Medical Journal of The Islamic Republic of Iran (MJIRI)

---

Twenty patients with bulky (>4 cm size) FIGO stage IB cervical cancer were treated with cisplatin 50 mg/m2 and vincristine 1 mg/m2, administered intravenously at 10-day intervals for a total of 3 courses before radical hysterectomy. A complete clinical response was noted in 1 patient (5%) and partial response in 5 (25%). Fourteen patients (70%) had stable disease. There was no grade 3 toxicity noted. Of the 20 patients who received chemotherapy (ChT), 3 patients had parametrial and para-aortic involvement in these cases, the operation was aborted and radiation therapy given. The remaining 17 patients underwent radical hysterectomy and pelvic lymphadenectomy 10-15 days following ChT. Five of these patients (29.4%) had pelvic node metastases. Three patients had positive margins. These 8 patients received postoperative radiotherapy. Twenty-four months later 15 patients were alive (87%) and 2 had died.

---

In this study, anion-exchange chromatography was used to purify factor VII and factor IX from prothrombin complex (PPSB), which contains coagulation factors II, VII, IX and X. For this purpose, DEAE-Sepharose CL-6B gel , Pharmacia column XK-26 , high flow rate and two stepwise gradients with phosphate citrate buffer were used. The yield of the two lyophylized products, factor VII and factor IX concentrates, was 61 % and 75%, respectively. Specific activity of factor VII increased from 0.16 to 3.06 (purification-fold= 19.1) and specific activity of factor IX increased from 12 to 4.9 (purification-fold= 4.1). Results of electrophoresis on agarose gel-as well as immunoelectrophoresis-indicated higher purity of factor VII and factor IX compared to PPSB. Thrombogenicity of the two products were within the normal range defined for PPSB. In order to improve viral safety, solvent-detergent treatment was performed prior to further purification. Factor VII concentrate is used for patients with factor VII deficiency and also for hemophilia patients with inhibitors. Factor IX concentrate is used for treatment of hemophilia B patients.

---

The risks of transmitting viral infection by blood and plasma-derived products have long been known and still remain an area of concern. In this study, in the process of purifying human factor VII from prothrombin complex, SID treatment using tri-n-butyl phosphate and Tween 80 was employed and its capability and efficacy was studied. The results indicated that the process did not affect the biological function of the essential coagulation factors studied. In addition, the process was shown to be effective on enveloped viruses, where its inactivation factor for the model used, Herpes Simplex type I, was 5.5 logs. However, the procedure was not effective on poliovirus which was used as a model for non-enveloped viruses. It is therefore concluded that for increasing viral safety it is best to apply at least one more inactivating procedure which will be effective on non-enveloped viruses as well.

---

Normal healthy pulpal tissues were obtained from 19 impacted molars and symptomatic samples were obtained from 18 carious molars and premolars clinically diagnosed in all vital pulpal tissues. Student's t-test revealed significant differences in IL-2 concentrations, comparing symptomatic pulpal tissues with normal healthy samples (657, p

---

As IgM and IgA-enriched preparations are needed to complete the immunotherapeutic spectrum, a simple procedure is described for the preparation of IgM and IgA enriched immunoglobulins. Fraction III which was prepared by cold ethanol fractionation was treated by octanoic acid followed by ethanol precipitation and ion-exchange chromatography using Sephadex DEAE A-50 and 0.1 M tris-D.35M NaCI buffer, pH 8.1, resulting in recovery of 85 % IgM, 84% IgA and 33 % IgG. The comparison of our results with immunoglobulins' percentage in plasma indicates that IgM and IgA -enrichment was obtained by three times.

