مجله غدد درون ریز و متابولیسم ایران
سال نهم شماره 4 (پیاپی 36، زمستان 1386)

Several prognostic factors affect the outcome of thyroid carcinomas including tumor stage and distant metastases. Nm23 is a metastasis suppressor gene and has a crucial role in the control of metastatic potential of several carcinomas. The aim of our study is to evaluate expression of nm23 marker in benign and malignant thyroid neoplasms using the immunohistochemistry method and to elucidate its relationship with tumor size, vascular or capsular invasion and lymph node involvement. In a descriptive study, 200 paraffin blocks comprising of 38 benign and 162 malignant thyroid neoplasms stained with nm23 marker were studied. Cytoplasmic staining in more than 10% of cells was considered as positive. The relationship between nm23 and tumor size, vascular or capsular invasion, lymph node involvement was analysed using SPSS 11.5 software (p=0.05). There was 40% positive incidence of nm23 in follicular adenoma, 87.5% in hurthle cell adenoma, 67.2% in papillary carcinoma, 66.7% in follicular carcinoma, and 64.7% in medullary carcinoma. In follicular adenoma, frequency of nm23 positive tumors was directly correlated to tumor size (p=0.04). There are no statistically significant correlation between nm23 and tumor size, vascular or capsular invasion or lymph node involvement in malignant thyroid neoplasms. In papillary and medullary carcinoma, negative predictive value of nm23 for lymphnode involvement was over 80%. Also in follicular carcinoma, sensitivity and negative predictive value of nm23 for vascular invasion were approximately 90%. Lack of significant correlation between nm23 and tumor invasiveness (and probably metastasis) factors, demonstrate that although nm23 is a potentially metastasis suppressor gene, whereas in many other tumors it may play a different role in thyroid neoplasms, a role which necessitates further studies to be conducted.

Several factors are involved in the thyroid tumourigenic process. The role of Retinoblastoma (Rb) tumor suppressor gene mutation in thyroid carcinogenesis has been discussed. In this study we investigated the expression of Retinoblastoma gene in thyroid neoplasms and its association with clinical and histological findings, to evaluate its ability in distinguishing benign and malignant thyroid neoplasms and as a prognostic factor. The present cross sectional study investigated Avidin – Biotin immunohistochemistry using the Dako Rb – 1 clone in a series of 200 formalin – fixed, paraffin – embedded thyroid lesions, including 39 benign and 161 malignant neoplasms. Nuclear immunoreactivity in more than 10% of tumor cells was assessed as positive. Rb was positive in 74.2% of follicular adenoma, 87.5% of hurthle cell adenoma, 46.2% of papillary carcinoma, 66.7% of follicular carcinoma, 29.4% of medullary carcinoma and 50% of anaplastic carcinoma. Overall Rb nuclear immunoreactivity was observed in 76.9% of benign tumors and 45.9% of malignant lesions. No significant difference in Rb expression between follicular adenoma and follicular carcinoma was seen also no association was found between Rb expression and invasiveness in malignant tumors. The results of this study indicate that Rb gene expression in benign thyroid tumors is significantly higher than in malignant ones (P=0.001), an association observed particularly in women. Rb gene inactivation is likely to play a role in malignant evolution of thyroid neoplasms and considering female predominance in thyroid tumors, Rb immunohistochemistry can potentially aid in the distinction between benign and malignant thyroid tumors in conjunction with morphology, but it is not helpful in differentiation between follicular adenoma and follicular carcinoma.

Cytological radiation damage to lymphocytes can result in augmentation of cells with micronuclei. In this study we investigated cytological radiation damage to peripheral blood lymphocytes using the micronuclei assay (MNA) method. Considering the value of Iodine-131 in diagnostic and therapeutic nuclear medicine and high absorbed dose of I131 radioiodine in comparison with gamma emitters and the effect of type of radiation, dose and species on radiosensitivity of patients, this study was conducted. To evaluating the cytological radiotoxicity of therapeutic radiotracers such as radioiodine I131. We studied 22 patients with differential thyroid carcinoma who were referred for treatment with 100 or 150 mci I131. Before and one weak after treatment the peripheral lymphocytes were harvested and isolated by a cytological method and assayed for frequency of micronuclei as a marker of cytological radiotoxicity. The means of micronuclei in one hundred binuclear lymphocytes were 6.3±2.2 before treatment and and 9.6±3.1 after treatment, differences in the number of micronuclei being statistically significant (p value <0.05). High doses of radioiodine therapy used after surgery for differentiated thyroid carcinoma can increase micronuclei among peripheral lymphocytes as an indirect marker of chromosomal aberrations and cytotoxic radiation damage.

