Iranian Journal Of Pathology
Volume:4 Issue: 3, summer 2009

Ischemic heart disease (IHD) following atherosclerosis is the most common cause of cardiac deaths world wide. We aimed to investigate the pathologic features of atherosclerosis in non cardiac death cases to have an estimate of atherosclerosis prevalence in Mashad (North east of Iran).Patients and This descriptive (cross sectional) study was done, during October 2007 – March 2008, on 80 cadavers from 11 to 50 years old who had died of non cardiac causes and had no history of cardiac disease. After autopsy in forensic medical center, coronary arteries were removed and examined for atherosclerotic plaques. In case of a definite lesion, microscopic slides were also prepared. Otherwise, three random slides from each branch of coronary arteries were studied bya pathologist. We found that 73.1% of men and 61.5% of women had at least one fibrofatty or advanced plaque in major coronary arteries. Atherosclerosis in 41.8% of men and 30.8% of women was in advanced form. Frequency of advanced atherosclerotic plaques progressed with age reaching a maximum of 78.5% by the age of 41-50 years. In addition, prevalence of plaques suddenly increased after second decade of life. Atherosclerotic plaques were most commonly found in left anteriordescending artery (60%) followed by right coronary (50%) and left circumflex (42.5%) arteries. This study showed an unexpectedly high prevalence of atherosclerosis in thispopulation. It highlights the importance of cardiovascular risk factor screening from early ages of third decade

Urinary tract infection is one of the most common bacterialinfections in the human population, and more frequent infection during pregnancy. With noticeto this point that most of urinary tract infections during pregnancy are asymptomatic, they couldlead to serious complications such as prematurity, low-birth weight, hypertension, and higher fetalmortality rates if untreated. This study was aimed to determine the prevalence of asymptomaticbacteriuria, bacterial agents and their antibiotic susceptibility pattern in pregnant women attendingSemnan public health centers during 2007-8.Patients and In this descriptive cross sectional study, pregnant women attendingSemnan public health centers during May 2007 and June 2008 were investigated. Clean catch midstream urine samples were collected and cultured on Eosin Metylene Blue agar and Blood agar bycalibrated loop method. Suspected colonies were identified, antibiotic susceptibility test was done. Of 297 samples, 10 (3.3%) were positive for asymptomatic urinary tract infection. Thedominant bacterial isolate was Escherichia coli (70%). The antibiotic susceptibility was observedto ciprofloxacin, ceftazidime and cefotaxime (80%), the most resistance was amoxicillin- clavulanicacid (90%). Frequency of asymptomatic UTI in pregnant women in this study is significantlylower than similar studies. Antibiotic susceptibility rate to using antibiotics do not show significantdifferences with most other studies.

Microscopic evaluation of cervicovaginal smears (Pap smear)plays an essential role in detection of preneoplastic and neoplastic lesions of uterine cervix. A wide spectrum of changes is seen in Pap smears. Interpretation of intermediate changes which resulting in observation of so- called ASCUS is difficult. ASCUS is defined as a cellular change that is more marked than typical reactive change but lack features diagnostic of intraepithelial neoplasia. The aim of this study was determination of reliable cytological parameters to identifying real nature of ASCUS.Patients and In this descriptive, cross sectional study, all Pap smears with presence of ASCUS, which followed by biopsy samples in Urmia, Shahid Matahari hospital during March 1999 to December 2002 were reviewed. In this regard, 17 parameters of cytoplasm, nuclei and smear background were considered and data were analyzed by SPSS and Chi Square test. Four parameters of irregular nuclear contour, increased nucleo- cytoplasmic ratio,cytoplasmic vacuolization and dirty background are highly suggestive of dysplasia. It is important to consider that to find out the real nature of ASCUS a group of parameters are more helpful than a single one. In addition, a single Pap smear is not enough for thispurpose and further investigation is required.

