Iranian Red Crescent Medical Journal
Volume:10 Issue: 4, 2008

We present a case of osteosarcoma arising from an osteochondroma of the right tibia in a 71 year old man. The radiographic studies were suggestive of a malignant lesion. Histologic examination showed a conventional osteosarcoma that eroded the cartilagenous cap. The patient received postoperative chemotherapy with no evidence of metastasis until three years following the operation. The occurrence of osteosarcoma out of osteochondroma is an extremely rare event and very few cases have been reported.

Visceral leishmaniasis (VL) or Kala-azar is still a common parasitic infection among children in Iran. This study was performed to investigate the relationship between blood group type and VL among Iranian patients. were enrolled. The bone marrow materials of 249 children who were clinically suspected for VL were provided from the posterior iliac spine by Jamshidi`s needle. LD bodies were identified in all cases and diagnosed as VL. The distribution of blood group type of all infected patients was compared with that of a control group of normal donors (2490). There were 198 males and 51 females among VL patients. In both the VL and control groups, the maximum percentage was found in blood group O and minimum in blood group AB. Our results showed that the blood group was not a risk factor in the occurrence of VL. The ABO-Rh blood groups were not associated with the occurrence of VL in Iranian patients.

Stroke is considered as a lethal condition associated with significant mortality and morbidity. After stroke, complications are common and cause devastating effects on rehabilitation. The present study was designed to study the frequency of complications in acute stroke patients in Peshavar, Pakistan. This prospective observational study was conducted from March 2006 to February 2007 in the General Surgery and Neurosurgery Postgraduate Medical Institute, Lady Reading Hospital and Department of General Medicine of Hayatabad Medical Complex in Peshawar, Pakistan in a tertiary health care facility. The study was conducted on 100 consecutive patients of acute stroke, presenting within 7 days of the onset of stroke. All patients fulfilling WHO definition of acute stroke were admitted. The patients with subarachnoid hemorrhage were excluded from study. After initial assessment for the degree of neurological defect and functional disabilities, the patients were investigated for stroke types and cause. Daily assessment of all patients for occurrence of complications was done till discharge from hospital or death of the patient. Fift-eight (58%) patients were male and 42 (42%) were female with a mean age of 59.98 (±11.95) years. The patients with intra-cerebral bleeding were 32 while those with cerebral infarction were 64 and cases with lacunar infarction, were 4. The median hospital stay was 6 days. The main complications were aspiration pneumonia in 28 (28%), constipation in 28 (28%), chest infection in 27 (27%), dehydration in 21 (21%) and urinary tract infection (UTI) in 12 (12%). 16 patients (16%) had no complications and seven patients died. Aspiration pneumonia was the cause of death in four patients (57%) during their hospital stay. Post-stroke complications are very common and these can alter the outcome of stroke patients. Multidisciplinary stroke management is needed to decrease the complications of acute stroke.

One of the most common umbilical abnormalities in neonates is umbilical granuloma, causing inflammation and drainage. The common treatment is application of a 75% silver nitrate stick. This study was carried out to compare the effect of 2 and 24 hours salt (NaCl) in treatment on infant umbilical granuloma. From January 2004 to January 2006, at Neonatal ICU and Infant Follow-up Clinic of Imam Reza Hospital, Mashad University of Medical Sciences, Mashad, Iran, two groups including 20 infants with umbilical granuloma undergoing a 24 hours treatment with salt as the case group and 20 infants undergoing a 2 hours treatment with salt as the control group were compared. There were18 boys and 22 girls. The treatment days in case and control groups were 1.2+0.6 and 2.1+0.4, respectively and the difference was statistically significant. In either group, there were no significant differences between sex, birth weight, time of umbilical separation and age of enrollment. 24-hours treatment of umbilical granuloma with salt was shown to be more effective than the 2- hours treatment metho

Radiotherapy of prostate carcinoma often results in high doses to surrounding structures, such as the rectum and bladder. Therefore, these organs should be closely monitored. The aim of this study is to evaluate the dose received by the target volume and rectum to compare two different methods of dose measurement with each other and to check the homogeneity of dose in the tumor volume. The dose distribution throughout a planned target volume and the rectum (OaR) in a phantom exposed to 9 MV photon beam, similar to treatment conditions were studied. Several techniques of external beam radiation therapy such as two-, three- and four-field have been planned. Dosimetry was performed using GAFCHROMIC ® film and TLD-100 chips. The rectal and cancer volume measured doses in treatment were similar to the prescribed doses. The results of two dosimetry types were compared with each other as well as with treatment planning. Rectal dose in three- and four-field (equal tumor dose and equal applied dose) techniques were respectively 23.15, 28.87 and 15.22% lower than the tumor dose. There was not a statistically significant difference between received and prescribed doses. So, this study showed that the Gafchromic film dosimetry can be used for fast dosimetric evaluations.

Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2-3 folds. The factors responsible for this association remain under evaluation. In this study, the prevalence of isolated right ventricular infarction (RVMI) and ischemia were compared with isolated RVMI in other patients. This observational and analytical case-control pilot study enrolled 100 patients (82 men and 18 women) with suspected exacerbation of COPD hospitalized in the emergency department of Noor Hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran from 2003 to 2005. Spirometry was performed with the equipment that met the American Thoracic Society performance criteria. Frequent electrocardiography (including V3R –V4R) and CK-MB enzyme assay were done. Of the 100 patients, 35 (35%) were excluded due to lack of criteria of the study. Echocardiography revealed that all patients with exacerbation of COPD had tricuspid regurgitation about 3-4 m/s, indicating moderate to severe pulmonary hypertension (PH). OF the 65 patients, 6 (9.2%) with moderate to severe pulmonary obstruction had isolated right ventricular myocardial infarction. Also, 9 (13.8%) patients had ST segment depression≥ 1 m in V3R and/or V4R. The difference between the patients with and without exacerbation of COPD accompanying isolated RV MI was significant. Increase in the right ventricular pressure reduces the right coronary artery flow which results in ischemia, infraction and circulatory collapse. The results indicate that patients with exacerbation of COPD are at risk of isolated RV ischemia and infarction. Therefore, V3R and V4R lead should be taken.

Development of a drug which could prevent or delay the onset or progression of cataract will help to reduce the number of people getting blind due to cataract worldwide. This study was undertaken to evaluate the clinical and biochemical changes of the crystalline lens and gel-electrophoresis of water soluble proteins in a selenite- induced cataract and to assess the preventive role of L-Cysteine and vitamin C in rat as an animal model. Cataracts were induced in rats by administration of sodium selenite. In control group, saline was injected subcutaneously (SC). In experimental groups (groups 2-5), sodium selenite (20 μmol/kg) was injected SC. Rats in group 3 received SC injections of 0.1 ml of vitamin C (0.3 mM), in group 4 received SC injection of 0.1 ml of L-cysteine (0.05 μmol) and those in group 5 received SC injection of 0.1 ml of L-cysteine (0.1 μmol). The development of cataract was assessed clinically. Then, the lenses were checked for total and soluble protein concentrations and eletrophoretic pattern (SDS-PAGE). Sodium selenite could induce cataract and cause biochemical and eletrophoretic changes in the lens. L-cysteine and vitamin C were highly effective in preventing or minimizing selenite-induced cataract and in maintaining near-normal total protein and soluble protein concentrations of the lens. These reagents were also effective in restoring the near normal pattern of lens proteins in SDS-PAGE. L-cystein was more effective than vitamin C in prevention of cataract but the difference was not statistically significant. Our results showed that cataractous and biochemical changes of the crystalline lens proteins due to selenite can be minimized or prevented by L-cysteine and vitamin C.

Following the widespread use of poliovirus vaccine in the mid-1950s, the incidence of poliomyelitis declined rapidly in many industrialized countries. The aim of this study was to determine the surveillance of poliomyelitis and acute flaccid paralysis (AFP) in Fars Province, southern Iran to detect poliovirus wherever it may circulate. From 1995 to 2006, in a cross-sectional study, all patients over 15 years of age with flaccid paralysis in Fars Province of Iran were enrolled. The surveillance medical officers visited every AFP case, took clinical histories, and performed clinical examinations. Two stool samples were collected from each reported case within 14 days of the onset of paralysis and sent to WHO-accredited laboratories for poliovirus isolation and intra-typic differentiation. AFP cases from which stool sample of wild poliovirus was isolated were classified as confirmed poliomyelitis. Those AFP cases whose cultures for poliovirus were negative were referred to an expert panel. Whenever possible, nerve conduction velocity tests, electromyography, and other diagnostic modalities such as brain and vertebral MRI were performed along with a detailed neurological examination at least three weeks after the onset of paralysis. The non-polio AFP rate was 227 (mean: 18.91 per year). Only one case of poliomyelitis was reported in the first year of surveillance. Other 226 cases had non-polio AFP. The most common cause of paralysis among these patients was Guillain-Barre syndrome (66%). The non-polio AFP rate is almost in agreement with the estimated incidence of AFP in the population aged 0-15 years worldwide. Routine coverage with three doses of OPV with supplementary immunization activities has reportedly reached over 95% of all target children. The existing system must be closely monitored and actively supported to maintain and constantly improve performance.