Hip fracture, the most serious complication of osteoporosis, imposes a heavy finanicial burden for treatment on any health system, and accounts for more than 20% of orthopedic beds in many countries. The aim of this study was to determine the incidence rate of hip fracture in Zanjan, Iran over a period of two years, (March 21, 2003 to March 21, 2005). In this study, we assessed all cases discharged with final diagnosis of hip fracture (Intertrochanteric, Subtrochanteric, Trochanteric and neck fracture) in Zanjan shafiyeh hospital, which is the only referal center for hip fracture in Zanjan province. Of 490 cases of hip fractures, admitted in the last two years, 337 cases were attributable to osteoporosis 57.9% of fractures were in males and 42.1% were in females. Most of the cases were urban residents. The highest incidence rate was observed in the group 70-79 year age group, mean age being 71.24 years, (71.34 -males and 71.09 yr- females). Causes of 58.8% of fractures were simple falls or falls from stairs 27% of fractures occurred in winter but there was no significant difference between seasons. The average time of hospitalization was 8.12 days. In the osteoporotic fracture group, hospital mortality rates were 4.45%. In most reports worldwide, hip fracture is more prevalent in women, whereas in our study, hip fracture in all age groups was more prevalent in men. Since 50% of fractures occurred before the age of 70, early interventions for prevention of osteoporosis, particularly in men are necessary. Prevalence of osteoporotic fracture in men needs further study.

There are inconsistent data regarding the role of vitamin-D in determining bone mineral density (BMD) especially in less severe vitamin-D deficiency. The aim of this study was to investigate the possible association between 25(OH)D and BMD in healthy free-living postmenopausal women in a population-based study. We enrolled 245 postmenopausal women, aged between 40 to 80 years, randomly selected from the Tehran Lipid and Glucose Study. Measurements of BMD were taken at the lumbar spine and upper femur by dual X-ray absorptiometry additional to demographic and anthropometric data, serum 25(OH)D, PTH, calcium, phosphorus and alkaline phosphatase were measured according to the currently used laboratory methods. Bivariate and multivariate analyses were used to explore the association between 25(OH)D, BMD and other clinical and biochemical variables. Mean age and duration of menopause were 58±7 and 9.4±6.8 years, respectively 25(OH)D (29.3±24.9 ng/ml) was <10 ng/ml and 11-20 ng/ml in 5.2% (n=13) and 37.6% (n=92) of women, respectively 25(OH)D correlated inversely with LnPTH (r=-0.25, p<0.01). However no association was found between 25(OH)D level and BMD at any of the skeletal scanning sites in bivariate analysis or multiple linear regression analyses, after adjusting for age, years since menopause, body mass index (BMI), calcium and LnPTH. In the multivariate analyses, BMD correlated inversely with LnPTH, in addition to age and BMI (R2=20%, p=0.03) only in femoral neck, but not at any other sites. This study showed no association between 25(OH)D and BMD in postmenopausal women.

Cardiovascular disease is the most important reason for mortality in many countries, and because of its increasing prevalence, it is vital to recognize the related risk factors. Hypertension is a major risk factor for CVD. Waist circumference (WC) cut point is a simple way to recognize hypertension. WC cut off points vary for different races, making it nessecary to determine WC cut off points in Iranians. This study was conducted to determine the waist circumference cut off in related to hypertension in Iran. Methods and Materials: We enrolled 83772 individuals, 41775 men and 41997 women, aged eighteen years and older from cities and villages throughout the country. The cut off point for waist circumference was determined and exams for blood glucose and COL, TG was done. Cut off points for waist circumference were determined for hypertension using the ROC curve analysis, yielding 89 cm for men and 93 cm for women. These results showed that the cut off point for WC in Iran is higher than other Asians and is more similar to whites the present study shows that waist is ciruimference a strong determinant in relation to hypertension.

