Archives of Iranian Medicine
Volume:8 Issue: 4, oct 2005

Oral lichen planus (OLP) is a chronic inflammatory disease characterized by relapses and remissions. There is currently no cure for OLP. Treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks. Topical steroids are the first-choice agent for the treatment of symptomatic, active OLP. Other topical agents that have been used in cases resistant to topical steroids include retinoids, cyclosporine, and tacrolimus. Oral and topical psoralen with a low dose of UVA is effective in treating OLP of various forms, but it seems to have too many side effects. Topical application of psoralen is promising, but IS still at experimental stage.The treatment of symptomatic OLP, especially the erosive variant, represents a perplexing therapeutic challenge. Despite numerous existing remedies, there are many treatment failures.

Wound repair is a natural reaction to injury, which results in restoration of tissue integrity. Wound healing occurs in 3 phases including inflammation, proliferation, and remodeling. There are common pathways in wound healing of human and certain animal species. To examine the healing effect of tragacanth mucilage on excisional full-thickness wound in rabbit. Mucilage was extracted from the dried tragacanth gum, using a mixture of water and glycerin (4:1) as the vehicle. Three percent, 6%, and 9% creams of tragacanth mucilage were prepared in the eucerin base. A full-thickness wound was made on the left flank of rabbits. Tragacanth creams were applied on the wound area twice daily. Control groups were treated with the drug-free cream base or commercial phenytoin cream 1%. Healing was determined quantitatively as the reduction in wound area. Histological study was performed using hematoxylin and eosin stain under light microscope. The wound healing profile of tragacanth-treated groups was significantly better than the nontreated groups. The best healing effect was observed with the 6% tragacanth cream, which exerted the lowest period for healing. This effect was significantly different from the control phenytoin or drug-free eucerin bases. The extent of tissue repairment was confirmed by histological examination. Tragacanth mucilage exhibited a considerable potency for wound healing. This is probably due to an acceleration of collagenation and proliferation phases of the wound repair.

Much research is being carried out to find a tumor marker for early diagnosis of breast cancer when the lesion is still small. CA15-3, a glycoprotein, is one candidate with probable use as tumor marker in breast cancer. We conducted this study to analyze the relationship between serum levels of CA15-3 and several variables including age, clinical stage, and the number of lymph nodes involved in breast cancer patients. One hundred and thirty-six females including 39 normal controls, 54 patients with benign lesions, and 43 with malignant lesions entered this study. A second and third sample was obtained from patients who were diagnosed as having breast cancer, one week and one month postmastectomy, respectively. CA15-3 was measured by ELISA. The number of patients in the malignant group (6 out of 43) with elevated CA15-3 levels was higher than that in the normal controls (3 out of 39) and patients with benign lesions (1 out of 54). Forty percent of patients in stages II and III had a higher frequency of abnormal CA15-3 values, whereas 13% of those in stage I disease did so. One week after mastectomy, the mean ± SD serum CA15-3 was 18.3 ± 14.6 U/mL. However, a month later, the mean ± SD was 21.7±19.7 U/mL, which was approximately the same as the preoperative values (mean ± SD: 22.1 ± 25.6 U/mL). There was an abnormal elevation in CA15-3 values when ≥4 lymph nodes were involved. The correlation between the elevated CA15-3 values and the number of involved lymph nodes was significant (P < 0.001). Ana­lysis of the CA15-3 values showed a sensitivity of 14.0% and a specificity of 92.3%. The positive and negative predictive values were 66.7% and 49.3%, respectively. The relative efficiency was 1.8%. In this study, CA15-3 was found to have no value in the screening for early diagnosis of breast cancer. We observed a strong correlation between elevated CA15-3 levels and the progression of breast cancer.

