Invasive carcinoma of the uterine cervix in Iran

 

Authors :

Haghdel M , Ardakany MS,Zeighami B .

Department of obstetrics Gynecology .

Shiraz University of Medical  Sciences  , Shiraz , Iran .

Fax : 98-71-301751

E.mail : ardl79@neda.net

Invasive carcinoma of the uterne cervix in Iran .

Key work : Invasive cervical carcinoma , diagnosis , radical husteredctomy , pelvic radiotherapy .

Synopsis .   A retrospective study on 204 newly diagnosed consecutive cases of invasive cervical carcinoma treated at shiraz  University of Medical Sciences affiliated hospitals from Jon 1985 till  Dec 1995 .

 

Abstract :

Objective : To reviw diagnostic aspects  , treatment and pathologic findings ihn patients diagnosed and treated for invasive cervical carcinoma in Shiraz Unir University of Medical Sciences hospitals .

Method : The hospital records of all patients admitted to the shiraz  University of Medical Sciences affiliated hospitals ( Memazee and Saadi hospitals ) with newly diagnosed carcinoma  of the uterine cervix between January 1985 and December 1995 , were reviewed .

Results : 204 nemly diagnosed patients were admitted with invasive cervival carcinoma of which 61 (30% ) were in stage I (FIGO ) , 96 (47% ) in stage II , 34 (16.6% ) in stage III  and 13 (6% ) in stage IV of the disease .  Of these 204 , the given treatments included surgery in 88 fptients , internal and external pelcic radiotherapy in 141 , both hysterectomy and pelvic radiotherapy in 22 , chemotherapy in 8 and cryotherapy in one patient . We found significantly positive relations with stage disease and chest Roentgenogram (p<0.02) , intravenous pyelogram (p< 0.0002) , sigmoidoscopy ( p<0.006) and cytoscopy ( p <0.045 ) . Of  the total number of pathologic specimens < squmous cell carcinoma was reported in 88% and adenocarcinoma in 11% . Recurrence rates of up to 15.5% for stage II and 5 % for stage I were calculated . Among the complications for which hospital admission was required , genitourinary complications were the most frequent .

Conclusion : The recurrence rate in stage I is lower than the estimated recurrence risk in several other surdies whichg can be due to a real asvantage of thd center’s practice  . This may pose the question of indispensability for the advanced and expensive diagnostic paraclinical work – ups .

 

 

 

Immunotherrapy in management of malignancies ; a review on

techniques and applications .

 

By : Mohammad Haghdel

Under the supervision of : Dr.Mahdi Shahriari MD.

Associate Professor

Paediatrics Haematologist Oncologist

1996-1997

Axknowledgements

The author would like to sincerely express his solomn gratitude fo all the medical sxientists and practitioners who offer their best and have no rivalry but in finding the best way to care for their patients .

 

Abstract :

Lmmunotherapy is a type of cancer treatment disigned to use patients own immune system to fight cacer  . Immunouherapy can be used alone of in conjunction with other conventional treatments such as surgery , radiation , and chemotherapy .

The excision of the cancerous tissues and thd invoved organs in both prinitive and imefficient .

Surgeons , even in the modern time are unable to reliably detect and destroy the involved tissues .

Both chemothrapy and radiotherapy are highly non – specific in lilling the viable cell masses at their height of growth . The unwwanted damage cased by radiation and chemotherapeutic agents to the growing children and the immunodeficiency that they produce is totally unacceptable .

Starategies for immunotherapy of cancer can be divided into the active and pasive ummunotherapy . More recent therapeutic modalities using cytokines have had the same aime as the earlier attempts at active non – specific immunotherapy , such as the injection of Bacillus Calmette Guerin (BCG) or Corynebacterium parvum , which were given to patients with cancer in an attempt to augment immune responses in a non – specific manner . Both these bacteria can activate macrophages which are then capable of causing tumour cell destruction as a bystaner effect . Immunization by tumour cells or their extracts is the ftom of acrive specific immunotherapy . Monoclonal antibodies of tumour infiltrating lymphocytes induce a fotm of adoptive or passive immunity against cancer cells .