The aim of this study was to determine the prevalences of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT and to develop an effective screening strategy for undiagnosed diabetes in a large urban Iranian community. The study population included 9,519 participants of the Tehran Lipid and Glucose Study, aged ≥ 20 years, with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. The numbers needed to screen (NNTS) to find one person with undiagnosed diabetes were estimated from age-adjusted logistic regression models. The prevalences of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Un-diagnosed diabetes was associated with family history of diabetes, increased body mass index (BMI ≥ 25 kg/m2), abdominal obesity, hypertriglyceridemia, hypertension and low HDL-C levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to an NNTS of 1.6 (95%CI: 1.57-1.71) and among women a combination of family history of diabetes and abdominal obesity, yielded an NNTS of 2.2 (95%CI: 2.1-2.4). Approximately 32% of Tehranian adults had either diabetes or some degree of other glucose tolerance abnormalities. Nearly 40% of total cases with diabetes were undiagnosed. Screening individuals with family history of diabetes, BMI25 kg/m2, abdominal obesity and hypertension may have substantial advantages.

Acromegaly, a multisystem disease, produced by growth hormone (GH) secreting pituitary adenomas, has devastating effects shortening life expectancy thus control of the disease is vital. Surgical removal of adenomas is the primary and standard treatment in these patients. In this study, results of trans-sphenoidal surgery in 95 patients admitted consecutively to the Shohada-e Tadjrish Hospital, over 9 years beginning 1996, were analyzed. Data were collected retrospectively from files of all patients admitted to our hospital, over 9 years, and operated using a trans-sphenoidal approach. Clinical and radiological evaluations were reviewed and intra-operative findings, postoperative complications, immediate hormonal assay results and long term follow ups were analyzed. Forty eight patients were female and 47 male (1/1 ratio) with mean age of 39.2 ± 12 years. Acromegalic features were present in almost every patient with a mean duration of 46 ± 43 months. Macroadenomas were discovered in 70 patients and microadenomas in the other 25 there was no mortality. Postoperative complications were as follows: Temporary DI in 80, CSF rhinorrhea in 11 and meningitis in 4 (all were managed conservatively with only one case of permanent DI) 79 patients had follow up (mean 13±12 months) 64% of patients (76% of microadenomas and 62% of macroadenomas) had remission (post-operative GH < 5 ng/mL), but with remission criteria of GH < 2.5 ng/mL there was 51% remission rate (65% of microadenomas and 44% of macroadenomas). In five patients, following initial surgery, there was recurrence after 1 to 4 years, which was controlled in 4 of with a second trans-sphenoidal surgery, with the remaining one case being referred for radiotherapy.

Diabetes causes hypertension in most diabetic patients. Pomegranate juice is known to have antioxidant and antiatherosclerotic properties the purpose of this study was to determine the effects of pomegranate juice consumption on blood pressure of type 2 diabetic patients. In 1384, in a randomized clinical trial study, 61 diabetic patients (54.9±8.4 years old), attending the Special Diabetic Affairs Foundation and the Iranian Diabetic Society, were recruited, and were randomly allocated to either the pomegranate juice consumption or the control group. Patients in the pomegranate juice group consumed 200ml of pomegranate juice (sugar or additives free) daily for six weeks. The questionnaires for general characteristics, semi-quantitative food frequency and 24-hour food recall were completed by interview. Blood pressure and anthropometric measurements, including weight and height, were measured at baseline and at the end of the study. SPSS software was used for data analysis and Paired T-test, Independent T-test, Covariance analysis and Chi Square test were conducted. The mean body mass index, nutrients and fiber intake, drug intake and physical activity of patients did not change during the study. In the pomegranate juice consumption group, the mean systolic blood pressure (P< 0.001) and diastolic blood pressure (P< 0.05) were significantly decreased compared with baseline. The mean systolic blood pressure (P< 0.02) and diastolic blood pressure (P< 0.03) were significantly different between the pomegranate and control groups after intervention. Considering the positive effect of pomegranate juice consumption in reducing systolic and diastolic blood pressure in diabetic type 2 patients it may be recommended for hypertension prevention in these patients.