Brucellosis is a main transmittable zoonotic disease, which isendemic, and a common health burden in Iran. Adenosine deaminase (ADA) is an essential enzyme which is involved in purine metabolism and its role in immune system is very important. The aim of this study was to determine serum changes of ADA and C-Reactive Protein (CRP) levels in patients with brucellosis.Patients and The study was a case-control one on 36 patients and 36 controls. The serum level of ADA and quantitative CRP was measured in both patients and controls. We also measured the Wright, Coomb,s Wright and 2-mecapto ethanol (2ME) in two participants groups.Statistical analysis was performed using SPSS for windows Version 11.5 ADA serum level in patients group showed a significant difference compared to control group (31.6425.1± vs. 13.973.9±, P<0.0001). Quantitative CRP level in patients group was higher than control group significantly (25 ±20.7 vs 6.94.4±, P<0.0001). There was a correlation between level of serum ADA and serum CRP in patients significantly (P<0.004) while there was no correlation between Wright, Coom,s Wright, and 2ME with serum ADA and CRP levels (P=NS). This finding shows the serum level of ADA and CRP are two important parameters in diagnosis, treatment of brucellosis with the considering of the clinical manifestations and other paraclinic findings. However it is advisable to perform more studies.

Approximately 45% of benign peripheral nerve sheath tumors(PNST) occur in head and neck regions. Malignant peripheral nerve sheath tumors (MPNST) are less common and only 815%- of these tumors occur in head and neck region. In this study, we aimed at evaluating the demographic characteristics, pathologic findings, locations, main clinical presentations and family history of these tumors in head and neck regions.Patients and In a cross sectional and retrospective study, we analyzed head and neck peripheral nerve sheath tumors in patients who referred to Amir-Aalam Hospital affiliated toTehran University of Medical Sciences for 10 years (1996 to 2005). There were 113 cases with a kind of nerve sheath tumor; the female/male ratio was 1.09. The frequency of schwannoma, neurofibroma and MPNST was 66.37%, 30.1% and 3.53%, respectively including 39 cases of acoustic neuroma, 18 cases of cervical nerve trunk involvement, 12 cases of facial nerve involvement, 11 cases of the 10th cranial nerve PNST and only one case of cervical sympathetic nerve involvement. Schwannomas are the most common types of PNSTs seen in head and neckregions, and aucoustic neuroma comprises the majority of them. About 25- 45% of extracranial schwannomas also occur in head and neck regions that usually present a slow growing of the mass lesion and various mass effects. Although neurofibroma and MPNSTs are less common, they must be kept in mind as differential diagnoses of other benign and malignant lesions in this region.

Nosocomial infections are one of the most important worldwidehealth and increased patients hospital stay, therapeutic problem and mortality rate. This study was designed to determine the frequency of microorganisms isolated from tracheal tube in patientsadmitted to ICU Shaheed Mostafa Khomeini Hospital Tehran, Iran, from 2001-2005.Patients and In this cross-sectional descriptive study, 352 patients admitted to ICU of the hospital were evaluated from 2001-2005. Information was derived from 18 questions in 2 parts,demographic and clinic/paraclinic. Data were analyzed by SPSS statistical software, and MeanWhitney, chi-square tests. Most patients were in 70-98 years age group, with the mean age of 62.73±10.03, 64.2%& 35.8% were male and female, respectively. The highest hospitalization times were 2-30 days with the mean times of 24.06±16.68 days. In addition, the median time of intubation was 9 days. The mostcommon microorganisms were Staphylococcus aurous (23.6%), Klebsiella spp. (23.3%) Acintobacterspp. (20.7%), Pseudomonas aeroginosa (18.2%) Escherichia coli (7.7%), and Enterobacter spp.(5.7%). There was significant association between the time of endotracheal intubation and S. aurous, P. aeroginosa, Klebsiella spp., Enterobacter spp. (P<0.05), and between E-coli and hospitalization time(P<0.05). No significant association was found between Acintobacter spp. and other microorganism with other variants. It seems that there is no difference between our research and other studies about microorganism isolated from patients with endotracheal tube. We recommend a similar study designed in another hospital to determine the epidemiologic pattern of microorganism frequency.