---

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor size greater than 4 cm (bulky) in diameter have worse outcome.' The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NArC) programs followed by radical hysterectomy in stage Ib - lIb bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage Ib - IIb bulky cervical cancer were treated with preoperative extemal beam radiotherapy to 45Gy plus weekly cisplatin 50 mg/m2 or preoperative neoadjuvant chemotherapy by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7-10 days, for three courses, Surgery was perfonned 4-6 weeks after completion of the preoperative treatment. There was no significant difference between age, stage, tumor size and histopathological type in the two groups (p>0.05).Toxicity associated with the two treatment methods was usually mild. In the chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long term hydronephrosis that needed ureteral stenting. Before surgery, complete and pmiial clinical response had no significant difference between the two groups (p>0,05). After surgery, lymph node and parametrial involvement had no significant difference between the two groups (p>0.05). In the NAIC group more patients had significant residual tumor (p=0,0 12) but residual tumor size had no significant difference between the two groups (p>0. 05). Pathological complete response was significantly higher in the chemoradiation group (p= 0. 004), According to the results of this study it seems that NArC and chemoradiation have similar effects on survival prognostic factors

---

Objective: The goal of this study is to evaluate the efficacy of intraperitoneal (JP) cisplatin as consolidation treatment, in epithelial ovarian cancer patients with pathologically negative surgical reassessment, following first-line platinum-based chemotherapy. Methods: This study included 22 patients with FIGO stage (IIc- IV) epithelial ovarian cancer (EOC) which had no evidence of disease and were assessed by second- look surgery. They were given 3 cycles of intra peritoneal (IP) cisplatin (100 mg/ m2) with 3 weekly intervals as consolidation therapy. Survival was compared to that of a group of contemporaneous patients undergoing observation only, after completion of standard therapy. Results: Median age of these 22 patients was 56 years (30-70 years). Stage distribution was II (3), III (16), and IV (3). Histologic grade was I (1), II (11), III (9), and residual disease at completion of initial surgery was none/microscopic in 4/22 (17%) patients. Median age of 43 patients who did not receive consolidation therapy was 52 years (28-74years). Stage distribution was II (7), III (32), and IV (4). Histologic grade was I (8), II (17), III (15), and not recorded (3). Median follow-up for both groups has been 46 months. Median disease-free survival (DFS) for the observed patients is 28 months and 44 months in the consolidation group. DFS distribution between groups was compared using the log-rank test and found to be significant (p= 0.03) Conclusion: Multivariate analysis revealed that the only significant predictor of improved DFS was protocol treatment (p< 0.01). This study indicates that consolidation IP cisplatin following negative second-look surgery is feasible, severe toxicity was not frequent and may provide a favorable outcome in terms ofDFS compared to nonprotocol patients who underwent observation alone. Further trials will be required to evaluate the role of consolidation treatment and improve its options in ovarian cancer.

---

   ABSTRACT

  Human blood and blood products is the source of a wide range of medicinal products used for the treatment and prevention of a variety of injuries and disease. Despite stringent routine measures and filters employed, residual pathogen infectivity remains an important challenge in the field of blood transfusion. In this article various measures and technologies that can be applied in order to reduce the residual risk are reviewed.

---

 Abstract

 Castleman disease or giant node hyperplasia is a rare disorder of the lymphoid tissue most often involving the mediastinal lymph nodes. We report a case of localized retroperitoneal hyaline-vascular type of Castleman disease. A 35-year old woman presented with mild epigastric pain with radiation to the back. Amild anemia was the only abnormal associated finding. Abdominal ultrasound and CT- scan showed a homogeneous well-demarcated mass beneath the pancreas. Excisional biopsy on laparotomy revealed a highly vascular encapsulated mass with a diameter of 6 centimeters. Histopathology examination was diagnostic: hyaline-vascular hype Castleman disease. Castleman disease, although rare, is one of the differential diagnoses of a retroperitoneal mass, most often discovered incidentally or due to pain and compressive symptoms. Excision is both diagnostic and curative for management of the localized form of Castleman disease.

---

 Abstract

 Background: Mustard gas, lethal in high doses, affects multiple organs such as skin, eye and respiratory system. We studied the development of late onset mustardinduced polyneuropathy among chemically wounded Iranian veterans.

