مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و یکم شماره 6 (پیاپی 150، شهریور 1392)

Prostate cancer is the third leading cause of death and is the most common cause of cancer in elderly men. Regarding to the low accuracy of screening methods such as prostate-specific antigen (PSA)، Digital Rectal Examination (DRE) and trans rectal ultrasound (TRUS) in detection and localization of tumor، Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) attracted many attentions in the past years. DWI reveals micro-molecular diffusion، which is the Brownian motion of the spins in biologic tissues. This technique can delineate pathologic lesions with high tissue contrast against generally suppressed background signal. In this paper، the value of DWI in detection of prostate cancer is studied. In this cross-sectional study، the studied population are suspicious patients to prostate cancer based on high Prostatic Specific Antigen level or abnormal Digital Rectal Examination who refered for prostate biopsy to radiology department of Hazrat-e- Rasoul Hospital during the year 2011. The results of DWI are compared to biopsy results for all patients. Eighty five patients are selected. The DWI sensitivity in detecting of prostate cancer is 100%، specificity 97. 1% and positive and negative predictive values are 89. 5% and 100%، respectively. The results showed that if DWI reports the prostate cancer as negative، the result was highly reliable and if it reports as positive، although the report was not 100% reliable، but it still had high reliability، more than 90%. DWI had high accuracy in detecting prostate cancer for patients with cancer. Also the accuracy of this method for patients without prostate cancer was acceptable compared to the other common methods.

Gestational trophoblastic disease (GTD) is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization (WHO) classification they include: Hydatidiform mole (complete and partial)، invasive mole، choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by pre-evacuation ultrasonographic evaluation، laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis، the accurate diagnosis، follow up and recommendations given to patients may differ. Consecutive cases with diagnosis of GTD from archive of pathology department of women (Mirza Kochak Khan) hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity، parity، history of previous abortion and gestational trophoblastic disease، the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated. Out of 220 cases with clinically gestational trophoblastic disease diagnosis، 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole (CM)، 84 partial mole (PM)، 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy (4. 1%) and high degree of concordance between ultrasonography and histological diagnosis is seen. Ultrasonographic examination accompanied with clinical examination، beside histological assessment as gold standard have high efficacy in diagnosing complete mole. This study did not show this finding for partial mole.

As regard to high prevalence of Helicobacter pylori infection and complications of it''s persistence، as well as anti-bacterial activity against of Helicobacter pylori and anti-inflammatory properties of omega-3 fatty acids، this study was conducted to evaluate the effects of supplementation with Docosahexaenoic Acid (DHA) on the eradication of Helicobacter pylori infection، some serum inflammatory markers and total antioxidant capacity.

In a double-blind، placebo-controlled clinical trial، 66 H. pylori positive patients (33 in the intervention group and 33 in the control group)، along with tetra-drugs H. pylori eradication regimen، randomly received daily two grams morDHA supplement or Medium Chain Triglyceride (MCT) oil as placebo for 12 weeks. Dietary intake data was collected by 24 hour food recall and analyzed by Nutritionist IV software. Sampling from fasting blood and measuring weight، height، body mass index (BMI) and level of physical activity were done at the first and the end of the study. As well as، eradication test of the infection was performed for all patients at the end of the intervention.

Eradication rate of the infection، the level of interleukin-6 (IL-6)، high sensitivity C-reactive protein (hs-CRP) and total antioxidant capacity (TAC) didn''t have significant difference between two groups at the end of the study (P>0. 05)، while the level of interleukin-8 (IL-8) was different between two groups (P=0. 008). Difference of the concentration between the beginning and the end of the study was not significant in any factors between two groups (P>0. 05).

Intake of morDHA supplement didn''t have significant effect on the eradication of H. pylori، serum levels of IL-6، hs-CRP and TAC، while it was effective on the level of IL-8.

Ventilator Associated Pneumonia (VAP)، developing in mechanically ventilated patients after 48 hours of mechanical ventilation، is the second most common nosocomial infection. Therefore، there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU)، over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation، NICU length of stay، hospital cost، and death. Thirty eight patients were enrolled (58% were boys and 42% were girls). 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%). On multiple regression analysis، duration of mechanical ventilation was associated with VAP (P=0. 00). Patients with VAP had greater need for mechanical ventilation (18. 7 vs 6 median days)، longer NICU length of stay (39 vs 21. 5 median days) and higher total median hospital costs (79. 5 vs 52 million rials) than those without VAP. The mortality rate was not different between two groups. In mechanically ventilated neonates، those with VAP had a prolonged need for mechanical ventilation، a longer NICU stay، and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

The request for lumbosacral MRI in Iran based on previous studies is high (almost half of all MRI cases)، so، our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by complementary health insurance in Tehran through comparing MRI practice with valid guidelines. Information of 274 complementary insured patients at Dana Insurance Company in Tehran، who had undergone low back MRI was studied. A portion of information in the questionnaire including age، sex، the physician’s field of specialty، and MRI report، was derived from the medical records. Other information based on guidelines indications، including duration of the prolonged back pain، record of associated infection، malignancy or trauma، saddle anesthesia، lower limb motor deficit and incontinence of urine or feces، was elicited from patients orally. Males represented 35% and females 65% of patients. Also، males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty (orthopedic، neurosurgery and neurology). Considering the indications of lumbar spine MRI request (prolonged back pain of more than one month duration، incontinence of urine or feces، lower limb motor deficit، saddle anesthesia، recent related trauma، infection and malignancy)، approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines. Out of every five cases of lumbar spine MRI، four cases were not requested based on guidelines، suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