Whether non-steroidal anti-inflammatory drugs have a detrimental effect on tendon regeneration is still a matter of debate. As such, the purpose of this study is to determine the effect of diclofenac on tendon healing. Sixty four guinea pigs were randomly divided into two main groups (group A: histological study, group B: biomechanical study). Then tenotomy and repair of right Achilles tendon were done. Half of the animals in each group received diclofenac (1 mg/kg/bid) and the other half received placebo. Half of the animals in each group were sacrificed at 2 weeks and the remaining animals at 6 weeks post-operation. In group A, histological study for determining maturity of healing of tendons in diclofenac and control groups was done, and in group B, tensile force to failure of tendons at two and six weeks of post tenotomy was determined. After two weeks, of the group A1, four animals in the experimental and five in the control group were labeled as relative immature. Four of the animals in the experimental and two in the control subgroups were labeled as relative immature. These differences were not significant. In group A2, five animals in the experimental and three in the control group were in the relative mature and three of those in the experimental and four of the control group were labeled as relative immature group. In group A1, the tensile force to failure was 24.175 N and 25.371 N in the experimental and control groups, respectively. In group B2, mean force to failure was 41.019 N in the experimental and 39.743 N in the control group. There was no significant difference between both groups. Diclofenac at the dosage of 1 mg/kg/bid did not appear to affect histological and biomechanical characteristics of tendon healing

The human heavy (VH) and light (VL) chain variable genes are amplified and randomly assembled together and cloned into the minor coat protein gene (g3p) of M13 bacteriophage. The resulting library of scFv is expressed on the phage as g3p fusion protein. The high affinity specific scFv antibodies can be selected against a key antigen using panning process. Our aim was development of scFv antibodies against P185 tumor antigen by recombinant phage antibody system and panning process. Antibody engineering technology was applied to lymphocyte mRNA of a non-immune donor and a scFv library was constructed. The library was panned against an immunodominant epitope of P185 which its reactivity had been tested with sera from breast cancer patients. DNA fingerprinting of the scFvs selected the predominated clones. These were then screened by ELISA. A large library including high repertoires of VH and VL was constructed. DNA fingerprinting differentiated a number of clones. After selection against the immunodominant epitope of P185, nine clones were differentiated including two predominated scFv antibodies. The predominated antibodies were bound to the corresponding epitope and produced a positive ELISA. The high affinity P185 specific scFv antibodies which were originated from human genes and bound specifically to the P185 epitope are valuable clinical agents and have the potential to be used in cancer immunotherapy in which P185 overexpression and metastasis occurs.

There is still a question whether first seizure leads to epilepsy. Several risk factors have been reported in this relation. This study was undertaken to determine the risk of recurrence after a first unprovoked seizure in children. In a prospective study between December 2003 and December 2005, 156 children who presented with a first unprovoked seizure were enrolled and followed for at least 18 months. Potential predictors of recurrence were compared, using the Cox Proportional Hazard model in a univariable and multivariate analysis. Survival analysis was performed, using the Kaplan-Meire curves. Seventy two children (46.2%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 28.8%, 41.7% and 46.2% at 6, 12, and 24 months following the first seizure, respectively. The median time for repeated seizure was 4 months while 62.5% of the recurrence occurred within 6 months, 88.9% within 1 year and 100% till the end of the second year. On multiple analysis, risk factors for resumption of seizure consisted of abnormal electroencephalography (EEG), seizure during sleep, abnormal brain imaging and history of perinatal problems. On univariable analysis, abnormal EEG, abnormal imaging (remote etiology of seizure), history of neonatal problems, previous febrile seizure, and family history of afebrile seizure increased the risk of recurrence. The study revealed that the risk of seizure recurrence in our patients was relatively high. Those who had abnormal electroencephalography, past history of prenatal problems, remote etiology for seizure, abnormal brain imaging, and seizure during sleep were at greater risk for recurrence of seizure.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer among men in the developed world. The objective of this study was to document the gender, age, sites of occurrence and histological differentiation of the HNSCC in southern Iran. In a retrospective study from 1992 to 2007, 386 patients with a histological diagnosis of the HNSCC were investigated in departments of pathology of Shiraz Dental School and Khalili Hospital in southern Iran. Among 386 cases, there were 289 male (74.9%) and 97 female (25.1%). In younger patients, the male to female ratio was lower than that in the older ones. The larynx was the most commonly affected site (44%), followed by the oral cavity (34.7%), skin (7%), oropharynx (3.1%), hypopharynx (2.9%), cervical esophagus (2.3%), other sites (4.2%) and unknown site (1.8%). 45.6% were well but 8.3% were poorly differentiated for SCC. HNSCC was most common in the larynx and oral cavity with an older aged male preponderance, but male to female ratio was lower in younger patients than older ones.

