Acta Medica Iranica
Volume:43 Issue: 5, Sep-Oct 2005

The current challenges in the management of esophageal cancer are to obtain a better understanding of underlying molecular alterations to provide new treatment options. We studied the p53 and Bcl-2 protein expression in esophageal carcinomas to correlate molecular alterations with clinicopathological findings. Tissue samples of 37 patients with advanced esophageal carcinoma were analyzed by immunohistochemical techniques. Positive immunostaining for p53 and Bcl-2 were observed in 67.6% and 43.6% of tumor samples, respectively. The prevalence of Bcl-2 overexpression was significantly greater in p53+ tumors ‎as compared with p53- tumors (P = 0.003). Unlike p53, positive Bcl-2 immunostaining correlated significantly with tumor type (P = 0.001) and histological differentiation (P = 0.007). Our data also showed that 35% of patients were positive for both proteins and 32.4% of patients were positive for p53 but negative for Bcl-2 expression. These results indicate two types of double gene alterations that obviously would affect tumor biology and response to chemotherapy. Therefore, it is advisable to determine expression profile of certain genes including p53 and Bcl-2 in tumor samples before selecting chemotherapy regimen.

Iontophoresis of epinephrine for assessment of neuromuscular junction response is a new technique that can improve diagnose of neuromuscular dysfunction. The purpose of this study was to investigate the effects of iontophoresis of epinephrine on neuromuscular junction response. Iontophoresis of epinephrine solution (1mg/ml), sodium chloride, calcium gluconate, epinephrine with sodium chloride and distilled water was applied in five groups of healthy men and 7 patients with myasthenia gravis (MG). Amplitude, depolarization, repolarization and recovery times and slops of compound muscle action potential (CMAP) were measured. Also low repetition stimulus tests were applied before and after iontophoresis of epinephrine. Following results were obtained: 1) iontophoresis of sodium ion increased depolarization time, and iontophoresis of sodium and calcium ions increased recovery and duration times of CMAP, 2) slope of depolarization and recovery were reduced by iontophoresis of active ions, 3) iontophoresis of epinephrine increased slope of recovery or Na-K transport at 10 and 15 minutes after iontophoresis, 4) iontophoresis of epinephrine in patients with MG reduced amplitudes of all CMAPs and percentage of decrement between first and fifth signal increased at low frequency stimulus test, and 5) iontophoresis of epinephrine in normal group increased percentage of amplitude increment between first and fifth signal in low frequency stimulation test. Neuromuscular responses in patients with MG in comparison to normal men are sensitive to iontophoresis of epinephrine and demonstrate significant decrement findings to low repetition stimulus tests. Iontophoresis of epinephrine with RNS tests can be useful in assessments of these patients.

At the highest signal levels, the masking function for the off-frequency condition seems to become more linear. While some basilar membrane data show more linear growth at high levels, others do not. Aim of the present study is to assess function of masking at high levels regarding its clinical appearance. In this experiment we evaluated the hearing thresholds of three different signals (wide-band, low pass filtered, and high pass filtered noises) in presence of a high level low frequency masker (90 dB SPL, 220 Hz), and we decreased the transmission of both masker and signal by changing the middle ear stiffness in 42 normal subjects to determine whether or not their thresholds will change by the same amounts which leads to linear function or their thresholds will change by different amounts which will be related to nonlinear function of masking at high levels. Mean wide-band, low pass filtered, and high pass filtered noises hearing thresholds were better (lower) in +/- 300 daPa air pressure conditions than 0 daPa pressure, and these differences were statistically significant. In conclusion, as the level of the tone was effectively decreased by changing the impedance, frequency tuning improves and the noise was less suppressed by the tone, making it easier to detect. Therefore, at the highest signal levels, the masking function for the off-frequency condition seems to remain nonlinear.

The outcome and proper management of fetal hydronephrosis have not been completely defined. The purpose of this study was to determine incidence and outcome of infants with a history of prenatal hydronephrosis diagnosed by ultrasound. In a three-year period from 2000 to 2003 we identified 211 cases (271 renal units) of fetal hydronephrosis in which renal pelvic anteroposterior diameter was more than normal diameter at various stages of pregnancy. Incidence of fetal hydronephrosis was 3.8 percent in the 55500 fetuses screened by ultrasound. A total of 187 fetuses (240 renal units) followed up underwent postnatal sonography and only in ten cases renal pelvic anteroposterior diameter was greater than 15 mm that required surgical correction. The most important advantage of knowing that a fetus has ultrasound findings of persistent hydronephrosis is ability to begin timely evaluation of the newborn to identify severity of hydronephrosis and prevent progressive deterioration of renal function.

