مجله علوم پزشکی رازی
سال شانزدهم شماره 7 (پیاپی 64، مهر 1388)

Increased mortality ratedue to prostate cancer shows the growth of this disease.Prostate cancer is the second most widespread malignancy after lung cancer in men.It is important to use new methods in the radiation therapy of prostate cancer that are associated with lower exposure of the normal tissues. Nowadays, in most of the radiotherapy centers in our country, the Co-60 Unit with 2-dimensional treatment planning system is used for radiotherapy of prostate cancer. Therefore, it is essential to evaluate and verify the absorbed dose in thecritical organs such as bladder and rectum to prevent the side effects.In this study, the absorbed dose by these organs was measured in the process of radiotherapy of prostate cancer. In this experimental study the received dose by rectum and bladder, in the 2-dimensional treatment planning for radiotherapy of prostate cancer, was measured on tissue-equivalent and anthropomorphic phantom using Thermoluminescent dosimeters (TLD-100). The results were compared with the calculated values in the treatment planning software by t-test statistical method. One-sample Kolmogorov-Smirnov was also used for data analysis. SPSS V.15 was used for data evluation. The measured values of the absorbed dose by bladder and rectum were 236.8±14.9 cGy and 257.3±17.5 cGy, respectively. Results showed the measured absorbed doses in the phantom were significantly higher than estimated values (bladder: 162.4±2.2 cGy and rectum: 158.9±2.4 cGy)than from the treatment planning software (p <0.05). As the results show, the absorbed doses of bladder and rectum are higher than the calculated values by the software. In practice in the 2D treatment planning, one slice of CT-scan image is used for drawing.Meanwhile the tissue inhomogeneties in the body are 3-dimensional therefore the calculated volume of the target and organs at risk will be unprecise. This will lead to uncertainty in the calculation of the absorbed dose. In addition the effect of scattering due to tissue inhomogenities is added to this uncertainty.Thus, when using the�2D treatment planning, it is recommended to remember that the absorbed doses of bladder and rectum are significantly higher than those calculated on software.

In addition to exposure to Mycobacterium tuberculosis (MTB), development of tuberculosis is influenced by environmental and host genetic factors, and clinical disease only occurs in less than 10% of the infected individuals. Vitamin D metabolism leads to activation of macrophages and restricts the intracellular growth of mycobacterium. This effect may be influenced by polymorphisms in the vitamin D receptor (VDR) gene. In the present study we investigated the impact of VDR gene variation in susceptibility to pulmonary tuberculosis. This study was a case-control analysis in an Iranian population. We evaluated four VDR gene polymorphisms [defined by the presence of restriction endonuclease sites for FokI (F/f), BsmI (B/b), TaqI (T/t), and ApaI (A/a)] in 96 patients with tuberculosis and 122 matched healthy controls. A modified polymerase chain reaction with sequence-specific primers (PCR-SSP) technique was used to identify these polymorphisms in VDR gene simultaneously.Chi square was used for data analysis. Comparison of allele and genotype frequencies for the above VDR gene polymorphic sites revealed no significant difference between patient and control groups. This data may rule out the importance of VDR gene polymorphisms in susceptibility to tuberculosis among Iranian population.

Many different routes have been introduced for prolonging the duration of axillary block in upper extremity procedures. In this study the effect of adding dexamethasone to lidocaine during axillary plexus block has been studied. Patients and This study was designed and performed as a double blind randomized clinical trial.The patients candidated for upper extremity procedures in Hazrat Fatemeh Hospital operation room, entered the study based on inclusive and exclusive criteria.The patients were divided in to two 30-person groups randomly. For axillary block in the first group (control or lidocaine group), a combination of 34cc lidocaine1.5 %, 2cc sodium bicarbonate and 2cc distilled water was used in the second group(dexamethasone group) the utilized solution was similar to that used in the first group but with 2cc of dexamethasone (8 mg) used instead of distilled water. The onset of sensory, motor and sympathetic block, duration of sensory and intensity of post operative pain was measured and recorded.The data was analysed with SPSS V.13.The quantitative data was displayed with mean and standard deviation. The qualitative data was displayed with frequency.The Chi square and t-tests were used for quality data quantity data, respectively. The onset of sensory, motor and sympathetic block was similar in both groups and no significant statistical difference was present.The duration of the block and the time of the first request for analgesia post operatively were meaningfully longer in the dexamethasone group than lidocaine group(control group). Also the intensity of post operative pain from recovery to 6th hour after operation was meaningfully less in dexamethasone group than in control group. This study revealed that addition of dexamethasone to the combination of sodium bicarbonate and lidocaine for axillary plexus block can prolong the duration of block.Increase in the duration is more prominent for sensory than motor block. Meanwhile the post operative analgesia in this group was more than lidocaine group.