 Methods: In this descriptive study, 100 chemically wounded Iranian veterans with severe eye involvement were examined for any signs and symptoms of polyneuropathy by an internist. 20 patients were suspected to have neurological symptoms or signs. These patients were examined by a neurologist again. 13 showed abnormal neurological symptoms. Electrodiagnostic exams were performed for this group by another physician.

 Results: 13 veterans had abnormal neurological exam results with prominent sensory signs and symptoms in almost all of them. Brisk deep tendon reflexes were found in 3 cases. Electrodiagnostic studies were compatible with axonal type distal sensory polyneuropathy in 6 subjects.

 Conclusion: To the best of our knowledge, this is the first report of late onset polyneuropathy among chemically-wounded victims who were exposed to mustard gas. The pathophysiology of this form of neuropathy is still unknown. Unlike most toxic neuropathies, obvious clinical signs and symptoms appeared several years after exposure. No specific treatment for polyneuropathy due to chemical weapons exposure has been described to date.

---

  Abstract

  Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and is an important health economic problem. Since 1960, there has been an increase in mortality associated with COPD, especially in men. Acute exacerbations form a major component of the socioeconomic burden of COPD which mainly results in long-term hospitalization. Despite the high number of COPD-related hospitalizations, relatively little is known about the mortality rate and related determinants of patients hospitalized for this acute deterioration in the clinical course of COPD. The aim of this study was to evaluate the factors affecting duration of hospitalization in Iranian patients with COPD.

  Methods: This cross-sectional study was performed on 68 COPD patients who were

  hospitalized in Rasool-e-Akram hospital in Tehran, Iran for the period 2005-2006. During

  hospitalization, patients’ chief complaint, symptoms and signs, results of physical examinations,spirometry, arterial blood gas (ABG) and ICU admission were recorded. Data were analyzed using Independent T-test, One Way ANOVAand Correlation tests.

  Results: The patients were 41(60.3%) males and 27(39.7%) females with the mean age

  of 69.7(SD=13.52) years. The mean duration of hospitalization was 11.82(SD=5.49) days and 3(4.4%) patients died. The family history of pulmonary disease (P=0.018), habitual snoring (P=0.031), and mean baseline arterial PaO2 (P=0.010, r= -0.361) were determined as factors affecting duration of hospitalization. On the other hand, other factors such as smoking (P=0.992), patient’s gender (P=0.735) and spirometric indices did not significantly associate with duration of hospitalization.

  Conclusion: The fact that people hospitalized with COPD have a subsequently increased risk of death compared with those not hospitalized suggests the former are an atrisk group and shows the importance of factors affecting duration of hospitalization. Our results show that more attention must be paid on habitual snoring and low arterial pO2 which may have potential effects on duration of hospitalization in COPD patients.

 

---

  Abstract

  Background : Cancer has not been elucidated in colerectal site. C-reactive protein

  (CRP) is a product synthesized in hepatocytes and has been reported to be up-regulated

  by such proinflammatory cytokines as interleukin-1 (IL-1), interleukin-6 (IL-6),

  and tumor necrosis factor (TNF). The significance of a preoperative serum elevation

  was evaluated using CRP as a predictive indicator for the malignant potential and

  prognosis.

  Methods: Forty consecutive patient with colorectal cancer whose local lesions

  were resected in our department, plus forty healthy volunteers, were selected. Any

  patient with inflammatory diseases such as infection or collagen disease was excluded

  from the current study. The preoperative serum CRP level and the control group

  were measured. The relationships between the serum elevation of CRP and both the

  clinicopathologic factors and prognosis of the patients was investigated.

  Results: The rate of patients with elevated serum CRP level was significantly

  higher in the colorectal cancer patients in comparison to the control group (55% versus

  2.5%). Furthermores the incidence of liver metastasis, peritoneal carcinomatosis,

  histopathologic lymph nodes metastasis, and tumor invasion in colorectal cancer patients

  with a preoperatively elevated serum CRP level were significantly more frequent

  than in those with a negative serum CRP level. The survival rates of the colorectal

  cancer patients without a preoperative elevation of the serum CRP proved to

  be significantly more favorable than that of the colorectal cancer patients with such

  an elevation (94.4% versus 59.1% P<0.001).