Renal transplantation is the preferred therapeutic method for patients with end-stage renal disease. Patients with renal failure have significant associated medical conditions، such as cardiovascular disease. The suitable anesthesia for renal transplantation requires minimal toxicity for the transplanted organ، as well as sufficient pain relief and maintenance of optimal blood pressure and intravascular volume to keep renal functions. The aim of this study was to improve our experience of spinal anesthesia in patients undergoing renal transplantation. Sixty consecutive patients scheduled for elective renal transplantation over a period of two years who consented for spinal anesthesia were enrolled in the study. Intraoperative hemodynamic، intravenous fluids and infused blood products، duration of surgery، urine output and arterial blood gas and intensity of pain score in the recovery room were monitored. We also noted intraoperative and postoperative complications. Spinal anesthesia was satisfactory in all، but in five patients they required supplementation with general anesthesia for excessively prolonged surgery. There were no significant intraoperative hemodynamic changes. The total intravenous fluid used during surgery was 65. 15±7. 2 mL/kg، the mean surgical time was 170±22 min. The mean of mean arterial pressure (MAP) during the operation was 98±12 mmhg. There was no significant acidosis at the end of the operation (PH=38±0. 03). Also the mean intensity of pain was 4±2 in recovery and a few of patients suffered from bladder catheter bladder discomfort in the recovery room (8 patients). Spinal anesthesia is a successful regional anesthetic technique in well selected patients for renal transplantation. A successful outcome in this technique is dependent on close intra-operative monitoring، optimization of intravascular fluid volume and keep the hemodynamic status in optimal range.

Chemotherapy-induced nausea (CIN) in the anticipatory and acute phase is the most common side effect in cancer therapy. The purpose of this study was to investigate the effect of ginger capsules on the alleviation of this problem.

This randomized، double-blind، placebo-controlled clinical trial was performed on 80 women with breast cancer between August till December 2009 in Imam Khomeini Hospital، Tehran، Iran. These patients underwent one-day chemotherapy regime and suffering from chemotherapy-induced nausea. After obtaining written consent، samples were randomly assigned into intervention and control groups. Two groups were matched based on the age and emetic effects of chemotherapy drugs used. The intervention group received ginger capsules (250 mg، orally) four times a day (1 gr/d) and the same samples from the placebo group received starch capsules (250 mg، orally) for three days before to three days after chemotherapy. To measure the effect of capsules a three-part questionnaire was used، so the samples filled every night out these tools. After collecting the information، the gathered data were analyzed by statistical tests like Fisher’s exact، Kruskal-Wallis and Chi-square using version 8 of STATA software.

The mean ± SD of age in the intervention and placebo groups were 41. 8 ± 8. 4 and 45. 1 ± 10 years، respectively. Results indicated that the severity and number of nausea in the anticipatory phase were significantly lower in the ginger group compared with placebo group (P=0. 0008، P=0. 0007، respectively). Also، the intensity (P=0. 0001) and number (P=0. 0001) of nausea in the acute phase were significantly lower in the ginger group. On the other hand، taking ginger capsules compared with placebo did not result in any major complications.

Consuming ginger root powder capsules (1 gr/d) from three days before chemotherapy till three days after it in combination with the standard anti-emetic regimen can help to reduce the anticipatory and acute nausea.

The aim of this research was to determine the effect of olive oil on interleukin 6 (IL-6)، Tumor necrosis factor a (TNF-a) and cortisol hormone in response to exhaustive exercise in active girls. Twenty four healthy girls aged 21-27 years participated in this study. The subjects were randomly assigned to supplement (n=12) and control (n=12) groups. Supplemented group was fed with olive oil for one week. Blood samples were taken in a week before of exercise test، before exercise، immediately and 1 hour after the end of the exercise. There was a significant increase in the level of cortisol، IL-6 and TNF-α in the supplement and control groups in compared with a week before of exercise test and before exercise test (P≤0. 05). There was no significant difference in cortisol levels between the two groups (P≥0. 05)، but there was a significant difference between the levels of TNF-α and IL-6 in immediately and one hour after the end of exercise (P≤0. 05). These markers were lower in the supplement group. Our results show olive oil prevent from increasing inflammatory markers in active girls during exhaustive exercise.

The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma. Gondii infection and describe the clinical presentation from birth and follow up them. We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged، transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T. Gondii- antibodies (IGG، IGM) evaluated by ELISA methods. Neonates with positive T. Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease. Gestational age of newborns was between 28-41 weeks. Positive T. Gondii -IGM and T. Gondii -IGG determined in 1. 5%، 44. 1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%)، and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases. One and a half percent of newborns were seropositive for T. Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.

Ischaemic pain counts among the most difficult to treat pains in palliative care. Ischemic pain is frequently severe، and usually resistant to available analgesics. Treatment of this condition is difficult، especially when the condition is inoperable. A 36-year-old woman with the diagnosis of systemic lupus erythematosus with severe ischemic pain in the lower leg due to vascular problems presented to Akhtar Hospital. The patient was arranged for lumbar sympathetic block which was performed in two stages with one week interval. In the procedure، a long needle with No. 22 gauge and the length of 15 cm was used. Under view of fluoroscopy guide، 10 cc marcaine 0. 125% was injected. In the second stage، 5 cc of marcaine 0. 25% and 5 cc of phenol 0. 6% were used. Pain improvement was observed immediately after neurolytic lumbar sympathetic block. Three-month follow up period revealed improvement of quality of life. Lumbar sympathetic block is considered as a safe and useful technique. Clinically، the technique is effective for pain relief in patients who develop lower leg pain due to vasculitis.