Ginger (Zingiber officinale) extract supplementation has been shown to improve the severity of symptoms and decrease the nonsteroidal antiinflammatory drug (NSAID) requirements in patients with osteoarthritis (OA). To assess the effects of ginger extract as an alternative to NSAIDs and as a supplement drug in the symptomatic treatment of OA. Between April and October 2002, 120 outpatients with OA of moderate to severe pain, requiring only the use of NSAIDs, were enrolled into a double-blind, randomized, placebo-controlled clinical trial. These patients were randomized into three groups of 40, including the placebo (PL), ginger extract (GE), and ibuprofen (IBP) groups. After a washout period of one week (week 0), patients received either 30 mg ginger extract in two 500 mg capsules, placebo, or three 400 mg ibuprofen tablets daily for one month. Acetaminophen tablet was prescribed as a rescue analgesic during the study. The clinical assessments included a visual analog scale (VAS) for pain, gelling pain, joint swelling measurement, and joint motion slope measurement. Joint motion slope was measured by goniometry (normal = 130°, limited = 120°, and very limited = 110°). The improvement of symptoms (defined as reduction in the mean change) was superior in the ginger extract and ibuprofen groups than the placebo group. VAS scores and gelling or regressive pain after rising the scores were significantly higher in the PL group than both the GE and IBP groups, a month after the treatment (P < 0.0001). However, there was no significant difference in VAS and gelling pain scores between the ginger extract and the ibuprofen groups. Ginger extract and ibuprofen were significantly more effective than the placebo in the symptomatic treatment of OA, while there was no significant difference between the ginger extract and ibuprofen groups in a test for multiple comparison.

Posterior sagittal anorectoplasty (PSARP) is the newest and most-widely-used technique for correction of anorectal malformations (ARMs). In the present investigation, the functional outcomes of PSARP and also the relationship between the complications and the sacral ratio (SR) have been studied. The study group included 49 patients (25 males and 24 females) with ARMs, operated on by the PSARP technique during 1995 – 1999. The patients had been followed up for at least 4 years. Those with mental retardation were not included in this retrospective study. For objective evaluation of the sacrum, the SR was calculated in all of the patients. In the female patients, rectovestibular fistula (46%) and in the males, perineal fistula and imperforate anus without fistula, each with equal frequency (28%) were the most common anomalies. The mean SR in the study group was 0.72 + 0.04. SR was 0.67 + 0.03 among patients who had associated urogenital anomalies, 0.69 + 0.04 in patients suffering from soiling, and 0.67 + 0.02 in patients who had postoperative fecal incontinence. The most common complication following PSARP was soiling (44.9%) and then constipation and fecal incontinence in order of frequency. None of the cases developed urinary incontinence or other urinary complications after PSARP. Seventy-three percent of the patients had voluntary bowel movements (VBMs) and 51% were totally continent. Although the PSARP has a negligible complication rate, the success and outcome of the surgical correction in view of the bowel function depend on the development of the sacral nerves. SR reflects the sacral bone development and can be easily calculated by a pelvic AP film. Considering the lower SR in patients suffering from postoperative soling and fecal incontinence, in comparison to the normal group (0.77), SR could be used as a prognostic index to predict the probability of achieving total continence following PSARP.

Low-birth-weight (LBW) is universally used as an indicator of health status and is an important subject of national concern and a focus of health policy. LBW has been shown to be associated with a higher risk for childhood mortality and morbidity. To determine the important risk factors which could affect the delivery of LBW neonates. This case-control study was undertaken to determine some risk factors for LBW in two university hospitals in Tehran during a 12-month period between 2002 and 2003. One hundred and sixty neonates constituted the LBW group and 300 neonates constituted the control group. Maternal risk factors including body mass index (BMI), educational level, interval between pregnancies, history of previous delivery of LBW neonates, abortion, infertility, unwanted pregnancy, and diseases were analyzed between the two groups. Mean of maternal age was similar between the two groups. Of 160 LBW neonates, 58% were females and 42% males. It was found that mother’s BMI, unwanted pregnancy, educational level of mother, short and long intervals between pregnan­cies, previous history of delivering LBW neonates, and maternal diseases are associated with an increased risk of LBW. The majority of factors which lead to the delivery of LBW neonates are preventable.

