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Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation that occurs due to immunosuppression and other risk factors. PTLD may present with involvement of other organs and with unusual presentation. The presentation is often extranodal (e.g., in the gastrointestinal tract, lung, or the central nervous system). Herein, we report on a 1.5-year-old girl who underwent liver transplantation almost 5 months prior to admission. She was on medications such as tacrolimus and prednisolone. Her presentation was started with symptoms of the upper respiratory infection followed by croupy cough and respiratory distress with no response to usual treatments. She had respiratory arrest during broncoscopy. Therefore, emergency tracheostomy was done. Biopsy from the paratracheal mass revealed large B cell non-Hodgkin lymphoma (PTLD, monomorphic and high grade). This case presentation shows that persistent upper airway symptoms, particularly stridor and croupy cough, in children who underwent liver transplant should be further evaluated; the physician needs to have a high degree of clinical suspicion for the diagnosis of PTLD in this situation.

Mohammad HosseinAghiliKhorasani،the famous Iranian physician، lived in the late 12 and early 13 Hijri. Gharabadin-e-Kabir، Makhzan-ol-Advieh، Kholasat-ol-Hekmah and Moalejat are the books left from Aghili. Moalejat is an invaluable book including a complete classification of diseases according to Iranian traditional medicine together with experienced prescriptions. This study deals with vertigo from Aghili''s points of view in Moalejat. Patients describe the experience of different feelings in their head and the disturbance in their gait as dizziness. Worldwide the prevalence and annual incidence of vertigo are 5 and 1 percent، respectively. Vertigo is known as dovar in Iranian traditional medicine. Dovar is a state in which the patient feels that things rotate around him or her. The general cause of dovar is the waving motion of rooh in the brain''s vessels and spaces. The motion of rooh might be due to external causes like trauma and falling down. This state seems like throwing a heavy object in water and the formation of circular waves. Sometimes dovar is due to internal causes created in the brain. In this case، the patient feels that the objects are spinning، but the objects are، in fact، still and it is the corporeal spirit which is moving. Dovar owing to internal causes is divided into two categories. In the first category، the substance causing dovar is in the brain and in the second one، the other organs are involved. In traditional medicine، treatment of the patients with dovar is based on the diagnosis of the causes. If the causes are considered to be external، then the conversion of temperament to its natural state is the first step. Of course، as in all cases prevention is the best solution. If dovar is due to internal causes، we should identify whether the brain or the other organs are involved، and then the conversion of temperament or the emission of the causing substances should be considered.

In recent years، alternative medicine is increasingly used among physicians and researchers. Lack of success in controlling chronic diseases such as diabetes، cardiovascular diseases and cancer by conventional medicine، and public acceptance of alternative medicine، due to the use of herbal and natural medicines instead of chemicals، are the major reasons for this trend. Iranian traditional medicine is a school based on humeral medicine. There is difference between diagnostic model of traditional medicine and that of conventional medicine. In this approach، diagnosis and treatment are based on identifying the temperament and returning it to health state، if it is not in the normal state. Then we should consider the causes of deviation of temperament from health state. Male erectile dysfunction is a common disorder that Iranian traditional medicine has offered some effective treatments for it. Erectile dysfunction is inability to achieve or maintain an erection to engage in sexual intercourse. Before 1992، erectile dysfunction was equal to impotence which included orgasm dysfunction and premature ejaculation، as well. Nowadays، there are effective remedies including oral، local or infusional treatments for erectile dysfunction. These treatments، however، have a lot of side effects and do not result in complete cure. In Iranian traditional medicine، impotence is known as weakness of Baah and its treatment is based on involving chief organs (heart، liver and brain) and returning them to health temperament. Most of these remedies involve prevention and regimen. Although there are a lot of discrepancies between conventional and traditional treatments، the traditional interventions can be investigated in clinical trials. This research aimed to facilitate further research for those without familiarity with basics of Iranian medicine in this connection