  Conclusion: Apreoperative serum elevation of CRP was thus found to be an indicator

  of the malignant potential of the tumor as well as prognostic factor for patients

  with colorectal cancer.

 

---

Abstract

Background

contributes substantially to patient morbidity and mortality.In this study we investigated

the range and distribution of T-lymphocyte. Subsets CD3

helper/inducer cell,.th ), CD8

: Severe immunosuppression occurs after large thermal burn and probably+ (T cells) CD4+ (T+ (T suppressor /Cytotoxic cells ,TS/C), CD3+

CD4

thermal injury.

+/CD3+CD8+ ratio, CD19+ (B cells) and CD16+ (NK cells ) in patiens following

Methods

studied.The total body surface area of the burn injury, ranged from 30 to >70%. Whole

blood samples were collected at three and seven days postburn. Partec flowcytometry

system and triple color flowcytometry reagents (Dako Co), were used to evaluate peripheral

blood lymphocytes population of patients admitted at the Motahary Burn Center

in Tehran.

: Forty male, aging 18-60 years with major thermal injury were

Results

reduction in relative number of CD3

postburn.CD4

range in seven days following injury. CD19

burn patients at both three and seven days. The number of CD16

declined in three days and moderately increased on day seven, following injury.

Thus, the data showed that thermal burn injury suppressed T-lymphocyte subsets proliferation

in various days .In addition, all compartments of showed phenotypic changes

in the 3th and seventh days after burn, in different groups of age. Thermal burn injury

suppressed T cell subsets proliferation on day 3 and 7 postburn, when compared to normal

controls. (P <0.05) at 3 and 7 days post burn.

: Compare to healthy controls, patients with burns have shown a significant+, CD4+ and CD8+ T cells at three and seven adys+/CD8+ ratio were below normal range in three days and remained in normal+ B cell populations were elevated in+ NK cells were significantly

Conclusion

factor in immunosuppression and development of sepsis in thermal burn patients.

: Significant changes in lymphocytes population could be an important

---

 Background: Lower limbs antigravity muscles weakness and decreased functional ability have significant role in falling. The aim of this study was to find the effects of aging on muscle strength and functional ability, determining the range of decreasing strength and functional ability and relationship between them in healthy women.

 

Methods: Across-section study was performed on 101 healthy women aged 21-80 years. The participants were divided into six age groups. The maximum isometric strength of four muscle groups was measured using a hand-held dynamometer bilaterally. The functional ability was measured with functional reach (FR), timed get up and go (TGUG), single leg stance (SLS), and stairs walking (SW) tests.

 Results: Muscle strength changes were not significant between 21-40 years of age, but decreased significantly thereafter. Also, there was a significant relationship between muscle strength and functional ability in age groups.

 

Conclusion: Both muscle strength and functional ability is reduced as a result of aging, but the decrease in functional ability can be detected earlier.

 

---

 

Cerebrovascular disease is one of the leading causes of death in the world, and about one-fourth of cerebrovascular deaths are due to ruptured cerebral aneurysms (CA). Hence it is important to find a way to reduce aneurysm formation and its subsequent morbidity and mortality. Proteolytic activity capable of lysing gelatin has been shown to be increased in aneurysm tissue and expression of plasmin, membrane-type matrix metalloproteinase- 1(MT1-MMP), and matrix metalloproteinase-2 (MMP-2) in aneurysmal wall is more than what we observe in normal cerebral arteries. MMP inhibitors such as doxycycline and statins may prohibit aneurysm formation and growth. MMPs are important in tissue remodeling associated with various physiological and pathological processes such as morphogenesis, angiogenesis, apoptosis and tissue repair. In this article we review the role of MMPs and MMP inhibitors in formation of aneurysm.

 

---

 

Background: Asthma is a common condition in general medical practice, and it accounts for about 1% of all ambulatory hospital visits. Nowadays, hospitalization rates for asthma have actually been increased in some demographic subgroups despite recent advances in treatment. Understanding the underlying factors that contribute to hospitalization and especially duration of the hospitalization of asthmatics could help elucidate the recent rise in morbidity and also reduce the high demand on health care systems of the disease. The aim of this study was to evaluate factors affecting the duration of hospitalization for Iranian patients with asthma.

 

Methods: This study was conducted on 55 asthmatic patients (diagnosis of asthma was in accordance with the criteria of the American Thoracic Society). The study was performed on patients hospitalized in Rasoul-e-Akram hospital in Tehran, Iran during the period 2005-2006. During hospitalization, the patients’ most common complaints were recorded as the symptoms and signs of the medical condition, results of physical examinations, spirometry, arterial blood gas analysis (ABG), and ICU admission.

 

Results: There were 18(32.7%) male and 37(67.3%) female patients with a mean age of 54.96 (SD=17.54) years. The mean duration of hospitalization was 8.31(SD=4.69) days that ranged between 2 and 23 days. The mean baseline arterial PH (p=0.039, RPearso = -0.362), baseline arterial [HCO3] (p=0.042, RPearson = 0.361), changes of FEV1 after bronchodilator (p=0.041, RPearson= -0.363) and patient's age (p=0.002, RPearson=0.0433) were determined as factors affecting duration of hospitalization.

 

Conclusion: Our results showed that more attention needs to be given to the findings of arterial blood gas and spirometry which can potentially affect the duration of hospitalization of asthmatic patients.

 

---

  Background: Factor VII concentrates are used in patients with congenital or acquired factor VII deficiency or treatment of hemophilia patients with inhibitors. In this research, immunoaffinity chromatography was used to purify factor VII from prothrombin complex (Prothrombin-Proconvertin-Stuart Factor-Antihemophilic Factor B or PPSB) which contains coagulation factors II, VII, IX and X. The aim of this study was to improve purity, safety and tolerability as a highly purified factor VII concentrate.

  Methods : PPSB was prepared using DEAE-Sephadex and was used as the starting material for purification of coagulation factor VII. Prothrombin complex was treated by solvent/detergent at 24°C for 6 h with constant stirring. The mixture of PPSB in the PBS buffer was filtered and then chromatographed using CNBr-activated Sepharose 4B coupled with specific antibody. Factors II, IX, VII, X and VIIa were assayed on the fractions. Fractions of 48-50 were pooled and lyophilized as a factor VII concentrate. Agarose gel electrophoresis was performed and Tween 80 was measured in the factor VII concentrate.

  Results : Specific activity of factor VII concentrate increased from 0.16 to 55.6 with a purification-fold of 347.5 and the amount of activated factor VII (FVIIa) was found higher than PPSB (4.4-fold). Results of electrophoresis on agarose gel indicated higher purity of Factor VII compared to PPSB these finding revealed that factor VII migrated as alpha-2 proteins. In order to improve viral safety, solvent-detergent treatment was applied prior to further purification and nearly complete elimination of tween 80 (2 μg/ml).

  Conclusion : It was concluded that immuonoaffinity chromatography using CNBr-activated Sepharose 4B can be a suitable choice for large-scale production of factor VII concentrate with higher purity, safety and activated factor VII.

---

  Background: CT scan and nuclear medicine exams deliver a great part of medical exposures. This study examined professional radiation hazards in CT scan and nuclear medicine workers.

  Methods : In a cross sectional study 30 occupationally exposed workers and 7 controls (all from personnel of a laboratory) were selected. Physical dosimetry was performed for exposed workers. Blood samples were obtained from the experimental and control groups. Three culture mediums for each one were prepared in due to routine chromosome analysis using G-banding and solid stain.