The cinical work on immunotherapy got a new start by early seventies and the word “immunotherapy” appeared in medical indices in 1972 . On an electronic search for the articles related to imunotherapy and treatment of cancer more then ten thousand enteries were found . Immunotherapy has literally been tried for “each and every” human neoplastic disorders but well controlled clinical trials are scaece . In this review , I have tried to offer a realistic survay of the curent progress in immumotherapy of cacer .

 

 

Folow up 100 breast cancer with tumourmarkers

 

Anthors and insitution :

Eisa Baybordi

Shariati hospital Tehran University

 

Absrtact :

Study the records of these patients in cross section methods we recognized 33 relapse case after 10 yours follow up . Then we assessment the role of 2 tumors marker , CEA ,CA15-3 fir early detection of relpase . which were examined every 6 months . All the patients were female . patients ages was between 20-75 years old . At the time of diagnise none of thems were not checked for CEA and CA15-3 . We diagnosed their relapse by physical exam CT scan and X ray , with paraclinical date like this 2 tumourmarkers .

Result :

 We find 3 relaps case with out any rissing in level of CEA  and CA15-3 Markers . Twenty relapse had only rissing in CA15-3 level 10 patients only had elevated CEA . 30 patients showed rissing in level of CEA and CA15-3 .

We concluded that CA15-3 has 30% false negativeand CEA 50% false negative for early detections of relapses . Tumour marker CA15-3 has more effective in breast cancer follow up .

 

 

 

Gastrointestinal lymphoma

 

A report ftom Shariati hospital Iran

Authors :

Ghavamzadeh . B.Bahar.M.Nasseri.P.Iravani.M.Baybordy.E

 

Department of Hematology Oncology & BMT.Tehran  University of Medical Science .

Tehran , Iran .

In a retrospective study , 59 patients who were diagnosed & treated between 1992 to 1996 as GI lymphoma were considered . The mean age was 3406 (SD:16.3) yr . Twenty two patients were female and 37 were male . The most prevalent symptoms at presentation were triad of abdominal pain anorexia and weight loss . physical exam of abdomen revealed no abnormal finding in 66% , and abdominal mass in 22% as the most pre valent finding 54 patients were undergone endoscopy , there was mucosal thickening in 37% , intraluminal mass in 18% and ulcer in 18% of patients . The sites of lymphoma were in stomach in 17 (30%) , small intestine in 34 (61%) and large bowel in 5 (8.9% ) of patients . The sites were not evaluable in 3 patients . Gastric lymphoma were in stomach in antrum and pylorus and small intestine lymphoma involved deudenum and jujenum , as the main sites of involvment . There were 20 (34% ) cases of IPSID , 20 (34 % ) cases of large cell lymphoma and 9 (15 % ) cases of small & lsrge cell lymphoma ,  other types of lymphoma were reported with loss frequency .

These patient were treated by combination chemotherapy (CTX) alone . Surgery + CTX , CTX+radiotherapy , antibiotic with or without CTX in IPSID cases and surgery + CTX+radiotherapy .Complete remission was achieved in 13 (77% ) cases of IPSID , 13 (81.3% ) cases of gasteic lymphoma and 6 (50% ) cases of small intestine lymphoma with a mean duration of disease free survival of 30 (SE=8.3) , 34 (SE=10) and 18 (SE=5.2) respectively .

IPSID and large cell  lymphoma were the most prevalent pathology in this study in GI lymphoma . In an investigation for diseade free survival by Kaplan-Meier methed , there was no advantage for combination of surgery and chemotherapy over chemotherapy alone (P.O.18) .

 

 

Hepatitis C virus and HIV infection in hemophilic patients ,

in fare province , Iran

 

Author : Mahdi Shhriari, MD

Shiraz University of Medical Sciences , Shiraz , Iran

 

Hepatitic C virus infection is frequent among hemophilic patient with non-inactivated factor concentrates . Both HCV genotype and viral load have been suggested to be important progenostic markers of disease progression and treatment outcome .

In this way we studied 65 hemophilic patients received non virally inactivated factor- concentrates of FEP for at least 5 years to find the prevalence of HCV and HIV infection among them .