As a serious neuropsychiatric disease, hepatic encephalopathy (HE) is a clinical condition with several types regarding chronicity and clinical diversity that can develop as a complication of both acute and chronic liver failure. This study evaluates changes in thioacetamide (TAA)-induced acute hepatic encephalopathy (AHE) in rat as an animal model.. Both genders of C57BL6, BALB/C mice and Sprague Dawley rats; (10 animals in each group) were compared for induction of AHE to clarify which animal and gender were appropriate. The animals (10 male rats in each group) were categorized in 4 groups according to the dose of the TAA administered (200, 300 and 400 mg/kg of TAA at 24 h intervals for 4 days). A control group was treated with solvent of TAA which was water (5 ml/kg/day). The behavioral, biochemical markers of hepatic failure and histological aspects of thioacetamide (TAA) induced AHE and the correlation between the clinical severity and liver failure biomarkers were evaluated.. Rat was shown to be an animal model of choice for AHE while the optimum dosage of TAA to induce AHE was 300 mg/kg/day at 24 h intervals for 4 days. The behavioral score was partially correlated with the rising of some biomarkers and pathological findings.. Rat can be introduced as the animal of choice for AHE to study the pathophysiology, pharmacology and the survival rate of disease in liver transplant patients.

Finding more efficient agents with fewer side effects for treatment of burns has always been a concern for researchers. Silver sulfadiazine (SSD), apparently due to its antimicrobial effect, is still one of the most common prescribed agents. Previous studies suggested that Arnebia euchroma (AE) has shown antimicrobial and anti-inflammatory activities. This study investigates the healing effect of AE extract in comparison with SSD in second degree burn wounds.. Fort eight female Wistar rats (220±20 g) were divided into four groups. Standard second degree burn wounds were induced on the back of their necks. One group was treated with SSD; two groups were treated with AE cream at concentrations of 10% (AE10) and 20% (AE20) and the control group which received no treatment. The duration of treatment was 28 days.. This study revealed that AE and SSD noticeably improved re-epithelization, fibroblasts proliferation, and collagen bundle synthesis and had a noticeable anti-inflammatory effect compared with the control group.. Results of the present study revealed that Arnebia euchroma herbal extract was an effective treatment for second degree burn wounds when compared with SSD.

Liver transplantation (LT) is the standard treatment of end-stage liver diseases (ESLD). Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset (after 6 months of LT) Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient (2%) developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder (PTLD). The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications.

Retinoblastoma (RB) is the most common primary intraocular cancer of childhood. There is no published report on this affliction at our center as a referral center in southern Iran. This study aimed to perform a 15 years epidemiological assessment of RB, in Fars Province, Southern Iran. We retrospectively analyzed medical records of all patients with RB diagnosed in Khalili Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, Southern Iran. All available pathologic slides were reviewed and staging of tumors were revised using the TNM classification of 2008. Sixty-seven patients were enrolled in this study (46.3% females and 53.7% males). Among the cases, 71.6% had unilateral and 28.8% bilateral RB. The mean age of symptom presentation and diagnosis were 20.5±16.5 and 26.3±20.1 months, respectively, which were significantly lower in bilateral cases. Leukocoria wasthe most common presenting symptom (56.7%), followed by strabismus (10.4%). The result of histopathological review showed that RB in 70% of patients was at T1, T2 and T3 stage, but 30% were at T4 stage. Demographic and clinical variables of RB under the present study are comparable with published reports but our patients were diagnosed at the later stage, leading to poorer prognosis. It is necessary to expand the existing organizations into a comprehensive population-based registry system to obtain a clearer picture of the epidemiology of RB in our region.

Liver transplantation (LT) is a life-saving treatment for end-stage liver diseases (ESLD). Cytomegalovirus (CMV) infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset (after 6 months of LT) CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients (6%) developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children.

