مجله علوم پزشکی رازی
سال هفدهم شماره 11 (پیاپی 81، بهمن و اسفند 1389)

The mortality rate of car crashes in Iran is very high worldwide. Most of these injured persons have urologic injuries. In our country, the prevalence of urologic injuries accompanied by multiple traumas is about 10-12%. The aim of this study was to evaluate the epidemiology of patients with urologic trauma and the diagnostic and therapeutic modalities. We used a check list that consisted of the etiology of trauma, urologic trauma, co-morbid trauma, vital signs, diagnostic procedures, type of treatment and final outcome. The files of 76 patients with multiple injuries accompanied by urologic trauma that had referred to emergency department of Rasool Akram hospital between 2007 and 2008, were evaluated. We used t, Chi-square, One way ANOVA and their equivalent non parametric tests in our statistical analysis. SPSS V. 16.0 was also used. Mean age of patients was 33±2 years. The mean hospitalization period was 11.6±6 days. There were 35 kidney injuries (44.5%) with grades I-V. Twenty-five patients (26.3%) had bladder injuries, 14(18.4%) urethral injuries, 37(48.7%) co-morbid injuries, 13(17.1%) external genitalia injuries (scrotal/testis) and 4(5.2%) had ureteral injuries. Pelvic fracture (19 patients- 24.7%) was the most common co-morbid injury. Overall there were three deaths that were accompanied by non-urologic co-morbidities. There were 43 patient (55.6%) with complete improvement and 30 patients (39.5%) who needed delayed surgery. Complications of urologic surgery were low and nobody died of these complications. There was no significant relationship between trauma etiology and the severity of injury. This difference might have been due to less number of patients, incomplete hospital files or death of patient with severe injury at the time of accident. Complications during treatment were fully controlled. Our facilities for diagnosis and treatment meet our needs.

Biochemical and immunological investigations have indicated cardiac dysfunction and damage with changes in cardiac markers and inflammatory cytokines after endurance exercise.Therefore, there is a rational background to study the effect of cardiac pathophysiology during endurance exercise.This study was undertaken to determine the effect of endurance exercise on cardiac and inflammatory markers in elite kayakers.

Male professional kayakers with mean age of 22.5±3.24yr, mean weight 78.7±7.18 kg and mean height of 184± 4.357cm participated in a quasi-experimental study. Participants kayakied 8000 meters with 75-80% heart rate for 60 minutes. Blood samples were taken before, immediately and three hours after a prolonged endurance kayaking. Repeated measures followed independ t-test used for statistical analysis. SPSS v>16 was used for analysis.

NT-proBNP levels significantly increased (24.05 vs 19.362 pg/ml) (p<0.001). The plasma IL-6 insignificantly decreased in response to prolonged endurance kayaking (0.755 to 0.74 pg/ml)(p=0.91). There was no association between IL-6 and NT-proBNP levels after exercise.

Exercise-induced increase in NT-proBNP may represent physiologic reaction under special conditions and seems to have no significant pathological effect in the athletes. Decreased IL-6 plasma levels did not indicate myocardial damage. Based on thge results of this study endurance exercise does not effect the cardiac dysfunction and structural myocardial damage.

Breast cancer is the most common cancer and the second cause of cancer death among women. Despite recent developments in therapeutic tools about 25% of all the involved cases die annually. The clinical, molecular, and pathologic features of breast cancer in BRCA1 mutation carriers suggest that BRCA1 may function as a stem-cell regulator. The purpose of the current study was to investigate the correlation between BRCA1 protein expression and clinicopathological characteristics, and putative cancer stem cell marker (CD44 (in breast carcinomas. In this experimental study, immunohistochemistry was performed on 156 primary operable breast tumors employing a monoclonal anti-BRCA1 primary antibody. The relation between BRCA1 expression and variations such as age and pathologic features andCD44 was studied by Chi square test. SPSS V.16 was also used for data analysis. Altered BRCA1 expression was significantly associated with high grade and poor prognosis breast tumors (p=0.006). Mutated BRCA1 was also more often seen in early onset breast cancer patients (≤ 40 years) rather than patients over age of 40 (p=0.04). There was also a significant correlation between the BRCA1 andCD44 expression (p= 0.02). Our results indicat ed that mutated BRCA1 expression is a marker of tumor aggressiveness, and its expression related to breast cancer stem markerCD44 in primary breast tumors. These finding support the idea that loss of BRCA1 expression may result in an accumulation of genetically unstable breast stem cells, providing targets for further carcinogenic events.

