Medical Journal Of the Islamic Republic of Iran
Volume:22 Issue: 4, Winter 2009

Cancer has not been elucidated in colerectal site. C-reactive protein (CRP) is a product synthesized in hepatocytes and has been reported to be up-regulated by such proinflammatory cytokines as interleukin-1 (IL-1), interlukin-6 (IL-6), and tumor necrosis factor (TNF). The significance of a preoperative serum elevation was evaluated using CRP as a predictive indicator for the malignant potential and prognosis. Forty consecutive patient with colorectal cancer whose local lesions were resected in our department, plus forty healthy volunteers, were selected. Any patient with inflammatory diseases such as infection or collagen disease was excluded from the current study. The preoperative serum CRP level and the control group were measured. The relationships between the serum elevation of CRP and both the clinicopathologic factors and prognosis of the patients was investigated. The rate of patients with elevated serum CRP level was significantly higher in the colorectal cancer patients in comparison to the control group (55% versus 2.5%). Furthermores the incidence of liver metastasis, peritoneal carcinomatosis, histopathologic lymph nodes metastasis, and tumor invasion in colorectal cancer patients with a preoperatively elevated serum CRP level were significantly more frequent than in those with a negative serum CRP level. The survival rates of the colorectal cancer patients without a preoperative elevation of the serum CRP proved to be significantly more favorable than that of the colorectal cancer patients with such an elevation (94.4% versus 59.1%; P<0.001). Apreoperative serum elevation of CRP was thus found to be an indicator of the malignant potential of the tumor as well as prognostic factor for patients with colorectal cancer.

Gastric cancer is the second most common cancer and also the second cancer related death all over the world. In recent years recorded data for tumor has shown a rise in the incidence of gastric cancer in young individuals. The present study was designed to compare some of the epidemiologic characteristics of individuals suffering from gastric cancer aged below and above forty years. This cross-sectional study was performed on 389 patients suffering from gastric cancer referred to a referral private clinic in Tehran during the years 1991 and 2001. The patients were divided into two groups، those older than 40 years and the younger ones. The demographic information، the tumor type and location as well as the prevalence of the H. pylori infection was compared in the two groups. The collected data were entered in SPSS version 13 and analyzed using chi-square and fisher exact test. Fifty patients (12. 9%) were reported to be lower than 40 years. The mean age of the patients in this group was 32. 1±6. 8years while the number was calculated to be 63. 23 ± 9. 7 years in the other group. The male to female ratio in the group younger and older than 40 years was 1. 9:1 and 2. 6:1، respectively. Adenocarcinama and lymphoma compromised 70% and 12% of the individuals younger than 40 years whereas they were reported in 89. 3% and 3. 2% of the patients in the other group. While cancer in the middle third of stomach was the most frequent type in both groups، the prevalence of upper third gastric cancer was considerably higher in those younger than 40 years old (19. 9% vs. 5%). H. pylori infection was seen in 23. 2% of the younger group، while more than 56% of the older group suffered from H. pylori infection. There was a statistically significant difference between the two groups (P<0. 017). gastric cancer is not rare among the individuals younger than 40 years old. The disease is reported to be seen in the absence of H. pylori infection in the majority of these cases. There is a considerable difference between the prevalence of malignant lymphoma in this group of patients compared with the older patients.

Spondylolysis and spondylolisthesis can be associated with significant low back pain، especially in physically active adolescents. Non-operative management is usually successful in improving symptoms، but surgical intervention is occasionally required. The aim of this study was to determine the effect of in situ posterolateral fusion in the treatment of refractory cases with spondylolysis. In this prospective before and after study، we described our experience in13 patients managed by in situ fusion after failing multimodality non-operative treatment. All surgical procedures were performed by the senior author and by a similar technique. The spondylolytic vertebra and the one below were fused، in situ. Finally، clinical outcome and recovery rates of clinical symptoms were evaluated by Henderson’s functional capacity and Oswestry Disability Index version 2. 1، respectively. The mean duration of non-operative management was 36 (12-72) months. There were 8 males and 5 females. Average pre- and postoperative Oswestry Disability Indices were 28. 4%±13. 7% and 4. 9±7. 8 respectively (P=0. 001، significant). All patients had follow-up contact on an average of 42. 3 months (range 30 - 62 months). Based on Henderson’s clinical outcome functional capacity at the final follow- up stage clinical outcomes were excellent in 10، good in 2 and poor in 1 patient. The case with poor result had a pseudoarthrosis and was re-oprated. Finally he had an excellent outcome. We accept that the number of our cases is not high significantly but it can be claimed that in situ fusion is a safe and effective modality to treat symptomatic patients with spondylolysis and low-grade spondylolisthesis. A study with much more cases is strongly recommended.

Reamed interlocking intramedullary nailing of the tibia is a procedure for the treatment of a non-infected tibial nonunion. The purpose of this clinical study was to evaluate the outcome of this method as a treatment of tibial nonunion.

Twenty-nine patients with nonunion after initial therapy for tibial fracture were retrospectively assessed after a reamed interlocking intramedullary nailing. The main measurements were derived from radiographic and clinical union as well as time from reamed nailing to union.

Twenty-eight patients achieved union of their fracture (97%). The average time from reamed nailing to union was 7.6 months. Serious complications included one severe infection in the site of surgery (3%) and one tibial fracture distal to the nail (3%).

Reamed interlocking intramedullary nailing for nonunions of the tibia resulted in a high union rate and was associated with a low complication rate. This technique is recommended as a standard procedure for non-infected tibial nonunions.

