective in reduction of aldose reductase activity in vivo and consequently could delay the progress of cataract.

The exposure to electromagnetic field emitted by mobile telephones is increasing rapidly worldwide that causes side effects, including thermal and non thermal side effects. Ear proximity to electromagnetic source may lead to greater damage and side effects, including hearing loss. This study was performed to assess the chronic effect of exposure to electromagnetic field of mobile telephones on hearing by audiometric measurements. A total of 200 subjects (100 users and 100 non-users) were studied, using historic cohort method. The subjects did not have history of any clinical condition possibly implicated in hearing loss, history of ear disease or pathology in otoscopic examination. Only the users dominant ears were studied (right side 75% and left side 25%). Pure tone threshold of all subjects were in the normal range but there was a significant difference between mean pure tone threshold of user and non-users, +0.12 ± 5.93dB and -3 ± 4.73dB, respectively. Duration of use was also related to threshold changes. This investigation showed that mobile sets may cause increase of the pure ton threshold. We suggest further studies to find out potential hazards of using mobile telephones and to develop guidelines for the mobile telephone users.

Telemedicine is an indispensable tool in the hands of doctors to accelerate and facilitate the process of data interchange. To publicize and distribute the culture of utilizing this technology and providing the necessary equipment for this purpose and also to commence some useful activities in this field of science in Iran, the researchers group have designed and performed a telemedicine internet site with the goal of medical consultation. Software was designed and prepared, which is accessible to three groups of users with definite level of access for each one: normal users, doctors and site administrators. There are four main forums on this website with the following titles: medical consultation (Q&A), doctors’ special forum, scientific and research centers and also special disease groups, and the forum of graduates and medical students. Ultimately, we could achieve a new horizon to expand telemedicine activities in the field of medical consultation. A free web-based system was developed through the address of www.teleteb.com with the aim of remote medical consultation, developing the public health services and creating a powerful scientific and research link in the society of medicine.

Primary growth hormone insensitivity syndrome (GHIS) is a rare entity which can be due to defects in growth hormone (GH) receptor that is called type 1 Laron syndrome (T1LS) or post receptor defects (type 2 Laron syndrome). The aim of study was determining the clinical and hormonal milieu of the patients with primary GHIS and their response to IGF-I (insulin like growth factor-I) generation test (IGT). GH, IGF-I, IGF-II, IGF binding protein 1 and 3 (BP-1 and BP-3), GH binding protein (GHBP) and anti-GH antibody were detected by ELISA and RIA methods. IGF-I and BP-3 were measured before and after IGT. Nine patients (8 males, 1 female) (mean age ± SD, 6.4 ± 5 years) with severe short stature and high GH level were studied. Height SDS was - 8.5 ± 2.6. In 7 patients GHBP was zero, IGF-I and BP-3 were low and did not increase after IGT, so they had T1LS. Two brothers did not show the hormonal milieu of GH receptor defect, and were called non Laron syndrome (NLS). Birth weight in patients with T1LS and NLS was 3.65 ± 0.2 Kg and 1.65 ± 0.2 Kg, respectively (P = 0.001). All of the patients had typical clinical feature of GH-deficiency, but nasal bridge depression and microphallus were not seen in NLS. GH treatment of NLS, normalized their growth velocity, but without catch up growth. In conclusion IGT can differentiate Laron syndrome from other types of short stature. GH and IGF-I of fetus have no role in intrauterine growth.

The term calcifying odontogenic cyst (COC) was first introduced by Gorlin in 1962. COC occurs mainly as an intra-osseous lesion in mandible or maxilla but the peripheral variation of COC has also been reported. The confusion about COC nature as cyst or tumor has not been resolved and a vast diversity has been shown in clinicopathologic aspects of COC. The purpose of this study was the review and analysis of COC variables such as age, gender and location and reclassification of histopathologic features of cases. The study was a retrospective review, cross sectional and case series one. The records of 36 patients were obtained and the clinical characteristics such as age, gender and location of COC were registered. The histopathologic features of cases were reviewed and reclassified. The data showed that 38.3% of cases occurred in the fifth decade and beyond; 67.6% were in males and 32.4% in females. Considering location, 51.5% of COCs were found in mandible and 48.5% in maxilla; 65.6% were located in posterior part of jaws. Of the 36 cases diagnosed as COC, 32 (88.8%) had cystic features and 4 (11.11%) were tumoral. For better determination of histopathologic and biologic features of COC, more investigations are needed.

Perivascular epithelioid cell tumor (PEComa) is composed of HMB45+ epithelioid cells with clear to granular cytoplasm and perivascular distribution. We describe a uterine PEComa in a 33 years old woman where tumor cells were positive for HMB45 but negative for epithelial markers and negative or positive for smooth muscles markers.

Castleman’s disease (angiofollicular lymphoid hyperplasia) includes a heterogeneous group of lymphoproliferative disorders. The cause of this disease remains uncertain. There are two types of localized Castleman’s disease: the more common hyaline vascular and the plasma cell types. Mixed variant is an uncommon localized lesion in general population. The lesions can occur in any part of the body that contains lymphoid tissue, although seventy percent are found in the anterior mediastinum. We report a thirty years old boy with Castleman’s disease who presented with fever, anorexia, weight loss,sweating, anemia and abdominal mass. The histologic examination of the biopsy specimens revealed a mixed hyaline vascular and plasma cell type of Castleman’s disease.

Renal vein thrombosis (RVT) is the most frequent vascular abnormality in newborns, but rarely seen in adults. RVT is an acute problem, and diagnostic and therapeutic approaches should be done immediately. Surgical thrombectomy is not a rational approach and the treatment of choice is conservative management and thrombolytic therapy. We present a 45 years old male patient with chronic renal vein thrombosis who was treated with thrombolytic therapy successfully.