Medical Journal Of the Islamic Republic of Iran
Volume:23 Issue: 2, Summer 2009

Rotator cuff tear is one of the most common causes of shoulder complaints in the elderly. Based on the severity and patient''s condition, a variety of methods applies to manage the tear and surgery is an important method, which could be done by open or arthroscopic technique. The current study aimed to investigate and report short-term results of arthroscopic repair of complete rotator cuff tears. This was a cross-sectional study on 183 patients who underwent arthroscopic surgery to repair rotator cuff tear in three different hospitals of Tehran between January 2003 and August 2006. Of all patients, 107 cases included in our study, which had a complete rotator cuff tear, and at least one-year follow up record. 89 patients (56 male and 33 female) attended assessment sessions and were evaluated by UCLA(University of California, Los Angeles) Shoulder and Elbow Scoring System, pre- and post-operatively, and acromioplasty was performed in 83 patients. With a mean age of 53.2 ± 15.8 (32-71) years, the average UCLA score was 11.3 before the surgery and 31.4 post-operatively. There were 11 patients with excellent scores, 62 good, 11 fair, and 5 poor scores. 9 out of 11 cases with excellent score and 34 out of 62 with good score were younger than 55 years; however, 13 cases were older than 60 years amongst 16 fair or poor scores. Arthroscopic repair of complete rotator cuff tear would cause a significant improvement in a short-term period and results are better in younger patients, through the UCLA scoring system.

Inflammation and wear debris may be responsible for bone lysis and subsequent lost in aseptic arthroplasty. Prostaglandin E2، platelet activating factor، and histamine are important mediators of inflammatory cells. We studied histopathological changes of cement-bone interface after using specific antagonists of these mediators. Left and right tibiae of 120 rats in ten groups were drilled. The left side was filled with polymethylmethacrylate and the right side was used as control. The first three groups respectively received 1mg/kg، 10mg/kg، and 25mg/kg of terfenadine، the second three groups respectively received 0. 08mg/kg، 0. 32mg/kg، and 0. 64mg/kg of alprazolam، and the third three groups respectively received 1mg/kg، 5mg/kg، and 25mg/kg of naproxen. The tenth group received no drug and served as the control group. The animals were killed after 16 weeks and studied by one pathologist. Cellular reaction in the left side was significantly more than the right side in all cases. Medium and high doses of terfenadine and naproxen and high doses of alprazolam could also significantly decrease giant cells and histiocytes. Increased cellular reaction in the cement-bone interface was suppressed by administration of PGE2، PAF، and histamine specific inhibitors. The use of these agents may induce retardation of the bone loss associated with early prosthetic loosening.

Low birth weight neonates are confronted with some problems after birth، they should be followed up and evaluated at different ages of life. The aim of this study was to determine the impact of birth weight on the risk of sensorineural hearing impairment on children. This cross sectional and retrospective study determined the prevalence of hearing problems in low birth weight and normal birth weight school age children. The sample was consisted of 2400 children who referred to special educational organization for hearing screening before entrance to school in Mashhad - Iran between June 2005 and June 2006. Hearing problems were checked in all groups. Case definition was based on the mean sensorineural hearing loss of more than 35 decibel (dB) hearing level (HL) and in the better-hearing ear averaged over the pure-tone hearing thresholds at 500، 1000، 2000 and 4000 Htz. The results were then compared the low birth weight and normal birth weight children. This study showed that prevalence of hearing problems was 1. 4%. The prevalence of hearing impairment in low birth weight (LBW) was 2. 1% and 1. 3% in normal birth weight (NBW). There wasn''t significant difference in hearing impairment between two groups (p=0. 255). Conclussion: In this study there was no significant difference between low birth weight and normal birth weight children in hearing impairment although other studies indicated that the risks of hearing impairment increase with the LBW and low gestational age neonates. More investigation is needed for detecting the subtle hearing problems in children.

The Iranian breast cancer patients are relatively younger than their Western counterparts. Evidence suggests that alterations in estrogen signaling pathways، including estrogen receptor-α (ER- α)، occur during breast cancer development in Caucasians. Epidemiologic studies have revealed that age-incidence patterns of breast cancer in Asians differ from those in Caucasians. Genomic data for ER- α in either population is therefore of value in the clinical setting for the Iranian breast cancer. A case-control study was conducted to establish a database of ERpolymorphisms in Iranian women population in order to compare Western and Asian with Iranian (Asian-Caucasians) distributions and to evaluate ER- polymorphism as an indicator of clinical outcome. DNA samples were prepared from Iranian women with breast cancer referred to Imam Khomeini Hospital Complex clinical breast cancer group (150 patients) and in healthy individuals (147 healthy control individuals). PCR single-strand conformation polymorphism technology was performed. Asite of silent single nucleotide polymorphism (SNP) was found، as reported previously in Western and Eastern studies، but at significantly different frequencies. The frequency of allele 1 in codon 325 (CCC}CCG) was significantly higher in the breast cancer patients (39. 6%) than control individuals (28. 9%; P = 0. 007). The allele 1 had also significant association with the occurrence of lymph node metastasis. Data suggested that ER- α polymorphisms in exon 4 codon 325 was correlated with various aspects of breast cancer in Iran. ER- α genotype، as determined during presurgical evaluation، might represent a surrogate marker for predicting the breast cancer lymph node metastasis.