Some studies suggest that magnesium deficiency contributes to the cardiovascular complications associated with diabetes mellitus. Hence the present study investigated the effects of orally administrated magnesium on isolated aorta contractility in response to KCl and Phenylephrine (Phe). Sixty male Wister rats (180–250 g) were divided into two diabetic and two control groups. One sub group of each received magnesium sulfate in their drinking water, while two other groups, had only tap water. After 8 weeks, thoracic aorta was isolated, cut into 2-3 mm rings and mounted in an organ bath. The tissue was then exposed to cumulative doses of KCl (10, 20, 40, 60 and 80mM) and Phe (10-9, 10-8, 10-7, 10-6, and 10-5M) and contractions were measured by an isometric transducer. During the mentioned time, fasting blood samples were drawn every 2 weeks to measure plasma glucose level. Vasoconstrictive responses to KCl and Phe were significantly higher in control groups, compared to diabetic groups (P<.05) and there were no significant differences between Mg-treated and non Mg-treated rats. Maximal contractions to KCl were 2.91±0.31, 2.79±0.18, 2.37±0.16 and 2.42±0.11 and the maximal responses to Phe were 3.25±0.17, 3.12±0.25, 2.57±0.33and 2.73±.21 in control, Mg-treated control, diabetes and Mg-treated diabetic groups, respectively. No significant difference was found in plasma glucose between Mg-treated groups and non mg-treated groups. Oral administration of magnesium for 8 weeks has no effect on isolated aorta contractility in diabetic rats.

Although data shows the effects of stress on the cardiovascular system, there is no information on their reversibility. The aim of this study is to determine the reversibility of stress effects on responsiveness of isolated rat aorta. Thirty-six male rats were divided into three groups, the control, physical stress, and psychological stress groups. During study animals were kept in 12h/12h light/dark cycles at 23 ± 2 ºC and had free access to food and water. Stress was induced by the Communication Box for three weeks. Physical stress applied with electrical current (1mA, 1Hz, 10 sec/min) applied one hour twice daily. After one month recovery post stress responsiveness of isolated aorta to potassium chloride and phenylephrine were determined. The results of this study showed that one month recovery, following stress reverse, serum corticosterone and isolated aortic contractility in rats, so that no significant differences were observed between the control and stress groups the decreased adrenal weight coused by physical stress also reversed to normal one month after stopping the stress. It can be concluded that effects of physical and psychological stress on isolated aortic tensions is not permanent, and can be reversed.

Hemp is considered a nutritional and narcotic plant whole hempseed has almost 3% saturated fatty acids and 28% unsaturated fatty acids. This study aimed at evaluating the effect of hempseed on lipid profiles of male rats. After acclimatization, at the beginning of the experiment (day 0) animal feeding was stopped and after 14h fasting the animal was anesthetized by ketamine/xylazine combination and 2ml a heart sample blood was taken. The rats were fed normal diet (modified AIN-93M pellet) and 5g/Kg of hempseed powder solution (HPS 40%) via gavages daily for 30 days and at the end of experiment (day 31) blood samples were taken again. The lipid parameters were measured by enzymatic-colorimetric techniques. In spite of ω3, ω6 unsaturated fatty acids that are highly present in hempseed, short term hempseed feeding of hempseed additive in male rats did not improve lipid profile the mean fasting serum triglyceride, total cholesterol, LDL-C levels increased, while the mean fasting HDL-C decreased. In fact, no (p<0.05) statistical significant changes were observed in levels of the above mentioned parameters. Obviously the Isfahanian variety of the Cannabis plant has high content of an orexigenic, narcotic component (Tetrahydrocannabinol: THC), which does not alter the lipid profiles of rats if used over a long time it may lead to development of dyslipidemia.