Recent advances in molecular and cellular biology and the importance of Epidermal growth factor receptor(EGFR) in the development and progression of many solid malignancies such as Colorectal Cancer (CRC) and non- small cell lung cancer have allowed rapid advances in rational drug design and targeted therapies for malignancies.Cetuximab or Erbitux, an IgG1 monoclonal antibody that targets the EGFR,is one of the most recent treatments for advanced colorectal cancer. The aim of this study is the comparison of "standard chemotherapy" with "combination of standard chemotherapy and Cetuximab" in the survival of advanced colon cancer patients.At the time of this trial, the K –ras mutation wasn’t defined as a cause of response to monoclonal antibody. Patients and Ninty-one patients with relapsed advanced CRC were enrolled in this semi -experimental trial.The age of patients was between 20 to 80 years. We randomly selected 47 patients to receive standard chemotherapy and 44 patients to receive chemotherapy and Cetuximab(combined therapy). Duration of treatment was based on the factors such as serious drug reactions to, death or reaching therapy allotted time of the treatment. Thus survival was measured in the two groups. After gathering the information, they were presented in the form of statistic and numeral tables. We used Kaplan Meier table to evaluate the survival analysis and Logmar and Breslow tests for the comparison between the survival time of two groups. We also evaluated the number of deaths with Chi square and Fisher's exact tests.The p-value was defined as 5% and all the analyses were done with SPSS V.15. Since June 2004 to November 2007, 91 patients aged 20-76 years and kf>60% with refractory advanced CRC were evaluated. Forty –four patients (48%) received combination therapy and 47 (52%)cases received combined monotherapy with chemotherapy regimen. Among the 47 patients on standard therapy, 18 (38.3%) and among 44 patients on combination therapy 13 (29.5%) expired. Median survival in standard therapy was 236 + 20 days and in combination therapy was 301 + 27 days(p=0.2011). Although Cetuximab improves the response rate and disease progression as compared to standard chemotherapy,combination therapy (cetuximab and standard chemotherapy) does not have any significant difference in regard to survival of patients with advanced CRC.

Varicella is a common, highly contagious disease. It is usually benign, but has potentially serious complications especially in the infants, adults, pregnant women and immunodeficient patients. This study was planned to evaluate the protective antibody against Varicella zoster virus infection (VZV) in children that had referred to Hazrat-e- Rasool Akram Hospital. In this cross-sectional study, VZV infection was studied by determining the presence of IgG and IgM antibody using EIA method. One hundred twenty serum samples were collected from children that referred to Hazrat-e- Rasool Akram Hospital. Individual's age ranged between 1-16 years (4/5±3/71 yr). The results were analyzed by t-test and Chi-square test. VZV infection was 42.5% (51 out of 120). Seroprevalence rate for protective antibody against VZV in different age groups was 30.66% (1-4 years), 55.55 %(5-8 years), 66.66 % (9-12 years) and 83.33% (13-16years). There was a correlation between age and the presence of anti-VZV antibody in the serum (p<0.05). We recommend VZV vaccination to be ideally administered to children 12 months of age and older.