The polymorphic variants at codon 72 of the p53 gene، encoding either proline or arginine at residue 72، produce marked change in the structure of p53. From the evidence that the DNAmismatch repair system and p53 interact to maintain genomic integrity، we hypothesized that the codon 72 variation may influence the prevalence of microsatellite instability; a feature of malignancies associated with mismatch repair deficiency in breast invasive ductal carcinoma. TP53 codon 72 genotypes were detected by PCR using specific primer pairs for amplifying the Proline or the Arginine Alleles. Then، the frequencies of microsatellite instability (MSI) were analyzed in three genotypes of P53 codon 72 using genomic DNAs from 120 specimens of breast ductal carcinomas by testing the BAT-26 marker. From 120 specimens، 73 (60. 8%) was Arg/Arg، 31 (25. 8%) Arg/Pro and 16 (13. 3%) Pro/Pro. MSI analysis revealed that 24. 2% of the tumors (29 patients) was microsatellite instability-positive and 75. 8% (91 patients) was microsatellite instability -negative. The frequency of microsatellite instability in the Arginine/Arginine، Arginine/ Proline and Proline/Proline genotypes were 14 (19. 2%)، 12 (38. 7%) and 3 (18. 8%) respectively. A significant difference in distribution of MSI was found for the Arginine/ Proline genotype compared with (grouped) Arginine/Arginine and Proline/ Proline genotypes (P=0. 028). Our findings suggested that breast invasive ductal carcinomas arisingin individuals with p53 codon 72 heterozygosity (Arginine/Proline) may be preferentially prone to microsatellite instability more than other genotypes.

Pseudoarthrosis of the tibia poses one of the most challenging treatment problems in all of orthopedics. The goal of the study was to assess the clinical outcome of intramedullary rod fixation in its treatment. The results of the management for nine patients with pseudoarthrosis of the tibia with IM rod fixation were reviewed retrospectively between 1986 - 2006. The mean duration of follow up was 8. 95 years (range، 3. 5 months to 14. 2 years). The mean age of the patients at the latest follow up was 13. 5 years (range، 9 to 23 years). Initial union of the fracture site occurred in seven of nine patients with the mean duration of 7. 6 months (range، 3. 5 to 15. 5 months). Five patients had limb length discrepancy with the mean of 7. 2 cm (range، 1. 5 - 12 cm). Three of them were treated with tibia lengthening procedure with the Ilizarov method. One had a peroneal nerve palsy postoperatively. Two patients had refracture treated with casting and rod exchange. Electrical stimulation was applied in two patients but it was impossible to predict how much it played a role in the union. IM rod fixation technique has a satisfactory functional outcome. The technique has a high level of acceptance by parents and patients. It should be recommended as the treatment of choice for the management of congenital pseudoarthrosis of the tibia.

Despite sophisticated conventional medical treatment and the continued development and improvement of coronary revascularization modalities in recent years، a significant number of patients still suffer from refractory angina pectoris and cannot be successfully managed. Advances in therapeutic options have led to an increase in the average of life expectancy even in such no-option patients. Management of these patients is a challenging problem because most of them have already undergone multiple coronary interventions or surgeries and therefore are not suitable candidates for further procedures. In this situation، cardiologists who frequently face the patients are limited in their decision making when all therapeutic methods have been exhausted. The aim of this review article was to draw attention to the novel therapeutic strategies currently available for this condition، including nonconventional medical treatment، improving myocardial perfusion، neuromodulation، new vessel formation and eventually heart transplantation. Unfortunately، these therapies have only a complementary role because of inadequate experience. Therefore، maximal conventional treatment along with these options should be used on an individual basis.

Urinary retention، a rare childhood problem which is most commonly caused by urinary tract infection. However، neurological neoplasm must also be considered in differential diagnosis. We report here a 3 year old girlthat was referred to the pediatrics department of Kashan University of Medical Sciences (KAUMS) with a history of urinary retention for 10 days. By insertion of a Foley catheter specimens obtained for urinalysis and culture، and also antibiotics were administered، but no clinical improvement encountered and the patient developed lower limbs weakness. Magnetic resonance imaging of the spine revealed an intramedullary mass lesion at located in T10 to T12. Gradual improvement appeared after surgical excision of an infected epidermoid cyst and completion of the course of antibiotics.

Intraabdominal schwannomas are rare tumors that may arise from viscera or abdominal wall. The rarity accompanied by occurrence in odds places may make their diagnosis difficult and delayed. We present a case of distal paraesophageal schwannoma with long-term cachexia. A34-year-old man presented with long-lasting vomiting، dysphagia، and progressive cachexia for four years. Multiple paraclinical assessments were normal; subsequently he was referred to psychiatric department and treated for anorexia nervosa for three year without any improvement. Further evaluations showed a mass in diaphragm hiatus in paraesophageal region. Explorative laparotomy revealed a cylindric shaped encapsulated tumor parallel to distal esophagus risen from vagus nerve، which was resected completely. Pathological and immunohistochemical examinations of the tumor revealed a benign plexiform schwannoma. After surgery، the patient was relieved from symptoms and gained weight significantly. It is important to consider physical causes in patients with cachexia who are treated for psychiatric problems and it is necessary to reevaluate these patients specially when there is no response to psychiatric treatments.

The Intraparenchymal schwannomas are very rare tumors with only 52 reported cases. We describe a 38 years old man with eight months history of poorly controlled seizures despite of medical therapy. On brain CT scan a 1. 5 x 1. 5 cm hypodense enhancing lesion was seen in right posterior-inferior frontal lobe. On brain MRI the lesion was hypointense in T1 and hyperintense in T2 with homogenous enhancement after contrast injection. He underwent localized craniotomy and total excision of the tumor. The tumor was completely covered by brain cortex and well demarcated with fleshy consistency and grayish color. After histopathologic examination and Immunohistichemical staining، diagnosis of the schwannoma was established. During 6 months period of follow up no seizure was reported by the patient.