Salmonella infections are endemic in many developing countries with poor sanitary conditions, but emerge sporadically as a serious public health threat in developed countries. Infections with multidrug resistant (MDR) strains of Salmonella have been associated with treatment failures. Salmonella spp. resistant to extended spectrum cephalosporins are increasing in prevalence worldwide. The aim of this study was to determine the antimicrobial susceptibility, multidrug resistance and extended spectrum beta lactamase (ESBL) production among clinical isolates of Salmonella spp. during 2007 in Tehran, Iran.Patients and In this cross-sectional study, fifty Salmonella spp. were identified by API 20E system and serotyped by the slide agglutination test. Disk diffusion test was performed. Double disk synergy test was used as a screening test for ESBL production, using disks of cefotaxime andceftazidime with and without clavulanic acid. From 50 Salmonella spp. 12 (24%) were S. enterica serogroup paratyphi B, 24 (48%)S. enterica serogroup paratyphi C and 14 (28%) were S. enterica serogroup Typhi. The most susceptibility and resistance were observed to ceftazidime (98%) and amoxicillin-clavulanic acid (96%), respectively. 28(56%) were resistant to 5 or more antibiotics. ESBL production was detected by double disk synergy test in one isolate (2%). Results showed increase in antibiotic and multidrug resistance pattern of Salmonella spp. comparing to previous studies in Iran and other countries. It seems that this is the first reportof Salmonella spp. ESBL producing in Iran.

Human brucellosis is common in developing countries and is a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the literature. Here we present a case of a 32-year-old man with history of consumption of cheese made from raw milk seen with occurrence of pancytopenia and diffuse maculopapular rash during the course of Brucella infection. Physical examination showed fever, splenomegaly, mild hepatomegaly and pruritic maculopapular exanthema over the trunk, arms and legs. Laboratory tests revealed pancytopenia. Parasitic examinations and serologic tests for syphilis, salmonellosis,rickettsiasis, toxoplasmosis, Epstein-Barr virus, human immunodeficiency virus, and hepatitis Band C viruses were negative. There was no history of drug consumption.The Brucella agglutination test titer was 1/1280 and histological examination of skin biopsy showed lymphohistiocytic perivascular infiltrates in the upper dermis.Lesions were interpreted as Brucellar dermatitis, The patient was subsequently treated with oral doxycycline and rifampin and was discharged in good health. If there is suspicion of exposure to infected food products, brucellosis should be included in the differential diagnosis of pancytopenia in Brucella-endemic areas; there may be skin lesionsother than purpura that can accompany thrombocytopenia.

Kaposiform hemangioendothelioma (KHE) appears as a single lesion at birth or early infancyin an equal sex ratio. A rare aggressive vascular proliferation has been recognized as a separate entity from other childhood vascular neoplasm. A 3-year-old Iranian boy with a rapidly enlarging mass in his (posterior aspect of skull at the midline) skull was present here. Physical examination revealed a dark-red, firm mass measuring 5 × 4.5 cm in the posterior aspect of skull. No association with Kasabach- Merritt syndrome (KMS) was observed despite its size. Histologically, KHE was composed of infiltrating nodules with slitlike or crescentic vessels that are poorly canalized and lined by spindled endothelium cells. Immunohistochemically, both spindle and epithelioid cells were immunoreactive for CD34 and CD31, while negative for EMA, cytokeratin or S100 protein. α-SMA were detected in pericytes surrounding spindle cells. Recurrence occurred 2 month after first operation. Wide resection was performed at second operation and the patient was still alive during the 1-year follow- up period.

Peripheral calcifying cystic odontogenic tumor (PCCOT) is a rare odontogenic lesion, whichrepresents about 1% of jaw cysts. Here we report clinicopathologic, radiographic and CT scan images of a new case of recurrent large PCCOT located in mandibular gingiva in a 77-year-old male with history of a nodular mass in the same area, which had been completely excised 3 years ago.In reviewing the literature, we found 55 previous reported cases with a mean age of 48.8 yr at the time of diagnosis. A majority of cases appear as a circumscribed nodule less than 1.5 cm in greatest diameter, without bony involvement. No case larger than 4cm in diameter has been reported. Only one case of recurrent PCCOT was seen in reported cases.