Unsaturated fatty acids are known to decrease serum leptin level. Considering that wild pistachio oil is a rich source of UFA and the reciprocal effects between leptin and thyroid hormones, the aim of the present study was to investigate the impact of dietary wild pistachio oil on serum leptin concentration and its relationship with thyroid hormones. We took 28 healthy adult male rats and divided them randomly in to the four groups group 1 a control, and the other 3 groups received a normal diet without, 5, 10 and 20% of wild pistachio oil, respectively. RIA for thyroid hormones assay (T3 and T4) and ELISA for leptin, fT3 and fT4 measurement were used. After 60 days, serum leptin levels reduced with increasing wild pistachio oil concentration in the diet in the control group with normal diet, no significant alterations were seen. This reduction also was not statistically significant in the 10% wild pistachio oil group, whereas differences between groups were significant, indicating the increasing effects of increased amounts of wild pistachio oil percent on the reduction process observed. Pearson correlation coefficients were calculated between leptin and thyroid hormones in the different sampling times. Control group did not have any significant correlation. In group 2 (fed with 5% wild pistachio oil), leptin concentration had a negative significant correlation with T4 and fT3 and a positive significant correlation with fT4 in the third stage of sampling (day 30). A positive significant correlation between leptin concentration and fT4 in the fifth stage of bleeding (day 60) was observed in group 3 (fed with 10% wild pistachio oil). In group 4 (fed with 20 % wild pistachio oil) a significant negative correlation between leptin concentration and fT3 was observed in the second stage of sampling (day 15). Wild pistachio oil has a high content of unsaturated fatty acids, and reductins in serum leptin levels in the rats studied can be due to these acids. Oral consumption of wild pistachio oil has a positive effect on reductiong leptin and LDL-cholesterol thyroid hormones and prevention of cardiovascular diseases.

Iodine deficiency today is a risk factor for delayed growth and development and is the most common preventable cause of brain damage worldwide. Over of 2 billion (38%) of the world’s population from 130 countries are at risk. Iodine deficiency causes inadequate thyroid hormone production, iodine being essential constituent of the thyroid hormone. Iodine deficiency was once considered a minor problem, causing goiter however it is now known that the effects on the developing brain are much more deadly, and constitute a threat to the social and economic development of many countries. The history of iodine deficiency began with the first reports of goiter and cretinism, dating back to the ancient civilizations, the Chinese and Hindu cultures and then to Greece and Rome. The first detailed descriptions of these subjects, and documentation of the word “cretin” appeared in Diderot’s encyclopedia in 1754, to refer to an “imbecile who is deaf, dumb with a goiter hanging down to the waist”, at that time widely present in Switzerland, southern France and Northern Italy. The 19th century marked the beginning of serious attempts to control the problem, however, not until the latter half of the 20th century that the necessary knowledge for effective prevention and control was acquired present-day practice is based on the work of David Marine, who in 1915, declared that “endemic goiter is the easiest known disease to prevent.” In the same year, Hunziger proposed that iodized salt be used for goiter control in Switzerland. Today the number of countries with iodine deficiency as a public health problem has decreased from 110 to 45, between 1993 and 2003. An estimated 41 million annual newborns still come into the world unprotected from brain damage as a result of iodine deficiency. Monitoring of IDD elimination programs and education are two of the crucial elements for sustainability. Successes in some countries, e.g., Iran, China, Cameroon and Peru, show that sustainable optimal iodine nutrition is possible.

Adrenal tumors that secrete androgens are rare the tumor may be an adenoma or a carcinoma. This paper discusses the signs and symptoms, diagnostic methods, treatment and prognosis of these tumors, witnessed in 3 cases of androgen producing adrenal tumors. The first case was a 14 year old girl presented with hirsutism and virilism and primary amenorrhea. Testosterone and DHEAS showed very high levels while other adrenal hormones were within in normal limits. A pure androgen producing adrenal adenoma was diagnosed in this patient. The second case was a 7 year old girl with hirsutism, virilism and cushingoid facial features, acne and weight gain and a large abdominal mass. An adrenal carcinoma producing cortisol, testosterone, and DHEAS was diagnosed in this patient. The third case was a 10 month old baby with weight gain cushingoid facial features, acne and growth of pubic hair. High level of DHEAS, testosterone and cortisol due to an adrenocortical carcinoma, detected in this patient.