The utility of elastography during EBUS-TBNA in a population with a high prevalence of anthracosis.

BACKGROUND: Ultrasound elastography, is a pioneer sonographic modality that is conducted during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in order to increase the accuracy of sampling location. The current study aims to evaluate the usefulness of elastography during EBUS-TBNA in a population with a high prevalence of anthracosis. METHODS: This prospective single-blinded study was performed on 69 lymph nodes (LNs) of patients with mediastinal lymphadenopathy undergoing EBUS-TBNA and EBUS-elastography from October 2017 to July 2018. The stiffness level of the tissue was translated into a color to demonstrate the hardness of tissue. Blue and total areas of each section were measured to calculate the hardness of each LN. RESULTS: Sixty-nine LNs were evaluated by elastography. Twenty percent of LNs were malignant. There was a statistical difference between malignant and non-malignant nodes based on color dominancy (P = 0.032). However, with the exclusion of anthracosis nodes from the analysis, the difference was more significant (P < 0.001). Moreover, when the blue dominancy was used as the predictor of malignancy or anthracosis, the results showed a significant correlation (P < 001). CONCLUSION: The usefulness of elastography in selecting the hardest area of tissue that is appropriate for diagnosing diseases has been proven previously. Since in countries with a high prevalence of anthracosis, blue color achieved using elastography predicts either malignancy or anthracosis so, cases with blue dominancy of LNs in elastography and the white color in the EBUS-TBNA indicate anthracosis-caused calcification should be reconsidered.

Nutrition and lung cancer: a case control study in Iran.

BACKGROUND: Despite many prospective and retrospective studies about the association of dietary habit and lung cancer, the topic still remains controversial. So, this study aims to investigate the association of lung cancer with dietary factors. METHOD: In this study 242 lung cancer patients and their 484 matched controls on age, sex, and place of residence were enrolled between October 2002 to 2005. Trained physicians interviewed all participants with standardized questionnaires. The middle and upper third consumer groups were compared to the lower third according to the distribution in controls unless the linear trend was significant across exposure groups. RESULT: Conditional logistic regression was used to evaluate the association with lung cancer. In a multivariate analysis fruit (Ptrend < 0.0001), vegetable (P = 0.001) and sunflower oil (P = 0.006) remained as protective factors and rice (P = 0.008), bread (Ptrend = 0.04), liver (P = 0.004), butter (Ptrend = 0.04), white cheese (Ptrend < 0.0001), beef (Ptrend = 0.005), vegetable ghee (P < 0.0001) and, animal ghee (P = 0.015) remained as risk factors of lung cancer. Generally, we found positive trend between consumption of beef (P = 0.002), bread (P < 0.0001), and dairy products (P < 0.0001) with lung cancer. In contrast, only fruits were inversely related to lung cancer (P < 0.0001). CONCLUSION: It seems that vegetables, fruits, and sunflower oil could be protective factors and bread, rice, beef, liver, dairy products, vegetable ghee, and animal ghee found to be possible risk factors for the development of lung cancer in Iran.

The effects of vasectomy on epididymal morphology and sperm parameters in adult male balb/c mice / Efectos de la vasectomía sobre la morfología del epidídimo y los parámetros espermáticos en ratones balb/c adultos

Vasectomy is a common contraceptive procedure in men. The present study is aimed to explore the impact of vasectomy on epididymal morphology and sperm parameters in adult male Balb/c mice. Twenty adult (age: 8 weeks) male Balb/c mice, weighting 20-30 g were used in the experiments. They were divided into 2 groups (vasectomy and sham). The operations were performed under sodium pentobarbital (40 mg/kg body weight, IP) anesthesia via a lower mid-abdominal incision. The left epididymis caput was fixed for histological studies and the right one was used for sperm count and motility. Progressive fast and slow sperm motility were significantly decreased in the vasectomized compared to the sham operation group (P<0.05) and the number of immotile sperm in the vasectomized group was increased in comparison to control group. Sperm granuloma was seen in 60 percent of epididymis after vasectomy. Also, Histological study showed an increase in tubular lumen diameter, interstitial space and infiltration of immune cells in interstitial tissue in vasectomized group. Vasectomy increases histopathological changes in epididymis and decreases the motility of sperm developing a reduction in fertility rates.

La vasectomía es un procedimiento anticonceptivo común en los hombres. El presente estudio tuvo como objetivo explorar el impacto de la vasectomía sobre la morfología del epidídimo y los parámetros espermáticos en ratones macho adultos Balb/c. Fueron utilizados en el estudio 20 ratones adultos (8 semanas de edad), con un peso ponderado de 20-30 g. Se dividieron en 2 grupos (vasectomía y Sham). Las cirugías se realizaron bajo anestesia con pentobarbital sódico (40 mg/kg de peso corporal, IP), con acceso a través de una incisión medio- abdominal inferior. La cabeza del epidídimo izquierdo fue fijada para estudios histológicos y la cabeza del epidídimo derecho se utilizó para el conteo de espermatozoides y evaluar su motilidad. La motilidad progresiva rápida y lenta de los espermatozoides se redujo significativamente en el grupo de ratones vasectomizados en comparación con el grupo Sham (p<0,05), y el número de espermatozoides inmóviles en el grupo sometido a la vasectomía aumentó. Granuloma espermático se observó en el 60 por ciento de los epidídimos después de la vasectomía. También, el estudio histológico mostró un aumento del diámetro del lumen tubular, espacio intersticial e infiltración de células inmunitarias en el tejido intersticial en el grupo sometido a la vasectomía . La vasectomía aumenta los cambios histopatológicos en el epidídimo y disminuye la motilidad de los espermatozoides, generando una reducción en las tasas de fertilidad.