Cancer is a significant health problem in the developing countries, and one that is likely to increase in future. Due to unavailability of data concerning cancer during the last 15 years in our area and young age structure of our country, this active hospital-based study was undertaken to determine the occurrence of cancer in Fars Province, southern Iran. Data including face-to-face interview with patients and a survey of their medical and demographic records in relation to all invasive cancers were actively collected from 1990 to 2005 from four university hospitals. Among 2993 cases of registered malignant neoplasms presented by site and sex, the crude incidence (CRs), and age-specific incidence and age-standardized incidence rates (ASRs) per 100,000 were determined, using the world standard population. Over a 5-year period, 1495 and 1620 cancer cases were registered in males and females, respectively, while breast cancer was at the top of 10 cancers in both sexes. With regard to the top 10 types of cancer, there was a remarkable difference between the results of our study and the estimated cancer incidence for Iran by Globocan 2000. Ethnic, racial and environmental factors may explain these differences but more studies in a longer time span are needed to clarify the causes.

Fanconi anemia (FA) is a chromosomal breakage disorder characterized by familial aplastic anemia (AA), various congenital anomalies, and a characteristic chromosomal response to clastogenic stress. In this study, chromosome breakage test was performed for 38 patients suspected of having FA and age-matched controls. According to the results, ten patients were considered as FA cases and 15 patients with no chromosomal breaks were considered as AA. Differentiation of FA from AA is very important because the primary treatment is different. This test should be done in every primary presentation of AA.

Weight gain during pregnancy for women with normal Body Mass Index (BMI) before pregnancy has been reported to be 11.5–16.0 Kg/m2 by IOM and supported by several authors. This study was carried out to determine the relationship between pre-pregnancy BMI and gestational weight gain and pregnancy outcome. In 476 pregnant women, BMI was categorized and weight gain was divided into less than normal and higher than normal groups based on Institute of Medicine (IOM) recommendations. Women with normal weight gain had better pregnancy outcomes. The incidence of low birth weight was higher among underweight women and those with low gestational weight gain. Overweight women and those with high gestational weight gain had a higher rate of cesarean delivery and postpartum hemorrhage. There was also a significant difference between the BMI early postpartum hemorrhage, method of delivery, neonatal weight, nausea, vomiting and weight gain during pregnancy. Women gained weight according to recommendations had good pregnancy outcome in relation to weight, lengths and head chest circumferences of the neonate and methods of delivery and post partum hemorrhage. The findings presented here indicate that prenatal care providers should consider women with abnormal prepregnancy BMI and gestational weight gain at an increased risk unconditionally and that they need special care to avoid the pregnancy-associated complications forthwith.

Sinus histocytosis with massive lymphadenopathy (SHLM) disease is considered to be indolent with self limiting pathology. However, severe morbidity and mortality have been attributed to complications of SHLM. Lower respiratory tract involvement, which is often unfavorable, is rarely reported and carries particularly grave prognosis. A case of sinus histocytosis with massive lymphadenopathy (SHLM) is reportedhere. The patient had lower respiratory and pleural involvement.

Heparin induced thrombocytopenia is a known complication of using heparin. In this case, the patient developed deep vein thrombosis while he was in the ICU. Upon administration of heparin, he developed thrombocytopenia. After stopping heparin and using alternative anticoagulation, there was no improvement in the platelet count, however. Eventually, there was another source of heparin that could contribute to the worsening of platelet function.

