rare case of gestational gigantomastia with hypercalcemia: the challenges of management and follow up

Background: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case

Case Presentation: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on May 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment

Conclusion: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition

TP53 codon 72 polymorphism and risk of sporadic prostate cancer among Iranian patients

The TP53 gene is one of the most frequently mutated genes amongst human malignancies, particularly TP53 codon 72 polymorphism. Furthermore, an association between the TP53 codon 72 variants and prostate cancer has been reported in several studies. Although some studies have indicated an association between the TP53 Arg/Arg variant and an increased risk for prostate cancer, other studies have shown a positive correlation between the TP53 Pro/Pro genotype instead. Therefore, to clarify if this polymorphism is associated with an increased risk of prostate cancer in Iranian men, we conducted a case-control study of 40 sporadic prostate cancer patients and 80 benign prostate hyperplasia cases. The TP53 codon 72 was genotyped using an allele specific PCR. A significant association between the TP53 codon 72 genotype and prostate cancer risk was found [OR = 6.8, 95% CI = [1.8-25.1], P = 0.005]. However, the results of this study did not support an association between age, the Gleason score nor TP53 genotype at codon 72 in prostate cancer patients. TP53 codon 72 polymorphism may have a great impact in the development of prostate cancer

Cerebral tuberculoma in pregnancy: overview of the literature and report of a case

Tubercle bacilli infect about one third of the world's population and over the past decade resurgence of tuberculosis has been a major health threat mainly due to increasing frequencies of immunosuppressive states and drug-resistant organisms. Although tuberculosis is essentially a lung disease, intracranial elements become involved in 5-10% of cases either as meningitis or tumour-like masses [tuberculoma]. Tuberculoma is common in endemic areas but its occurrence during pregnancy is occasional and of particular interest is its intriguing clinical picture mimicking toxemia of pregnancy and brain tumor. In addition, the effects of pregnancy on tuberculosis or vice versa have been controversial. We present here a review of the recent literature and discuss a case coming to medical attention with manifestations of intracranial hypertension during 2 consecutive pregnancies; 4 years apart. On operation a dura-attached mass was detected that proved to be a tuberculoma. After 18 months of close observation and under drug therapy she obviously improved with no ensuing complication. Immunodeficiency state associated with pregnancy is likely to play a role in activation of infection. Tuberculoma should be considered in differential diagnosis of eclampsia and brain mass particularly in women coming from endemic areas for this infection even in the absence of pulmonary involvement

impact of low serum triglyceride on LDL-cholesterol estimation

Most clinical laboratories directly measure serum triglyceride, total cholesterol, and high- density lipoprotein cholesterol. They indirectly calculate low-density lipoprotein cholesterol value using the Friedewald equation. Although high serum triglyceride [>400 mg/dL or 4.52 mmol/L] devaluates low- density lipoprotein cholesterol calculation by using this formula, effects of low serum triglyceride [<100 mg/dL or 1.13 mmol/L] on its accuracy is less defined. Two hundred thirty serum samples were assayed during a one-year period. In 115 samples, the triglyceride level was below 100 mg/dL and in 115 samples from age- and sex-matched patients the triglyceride level was 150 - 350 mg/dL [1.69 - 3.95 mmol/L]. In both groups total cholesterol was above 250 mg/dL [6.46 mmol/L]. On each sample, total cholesterol, high-density lipoprotein cholesterol, and triglyceride were directly measured in duplicate and low-density lipoprotein cholesterol measured directly and calculated with Friedewald equation as well. Statistical analysis showed that when triglyceride is <100 mg/dL, calculated low- density lipoprotein cholesterol is significantly overestimated [average :12.17 mg/dL or 0.31 mmol/L], where as when triglyceride is between 150 and 300 mg/dL no significant difference between calculated and measured low-density lipoprotein cholesterol is observed. In patients with low serum triglyceride and undesirably high total cholesterol levels, Friedewald equation may overestimate low-density lipoprotein cholesterol concentration and it should be either directly assayed or be calculated by a modified Friedewald equation. Using linear regression modeling, we propose a modified equation

Meningioma: A clinicopathological evaluation

As yet no unifying grading system for meningiomas has been adopted. We evaluate epidemiologic factors of meningioma in Iran & degree of agreement between the two commonly used grading systems namely WHO (2000) and Mahmood systems. During a 6-year period 238 meningiomas were selected and reviewed by two independent pathologists using both grading systems. 205(86.1%) cases were benign, 19(8%) atypical and 14(5.9%) malignant. 181(18%) cases were primary and 51(27%) secondary; 35(68%) of the latter benign, 7(14%) atypical and 9(18%) malignant. All intraspinal meningiomas were benign. In benign cranial and spinal types female to male ratios were 1.9: 1 and 1.3: 1 ; while in atypical and malignant types were 1 :1.4 and 1:3.1 respectively. Mean ages were 49.9 for benign. 41.1 for atypical and 50 for malignant types. The most frequent site of involvement in all grades of intracranial tumors was cerebral convexity (31.1 %). The most common subtype was menigothelial (65.1%). Female preponderance seen in benign nonrecurrent meningioma became increasingly less prominent and even reversed in recurrent, atypical and malignant forms. Benign recurrent tumors were similar to non-recurrent tumors microscopically. Kappa value comparing two grading systems was 0.947, so good agreements were found between Mahmood and WHO grading systems.

Factors associated with premature discharge of patients with psychosis against medical advice

This study was conducted to identify the characteristics of patients with psychosis who had escaped from hospital or were discharged prematurely and against medical advice. We carried out this retrospective study on 72 patients with psychosis who were discharged prematurely over a 38-month period and compared them to 76 patients with psychosis who were discharged according to the physician's order, as the control group. In addition to the demographic factors, we assessed the following: the patient's and their care giver's level of education, in hospital stay. suicidal idea and attempt, smoking, substance abuse, psychiatric diagnosis, arrest record, imprisonment, positive history of psychiatric disorder in the first degree family members, first episode of psychosis, admission with police assistance, unemployment, and escape history [from hospital, school, military service, home, work and prison]. The two groups of patients were comparable in regard to two factors: the in hospital stay, and a positive history of escape. The latter was defined as leaving home, quitting work, escaping from school and military service, and a positive history of escape from hospital. Irregular discharge of patients with psychosis seems to be predictable by their positive escape history, and therefore preventable. Irregular discharge is more likely in the first few days of hospital admission. There is also a great tendency towards irregular discharge when in hospital stay gets long