Intra-articular fractures of distal humerus in adults present a controversial challenge for orthopedic surgeons. Minor irregularities of the joint surface of the elbow usually cause some loss of function. This can usually be minimized by early, accurate open reduction with sufficiently rigid fixation to permit immediate motion. The posterior approach combined with Olecranon osteotomy and fixation with the two plates at right angles, a medial plate on the medial column and a posterior plate on the lateral column, is considered the standard of care of displaced intra-articular distal humeral fractures (AO type C). The purpose of this study was to evaluate the results of the treatment of intra-articular fractures of distal humerus. Patients and In this descriptive –croos sectional study we evaluated 46 patients (18 females & 28 males) with a mean age of 31.22 years, who had intra-articular fractures of distal humerus (Type C1- 17 and C2 & C3-17) and were operatively treated between 2000 and 2005. After a standard posterior approach with Olecranon osteotomy, internal fixation was achieved with unilateral or bilateral plates and screws. The outcome measured variables were pain scale, range of motion, the ability of daily activities, infections, nerve injuries, radiological assessments (mal:::union:::, non-:::union:::, malalignment, …), joint stiffness, osteoarthritis, recurrent bursitis, instability and need for fixation.We used the SPSS software for statistical analysis of data. The main indices that we used were frequency and percent.For statistical analysis Kendall's and Fisher's exact tests were used. p<0.05 was considered as statistically significant. There was no pain after surgery in 16 patients (34.8%). Mild pain in 17(37%), moderate pain in 11(23.9%) and severe pain was reported in 2(4.3%). The range of motion in 24 patients (52.2%) was more than 100 degree. It was 50 to 100 degree in 18(39.1%) and less than 50 degree in 4(8.7%). The ability to performprevious daily activity was "as before" in 14 patients (30.4%). It was "partially as before" in 26(56.5%) and "decreased activity" in 6(13%). Superficial infection was detected in only 2 (4.3%). None of the cases had deep infection.Only 2 of patients (4.3%) had ulnar nerve injury. Meanwhile 3 (6.5%) had non: ::union:::. The surgical repair of an intra-articular distal humerus fracture (especially the transolecranon approach for good visualization, routine ulnar nerve exploration and rigid internal fixation) is an effective procedure that permits early rehabilitation in these complicated fractures.

Patients with Chronic Renal Failure (CRF) are at high risk of renal osteodystrophy, and this condition develops at the early stages of chronic renal failure and covers a spectrum of bone changes such as osteoporosis. Hypogonadism is common among men with CRF. Many of the manifestations of hypogonadism such as bone disease, are also frequently seen among dialysis patients. The goal of this study was to determine the levels of testosterone, PTH, LH, BUN, Cr, and Alkaline phosphatase (Alk.p) in men with CRF in two groups with normal and abnormal bone densitometry. Patients and In this cross-sectional study, 63 patients with CRF were evaluated. Bone mineral densitometries (BMD) by DEXA method were requested for all patients. The level of testosterone, PTH, BUN, Cr, Alk.p and LH were compared in two groups with normal and abnormal densitometry. The results were analyzed by Pearson, T and Chi-square tests. A p value of <0.05 was regarded as a significant level. Sixty three patients were studied in this research. The average age of the patients was 50.58±13.32 years. We found significant relation between age, level of testosterone and PTH between patients with normal and abnormal BMD(p value<0.05). Osteoporosis is an important finding in CRF patients and another study to determine the beneficial results of testosterone replacement therapy is recommended.

Liver neoplasm is not an uncommon disease in Asian countries. Liposarcoma is a rare mesenchymal malignant tumor which usually originates in the retroperitoneum and extremities. From 1973 uptil now about 10 cases of primary liver liposarcoma have been reported.In this article we present the eleventh case in a young adult female. Case report: The patient was a 21 year old female who presented with fever, dyspnea and abdominal pain.She suffered from huge mass in the right lobe of liver with constitutional symptoms and respiratory distress. Despite aggressive surgery, the tumor recurred after six months and led to her death after a year. Hepatectomy is the best strategy to achieve a long term survival in these patients, as the tumor is highly invasive, has an increased rate of recurrence and the effect of radiotherapy and chemotherapy is unclear.