Mortality and Morbidity and Disease Free Survival after D1 and D2 Gastrectomy for Stomach Adenocarcinomas.

BACKGROUND: A number of randomized trials addressing alternative operative and multimodality approaches to gastric cancer have characterized early postoperative morbidity and mortality rates. The aim of this study was to compare mortality and morbidity and disease free survival after D1 and D2 gastrectomy for adenocarcinomas of the stomach MATERIALS AND METHODS: From June 2006 to January 2012, patients were selected according to information of the cancer administrator center of Ahvaz Jundishapur Medical University. The inclusion criteria were age between 20-85 years and histologically proven adenocarcinoma of the stomach without evidence of distant metastasis. Patients were excluded if they had previous or coexisting cancer or disability disease. In this research, D1 was compared to D2 gastrectomy. RESULTS: 131 patients were randomised, 49 allocated to D1 and 82 to D2 gastrectomy. The two groups were comparable for age, sex, site of tumors, and type of resection performed. The overall post-operative morbidity rate was 17.5%. Complications developed in 14.2% of patients after D1 and in 19.5% of patients after D2 gastrectomy (p=0.07). Postoperative mortality rate was 0.8% (one death); it was 2% after D1 and 0% after D2 gastrectomy. In this research disease free-survival after 3 years was 71.2 % with 63.2% after D1 and 76.8% after D2 gasterctomy. CONCLUSIONS: This study indicates that D2 gastrectomy with pancreas preservation is not followed by significantly higher morbidity and mortality than D1 resection. Based on the results of present study, D2 resection should be recommended as the standard surgical approach for resectable gastric cancer.

Long dose exposure of hydrogen peroxide (H2O2) in albino rats and effect of Podophyllum hexandrum on oxidative stress.

OBJECTIVES: The effect of Podophyllum hexandrum methanolic extract and alpha-tocopherol in reducing oxidative stress in male albino rats was evaluated. MATERIALS AND METHODS: Lipid peroxidation was monitored by measuring malondialdehyde (MDA) level in different tissues of rats. Activities of free radical scavenging enzymes (superoxide dismutase, glutathione peroxidase and catalase) were determined using H2O2 decomposition. RESULTS: Results showed that administration of H2O2 (0.1%) in drinking water of the rats, for 25 weeks, increased the malondialdehyde levels in liver, kidney and lung tissues of all the rats. However, rats receiving Podophyllum hexandrum extract and alpha-tocopherol had lower MDA levels in a dose dependent manner, which indicates decreased lipid peroxidation in these rats. Increase in the catalase activity appears to be a response to H2O2 accumulation. The decrease in the activity of catalase and increase in the activity of superoxide dismutase and glutathione peroxidase in different organs of the rats receiving Podophyllum hexandrum extract and alpha-tocopherol indicates the protective effect of the plant in combating oxidative stress undergone by the rats. OBJECTIVES: Rhizome of Podophyllum hexandrum have been ethnomedically claimed to possess a wide array of biological activities including anticancer activity. MATERIALS AND METHODS: To verify the folklore claim, this study was performed in a six Human carcinoma cell lines, Lung (A-549), Prostate (PC-3), Colon (Colo-25), Breast (MCF-7), Neuroblastoma (IMR-32) and CNS (SF-295) MCF-7 and MDA-MB-231. RESULTS: Methanol and 70% ethanolic extracts of the rhizome of Podophyllum hexandrum showed highest cytotoxic effect on MCF-7 (Breast) and Colo-25 (Colon) cell line, as determined with sulforhodamine-B (SRB) assay. CONCLUSIONS: These findings 1 - showed that Podophyllum hexandrum extract may ameliorate H2O2 induced oxidative stress by decreasing lipid peroxidation via alteration of the antioxidant defense system of the rats. 2 - these data also showed the anticancer activity of the plant extracts on different human cancer cell lines. However, further investigation is needed to assess the molecular mechanisms mediated anticancer activities of this plant.

Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran.

Visceral leishmaniasis (VL) is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. AntiLeishmania antibody was detected in 50 out of 1628 children (3.1%) by direct agglutination test (antibody titre > or = 1:3200). There was no significant difference in seropositivity between the sexes (2.8% males and 3.3% females). The highest rate of infection (5.2%) was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region.

Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran

Visceral leishmaniasis [VL] is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. Anti-Leishmania antibody was detected in 50 out of 1628 children [3.1%] by direct agglutination test [antibody titre > 1:3200]. There was no significant difference in seropositivity between the sexes [2.8% males and 3.3% females]. The highest rate of infection [5.2%] was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region

The risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-control, country-wide study on definitive cases.