Hematuria is one of the most common genitourinary findings in children and extensive evaluation frequently fails to establish its etiology. ‎A known cause of hematuria in children is nephrolithiasis. Ultrasound is a good method for diagnosis, but calculi less than 5 mm in diameter may not have a posterior shadow. Calyceal microlithiasis (CM) is characterized by presence of hyperechogenic spots less than 3 mm in diameter in renal calyces that are recognized by high resolution ultrasound. In this report, 200 children presenting with microscopic or macroscopic hematuria, dysuria, pyuria and recurrent urinary tract infection, occurring alone or in combination, underwent renal ultrasound at 3.5 MHZ and 7.5 MHZ. Although in 117 cases renal ultrasound at 3.5 MHZ reported normal findings, renal ultrasound at 7.5 MHZ revealed CM in 63.6% of patients presenting with hematuria. ‎There was a history of urolithiasis in one first or second degree relative of 72.4% of the patients. ‎Hypercalciuria was presented in 9.6% and hyperuricuria in 32% of the patients. We recommend that children who are either at greater risk of renal stones, or are highly suspected to be so, be referred for renal ultrasound screening at 3.5 and 7.5 MHZ concurrently.

Hepatitis B (HB) is an infectious disease occurring worldwide which can be transferred by some professions, including hairdressers. Health education is an essential component of public health campaign about this disease. The purpose of this study was to test the utility of the health belief model (HBM) in understanding and predicating the intention of hairdressers in prevention of HB in their clients. A quasi-experimental study was conducted to 140 hairdressers (70 men and 70 women) in Yazd, Iran. All subjects were divided into two groups: case group (35 men and 35 women) and control group (35 men and 35 women). A researcher designed questionnaire according to the framework of HBM was developed, pilot-tested and then completed before and after intervention. There was significant difference between the mean grade scores of knowledge of case group before and after intervention (P < 0.0001). The perceived threat of case group were also increased from 9.8 to 10.61 after intervention, but the perceived threat of control group were decreased from 9.97 to 9. The HBM may offer an effective foundation for development of an educational intervention program in hairdressers for prevention of HB in their clients.

The strain index (SI) is a substantial advancement and has been devised to analyze ergonomic risks for distal upper extremity (DUE) disorders. This semi-quantitative tool allows for the measurement of hazards and does not require unduly lengthy training to begin to use it accurately. Uses of the strain index include analysis of a current job to assess whether it is safe or hazardous, quantification of the risks, and assistance in the initial design of a job or in the redesign of a job. The aim of this study was to assess and analyze risk of developing DUE disorders in different jobs as well as hazard classification in an assembling electronic industry through SI method. Also, DUE disorders prevalence, work-related absenteeism and turnover extracted from SI results were compared and assessed by those obtained by Nordic musculoskeletal questionnaire (NMQ). The findings of this study showed that more than 50% of investigated jobs are categorized as "hazardous" and there is a significant difference between SI mean in hazardous and safe jobs (P < 0.0001). In addition, significant difference was found between prevalence of DUE disorders in "safe" and "hazardous" jobs (P < 0.049). But, no significant difference (P = 0.3) was obtained between mean absenteeism in "safe" and hazardous jobs. Also, no significant difference statistically was found between turnover in "safe" and hazardous jobs (X2 = 0.133, P = 1) and high prevalence of DUE disorders is due to low turnover rate of workers.

Hospitalization of child is one of the most stressful events of life for parents and children. This fear and stress may affect the process of treatment. Since there is no information available about the source of distress and needs of Iranian parents during the inpatient care of their children, we designed a research in order to discover the main source of worries and fears among parents. In this cross-sectional study 120 parents of 88 children were interviewed by structured questionnaire during the course of events when their child needed inpatient care. Twenty close ended questions were asked in order to assess the major source of worries and distress. Factor analyses were used as a statistical test for data analysis. The rotated factors pattern isolated 7 factors that accounted for 61.60% of variances and their factor loading was above 0.5: 1) environment adjustment, 2) lack of prehospitalization program, 3) lack of communication skills of caregiver, 4) parental skills, 5) hospitalization expenses, 6) lose of independence and 7) lack of information. Other items of questionnaire were eliminated because their loading factors were less than 0.5. This finding suggests parents’ education before and during the child inpatient care as a major need of parents. By parents education there is a chance of reducing their worries and fear and improve their parental skills. Offering prehospitalization programs also provide a good opportunity for parents to ask questions from staff members and may help them to adjust themselves with new environment.

