2 1016-1430 Iran University of Medical Sciences 83 Neurosurgery Frontal intraparenchymal schwannoma: a case report Parvaresh-Rizi Mansour b Hejazian Seyed Ebrahim c Rezai Mitra d b Department of Neurosurgery, Iran University of Medical Sciences, Tehran,Iran c Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran. d Department of Pathology, Iran University of Medical Sciences, Tehran, Iran. 1 8 2009 23 2 112 116 06 01 2010     Abstract   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.  
82 Surgery Vagus nerve shwannoma presented with long-term cachexia: report of a case and review of literature Ghafouri Ali e Khorgami Zhamak f Molanaei Saadat g e Dr Shariati Hospital, School of Medicine Tehran University of MedicalSciences.Tehran. Iran. f Dr Shariati Hospital, School of Medicine Tehran University of Medical Sciences .Tehran g Department of pathology, Milad Hospital, Tehran, Islamic Republic of Iran 1 8 2009 23 2 108 111 06 01 2010   Abstract   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.   81 Pediatric Acute urinary retention in a three years old girl: case report and review of literature Honarpisheh Ali h Sharif Mohammad Reza i Talebian Ahmad j Taghavi Ardakani Abbas k Tabesh Homayoon l Fakharian Esmaeel m h Department of Pediatrics, Kashan University of Medical Sciences,Kashan, Iran i Depatment of Pediatrics, Kashan University of Medical Sciences.Kashan, Iran. j Depatment of pediatrics, Kashan University of Medical Sciences. Kashan, Iran. k Depatment of Pediatrics, Kashan University of Medical Sciences. Kashan, Iran. l Depatment of Pediatrics, Kashan University of Medical Sciences. Kashan, Iran. m Trauma Research center, Kashan University of Medical Sciences. Kashan, Iran. 1 8 2009 23 2 105 107 03 01 2010     Abstract   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. 80 Cardiovascular Surgery Nonconventional therapeutic modalities in refractory angina pectoris Javidi Daryoosh n Saffarian Niloofar o n Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran. o Pars Hospital. 1 8 2009 23 2 96 104 03 01 2010     Abstract   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.   79 Orthopedic Surgery Assessment of the clinical outcome of IM rod fixation in the treatment of tibial congenital pseudoarthrosis Behgoo Seyed Abas p Ramezan Shirazi Mehdi Gharati Hajir p Iran university of Medical Sciences, Tehran, Iran. Shafa Yahyaian Hospital, Baharestan Sq., Tehran, Shafa Yahyaian Hospital, Tehran, Iran. 1 8 2009 23 2 90 95 03 01 2010   Abstract   Background: 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.   Methods: 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).   Results: 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:::.   Conclusion: 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.   78 Anatomical Sciences A preliminary study of microsatellite instability analysis in different genotypes of p53 codon 72 in breast invasive ductal carcinomas Nikbahkt Dastjerdi Mehdi Faghani Masoumeh Salehi Mansour Rabbani Mohammad Dept. of Anatomical Sciences, Medical school, Isfahan University of Medical Sciences, Isfahan,Iran Dept. of Anatomical Sciences, Medical school, Guilan University of Medical Sciences, Rasht, Iran Dept. of Genetics, Medical school, Isfahan University of Medical Sciences Dept. of Biotechnology, Pharmacy School, Isfahan University of Medical Sciences. 1 8 2009 23 2 83 89 03 01 2010   Abstract   Background: 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.   Methods: 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 .   Results: 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).   Conclusion: Our findings suggested that breast invasive ductal carcinomas arising   in individuals with p53 codon 72 heterozygosity (Arginine/Proline) may be preferentially   prone to microsatellite instability more than other genotypes.   77 Medical Genetics Genetic polymorphisms in the estrogen receptor - α Gene codon 325(CCC}CCG) and risk of breast cancer among Iranian women: a case control study Azimi Cyrus Abbasi Sakineh Department of Genetics, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Department of Medical Laboratory Sciences, Faculty of AlliedMedicine, Tehran University of Medical Sciences, Tehran, Iran 1 8 2009 23 2 75 82 03 01 2010   Abstract   Background: 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 .   Methods: 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 .   Results: 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 .   Conclusion: 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 .   76 Pediatric Birth weight and the risk of childhood hearing impairment Mohammadzadeh Ashraf Mokhtari Ne'matollah Farhat Ahmadshah Amiri Ra'na Esmaeli Habibollah Neonatal Research Center, Mashhad University of Medical Science, ENT Research Center, Mashhad University of Medical Science, Ghaem Hospital.Iran. Neonatal Research Center, Mashhad University of Medical Science, NICU of Emamreza Hospital.Iran. Neonatal research center, Mashhad University of Medical Science, Nursing and Midwifery Faculty Neonatal Research Center, Mashhad University of Medical Science, Community Medicine and Public 1 8 2009 23 2 70 74 03 01 2010  Abstract  Background: 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.  Method: 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.  Result: 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.  37 Orthopedic Surgery Evaluating suppression of PGE2, PAF, and histamine synthesis and histopathological changes of bones in the membrane surrounding particulate polymethylmethacrylate in the rat tibia Farahini Hossein Moghtadaei Mehdi Akbarian Ehsan Pazouki Mohammad Reza Zangi Mahdi Nayersabeti Pezhman Shaghaghi Amir Rasool-e-Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran. Rasule-Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran. Karolinska Institutet Stockholm, Sweden. Department of Physiology, Iran University of Medical Sciences. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Rasule-Akram General Hospital, Iran University of Medical Sciences. Rasule-Akram General Hospital, Iran University of Medical Sciences. 1 8 2009 23 2 64 69 11 11 2009   Abstract   Introduction: 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.   Methods: 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.   Results: 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.   Conclusion: 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.   36 Orthopedic Surgery Arthroscopic repair of complete tear of rotator cuff Aslani Hamid Reza Vahedi Hamed Zafarani Zohreh Shahid Beheshti University of Medical Sciences. Orthopedic Surgeon and Medical Researcher. General Practitioner and medical researcher. 1 8 2009 23 2 59 63 11 11 2009  Abstract  Background: 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.  Methods: 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.  Results: 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.  Conclusions: 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.