No association between simian virus 40 and diffuse malignant mesothelioma of the pleura in Iranian patients: a molecular and epidemiologic case-control study of 60 patients.

BACKGROUND: Diffuse malignant mesothelioma (DMM) is increasing in incidence on a worldwide basis and is linked to exposure to asbestos. Simian virus 40 (SV40), a DNA virus, was introduced inadvertently to human populations through contaminated polio vaccine during the years 1956-1963. It has been associated with various types of malignancy in animal experiments. There have been suggestions that SV40 might play a role in the pathogenesis of DMM. OBJECTIVE: To evaluate the association between SV40 and DMM in Iranian patients. METHOD: In a case-control study between the years 2007-2008, isolated DNA from 60 paraffin blocks of patients with DMM and 60 controls was assessed to detect three human polyomaviruses (JCV, BKV, and SV40) using three different sets of primers by multiplex nested PCR analysis. We related the patients with diffuse malignant mesothelioma to possible sites of exposure to asbestos. RESULTS: None of the DMMs nor any patient in the control group had SV40 genome on polymerase chain reaction (PCR). All of the cases were SV40 T antigen negative. CONCLUSION: This study suggests that DMM is independent of SV40 infection in Iran.

Hemophagocytic [corrected] lymphohistiocytosis associated with nephrotic syndrome and multi-organ failure.

Hemophagocytic lymphohistiocytosis (HLH) is still an important elusive and misdiagnosed condition despite of improved knowledge. Nephrotic syndrome associated with HLH is not a common feature and has been rarely reported in hemophagocytic syndrome. We report a 27-year-old man with HLH who progressed to multi-organ failure as well as nephrotic-range proteinuria, generalized edema, and hypoalbuminemia.

Relationship between angiogenic squamous dysplasia and bronchogenic carcinoma in patients undergoing white light bronchoscopy.

OBJECTIVE: To better understand the characteristic morphology of angiogenic squamous dysplasia (ASD) and its association with different types of common bronchogenic carcinomas using routine white light bronchoscopy. METHODS: Using a case-control design, 186 formalin-fixed paraffin-embedded blocks of bronchial tissue (136 cases, 50 controls) obtained from patients who underwent routine nonfluorescence bronchoscopy between 2004 and 2005 were studied. RESULTS: ASD occurred at a higher frequency in patients with neoplastic lesions compared with those without neoplastic lesions (28 of 136 versus one of 50). ASD was also more prevalent in patients with squamous cell carcinoma compared with other neoplasms. Seventy six per cent of the ASD patients (22 of 29) smoked cigarettes. The morphology of ASD on hematoxylin and eosin- and CD31-stained sections was characterized by prominent microvasculature and capillary projections closely juxtaposed to variable degrees of dysplasia in all of the bronchogenic carcinoma specimens, and to metaplasia in one case in the control group. CONCLUSION: ASD is a unique morphological entity that should be considered by pathologists even on bronchoscopic biopsies from patients who undergo white light bronchoscopy. The presence of ASD may represent a risk biomarker of bronchogenic carcinoma in screening programs and in chemoprevention of lung cancer.

Primary pulmonary plasmacytoma with diffuse alveolar consolidation: a case report.

Solitary extramedullary plasmacytomas are plasma cell tumors that tend to develop in mucosa-associated lymphoid tissues including the sinonasal or nasopharyngeal regions. Primary plasmacytoma of the lung is exceedingly rare and often presents as a solitary mass or nodule in mid-lung or hilar areas and diagnosed after resection. Herein, we report a case of primary pulmonary plasmacytoma that presented with diffuse alveolar consolidation and diagnosed by transbronchial lung biopsy.

Surveillance of antimicrobial susceptibility among bacterial isolates from intensive care unit patients of a tertiary-care university hospital in Iran: 2006-2009.