The results were as follows :

1-The prevalence of HCV infection in the study group was 40% (26 of 65 ) Vs 0.5% (366 of 69743 ) in control group p<0.000001 .

2-The prevalence of HIV infection in study group was 0 .

3-The prevalence of HBV infection in study group was 3% (2 of 65) Vs 0.3% (242 of 69743 ) in control group p<0.021 .

4-There was no difference between blood groups of Rh of hemophilic patients and mormal population .

5-There was no difference between blood groups of Rh of HCV-positive hemophilic patients and mormal population .

It’s obvious that the prevalence of HCV and HIV infection in hemophilic patients of Fars is less than the prevalence of these infections among hemophiliacs in western world and Japan (1,4) which ranges from 98-100% and 22-40% for HCV and HIV  respectively , which is mainly due to good selection of blood donation volunteers by Iranian Blood transfusion organization in Shiraz , Althought it may be due to low sensitivity of Elisa generation 2 for detection of HCV Ab so we are conducting a PCR method for detection of HCV Antigen .

Refrences :

1-Lee CA:Hepatitis virus and hemophilia Hemophilia 1:8;1995

2-Lam NP:Dose dependent acute clearance of hepatitis C genotype 1 virus with interferon alfa . Hepatology 26:226;1997 .

3-Philips A : The epidemiology of HIV deseas in men with hemophilia in the Uk Hemophilia 1 ( suppl 2):6;1995 .

4-Yanago Y ,One O and Shirahata A : Counselling for HIV positive hemophiliacs in Japan . Hemophilia 2:109;1996 .

 

 

Antilymphocyte Globulin Therapy In Childhood Aplastic Anemia

 

Author :Mahdi Shariari M.D

Shiraz University of Medical Sciences

Department of Pediatrics , Division of Pediatric Hematology Oncology

 

Immunosuppressive therapy is a successful method in the threatment of aplastic anemia . The use of Antilymphocyte globulin (ALG) had been recently recognized as an effective therapy in many aquired cases and the results obtained were comparable with or superior to Bone marrow transplantation .1-4

During last 3 years ( from September 1996 – September 1999) 20 cases with bone marrow biopsy proven diagnosis of aplastic anemia ; either aquired or costitutional ,  who had minimal or transient response to androgen therapy were hospitalized and were treated with A.L.G 15 mg/kg/day for five days . Followed by 1 mg/kg prednisolon with show taper off over 6 months and Danazal 100-200 mg/day ,for 6-12 mo .

Patient included in the study were 11 male and 9 remale , with mean age of 11 years ; 12 patients had sever aplastic anemia was defined as absolute neutrophil count (ANC) of <500/mm3 , corrected retic count <1% , platelet count <20000/mm3 ( presence of at least two of these factors ) and very hypocellular marrow . Moderate aplastic anemia was present in 8 patients and was defined as ANC<1500/mm3 , corrected retic count <1% platelet count <100000/mm3 ( presence of at least two factors ) and hypocellular marrow . Eight patients ( out of 20 ) had constitutional ( Fanconi) aplastic anemia proven with features of Fanconi and chromosomal brekage in Mitomycin enriched lymphocyteculture in metaphase arrest .

All of the patient were followed by CBC and LFT evera 2 wks for 3 months then monthly till complete response , then every other months ( mean follw up , 18 months , range 12 – 36 mo )

The  following results were obtained : Ten patients (50% ) including 3 cases of Fanconi anemia had complete response . 8 patient (40%) including 4 cases of Fanconi anemia ) had partial reponse , so overall 90% of patient had a response to A.L.G which is superior to previous puplished B.M. transplantation or ALG therapy . Only two patient ( including 1 case of Fanconi anemia ) had no reponse . No second that apart B.M. transplantation , ALG terapy is a good alternative method in the treatment of aplastic anemia and should be considered specialy when there is no HLA matched donor for B.M. transplantation .

Refrences :

1-Bacigalupo A , Chaple M , Hepws J , et al : Treatment of aplastic anemia with antilymphocyte globulm and methyl prednisolone with or without androgens . Br J Hematol 183:145;1993 .

