2023 CiteScore: 0.7
pISSN: 0044-6025
eISSN: 1735-9694
Editor-in-Chief:
Ahmadreza Dehpour, PharmD, PhD
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 41, No 1 (2003)
Articles
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We have analyzed paraffin sections from 55 patients with histologically confirmed Hodgkin’s disease (HD) for the presence of Epstein-Barr virus (EBV) markers using in situ hybridization to detect the EBV-encoded RNAs (EBERs) and immunohistochemistry to identify latent membrane protein-1 (LMP1) expression. Tissue specimens from 55 cases of Hodgkin’s disease included 22-mixed cellularity (MC), 27 nodular sclerosis (NC), one lymphocyte depleted (LD) and 5 lymphocyte predominance (LP). All of the confirmed EBV associated cases were examined and subtyped of the presence of Epstein-Barr virus (EBV) DNA by polymerase chain reaction. In situ hybridization revealed exclusive localization of virus in the tumor cells and FBV markers were present in 30 HD cases (55%) and were mainly confined to the mixed cellularity (MC) and nodular sclerosis (NC) subtypes. 1-MH immunohistochemistry has similar results as in situ hybridization. EBV positivity with regards of HD subtypes were 64% (14/22) mixed cellularity (MC), 44% (12/27) nodular sclerosis (NS), 0% (0/1) lymphocyte depleted (LD) and 80% (4/5) lymphocyte predominance (LP). Epstein-Barr virus-specific DNA sequences were detected by PCR in DNA extracts from paraffin-embedded tissues of all LMP1 positive cases. Twenty-eight cases were type 1 EBV and 2 cases type 2 EBV. There was difference between EBV-positive and EBV-negative HD patients with regard to age. Analysis of age group 1-14 years, 15-49 years and over 49 years, revealed 73% (16/22), 35% (10/29), 100% (4/4) EBV positivity, respectively. These findings compared to the EBV association pattern with HD in developed and developing countries suggest an overall intermediate pattern of EBV association with HD and high incidence of EBV children and elderly HD cases.
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The histopathologic diagnosis of orbital and ocular adnexal lymphoproliferative lesions is difficult, resulting controversy in classification, determining benignity or malignancy of them and treatment modality selection. We designed the following study to evaluate clinical, histopathologic and if necessary immunochemical features of them in decreasing indeterminate cases. The study includes 51 subjects of biopsy-proven orbital lymphoid lesions and inflammatory pseudotumors from pathologic practices of Farabi and Imain Khomeini Hospitals, from April 1994 to March 2000. We reviewed H&E stained slides. Then we examined clonality of indeterminate cases with evaluation of clonal immunoglobulin light chains (ĸ or λ) expression to find neoplastic cells. CD markers were used for excluding other closed morphologic differential diagnosis. In conclusion we determined 40 cases of lymphoproliferative lesions, divided to the following there groups: malignant lymphoma with sixty-five percent frequency were the most common type of them, reactive lymphoid hyperplasia with twenty percent was the second one and atypical lymphoid hyperplasia with fifteen percent was the third one. The most common site of involvement was orbit (57.5%). Males were affected slightly higher than females. Median age at diagnosis was 62 years. The most common type of lymphoma group was low-grade small lymphocytic lymphoma. It is necessary to note that 11 out of total 51 subjects were excluded under other pathologic diagnosis. On the other hand 4 cases of already diagnosed pseudo-tumors were reclassified into three lymphoid lesion categories above.
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To determine easily identifiable congenital anomalies (CA) prevalence and risk factors in the first 24 hours of life in a cross-sectional study we assessed 2291 live born neonates at four teaching hospitals from September 1999 until March 2000 in the south of Tehran. Data were collected by a structured form which contained neonatal characters including sex, gestational age, birth weight, history of CA in siblings, type of CA if there was any and maternal characters including maternal age, history of chronic illness, history of reproduction (including gravidity, parity, infertility and abortion) and conditions during recent pregnancy (including multiple gestation, vaginal bleeding, drug taking, smoking, exposure to X-ray and gestational illness). The prevalence of CA was 2.3% (55 cases). There were 29 males (52.7%) and 26 females (47.3%). Seventeen cases (30.9%) and 15 cases (27.3%) were low birth weight (LBW) and premature, respectively. There was positive history of CA in siblings of only 2 cases (3.6%). Mother of one case (1.8%) had history of drug ingestion during pregnancy. 14.5% (8) and 9.1% (5) of cases, mothers had chronic or gestational illnesses, respectively. Overall musculoskeletal system (30.59%), central nervous system (18.82%) and genital anomalies (16.48%) were accounted as the most common CA. There was statistical significance between CA and birth weight (Odds ratio [OR] 2.51, Confidence Interval [CI] 1.17-5.37).