Human infection with echinococcus granulosis is a common disease throughout south America, The Mediterranean littoral, The Middle East, Central Asia and East Africa, which usually occur in children and young adults. Formation of avascular cystic lesions in the liver, kidney, pancreas, bones, vitreus and brain can cause protean of signs and symptoms. Intracranial cysts usually present with focal neurological deficit and features of raised intracranial pressure. ‎Primary hydatid disease of the brain is a rare entity but may pose various diagnostic problems. In this study we report the clinicoradiological findings, treatment outcome and some other properties of intracranial hydatid cysts in 24 cases, emphasizing the fact that hydatid cyst should always be suspected in cystic lesions affecting intracranial cavity specially in endemic areas. Sixty five percent of our patients were children and young adults, 85% of whom came from rural areas. We found in contrast to other studies a female predominance (58%). Headache and vomiting were the most common symptoms. All but one of the patients had a solitary lesion in the cerebral hemisphere. In 21/24 (87%), cysts were removed intact. Four patients (three ruptured cysts during surgery and one case with additional cyst in the lung) received mebendazole (800 mg daily). Surgical mortality and postoperative complications were 8.3 and 20.8% respectively.

In this study to determine whether spine stiffness is predictive of clinical results after lumbar spinal fusion for spinal stenosis, a total of 78 patients were measured intraoperatively with Kocher clamp manual distraction technique to determine motion segment stiffness then spinal fusion was performed for any loose segment. ‎Statistical analysis revealed that stiffness measurement correlate with clinical results of surgery. During a minimum of 2 years follow up after surgery, patients who had loose motion segment before or after decompression and were fused had the same level of satisfaction with surgical results as patients without loose segments and fusion. ‎We concluded that intraoperative spinal stiffness measurement provide a good indicator to spine fusion after lumbar canal stenosis ‎surgery.

Atherosclerosis is the leading cause of death in most parts of the world. This disorder affects mostly patients above the age 40 years. This case report introduces a 17 years old girl with early development of coronary artery disease who had severe coronary atherosclerosis that did not respond to medical and interventional treatment and underwent surgical operation in cardiac surgery department of Shahid Madani Hospital, Tabriz, Iran. Presence of risk factors for atherosclerosis were evaluated and the only findings were positive family history of cardiac death in her uncle at about 52 years of age and high level of lipoprotein (a) in one of her sisters. In follow up evaluation of this patient, high levels of lipoprotein (a) was documented which was controlled with medical therapy. We concluded that high level of lipoprotein (a) was the probable cause of atherosclerosis in this patient. This case report emphasizes the need to screen siblings of patients with premature myocardial infarction.

Multicentric reticulohistiocytosis (MRH) is a rare proliferative histiocytic disease of ‎unknown cause with potentially disabling nature. Primary manifestations are involvement ‎of skin and joints. The articular destruction can lead to permanent joint deformities. Our ‎patient was a 47 year-old woman with bilateral symmetrical polyarthritis and reddish- ‎brown papulonodular cutaneous lesions. The diagnosis of multicentric reticulohistiocytosis ‎was confirmed by histological examination. Both skin and articular manifestations were only ‎partially treated with oral corticosteroids, monthly bolus cyclophosphamide, weekly ‎methotrexate and knee synoviorthesis with nitrogen mustard.

In the head and neck region, tracheal and larynx paragangliomas are much less common and subglottic paragangliomas have been rarely reported. Less than 60 cases with larynx paraganglioma and a few cases with ‎trachea paraganglioma have been reported ‎until know in the literature. ‎This report describes a 28 year old man suffering from progressive dyspnea due to tracheal and subglottal tumor. ‎Histopathology of tumor after surgery showed paraganglioma. ‎Clinical features, histological appearance and differential diagnosis as well as treatment are discussed.