BACKGROUND: Tuberculosis (TB) is an important cause of morbidity and mortality in renal transplant recipients and, because of its infrequency and the lack of medical awareness, it is usually misdiagnosed. This study was carried out to determine frequency and weight of multiple risk factors for post kidney transplantation TB. METHODS: A total of 44 cases (0.3%), out of 12,820 patients from 12 major kidney transplantation centers in Iran from 1984 to 2003, were compared with 184 healthy transplant subjects who were transplanted by the same surgical team. RESULTS: The mean age of cases and controls was 37.7 (13-63) and 35.6 (8-67) years (P=0.3), respectively. The mean duration of pre-transplantation hemodialysis was 30.3 (3-168) months in cases and 18.2 (1-180) months in controls (P=0.03). A positive past history of TB was detected in 2 cases and 1 control (P=0.3). The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases (56.8%) and 60 controls (32.6%) had rejection before diagnosis of TB (P=0.004; OR=2.7, CI(95%): 1.3-5.6). CONCLUSIONS: To our knowledge, this is the first study that demonstrated an increase in the risk of post-transplant TB by increasing the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes as 2 immunocompromised states. Further study is needed to clarify our new findings, specifically in relation to different immunosuppressive regimens.

Effects of renal transplantation on serum-free and total PSA levels.

PURPOSE: This study was undertaken to evaluate the effects of renal transplantation on serum level of free and total PSA. MATERIALS AND METHODS: In this study, we included 30 male patients with a mean age of 46 years with end-stage renal disease undergoing renal transplantation at our department. None of the patients had any history of prostate cancer. All patients had immediate onset of renal function after transplantation, defined by a spontaneous decrease in serum creatinine on postoperative day 1 and a subsequent decrease daily during week 1. Renal transplantation included living-related donors in all patients. Blood samples were obtained before and at posttransplant day 6 before removal of Foley catheter. Measurements of free PSA and total PSA were performed with immunofluorometric assays. Glomerular filtration rates were monitored by analyzing serum creatinine. The significance of changes with time was estimated by the Wilcoxon signed ranks test for paired observations with P<.05 considered statistically significant. RESULTS: The mean free and total PSA levels before transplantation were 0.22 (range, 0.0.05 to 0.4) and 1.5 ng/mL (range, 0.1 to 2.9), respectively. There was a significant decrease (30% of original levels) in serum fPSA at posttransplant day 6 (P<.05) in all patients. There was no significant changes of total PSA at posttransplant day 6. CONCLUSIONS: These results verify the hypothesis that free PSA is eliminated from the blood circulation by glomerular filtration and severe renal failure influences its levels. Thus, we should consider different cutoffs for free to total ratio before and after renal transplantation.

Preliminary report of a nationwide case-control study for identifying risk factors of tuberculosis following renal transplantation.

BACKGROUND: Tuberculosis (TB) is an important infection encountered posttransplantation, especially among patients in developing countries, where there are high incidences of morbidity and mortality. MATERIALS AND METHODS: One hundred and twenty subjects (1%) from 15 major kidney transplantation centers in Iran from 1984 to 2003 were compared with 440 controls who were matched for operative time, treatment center, and surgical team. RESULTS: Mean ages of research subjects and controls were 38.6 and 36.6 years (P = .04), respectively. The mean duration of pretransplantation hemodialysis was 29 months (range, 2 to 192 months) in research subjects and 20 months (range, 1 to 180 months) in controls (P = .003). Positive past history of tuberculosis was detected in 4 (3.3%) research subjects and in 7 (1.5%) controls (P = .2). Fifty-two research subjects (43.3%) and 241 controls (54.8%) had pretransplantation purified protein derivative of tuberculin less than 5 mm (P = .02). Mean dosages of initial and maintenance immunosuppressive drugs in research subjects and in controls were not significantly different. Sixty research subjects (50%) and 152 controls (34.5%) had rejection prior to diagnosis of TB (P = .03). CONCLUSION: To our knowledge, this is the first study that demonstrates an increased risk of posttransplant TB by prolonged duration of pretransplant hemodialysis and number of posttransplant rejection episodes. Further study is needed to clarify these findings specifically with respect to various immunosuppressive regimens.

Comparing Taguchi and anterior Lich-Gregoir ureterovesical reimplantation techniques for kidney transplantation.

Urologic complications are common in renal transplant surgery. Numerous innovations have been developed to circumvent ureterovesical anastomotic failure. In addition to the popular modified Lich-Gregoir technique, we evaluated Taguchi's method which is both quick and easy to perform. One hundred forty four patients were prospectively compared using Taguchi (n = 44) or the modified Lich-Gregoir (n = 100) for anastomotic time, which differed significantly (10.2 minutes for Taguchi, vs. 24.6 minutes to Lich-Gregoir; P < .005). Minor complications, however, were less among Lich-Gregoir patients (P < .02). We concluded to continue using the modified Lich-Gregoir ureteroneocystostomy despite taking longer time to perform.