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Since bone marrow has been shown to contain osteoprogenitor cells, an experiment was devised to test its effects when injected percutaneously into osteotomies sites in rabbit radii. In this experimental study, the osteogenicity and its effect on early bone repair of bone marrow grafts were investigated. The purpose of this study was to determine whether bone marrow grafted percutaneously led to increased bone production or had any effect on the early healing of fractures. The parameters tested included, cross-sectional area of callus (XS), breaking load (BL), tensile strength (TS) and callus volume (CV) at the fracture site. At two weeks post grafting four parameters, specially callus volume, were significantly higher 0.001
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Lorazepam has in increasingly being used in our country in recent years. Pharmacologically, lorazepam belongs to the benzodiazepines known for their wide neurotropic properties. There have been several studies on the side effects of the drug as stress disorders, tumors, preconvulsive activities in case of epileptic attacks, overdose, and behavioral problems, but little is known regarding the teratogenicity of the drug and its effects on the craniofascial development. In this study, a group of adult wistar rats of definite average of age and weight were selected and exposed to 2 mg/kg/day to 20 mg/kg day of lorazepam after conception (during the organogenesis in the days 9 to 18) in case and control groups. The fetuses were first studied macroscopically regarding gross anomalies, and then histologically and histochemically to exactly inspect the defects of tissue organogenesis. According to the results obtained, there was significant difference in the weight and length of the cases compared to the control group. Several anomalies of the eyes and ears (Coloboma of the eyelids with protruded globes and absence of the auricle and external auditory meatus), anomalies of the skull (Acrocephaly, and large rhombencephalon) were found. The craniofascial organs such as the nasal epithelium, tongue, salivary glands and the palates were also affected. According to the final analysis, there is a significant difference between the case and control groups. It was also found that taking the drug in the second half of pregnancy could affect the migration of the neural crest cells (being very sensitive) and change the mesenchymal structure of the neural crests. It also promotes the synthesis of proteins like growth hormone and growth factors. The fast, uncontrolled growth, defects the normal maturing process of the tissues during organogenesis, which ends in irreversible malformations.
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Although amebic liver abscess can be a cause of significant morbidity and mortality in all ages, there are few reports dealing with this entity in children. Twenty-four children with amebic liver abscess. Ages ranging between 8 weeks and 14.5 years were managed at the Tehran university hospital of children, Iran, between November 1987, and October 2001. The most frequency presentation was high-grade fever and right upper quadrant pain, associated with tender hepatomegaly, leukocytosis and an elevated erythrocyte sedimentation rate. The diagnosis was confirmed by elevated indirect hemagglutination titers and ultrasonograpy of the liver. Unlike the experience in adult patients, none of the patients had concomitant jaundice and significant derangement of liver enzymes. The abscesses were likely to be solitary (22 of 24 patients). There were 17 males and 7 females. Most patients (80%) were between 8 weeks to 14.5 years of age. In five patients possible predisposing factors were tuberculosis, chickenpox, tetralogy of fallot and thalassemia major. All patients received metronidazole (50 mg/kg/day), followed by a therapeutic course of a luminal amebicide. There was no death despite a mean delay of 15 days before presentation to our hospital. In conclusion a high index of suspicion, early institution of metronidazole therapy and aspiration of abscesses with potential to rupture are believed to have contributed to the better outcome in these children when compared with results in previous reports.