Although breast cancer in men is uncommon, its incidence rate has an increasing trend. Due to its low incidence, there are few studies in this subject and limited information is available. The purpose of this study was to investigate clinicopathological characteristics and survival of male breast cancer (MBC) in Fars Province, south of Iran. The data for this study were obtained from the population based cancer registry of Vice-Chancellor for Health Affairs of Shiraz University of Medical Sciences and Shiraz hospitals between January 1, 1989 and January 1, 2008, including 64 patients with MBC. Demographic, clinical and pathological aspects were investigated. The Kaplan-Meier method was used for the determination of survival rate and Log Rank test for the comparison. The Cox proportional hazards model was used for the multiple analysis. The patients’ mean age at the time of diagnosis was 60.3 years (SD=12.7). The most frequent age group (26.6%) was 51-60 years. The most common symptom (96.8%) was a palpable mass. The majority of patients (44.4%) had a symptom duration of less than or equal to 6 months. 56.3% of the patients had a tumor size of 2-4.9 cm. Forty six percent of the cases had axillary lymph node involvement. The median survival time was 10.0 years [95% confidence interval (CI): 6.0-14.0]. The 5 year overall survival rate was 66.0% (95% CI=51.0-81.0%). The median survival time of patients with axillary lymph node involvement was 8.2 years (95% CI=6.7-9.6) and for the cases without involvement was 12.0 years (95% CI=8.4-15.2). In addition to axillary lymph node involvement, positive family history in contrast to negative family history and left tumors in comparison with right tumors were poorer prognostic factors in univariate analysis respectively (p=0.006, p=0.031). In multiple analysis, axillary lymph node involvement was an independent predictor of poorer survival (Hazard ratio=1.6, 95% CI=1.1-6.4, p=0.030) and the other variables did not have a significant effect. The mean age of MBC in this series is lower than that in western countries. It is compatible to the mean age of female breast cancer which is approximately one decade less than that in developed countries. The survival rate of MBC is relatively lower than that in western countries. Axillary lymph node involvement is an important prognostic factor in the survival of MBC. Multicenter population based studies with greater number of patients are required for better estimation of different aspects of MBC in Iran.

Cholestatic jaundice is a potentially dangerous condition which is often misdiagnosed by paediatricians as physiological or breast milk jaundice. The two most common causes of neonatal cholestasis (NC) are biliary atresia (BA) and neonatal hepatitis (NH). Early and accurate differentiation of these two entities is very important as early surgery in BA improves the biliary drainage but the delay leads to irreversible hepatocellular damage. There has been much discussion over the value of hepatobiliary radioisotopic scans, liver histopathological features, serum g-glutamyl transpeptidase (GGTP) levels, and other tests which are widely used for differentiation of BA from NH. Stereology provides practical techniques for extracting quantitative information about a threedimensional material from measurements made on two-dimensional planar sections of the tissues. We suggest that the stereological study of different components of liver tissue may be useful in determining the function of liver and differentiating some liver diseases such as biliary atresia and neonatal hepatitis.

The prevalence of chronic constipation in children has been reported between 0.3 and 28%. This study was conducted in southern Iran to compare the effect of a balanced and high fiber diet in children with chronic functional constipation. During summer 2007, all children (60) who referred to the Pediatric Department of Mottahari Clinic affiliated to Shiraz University of Medical Sciences and were diagnosed with chronic functional constipation entered this study. A questionnaire on the child’s routine dietary regime was filled in for each child through face to face interviews with the parents. The questionnaire included demographic information, food habits, physical exam, and the para-clinical results of each participant. 30 parents were trained to supply a high fiber diet for their children, and its effect on chronic functional constipation was followed after two months. The children of these parents were considered as the case group and the other 30 children were considered as the control group. Before the parents were educated, the amount of fiber intake from fruits and vegetables by the children was 7.6±2.1 gr. in the case group which increased to 24.25±2.3 gr. after 2 months of training. The amount of water intake was 280 ml before training which increased to 600 ml afterwards and that of milk and yoghurt intake was 280 and 240 ml which decreased to 60 and 200 ml after training, respectively. The amount of beverage and fruit juice intake was 280 and 220 ml while after training it decreased to 100 and 60 ml, respectively. In the case group, 10% of the children had 3 to 6 times defecation per week before the intervention while this increased significantly to 56.7% of the children after the training. The stool consistency significantly changed from very firm to normal and soft consistency after training and the times of stool defecation increased significantly, too. The children’s nutrition status changed from a poor state to a good status after training. Drug treatment was more effective in children that consumed high-fiber diet. It was shown that some of these changes were significant. The difference between the two groups was not, of course, significant which might be due to the small sample size

Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation. There were 70 patients (5-15 years old) who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population (300 individuals) without any GI problem in the past year was determined by a questionnaire. The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant. Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies.