CASE_STUDY An unusual localization of hydatid cyst in a patient with AbstractHydatid disease is a widespread parasitic infection caused by tapewormEchinococcus and it affects mainly the liver, but other organs such as pelvic organscould be involved very rare. Here we report a case of hydatid cyst with involvementof oviduct in a woman with endometrial cancer. It was misdiagnosed as a multicysticright ovarian mass before surgery and by microscopic study it was shown as a primarydegenerated hydatid cyst which was also unusual. Although pelvic echinococcalcysts rarely occur, the gynecologists should be consider, and the possibility of ahydatid cyst when they find a pelvic cystic mass, especially in areas where the diseaseis endemic. http://mjiri.iums.ac.ir/article-1-22-en.pdf 2009-02-15 212 214 hydatid disease echinococcus oviduct endometrial cancer. Afsaneh Tehranian afsanehtehranian@yahoo.com 1 Tehran University of Medical Sciences, Roointan Arash AUTHOR Bita Eslami 2 Roointan Arash Women’s Health Research and Educational Hospital, Tehran University AUTHOR
CASE_STUDY Epidermal inclusion cysts of the breast AbstractEpidermal inclusion cysts are uncommon in the breast, but the consequences can besevere when these cysts occur in the breast parenchyma. Here, we report two suchcases. The patient in case 1 was an 37-year-old woman with a 3-cm palpable mass inthe right breast. Mammography revealed a round and smoothly outlined mass, whichindicated a benign tumor, and sonography showed an irregularly shaped and heterogeneoushypoechoic mass, fibroadenoma was suspected on the basis of clinical andimage findings, but excisional biopsy revealed an epidermal inclusion cyst. The patientin case 2 was a 50-year-old woman with a 2.5-cm lesion in the left breast. Mammographyrevealed a round, dense, smoothly outlined mass, and sonography showeda well-defined, central hyperechoic mass. . Breast cancer was suspected on the basisof the sonographic findings and the age of the patient, but the resected specimen revealedan epidermal inclusion cyst. Although epidermal inclusion cysts are benign,occasionally they may play a role in the origin of squamous carcinoma of the breast. .Mammographic and sonographic features of an epidermal cyst may mimic a malignantlesion. Malignant change appears to occur more frequently in epidermal inclusioncysts in the mammary gland, compared to common epidermal inclusion cysts,and this may be associated with origination of mammary epidermal inclusion cystsfrom squamous metaplasia of the mammary duct epithelium.Epidermmoid inclusion cyst of the breast is potentially serious, although such cystsare rare, and differentiation from a malignant or benign breast tumor is required. Excisionis probably the most appropriate treatment, and can eliminate the possible riskof malignant transformation. http://mjiri.iums.ac.ir/article-1-20-en.pdf 2009-02-15 207 211 epidermal inclusion cyst epidermoid cyst breast cancer. Amir R. Motabar amotabar@yahoo.com 1 Department of Surgery, Iran University of Medical Sciences, Rasool-e- Akram Hospital AUTHOR
CASE_STUDY Primary Tuberculosis of the submandibular gland: a case report AbstractChronic sialadenitis is a disease of salivary glands associated with chronic infections,systemic diseases and silolithiasis pathogenesis of the disease. Primary tuberculoussubmandibulitis is not a reported disease. The diagnosis was confirmed whena 45 years old lady suspicious to submandibular gland tumor was operated on for excisionalbiopsy. Histological examination of the specimen by expert pathologistruled out malignancy, granuloma or caseous necrosis. Cultures of discharge and tissuewere negative for mycobacterium tuberculosis. The only positive diagnosticmodality was Polymerase Chain Reaction for mycobacterium tuberculosis. Therefore,the four drug anti-TB regimen was initiated. After that a surgical fistula washealed and the patient left the hospital on her foot and there was no recurrence at leastfor one year. The endemic condition of tuberculosis in some populations has increasedthe rate of extra-pulmonary tuberculosis. One of the extra pulmonary sitesmay be the submandibular gland.It is recommended to consider tuberculosis in the differential diagnosis of submandibulargland masses especially in populations with endemic tuberculosis. http://mjiri.iums.ac.ir/article-1-19-en.pdf 2009-02-15 203 206 chronic sialadenitis tuberculosis submandibular gland. Mohammad Ajalloueyan ajall@ajall.com 1 ENT Department, Baqiyatallah Medical Science University AUTHOR Davood Yadegary 2 Department of Infectious Disease, Shahid Beheshti Medical Science University, AUTHOR
ORIGINAL_ARTICLE Psychological health and expectations of patients seeking cosmetic rhinoplasty   Abstract   Background: Cosmetic rhinoplasty is now carried out increasingly in an attempt   to solve the psychological and social problems of people who are discontent with   their nose. Little is known about either the psychological status of persons who seek   rhinoplasty or potential psychological changes following surgery. The challenge that   faces surgeons, is how to identify, before surgical intervention those patients who   may have a poor outcome in terms of psychological adjustment despite a technically   satisfactory result.   Methods: Atotal of 96 patients (84 women and 12 men) who were seeking cosmetic   rhinoplasty were selected and completed an adopted expectation questionnaire   and SCL-90-R, a 90 item self-report symptom inventory which measures 9 primary   symptom dimensions. It is designed primarily to reflect the psychological symptom   patterns of psychiatric and medical patients.   Results: The majority of the patients reported that their noses made them selfconscious,   and thought the rhinoplasty would change their lives. Interpersonal sensitivity   and anxiety were the most reported symptoms in SCL-90-R, followed by obsessive-   compulsive symptoms and depression.   Conclusion: The findings of this study enhance our understanding of psychological   factors in seeking rhinoplasty and provide insight into the surgical-psychological   management of these patients. http://mjiri.iums.ac.ir/article-1-18-en.pdf 2009-02-15 198 202 psychological health expectations cosmetic rhinoplasty SCL-90-R Azizeh Afkham-Ebrahimi afkhami@iums.ac.ir 1 Department of Clinical Psychology, Iran University of Medical Sciences, AUTHOR Mansour Salehi 2 Department of Psychiatry. Iran University of medical Sciences. AUTHOR MirFarhad Ghalebandi 3 Department of Psychiatry. Iran University of medical Sciences. AUTHOR Alireza Kafian-Tafty 4 Department of Psychiatry. Zahedan University of Medical Sciences, AUTHOR
ORIGINAL_ARTICLE What is the most appropriate test in detecting prostate cancer in patients with intermediate prostate specific antigen levels?   Abstract   Background: Regarding the variety of tests present for detecting and also screening   prostate cancer and also bearing in mind the advantages and disadvantages of   these tests we decided to re-evaluate these tests (total prostate specific antigen and all   of its modifications) in detecting prostate cancer in men with intermediate serum   PSAlevels.   Methods: Following a cross sectional study, 100 consecutive men with intermediate   serum PSA levels and normal digital rectal examination (DRE) were incorporated.   Total and free PSA levels and TRUS-guided systematic prostate biopsy were   performed. PSA density, percent free PSA and percent free PSA density were calculated and compared. Statistical analysis was carried out using STATA8 SE.   Results: Overall, 27 patients had prostate cancer and 73 had benign prostate pathology. PSA density had the greatest area under the curve (AUC) which was significantly higher than percent free PSA density (0.685 vs. 0.448, p<0.001). The AUC   of percent free PSA density was not different between benign and malignant biopsy   results nor was significantly higher than the AUC of percent free PSA (0.308) or any   other screening tests.   Conclusion: PSAdensity was the most accurate screening test for prostate cancer   in patients with PSA levels of 4-10 ng/ml and normal DRE. The percent free PSA   density was not significantly more accurate than percent free PSA and regarding the   costs of transrectal ultrasonography, it can be concluded that the percent free PSA is   more cost-effective and hence more appropriate than percent free PSA density to   screen prostate cancer.   http://mjiri.iums.ac.ir/article-1-17-en.pdf 2009-02-15 191 197 prostate cancer prostate specific antigen accuracy PSAdensity percent free PSA density. Daryoush Saedi Daryoush_saedi@yahoo.com 1 Iran University of Medical Sciences. Radiology Department, Hasheminejhad Hospital AUTHOR Iman Mohseni 2 Iran University of Medical Sciences. AUTHOR Hassan Jafari 3 Iran University of Medical Sciences. AUTHOR Hooman Bakhshandeh 4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, AUTHOR Majid Chalian 5 Iran University of Medical Sciences, Tehran, Iran. AUTHOR
ORIGINAL_ARTICLE Management of tibial non-:union: using reamed interlocking intra-medullary nailing  Abstract  Background: Reamed interlocking intramedullary nailing of the tibia is a procedure  for the treatment of a non-infected tibial non:::union:::. The purpose of this clinical  study was to evaluate the outcome of this method as a treatment of tibial non:::union:::.  Methods: Twenty-nine patients with non:::union::: after initial therapy for tibial fracture  were retrospectively assessed after a reamed interlocking intramedullary nailing.  The main measurements were derived from radiographic and clinical :::union::: as  well as time from reamed nailing to :::union:::.  Results: Twenty-eight patients achieved :::union::: of their fracture (97%). The average  time from reamed nailing to :::union::: was 7.6 months. Serious complications included  one severe infection in the site of surgery (3%) and one tibial fracture distal to  the nail (3%).  Conclusion: Reamed interlocking intramedullary nailing for non:::union:::s of the  tibia resulted in a high :::union::: rate and was associated with a low complication rate.  This technique is recommended as a standard procedure for non-infected tibial  non:::union:::s. http://mjiri.iums.ac.ir/article-1-16-en.pdf 2009-02-15 183 190 tibial fracture tibial non:union: tibial delayed :union: reamed interlocking intramedullary nailing. Siroos Malekpoor 1 Rasool-e-Akram General Hospital, Iran University of Medical Sciences, AUTHOR Mehdi Moghtadaei, mmoghtadaei@gmail.com 2 Rasool-e-Akram General Hospital, Iran University of Medical Sciences AUTHOR Ehsan Akbarian 3 Rasool-e-Akram General Hospital, Iran University of Medical Sciences. AUTHOR Soheil Hamedanchi 4 Rasool-e-Akram General Hospital, Iran University of Medical Sciences AUTHOR
ORIGINAL_ARTICLE In situ fusion for spondylolysis” is regaining its lost popularity  Abstract  Background: Spondylolysis and spondylolisthesis can be associated with significant  low back pain, especially in physically active adolescents. Non-operative management  is usually successful in improving symptoms, but surgical intervention is  occasionally required. The aim of this study was to determine the effect of in situ posterolateral  fusion in the treatment of refractory cases with spondylolysis.  Methods: In this prospective before and after study, we described our experience  in13 patients managed by in situ fusion after failing multimodality non-operative  treatment. All surgical procedures were performed by the senior author and by a similar  technique. The spondylolytic vertebra and the one below were fused, in situ. Finally,  clinical outcome and recovery rates of clinical symptoms were evaluated by  Henderson’s functional capacity and Oswestry Disability Index version 2.1, respectively.  Results: The mean duration of non-operative management was 36 (12-72)  months. There were 8 males and 5 females. Average pre- and postoperative Oswestry  Disability Indices were 28.4%±13.7% and 4.9±7.8 respectively (P=0.001, significant).  All patients had follow-up contact on an average of 42.3 months (range 30 - 62  months). Based on Henderson’s clinical outcome functional capacity at the final follow-  up stage clinical outcomes were excellent in 10, good in 2 and poor in 1 patient.  The case with poor result had a pseudoarthrosis and was re-oprated. Finally he had an  excellent outcome.  Conclusion: We accept that the number of our cases is not high significantly but it  can be claimed that in situ fusion is a safe and effective modality to treat symptomatic  patients with spondylolysis and low-grade spondylolisthesis. A study with much  more cases is strongly recommended. http://mjiri.iums.ac.ir/article-1-15-en.pdf 2009-02-15 175 182 spondylolysis intertransverse fusion posterolateral approach in situ fusion Hamid Behtash 1 Iran University of Medical Sciences, Tehran, Iran. AUTHOR Ebrahim Ameri 2 Iran University of Medical Sciences, Tehran, Iran. AUTHOR Mohamadsaleh Ganjavian 3 Iran University of Medical Sciences, Tehran, Iran. AUTHOR Farzad Omidi-Kashani omidif@mums.ac.ir 4 Mashhad University of Medical Sciences, AUTHOR Marzieh Nojomi 5 Iran University of Medical Sciences, Tehran, Iran. AUTHOR
ORIGINAL_ARTICLE Gastric Cancer in people below and above 40 is it different?   Abstract   Background: Gastric cancer is the second most common cancer and also the second   cancer related death all over the world. In recent years recorded data for tumor   has shown a rise in the incidence of gastric cancer in young individuals. The present   study was designed to compare some of the epidemiologic characteristics of individuals   suffering from gastric cancer aged below and above forty years.   Methods: This cross-sectional study was performed on 389 patients suffering   from gastric cancer referred to a referral private clinic in Tehran during the years   1991 and 2001. The patients were divided into two groups, those older than 40 years   and the younger ones. The demographic information, the tumor type and location as   well as the prevalence of the H. pylori infection was compared in the two groups. The   collected data were entered in SPSS version 13 and analyzed using chi-square and   fisher exact test.   Results: Fifty patients (12.9%) were reported to be lower than 40 years. The mean   age of the patients in this group was 32.1±6.8years while the number was calculated   to be 63.23 ± 9.7 years in the other group. The male to female ratio in the group   younger and older than 40 years was 1.9: 1 and 2.6:1, respectively. Adenocarcinama   and lymphoma compromised 70% and 12% of the individuals younger than 40 years   whereas they were reported in 89.3% and 3.2% of the patients in the other group.   While cancer in the middle third of stomach was the most frequent type in both   groups, the prevalence of upper third gastric cancer was considerably higher in those   younger than 40 years old (19.9% vs. 5%). H. pylori infection was seen in 23.2% of   the younger group, while more than 56% of the older group suffered from H. pylori   infection. There was a statistically significant difference between the two groups   (P<0.017).   Conclusion: gastric cancer is not rare among the individuals younger than 40   years old. The disease is reported to be seen in the absence of H. pylori infection in   the majority of these cases. There is a considerable difference between the prevalence   of malignant lymphoma in this group of patients compared with the older patients. http://mjiri.iums.ac.ir/article-1-14-en.pdf 2009-02-15 170 174 gastric Cancer; H-Pylori infection; lymphoma; adenocarcinoma Hossein Froutan Pishbijari, Froutan@ams.ac.ir 1 Department of Gastroenterology, Imam Khomeini Hospital, AUTHOR Morvarid Assefi Rad, 2 Imam Khomeini Hospital, AUTHOR Iraj Baghi, 3 Poursina Hospital, Guilan University of Medical Sciences, AUTHOR
ORIGINAL_ARTICLE Evaluation of preoperative elevation of serum c-reactive protein as an indicator for prognosis of colorectal cancer   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.   http://mjiri.iums.ac.ir/article-1-13-en.pdf 2009-02-15 164 169 C-reactive protein colorectal cancer. Seyed Reza Mousavi 1 Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, AUTHOR Arash Najaf beygi, a.najafbeygi@yahoo.com 2 Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, AUTHOR Mohsen Talebianfar 3 Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, AUTHOR Mohamad Zeinalzadeh 4 Shahid Beheshti University of Medical Sciences, AUTHOR Ataollah Heidari 5 Shahid Beheshti University of Medical Sciences, AUTHOR
ORIGINAL_ARTICLE Acomparison of percutaneous and pin-and-plaster techniques in distal radius fracture  Abstract Background: Distal Radial fracture is one of the most common fractures of the skeletal system. Although it has been believed to be a simple fracture with excellent outcomes, practical operations’ results have always been undesirable and even poor. The goal of this study was to compare two methods of treatment “pin and plaster and precautious pin fixation in patients with unstable extra-articular distal radial fracture. Methods: This clinical-trial study was done in Emdadi Kamyab Hospital of Mashad University in the year 2006. 78 Patients were randomly divided into 2 groups. One group (38 patients) was treated using pin and plaster and the second group (40 patients) were treated with percutaneous pin fixation.History, physical examination and pre- and postoperative x-rays were taken from all patients. The mean follow-up time was 12 weeks. Data were collected by questionnaires and were analyzed by descriptive statistics and SPSS software and T-test. Results: The mean age of the patients in both groups were approximately 53- years-old. There was no significant statistical differences according to sex between two groups. In pin-and -plaster group radial shortening was 2.9 mm, mean dorsal angulation was 22.18 degree, but in percutaneous pin (PCP) group the results were 4.05 mm, 23.43 degree respectively. Conclusion: Range of motion of the wrist and elbow, rotation of the Forearm, reduction of the fracture all yielded better results in the PCP group. http://mjiri.iums.ac.ir/article-1-395-en.pdf 2009-02-15 159 163 pin and plaster percutaneous pin fixation wrist fracture Farshid Bagheri 1 Mashhad Medical University, Mashahd, Iran. AUTHOR MohammadTaghi Peivandi drpeivandy@yahoo.com 2 Mashhad Medical University, Mashahd, Iran AUTHOR Mohammad Ghardaghi 3 Mashhad Medical University AUTHOR Hosein Ahmadzadeh Chabok 4 AUTHOR