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Obesity is the common clinical signs in hirsutism, which can cause metabolic disturbances like dyslipidemia, insulin resistance and hypertension. To investigate relationship of overweight and obesity with hormonal and metabolic parameters in suspected hirsute women, in a cross-sectional study, 184 suspected hirsute women were selected in a reproductive endocrinology outpatient clinic in north of Tehran from February 1997 to May 1999. Weight, height, waist and hip circumferences were measured and serum levels of lipids, hormones and glucose were determined. Overweight and overall obesity (OO-body mass index: BMI ≥ 25 kg/m²) and android obesity (AO-waist to hip ratio: WHR>0.85) were calculated. Hirsutism score of OO and AO women was higher than that of non-obese women (NO, P<0.001). OO woman had significantly lower levels of serum LH, estradiol, HDL and higher levels of triglyceride (TG), LDL and LDL/HDL ratio than non-obese women (P<0.05). In addition, the mean BMI, LH/FSH ratio and serum levels of testosterone (T), dehydroepiandrostenedione sulfate (DHEAS), insulin, and TG of AO women were higher (P<0.05) and their glucose/insulin ratio was lower than non-android obese women (NAO: WHR≤0.85; P<0.03). Multiple regression analysis of the data showed that WHR correlated most significantly with serum cholesterol, LDL and HDL levels; serum androstenedione with LDL/HDL ratio and serum glucose; and less significantly serum LH with serum insulin levels (P<0.02). Metabolic disturbances in these women are mostly due to obesity (especially android obesity), and high serum androstenedione levels.
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Chronic myelogenous leukemia (CML) is a stem cell disorder sometimes associated with lymphoproliferative disorders. CML may precede a lymphoproliferative disorder. There are a few reports showing associating of CML with multiple myeloma and we report a known CML case that transformed into a full-blown multiple myeloma. This patient had more than 69% of infiltrating myeloma cells in her bone marrow and Philadelphia chromosome was detected in 18 out of 42. However, the probable presence of some myeloma cells with classic Philadelphia-positive chromosome could be proposed.
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Non-alcoholic steatohepatitis (NASH) is a disease of unknown origin characterized histologically by alcoholic-like liver injury in the absence in the absence of significant alcohol intake. This study was conducted to assess the clinical and pathological features of NASH patients in Iran. Patients with elevated liver transaminases, negative serologic markers of viral or autoimmune hepatitis and no findings in favor of metabolic liver disease were enrolled. A careful history was taken with special attention to alcohol intake and ultrasonography and liver biopsy were performed in those with no evidence of significant alcohol intake. A histology showing moderate to gross macrovesicular fatty change with inflammation (lobular or portal), with or without Mallory bodies, fibrosis, or cirrhosis, was considered diagnostic for NASH. Patients with mild steatosis were rechecked for the presence of hepatitis C virus (HCV) infection. Fifty-three patients who met the above criteria entered the study. Thirty-two patients (60.4%) were male and 21 (39.6%) were female with the mean age of 37.8±11.3 years. Twenty-six patients (55.3%) were diabetic. Mean AST to ALT ratio was 0.95±0.52; 65.3%of patients had a ratio below than 1, and 95.9% were below of 2. Ultrasonography was abnormal in 32 (76.2%) patients. Liver biopsy showed mild steatosis in 35.7% moderate steatosis in 53.6% and severe forms in 10.7%. In 80.2% of patients, portal inflammation was present, and 15.1% had some degrees of fibrosis. The amount of increase in liver enzymes bore no relationship with the presence of fibrosis, portal inflammation, and degree of steatosis (P>0.05). The patients wee somewhat younger than other studies, and most of them were male which might be due to the low rate of alcohol consumption in our country. Most of the patients had body mass index (BMI) higher than normal. Our findings show that NASH must not be considered a disease confined to high-risk groups only, and its impact be larger than what is generally considered.
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Given preliminary evidence of timed, sequential chemotherapy of high dose cytosine arabinoside the current study was initiated to assess the side effects and efficacy of this regimen in patients with newly acute myelocytic leukemia (AML). Nineteen adults who referred to Hematology-Oncology and Bone Marrow Transplantation (BMT) research center of Tehran University of Medical Sciences were enrolled in a trial from Aug 1999 to Nov 2000. All patients had a Karnofski classification above 60%. At this time induction therapy consisted of daunorubicin or idarubicin given at a dose of 60 mg/m² and 12 mg/m² IV respectively on days 1-3, and cytarabine (Ara-C) 100 mg/m² intravenously by continuous infusion on days 1-7, followed by Ara-C 1000 mg/m² given on day 8-10 every 12 hours by IV infusion. Consolidation therapy started after 35th day. Of 19 fully evaluable patients, 10 patients achieved a complete remission, whereas 36.6% patients succumbed to death due to regeneration failure. The clinical data show that the overall survival rate from diagnosis 55.5% (95% CI, 30.8-78.5) at 6 months for the entire cohort of the patients. Disease free survival is also 50% (95% CI, 26-74). Mean duration of death due to treatment was 20 days (range 17-29) after beginning the regimen. Presenting WBC counts, French-American-British (FAB) classification, sex and age were not useful prognostic variables. Fever, diarrhea, nausea and vomiting and GI hemorrhage were seen in 19, 6, 4, 7 patients respectively. It seems the 3+7+3 regimen is a promising approach for the AML patients regarding to high complete remission rate, but more supportive care should be considered. Furthermore any, benefit in long-term outcome can’t be determined regardless to the choice of post remission therapy (e.g., GCSF, appropriate antibiotics and etc).