2-Frickhofen N , Kalt wasser JP : Treatment of aplastic anemia with antilymphocyte globuline and methyl prednisolone with of without cyclosporine . N Eng 1 Med 324:1299;1991 .

3-Matloob YH ,Bostrom B,Golembe B ,et al : Antilymphocyte globulin , cyclosporine and prednisolone for the treatment of sever aplastic anemia in children . Am J pediatr Hematol 16:104;1994 .

4-Park CW , Han CH , Kim CC , etal : Immunomodulation therapy for sever aplastic J Inter Med 4:28; 1989 .

 

 

 

Impact of prognostic Indicators on Survival Indices in Patients with Acute Lymphoblastic Leukemia diagnosed between 1372/1993 and 1379/1997 at the Shariati Hospital , Tehran , Iran .

 

 

A Ghavamzadeh ; M Khodabandeh ; M Iravani; AR Vassigh

Department of Haematology, Shariati Hospital , Tehran. Iran .

 

Abstract : It has long been astablished that certain clinical and laboratory features in patients with ALL come to exert an influence on survival indices . The number and significance of these prognostic indicators very from study to study . we perfotmed a cross-sectional retrospective study to evaluate the impact of a number of prognostic indicators on survival indices in 54 patients diagnosed with ALL at the Shariati Hospital between 1372/1993 and 1376/1997 . Following a comprehensive litrature search , we developed a list of established and putative prognostic indicators , and then proceeded to evaluate their influence on the three survival indices of time taken to achieve complete remission (CR) , disease –free survival (DFS) , and overall survival (OS ) . Univariate analysis showed a significant correlation between white cell count (WCC) and both DFS [p=0.01] and OS [p=0.02] . Among female patients , there was a significant correlation between age and CR [p=0.0042] . Multivariate analysis demonstrated only one significant correlation [between WCC and OS ; p=0.055] . Our result confirm the prognostic influence of admission WCC on outcome in parent with ALL. We recommend larger prospective studies that may elucidate further prognostic variables .

 

 

The effect of long term & short term miniconsolidation on survival in patient with Acute myelogeneous leukemia

 

P.Nasseri/ A.Ghavamzadeh / M.Keyhani/ M.Iravani / F.Elahi / RA.Sharirian/J.Natighi / K.Alimoghadam/ MR.Mortazavizadeh / M.Abasi / MR.Eshragian

Department of Hematology-Oncology / Tehran University of Medical Science / Tehran Iran

Summary :

Pupose : To investigate the value of three post remission methods of treatment , a retrospective study was done on 130 patients with acute myelogenous leukemia (AML) who were treated in SHARIATI and IMAM Hospitals in Tehran from 1991 to 1997 .

Patients and methods : ALL patients were in complete remission (CR) and had been  treated by ARA- C (300 mg/m2/day continuos’ infusion for 5 days ) and Daunarubicine (45 mg/m2/days for 3 days ) as induction and early consolidation therapy . Forty patients were treated by an additional similar chemotherapy as second consolidation and no futher treatment was Offered (glroup I) . Fifty patients were treated by ARA-C (120 mg/m2subcutaneously for 5 days ) and Etoposide (120 mg /m2 on day one ) and Mitoxantrone ( 12 mg/m2 on day one ) on each of successive months as short term miniconsolidations ( group II) .

Forty parient were treated similar to group II until reapse , as for up to 2 years as long term miniconsolidations (group III) .

Resulte : There was no difference regarence regarding mean age and other prognostic facrors between these groups ; treatment related mortality & morbidity was similar also .

Median duration of diseadse free survival (DFS) were 36 month ( 3.5 –68 with 95% CI ) , 17(12.5-21.5) and 19 (14.7-23.3 ) months respectively in these three groups . In a median observation of 14 months three was no difference in DFS & overall survival (OS) between these three groups (p=0.7)

Conclusion :We concluded that short of long term miniconsolidation chemotherapy would not improve DFS & OS in patients with AML comparing to standard treatment .

Key word : Acute myelogeneous , Consoidati on , Maintenance treatment  Correspondence : Massoud Iravani M.D , Hematology-Oncology ward , Shariati Hospital , Tehran 14114 , Iran .

Fax no : 0098218004140