  Results : There were significant increased incidence of chromatid gap (ctg) and chromatid break (ctb) with mean±SD frequencies of 3±0.84 and 3.1±1.40 per 100 cells respectively in the nuclear medicine workers versus controls with mean±SD frequencies of 1.9±0.69 and 1.3±0.84 for ctg and ctb, respectively. Chromosome gaps (chrg) were higher significantly in the nuclear medicine population (2.47±0.91) than in controls (1.4±0.9) (p<0.05). In CT scan group the ctg and ctb were increased with a mean±SD frequency of 2.7±0.79 and 2.6±0.91 per 100 cells respectively compared with control group. The mean±SD frequencies of the chrb were 2.0±0.75 and 0.86±0.690 per 100 cells for exposed workers and control group, respectively.

  Conclusion : This study showed chromosome aberrations in peripheral lymphocytes using solid stain method are reasonable biomarker reflecting personnel radiation damage.

---

Background: Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider&#39;s treatment.

Objectives: This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran.

Methods: In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, health technology assessment reports and economic evaluation studies were included. The results of included studies were analyzed via the thematic synthesis.

Results: Seven articles were included in the study. The results showed that image-guided radiation therapy, regardless of the imaging technique used in it, is associated with no major toxicity and has the potential to reduce the symptoms of poisoning. Using image-guided radiation therapy for prostate cancer resulted in substantial improvement in the quality of the received dose and optimal therapeutic dose of radiation to the targeted tumor while the radiation dose to the surrounding healthy tissues was minimal. Additionally, image-guided radiation therapy facilitated the diagnosis and management of exception deviations, including immediate changes and gross errors, weight loss, significant limbs deformity, systematic changes in the internal organs and changes in respiratory movements. Usage of image-guided radiation therapy for prostate cancer was associated with increased costs.

Conclusion: Current available evidence suggests that the image-guided radiation therapy can reduce the amount of radiation to healthy tissue around the tumor and the toxicity associated with it. This can enhance the safe dose of radiation to the tumor and increase the likelihood of destruction of tumor. The current level of evidence required conducting further studies on the costs and effectiveness of this technology compared with conventional technology.

---

Background: After lung and prostate cancers, colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women after breast cancer worldwide. Every year, more than one million people are diagnosed with colorectal cancer worldwide and half of these patients die from this disease, making it the fourth leading cause of death in the world. This systematic review aimed to assess the effectiveness of the two colorectal diagnostic tests of FOBT (fecal occult blood test) and FIT (fecal immunochemical test)) in terms of technical performance.

  Methods: To retrieve the relevant evidence, appropriate medical databases such as Cochrane library, NHSEED, Scopus and Google scholar were searched from February 2013 to July 2014, using free-texts and Mesh. In this study, inclusion/exclusion criteria of the papers, randomized controlled trials, economic evaluations, systematic reviews, meta-analyses and meta-syntheses of the effectiveness of FIT versus FOBT tests in moderate-risk populations (age: 50 to 70 years), which had reported the least of such outcomes as sensitivity, specificity and clinical outcomes were reviewed. The analyses of the effectiveness outcomes were performed in the form of meta-analysis.

  Results: Five papers were eligible to be included in the final phase of the study for synthesis. FIT showed a better performance in participation and positivity rate. Moreover, in terms of false positive and negative rate, FIT showed fewer rates compared to FOBT (RR:-4.06; 95% CI (-7.89-0.24), and NN-scope (Number need to scope) (2.2% vs. 1.6%), and NN-screen (Number need to screen) (84% vs. 31-49% in different cut off levels) showed significant differences in FOBT vs. FIT, respectively.

  Conclusion: In the five included studies (3, 11-14), the acceptability of FIT was more than FOBT. However, in our meta-analysis, no difference was found between the two tests. FIT was significant in positivity rate and had a better performance in participation rate, and a fewer false negative numbers compared to FOBT.