Dear Editor, Sulfur mustard (mustard gas) is the most important vesicant agent, and among all chemical warfare agents it has caused the greatest number of casualties of particularly, during the Iran–Iraq War (1980- 1988).1 The designation of chemical weapons as "weapons of mass destruction" emphasizes their potential catastrophic effect on the health of a large number of population.2 According to Iraq''s declarations, some 105,000 munitions filled with chemical warfare agents were supplied to their armed forces during the Iran-Iraq war from 1981 to 1988.3 Iraq also declared that about 1,800 tons of mustard gas were consumed during these years.4 There are numerous studies regarding late pulmonary, ophthalmic, dermatologic, immunologic, hematologic or carcinogenic complications of mustard exposure following the Iran-Iraq war,5-10 but the role of mustard exposure in the survivors'' fertility is still unclear. Recently, we came across an article in your journal entitled "Long-term effect of exposure to mustard gas on male infertility," which reported a 44% infertility rate among subjects who were "highly suspicious of being exposed to mustard gas during the Iran-Iraq war".11 The study''s findings contrast markedly with the findings of the studies of mustardexposed survivors at the Janbazan Medical and Engineering Research Center (JMERC). In order to better understand this subject, the following notes should be considered: The authors neither specified how they drew their sample nor when the study took place. 1. It is difficult to draw conclusions about a causal relationship between mustard exposure and male infertility when the exposure is "highly suspected" rather than confirmed and when no data are presented on the level of exposure. 2. Although previous reports have demonstrated the ability of sulfur mustard to cause adverse reproductive effects,12,13 few correlations have been established between mustard exposure and human infertility. In 2004, a study on sulfur mustard exposed survivors of Sardasht reported that the infertility rate was 8.3% among the exposed victims with confirmed exposure, which compares with a worldwide rate of 10-15%.14 Numerous clinical studies in the JMERC on mustard gas exposed survivors did not support the theory of reproductive toxicity of sulfur mustard. 2. In our recent work, a collective examination program as a part of the national health monitoring project run by the Iranian Veterans'' and War Victims'' Organization,1 and JMERC, 419 victims with documented exposure to sulfur mustard now suffering from severe respiratory or ophthalmic complications were investigated for cumulative or lifetime infertility. Of these, 402 were married of whom 10 survivors (2.5%) were reported to have fertility problems. Of these 10 cases with fertility problems, 8 needed to use IVF or other assisted reproductive therapies and 4 were childless. Other than the four who had no child, the subjects who were married had 1 to 13 offspring (mean: 3.5±1.8). We have found that, in contrast with previously reported laboratory studies11,12 in the long term (21.2±1.6 years after their exposure), there is no evidence of clinical life-time infertility among survivors with high dose mustard exposure. Because unverified reports of infertility after exposure to sulfur mustard could possibly lead to unfortunate consequences among chemical warfare victims, we would be grateful for your kindness in considering this letter as an opening to discussion on this subject. Conflict of interest: None declared.

Dear Editor, As cervical length decreases, the risk of preterm birth increases.1,2 The risk of early birth increases exponentially with decreasing cervical length in both singleton and multiple pregnancies.3 In such women individualization of risk would lead to rationalization of antenatal care, including frequency of visit, patient education in recognizing and reporting symptoms of spontaneous preterm Labour and timely administration of steroid.3 It is also possible that in women identified as being at high risk, the rate of preterm birth might be reduced by the prophylactic use of progesterone. 3 In women presenting with threatened spontaneous preterm Labour, transvaginal measurement of cervical length provides a useful distinction between those who are likely to deliver within subsequent 7 days and those who are not.3 A study of 3694 unselected finnish women scanned at 18 – 24 weeks of gestation at 25mm cutoff, the sensitivity and specificity for preterm birth before 35weeks was 7 and 92 percent respectively.4 In Iranian hospital of Dubai, every day many pregnant women with different nationality refer to obstetrics and Gynecology Clinic for travel certificate. From January to August 2008, transvaginal ultrasound was done to determine the length of cervix for 66 pregnant women who referred for certificate to travel. First they were sent to empty their bladder, ultrasound gel was placed on a transvaginal probe before the covering and then more ultrasound gel was placed on the cover. A small cushion was placed under the buttock for a better position. With the real time image in view, the transducer was gently placed in vagina until the cervical distance between internal and external os was determined. The relationship between the lower uterine segment and the axis of the cervical canal was categorized as T,Y,V and U shapes. ‘T’ for normal relationship of the area where the endocervical canal meets the uterine cavity, whereas ‘U’ represented almost the complete effacement. The age range of patients was 21-42 years old from 15 different nationalities. Gestational age was 21-35 weeks, while only one pregnant woman had a 17-week gestational age. The total cervical length measurements were 66. Sixty two cases had cervical length of ≥ 27 mm and 4 had <20 mm. In these 4 pregnant women, the relationship between lower uterine segment and the axis of the cervical canal was as follows: 1 with T, 2 with Y and 1 with V shape. In the 62 pregnant women, the relationship between lower uterine segment and the axis of the cervical canal was as follows: 57 with T and 5 with Y shape. Of these 5 women with Y shape, only one had had history of C/S in 35 weeks due to PROM in previous pregnancy, no other person had history of preterm labor pain. In 66 pregnant woman who referred just for certificate to travel, 4 had cervical length less than 20 mm (6.06%) and 2 (50%) had the Y shape. We can conclude that by measurement of cervical length before travel, the high risk pregnant women for preterm labor pain may be recognized and any unpredictable events may be prevented. Keywords: Cervical length; Travel permission; Pregnancy Conflict of interest: None declared.