Regarding the variety of tests present for detecting and also screening prostate cancer and also bearing in mind the advantages and disadvantages of these tests we decided to re-evaluate these tests (total prostate specific antigen and all of its modifications) in detecting prostate cancer in men with intermediate serum PSAlevels. Following a cross sectional study, 100 consecutive men with intermediate serum PSA levels and normal digital rectal examination (DRE) were incorporated. Total and free PSA levels and TRUS-guided systematic prostate biopsy were performed. PSA density, percent free PSA and percent free PSA density were calculated and compared. Statistical analysis was carried out using STATA8 SE. Overall, 27 patients had prostate cancer and 73 had benign prostate pathology. PSA density had the greatest area under the curve (AUC) which was significantly higher than percent free PSA density (0.685 vs. 0.448, p<0.001). The AUC of percent free PSA density was not different between benign and malignant biopsy results nor was significantly higher than the AUC of percent free PSA (0.308) or any other screening tests. PSAdensity was the most accurate screening test for prostate cancer in patients with PSA levels of 4-10 ng/ml and normal DRE. The percent free PSA density was not significantly more accurate than percent free PSA and regarding the costs of transrectal ultrasonography, it can be concluded that the percent free PSA is more cost-effective and hence more appropriate than percent free PSA density to screen prostate cancer.

Cosmetic rhinoplasty is now carried out increasingly in an attempt to solve the psychological and social problems of people who are discontent with their nose. Little is known about either the psychological status of persons who seek rhinoplasty or potential psychological changes following surgery. The challenge that faces surgeons, is how to identify, before surgical intervention those patients who may have a poor outcome in terms of psychological adjustment despite a technically satisfactory result. Atotal of 96 patients (84 women and 12 men) who were seeking cosmetic rhinoplasty were selected and completed an adopted expectation questionnaire and SCL-90-R, a 90 item self-report symptom inventory which measures 9 primary symptom dimensions. It is designed primarily to reflect the psychological symptom patterns of psychiatric and medical patients. The majority of the patients reported that their noses made them selfconscious, and thought the rhinoplasty would change their lives. Interpersonal sensitivity and anxiety were the most reported symptoms in SCL-90-R, followed by obsessive- compulsive symptoms and depression. The findings of this study enhance our understanding of psychological factors in seeking rhinoplasty and provide insight into the surgical-psychological management of these patients.

Chronic sialadenitis is a disease of salivary glands associated with chronic infections,systemic diseases and silolithiasis pathogenesis of the disease. Primary tuberculoussubmandibulitis is not a reported disease. The diagnosis was confirmed whena 45 years old lady suspicious to submandibular gland tumor was operated on for excisionalbiopsy. Histological examination of the specimen by expert pathologistruled out malignancy, granuloma or caseous necrosis. Cultures of discharge and tissuewere negative for mycobacterium tuberculosis. The only positive diagnosticmodality was Polymerase Chain Reaction for mycobacterium tuberculosis. Therefore,the four drug anti-TB regimen was initiated. After that a surgical fistula washealed and the patient left the hospital on her foot and there was no recurrence at leastfor one year. The endemic condition of tuberculosis in some populations has increasedthe rate of extra-pulmonary tuberculosis. One of the extra pulmonary sitesmay be the submandibular gland.It is recommended to consider tuberculosis in the differential diagnosis of submandibulargland masses especially in populations with endemic tuberculosis.

Epidermal inclusion cysts are uncommon in the breast, but the consequences can besevere when these cysts occur in the breast parenchyma. Here, we report two suchcases. The patient in case 1 was an 37-year-old woman with a 3-cm palpable mass inthe right breast. Mammography revealed a round and smoothly outlined mass, whichindicated a benign tumor, and sonography showed an irregularly shaped and heterogeneous hypoechoic mass, fibroadenoma was suspected on the basis of clinical andimage findings, but excisional biopsy revealed an epidermal inclusion cyst. The patientin case 2 was a 50-year-old woman with a 2.5-cm lesion in the left breast. Mammographyrevealed a round, dense, smoothly outlined mass, and sonography showeda well-defined, central hyperechoic mass.. Breast cancer was suspected on the basisof the sonographic findings and the age of the patient, but the resected specimen revealedan epidermal inclusion cyst. Although epidermal inclusion cysts are benign,occasionally they may play a role in the origin of squamous carcinoma of the breast.. Mammographic and sonographic features of an epidermal cyst may mimic a malignantlesion. Malignant change appears to occur more frequently in epidermal inclusioncysts in the mammary gland, compared to common epidermal inclusion cysts,and this may be associated with origination of mammary epidermal inclusion cystsfrom squamous metaplasia of the mammary duct epithelium.Epidermmoid inclusion cyst of the breast is potentially serious, although such cystsare rare, and differentiation from a malignant or benign breast tumor is required. Excisionis probably the most appropriate treatment, and can eliminate the possible riskof malignant transformation.

Hydatid disease is a widespread parasitic infection caused by tapewormEchinococcus and it affects mainly the liver, but other organs such as pelvic organscould be involved very rare. Here we report a case of hydatid cyst with involvementof oviduct in a woman with endometrial cancer. It was misdiagnosed as a multicysticright ovarian mass before surgery and by microscopic study it was shown as a primarydegenerated hydatid cyst which was also unusual. Although pelvic echinococcalcysts rarely occur, the gynecologists should be consider, and the possibility of ahydatid cyst when they find a pelvic cystic mass, especially in areas where the diseaseis endemic.