Spontaneous kidney allograft rupture.

Spontaneous renal allograft rupture is one of the most dangerous complications of kidney transplantation, which can result in graft loss. This condition needs immediate surgical intervention. Conservative management has dismal results. Its prevalence varies from 0.3% to 3%. Rupture occurs in first few weeks after transplantation. Predisposing factors for graft rupture are acute rejection, acute tubular necrosis, and renal vein thrombosis. There are growing reports about successful results of repairing these ruptured kidneys. In this study, we reviewed the medical records of 1682 patients who received kidney allografts from living donors from 1986 through 2003. There were six (0.35%) cases of renal allograft rupture. All were preceded by acute graft rejection. They were treated with antirejection medications. In first three cases, the kidney allografts were removed because the procedure of choice in this situation is graft nephrectomy; but in three next cases we repaired the ruptured grafts with good results in two of them. In conclusion, the procedure of choice for kidney allograft rupture is graft repair.

The results of grade IV cystocele repair using mesh.

PURPOSE: To evaluate the results of grade IV cystocele repair by 4-corner bladder and bladder neck suspension technique, using prolene mesh. MATERIAL AND METHODS: Thirty-one women with a median age of 61 years and severe anterior vaginal wall prolapse (grade IV cystocele) were treated by 4-corner bladder and bladder neck suspension technique, using prolene mesh. Of these, 3 had associated uterine prolapse, rectocele, and enterocele, one had rectocele and enterocele, and 18 had rectocele only. In these cases, pelvic floor defects were also repaired simultaneously and in 3, vaginal hysterectomy was done. Twelve patients had a previous failed cystocele repair. In a 32-month follow-up, the patients were evaluated with vaginal examination and upright cystography. Urinary continence during increased intra-abdominal pressure was also assessed, based on subjective symptoms. RESULTS: None of the patients had cystocele recurrence. Urinary continence during increased intra-abdominal pressure was seen in all of the patients. Intraoperative rectal or bladder injury did not occur. Transfusion was not required in any of the cases. Early complications (6 to 8 weeks postoperatively) included irritative urinary symptom in 17 patients, of whom, 8 had documented urinary tract infection that were treated successfully. Late complications were spotting in 3 cases (two were treated with topical estrogen and vaginal mucosal repair was done in one), dyspareunia in 4 sexually active patients, changes in urination pattern in 28 (improved significantly with behavioral therapy), long-term urge incontinence (>8 weeks) in 5 (medical treatment was successful in these patients), and prolonged intermittent catheterization in 1. Pelvic abscess and migration of mesh were not observed. CONCLUSION: According to our findings, using mesh in patients with grade IV cystocele, who had a previous failed surgery or weakness in supportive pelvic tissue, is an appropriate treatment modality.

Identification of a strong promoter of bacteriophage MB78 that interacts with a host coded factor and regulates the expression of a structural protein.

A strong promoter of bacteriophage MB78 which controls the expression of a small structural protein of the phage has been identified and characterized. Analysis of its nucloetide sequence upstream of the translational start site revealed the presence of conserved -10 (TAATAT) and -35 (TTCTCCT) regions. It was observed that transcription initiates with thymidine residue, 86 nt upstream of the translational start site. Transcription seems to undergo alternate up and down regulation. This promoter is efficiently recognized by sigma 70 RNA polymerase and a host factor also binds to it. Binding of RNA polymerase is independent of binding of the host factor.

Identification of a strong promoter of bacteriophage MB78 that lacks consensus sequence around minus 35 region and interacts with phage specific factor.

A strong promoter of bacteriophage MB78 does not have minus 35 consensus sequence although it has a TGn motif immediately upstream of minus 10 sequence as well as the AT rich UP element. It is efficiently recognised by the sigma 70 RNA polymerase, however, a phage-specific factor competes with sigma 70 RNA polymerase for binding to this region, the binding of the factor being stronger than that of the polymerase. Contrary to the reports in the literature the polymerase appears not to bind to the UP element whereas the phage-specific factor does. The latter seems to be involved in the regulation of the promoter activity.

A supercoil-specific endonuclease from Salmonella typhimurium cleaves both negatively and positively supercoiled DNA.

An enzyme which specifically cleaves supercoiled DNA to linear form through nicked circular form as intermediate was isolated from rifampicin-resistant mutant of Salmonella typhimurium, rif 39. The enzyme activity was stimulated by Mg+2, whereas Ca+2 had no effect. It does not require ATP for its activity. No activity could be detected with relaxed or single stranded circular DNAs. The molecular weight of the enzyme is approximately 34 kDa. The most characteristic feature of this enzyme is that it cleaves both positively and negatively supercoiled DNAs.