BACKGROUND: This study was conducted to determine the antimicrobial susceptibility patterns among common pathogens in the intensive care unit (ICU) of a university hospital in Iran between 2006 and 2009. METHODS: The isolates cultured in appropriate media and antimicrobial susceptibility were determined by disk diffusion tests according to the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: A total of 606 isolates were recovered from respiratory (70.63%), urine (20.13%), blood (4.95%) and wound (1.82%) specimens of 456 patients. The most common isolates were Acinetobacter baumannii (22.4%), Pseudomonas aeruginosa (20.6%), Staphylococcus aureus (11.1%), Escherichia coli (8.3%) and Klebsiella pneumoniae (4.8%). Less than 7% of A. baumannii isolates were susceptible to aminoglycosides, ceftazidime, cefotaxime, imipenem, cefepime and ciprofloxacin. None was susceptible to piperacillin and piperacillin-tazobactam. The susceptibility rates of P. aeruginosa to ciprofloxacin, gentamicin and piperacillin-tazobactam were 13.6, 17.4 and 33.3%, respectively. Methicillin-resistant S. aureus made up 96.2% of S. aureus isolates and was 100% susceptible to vancomycin and 51.9% susceptible to trimethoprim-sulfamethoxazole. CONCLUSION: Due to the high antimicrobial resistance in the ICU, we must focus on both a wiser use of antimicrobials and the prevention of infection.

Environmental risk factors for lung cancer in Iran: a case-control study.

BACKGROUND: Lung cancer remains the leading cause of cancer death in the world. In Iran, lung cancer is one of the five leading tumours and its incidence has been increasing steadily in both men and women. There is a paucity of data from Iran on risk factors for lung cancer. We evaluated environmental risk factors for lung cancer in a case-control study in five hospitals of Tehran. METHODS: Between October 2002 and October 2005, 242 (178 male, 64 female) patients with histologically confirmed lung cancer and two controls for each patient (242 hospital controls and 242 visiting healthy controls) matched for age, sex and place of residence were interviewed using a structured questionnaire on potential risk factors for lung cancer, including environmental and occupational exposures. Associations between risk factors and lung cancer were assessed using conditional logistic regression. RESULTS: Smokers were 66.5% of all cases (85.4% of men and 14.1% of women) and smoking was the strongest correlate of lung cancer in multivariate analysis [odds ratio (OR) 5.4, 95% confidence interval (CI) 3.2-8.9]. Occupational exposures to inorganic dusts (OR 4.2, 95% CI 2.8-6.7), chemical compounds (OR = 3.4, 95% CI 2.1-5.6) and heavy metals (OR 3.0, 95% CI 1.3-7.0) were also independent risk factors for lung cancer. CONCLUSIONS: In our study, smoking was the principal risk factor for lung cancer. However, preventable exposures in the environment, including occupational settings, should not be ignored.

Langerhans cell histiocytosis of the lung and thyroid, co-existing with papillary thyroid cancer.

A 24-year-old man presented to our center with a huge goiter compressing his airway. He had a previous diagnosis of Langerhans cell histiocytosis (LCH) of the lung. Core needle biopsy was consistent with histiocytosis. Thyroidectomy was performed. A very invasive mass was encountered at the time of surgery. Histopathology result was consistent with an invasive papillary cancer of thyroid co-occurring with LCH. Although association of LCH with different malignancies has been reported, co-existing invasive papillary thyroid cancer and LCH is a rare combination.

High expression of minichromosome maintenance protein 6 in classic Hodgkin's lymphoma points to a cell cycle arrest in G1 phase.

BACKGROUND: Minichromosome maintenance protein 6 (MCM6) is one of the six proteins of minichromosome maintenance family that are involved in the initiation of DNA replication and thus represent a marker for proliferating cells. The aim of this study was to determine the proliferation characteristics of neoplastic cells in patients with classic Hodgkin's lymphoma. METHODS: Paraffin-embedded blocks of lymph node, mediastinal, subcutaneous chest wall, and lung mass biopsies of 55 patients with classic Hodgkin's lymphoma were immunostained by the proliferation-associated monoclonal antibodies; Ki-S5 (Ki-67 antigen) and Ki-MCM6 (MCM6 antigen). RESULTS: High MCM6 antigen expression was a striking feature of Hodgkin's and Reed-Sternberg cells (median: 85%, range: 35 - 99%) in comparison with lower Ki-67 expression (median: 63.5%, range: 1 - 98%, P<0.001). This indicates that MCM6 is already expressed in the early G1 phase, a cell cycle fraction that is not covered by antibodies specific to the Ki-67 antigen. The proliferation rates were determined by two markers, independent of histologic subtype, stage, presence of B symptoms, and size. CONCLUSION: These data show that a subset of Reed-Sternberg and Hodgkin's cells is arrested in the early G1 phase and the MCM6-positive cells do not necessarily represent the real proliferating compartment of Hodgkin's lymphoma. Clinical relevance of this marker in patients with Hodgkin's lymphoma should be investigated.

Primary immune deficiencies presenting in adults: seven years of experience from Iran.

Primary immunodeficiencies (PIDs) are not solely diseases of childhood. We describe the clinical presentation and outcome for 55 adult patients with previously unrecognized PIDs. This series provides unique data regarding PIDs presenting in adulthood, and serves as a timely reminder that physicians must consider the diagnosis of PIDs in their adult patients. Using the experience gained from these patients, we outline key "warning signs" suggestive of an underlying PID. Only through increased physician awareness will patients with PIDs receive timely diagnosis and optimal management.