Nucleolar organizing regions (NORs) are loops of rDNA, which in humans, occur on the short arms of five acrocentric chromosomes, namely, 13, 14, 15, 21, and 22. NORs are usually demonstrated by binding their associated proteins (NORAPs) to silver (Ag+) ions. The reaction is called AgNORs. It has been determined that the number and the size of NORs are related to the proliferative activity and grade of malignancy.The purpose of this study was to determine the value of AgNOR method in assessment of the grade of malignancy in non-Hodgkin’s lymphoma (NHL) of the head and neck. Forty-one cases of paraffin embedded specimens of NHL, classified by the working formulation system, were selected and then examined by the AgNOR method. AgNORs were enumerated for all 41 cases of NHL (Standard Crocker). The mean AgNORs in 11 cases of low-grade, 15 cases of intermediate-grade and 15 cases of high-grade NHL was 1.66 (SEM = 0.098), 2.52 (SEM = 0.084), and 5.19 (SEM = 0.11), respectively. Through the analysis of variance and multiple comparison, a significant difference was found between the three groups of NHL (P < 0.0001). AgNORs is a reliable method, which could be used in grading of NHL in the head and neck area.

Accurate staging and grading of bladder neoplasms, which are the most important guides for the treatment of transitional cell carcinoma (TCC), depend seriously on the interpretation of tumor biopsies by pathologists and are largely subject to inter- and intra-pathologist variations. Therefore, it appears that clinicians should have additional guides to appropriately diagnose and treat high-risk patients. We evaluated the association of the grade of TCC of the urinary bladder with four patient’s variables, i.e., age, gender, cigarette smoking, and opium consumption, to find out if any of them could serve as a guide for clinicians. A retrospective study was performed on 255 individuals in whom TCC was diagnosed. Correlations between the grade of TCC and clinical features were determined. Age was not correlated with tumor grade (P = 0.59), but cigarette smoking (P = 0.032) and male gender (P = 0.029) showed positive associations with higher grades. The association between male gender and higher grades is probably due to the higher incidence of cigarette smoking among men (P < 0.001), making this correlation spurious. Because opium consumption had a significant correlation with smoking (P < 0.001), its correlation (P = 0.012) with high grades of TCC could not be validated as accurate. Cigarette smokers and males (according to a high prevalence of cigarette smoking among males) are more prone to develop high grades of urinary bladder TCC. In these high-risk groups, there should be a low threshold for the review of pathologic material if the primary pathological examination shows a low-grade carcinoma, for adjuvant treatment (intravesical therapy), and for careful follow-up after the treatment—especially when pathological differentiation between the grades is difficult.

Use of the community periodontal index of treatment needs (CPITN) provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions. To determine periodontal status and treatment needs by CPITN index in the Iranian adolescents. The study population consisted of 1,319 subjects aged 15 – 19 years, selected through a multistage cluster stratified random sampling from 13 different provinces of Iran. Six calibrated qualified examiners, using flat dental mirrors and CPITN probes conducted clinical examinations according to the World Health Organization (WHO) standards. The severity and prevalence of the periodontal diseases, as well as its frequency distribution were evaluated and reported according to gender; residency place; frequency of dental brushing; plaque index; number of family members; mean of decayed, missed, and filled teeth index (DMF); and CPITN. This study was performed during 1999 and 2000. In this study, only 14.5% of subjects demonstrated a healthy periodontal status, with a mean healthy sextant of 2.6. Bleeding was noted in 33.7% of subjects and calculus had the highest score (48.7%). Shallow and deep pockets were found in 3.9% and 0.5% of the population studied, respectively. Periodontal status in men was worse than women (P < 0.005). In urban areas it was better than the rural areas (P < 0.0001). The highest rate of calculus and bleeding were observed in subjects with high plaque index and low frequency of dental brushing (P < 0.005). A statistically significant (P < 0.005) relationship was also observed between CPITN scores and the number of family members. A positive correlation was found between the periodontal status and treatment needs with the DMF index (P < 0.02). We found that a high percentage of adolescents need treatment (TN1, TN2, TN3, 4). If the current trend is not reversed, with increasing the age, periodontal diseases could be escalated.

A successful kidney transplantation (KT) corrects the main metabolic abnormalities responsible for secondary hyperparathyroidism (HPT). Nonetheless, after several months, many patients keep abnormally high parathyroid hormone (PTH) levels and/or become hypercalcemic with persistent HPT. In the present survey, the frequency of high PTH levels and the influence of certain important factors on its evolution among patients with successful KT were investigated within three months posttransplantation. A total of 126 patients, who had successful KT, entered the study between 2000 and 2002. On the day of operation and three months later, demographic data and serum calcium, phosphorus, albumin, creatinine, and immunoreactive PTH (iPTH) (by IRMA) were checked. Hypercalcemic patients, at third month, were followed up for one year after transplantation. With respect to the post-KT iPTH level, patients were divided into two groups; those with iPTH above and below 60 pg/mL. The importance of several factors on the evolution of hyperparathyroidism was determined. Sequential changes in serum calcium were also assessed in hypercalcemic patients up to one year after transplantation. Twenty-one (16.6%) out of 126 patients had a post-KT serum calcium of >10.8 mg/mL. Post-KT iPTH value of > 60 pg/mL was found in 9 (7.1%) out of the 126 cases. There was a statistically significant relationship between the age of patients and duration of dialysis and a post-KT high PTH level (P < 0.001). Other risk factors did not seem to have a significant correlation with the post-KT high PTH level. In all hypercalcemic patients, PTH levels normalized but hypercalcemia persisted in 14 (88%) out of 16 patients up to 1 year after transplantation. Increased age of the patient as well as the duration of dialysis had significant influences on development of persistent HPT, three months posttransplantation. We believe that it is better to transplant the patients as soon as possible, in order to prevent the devastating complication of persistent HPT and hypercalcemia.

All aspects of lumbar disc surgery are being currently commented in pertinent medical literature, but only few studies have dealt with comparative results and the outcome of surgical treatment. To find out the possible correlation between preoperative symptomatic period and postoperative complete recovery time, and fitness to resume normal personal and professional life. In a retrospective study, we evaluated the outcomes of lumbar disc surgery by reviewing records of 153 consecutive patients who were surgically treated for lumbar disc herniation. The endpoint of this study for each case was defined at the time of complete recovery and/or between 4 to 12 months after surgery. A highly significant correlation (r = 0.6) existed between the pre- and postoperative duration of sciatalgic symptoms (P < 0.0001). Regression analysis showed that postoperative recovery time in months = 1.29 + 0.58 × preoperative duration in months. The duration of preoperative disabling leg pain has a significant predictive value for the overall outcome in lumbar disc herniation surgery.

Meningococcal diseases have been recognized as an important problem in military population. Most patients with meningococcal diseases have not had a direct contact with other similar patients. Thus, asymptomatic carrier is presumably the major source of transmission of pathogenic strains. To determine the carrier rate of the newly-arrived recruits to a military center and to find out the sensitivity pattern of the isolated strains. One thousand four hundred and fifty-six tonsilopharyngeal samples were collected during a 15-month period from 2002 through 2003. All the samples were plated on chocolate agar supplemented with 3 mg/L vancomycin and 2 mg/L amphotericin B. Meningococci were identified by a standard method. Sero-grouping of part of isolated strains was carried out by the slide agglutination test. The antibiotic resistance was measured by the broth macrodilution method with penicillin, rifampicin, and ciprofloxacin. Sensitivity of part of isolated strains against two antiseptic solutions, chlorhexidine and eucalyptus inhaler, were also tested. The mean of meningococcal carrier rate in 4+1 seasons was 11.4% for the newly-arrived recruits. After 1 ½ – 2 months, it raised to 33%. Increases observed in cold seasons were considerable. During the second sampling stage, the mean carrier rate was 38% for smokers and 28% for nonsmokers. Strains isolated from carriers were phenotypically heterogeneous, with a dominance of group B (~27%). All the invasive strains recovered concurrently from the patients with meningococcal diseases also belonged to this sero-group. The median of minimum inhibitory concentrations (MICs) for penicillin and rifampicin were 0.06 and 0.03 µg/mL, respectively. The MIC50 of ciprofloxacin was 0.004. Thirteen percent of the isolates were partially resistant to penicillin. It was 8% for rifampicin. More than 60% of the isolated strains were sensitive to 1/600 dilution of chlorhexidine. It was negligible against the eucalyptus inhaler. Our results indicate that the transmission rate is strongly associated with the season. Furthermore, there is a correlation between the carrier state and smoking habit. Domination of B sero-group among the carriers and patients could be due to the lack of B antigen in the available vaccines. The resistance pattern of tested strains was similar to that of other studies.