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A rare case of non-puerperal uterine inversion caused by a large fundal leiomyoma in a 39-year nulliparous, infertile woman resulting in intractable hemorrhage was reported after a myomectomy. Attempts to reduce the inversion vaginally by transecting the anterior and posterior cervix were unsuccessful and a laparotomy was performed. The inversion was not successfully corrected and hysterectomy was done.
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Lupus erythematosus (LE) is an autoimmune disease. The mortality rate and causes of death are different in various countries. The present study is done to find out the causes of mortality in the systemic lupus erythematosus (SLE) patients in lupus unit of Rheumatology Research Center and other wards of Shariati Hospital. This study was retrospective according to medical records of patients who were referred to Lupus Unit of Rheumatology Research center, ICU, Gynecology and Nephrology wards of Shariati hospital during 10 years, from 1991 till 2001. Of 2021-recorded patient’s files, 165 (7.8%) deaths were already recorded. 84.8% were female and 15.2% male. The duration of disease was 36±12 months. The mean duration of follow up from entering the study till time of death was 25.9±16.8 months. The causes of mortality were as follows: infection (12.1%), respiratory (8.5%), CNS (13.9%), kidney (3.6%), malignancy (1.2%), unknown (7.8%), active lupus (3%). Infection accompanied with other causes (27.9%) , respiratory with other causes (11.5%), CNS with other causes (5.5%) and renal with other causes (4.8%). Infections are the most common cause of death in SLE Iranian patients, which is compatible with some multicentric studies. But in some previous studies myocardial infarction was reported as the main cause of death.
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Development of inhibitor to factor VIII is the most serious complication of hemophilia therapy. To determine the prevalence of inhibitors in Iran hemophilia A patients exposed to blood products, 1280 hemophilia A patients (age range 9 months-84 years) were evaluated. All patients received several blood products such as fresh frozen plasma (FFP), cryoprecipitate, and factor VIII. 635 of 1280 patients (49.6%), 277 patients (21.6%) and 368 patients (28.8%) had severe, moderate and mild disease, respectively. 184 of 1280 patients (14.4%) developed inhibitor. The prevalence of inhibitor for severe, moderate and mild in hemophilia A patients was 22.8%, 9.4%, and 3.5% respectively. 41 patients (22.2%) and 143 patients (77.8%) were high responder and low responder respectively. Among 184 patients with inhibitor, 67 patients (36.4%) had blood group O and for B, A, AB blood groups, number of patients with inhibitor was 55 (29.9%), 50 (27.2%), 12(6.5%) respectively and 153 patients (83.1%) had Rh blood group.
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Caudal regression syndrome (Caudal dysplasia sequence) is a rare congenital malformation. It has a spectrum ranging from simple anal atresia to the absence of sacral, lumbar and possibly lower thoracic vertebrae and the most severe form called sirenomelia (Mermaid syndrome). Sirenomelia has a sole characteristic, which is the limbs fusion, with multiple internal structural abnormalities particularly in the renal tract (bilateral renal agenesis). This is a rare condition with a relative risk of 200-250 in diabetic pregnancies. The etiology of this syndrome is not well known. Maternal diabetes in considered to be other possible factors. We present birth of an infant with great congenital defect, which was categorized as the most intense form of caudal regression syndrome (sirenomelia). The baby was born from an uncontrolled diabetic mother who was ignorant of her diabetes. She had a sonographic report at early third-trimester of pregnancy, which had shown severe oligohydramnios and according to this reason the anomaly of the fetus was not detected at that time (antenatal). Since sirenomelia is a lethal abnormality, the infant died a few hours after birth. As notes above caudal regression syndrome is strongly associated with maternal diabetes; due to metabolic derangement in uncontrolled serum glucose.