Bile duct obstruction due to gall stone is the most common cause of biliary infection. Bacteria stabilize during the inflammation of gallbladder and it is confirmed that longer duration of inflammation is associated with more risk of post operative infection. In this study we sought to determine the biliary microbial flora in patients with acute and chronic cholecystitis in order to find the suitable antibiotic to treat preoperative infection by using antibiotic susceptibility test (antibiogram). This was a descriptive cross sectional study. From all patients with acute and chronic cholecystitis due to stones that underwent cholecystectomy a sterile sample was taken during surgery and sent for laboratory analysis. It was examined for gram negative and gram positive, aerobic and anaerobic bacteria. Bile culture was performed within an hour after taking samples. The data were registered and analyzed by statistical SPSS software version 11.5. The majority of patients (73.1%) suffered from chronic cholecystitis and the stones obtained were 48.7% of cholestrolic type and 29.5% of mixed type. No significant relationship existed between stone type and bile culture results. Gram positive cocci (e.g. streptococcus) and gram negative bacili (e.g. citrobacterfrondei) were found in 11.5% and 17.9% of the patients, respectively. Most sensitivity to antibiotics was towards fluoroquinolones. Study results showed that bile fluid was not infected in most of the cases and in positive cases sensitivity to fluoroquinolones such as ciprofloxacin, ofloxacin and norfloxacin was detected. The relationship between stone type and culture results was not significant.

Chronic sinusitis is a common cause of attending Otorhinolaryngology clinics. Hence in this study diseases with symptoms similar to chronic sinusitis were evaluated in Booali Hospital during 2009 and 2010. In this descriptive-analytical cross-sectional survey, 184 nonrandom patients attending Otorhinolaryngology clinics in Booali Hospital during 2009 and 2010 were evaluated. Patients with underlying diseases and or with previous history of sinus surgery and patients less than 16 years or more than 70 years of age were excluded. For statistical analysis Chi square, t, One way ANOVA, Fisher’s exact tests and SPSS V. 11.5 were used. The observed differential diagnoses included: 16.3% allergic rhinitis, 10.9% bacterial rhinitis, 19.6% vasomotor rhinitis, 9.8% medicomentosa rhinitis, 4.3% reflux-induced rhinitis, 15.2% tension headache, 13.6% migraine headache, 2.2% temporomandibular dysfunction, 44.6% nasal anatomical obstruction, 1.1% somatization disorder, and 10.9% olfactory dysfunction. According to the findings, it may be concluded that in patients with symptoms similar to chronic sinusitis, the differential diagnoses especially allergic and non-allergic rhinitis should be mentioned.

Cutaneous metastasis is a rare presentation of choriocarcinoma and as it is associated with advanced disease, it has poor prognostic sign. To the best of our knowledge about 11 cases of cutaneous metastatic choriocarcinoma were reported in the literature. Case Report: A 47-yr –old female complaining of cutaneous lesion with pruritis. She had history of choriocarcinoma following missed abortion. Skin biopsy revealed cytotrophoblast and syncitotrophoblast without chorionic villi. After 3 cycles of chemotherapy, serum βHCG decreased and skin lesion almost disappeared. As compared to other organs, skin is an uncommon site for metastatic cancer in the body, as it is usually associated with disseminated disease and grave outcome. However, cutaneous metastasis may be the first harbinger of visceral malignancy of unknown origin and could be an important diagnostic clue. Gynecologists should consider meticulously skin lesions in known cases of disease and even in patients without history of disease, because skin lesion may be the first sign of the disease.