Glomus tumor is a rare vascular tumor with a predominant subungual location in the hand. Different dorsal transungual surgical approaches have been described for excision of glomus tumor. In this report, the volar approach has been used for extirpation of subungual glomus tumor with osseous erosion and perforated distal phalanx in two patients. When feasible, by applying volar approach, the risk of nail deformity, which is a major concern after the tumor excision, can be eliminated.

Inflammatory pseudotumors of the lung are rare and may produce diagnostic and therapeutic dilemma for the clinicians, pathologists, and surgeons. Herein, we reported on four patients with this uncommon disease. They were three men and one woman with a mean age of 37 years (range: 20 – 50). Three cases were symptomatic, complaining of cough, expectoration of sputum, hemoptysis, and chest pain. Three had solitary pulmonary nodule (SPN) and one had a tumor-like mass in chest X-ray films. Wedge resection was performed for the first three cases. With suspicion of lung cancer, pneumonectomy was carried out for the last patient. The overall survival was 100%. There was no operative or postoperative complications/death or recurrence within 5 – 10 years of follow-up. All of them had benign appearances, which was proven by pathologic examination.Inflammatory pseudotumors of the lung are rare. Most behave in a benign fashion. It may increase slowly in size and sometimes has an aggressive behavior. Frozen section may be used during the operation for the diagnosis. According to pathologic examination, complete resection is safe and leads to excellent survival.

Metastasis of cancers to finger is a very rare finding. Herein, we report on an 80-year-old woman presented with a large painless ulceroproliferative lesion of her right thumb. The lesion was surgically excised. Pathological report revealed a papillary adenocarcinoma—a distant metastasis from the esophagus. The patient had an uneventful course and was discharged from the hospital.

Torsion of the testicles is typically seen in children of prepubertal age. This condition is extremely rare in perinatal period. The perinatal diagnosis of spermatic cord torsion is often difficult. Here, we report a case of a male newborn baby who was born with swollen and erythematous scrotum. Ultrasonography showed an enlarged left testis, with a nonhomogeneous texture and a regular border, bilateral hydrocele, and septate fluid collection on the left side. Following the diagnosis of acute scrotal condition, surgical exploration was performed. The left testis was gangrened with a blue coloration because of complete extravaginal torsion. Left orchidectomy, along with a fixation of right testis were carried out. Perinatal extravaginal testicular torsion, although a rare condition, is a true immediate emergency that needs early and quick medical attention, and surgical intervention to save testicular tissue.

Chylous ascites was diagnosed in a female neonate. Following the administration of a gastrografin enema, which showed the presence of gut malrotation, she was operated. This led to a complete recovery and optimal weight gain. For evaluation of chylous ascites in neonates, gut malrotation should be considered in order to prevent volvolus and further complications.

Although diabetes mellitus is common in acromegaly, diabetic ketoacidosis (DKA) is rarely reported in this disease. Herein, we reported on a 41-year-old man with acromegaly whose first presentation was DKA. After treatment of acromegaly, his diabetes subsided. We concluded that, even in nondiabetic individuals, a high level of growth hormone can rarely cause DKA.