Breast cancer in Iran: a review of 903 case records

A retrospective study was carried out in five main General District and Teaching Hospitals in Tehran (18 general surgical wards) to investigate breast cancer in Tehran, Iran. All patients who have had breast pathology during 1985-95 were reviewed. For each patient the following data were extracted from case records sex, age, type of disease (based on ICD-10 and ICD-O), breast cancer pathology, tumor size, lymph node involvement, pathological staging (based on TNM system), type of surgery, mass location and the affected side of breast. In all 3085 records were reviewed. Of these, in 903 cases the final diagnosis was breast cancer. The mean age of breast cancer patients was 47.1 (SD=12.3) y and the age-adjusted analysis showed that the observed number of breast cancer cases in the age group 40-49 was higher than expected (P<0.001). The majority of patients (71%) were patients with infiltrating ductal carcinoma, 70% had advanced disease (Stage III), and in 51% of cases the tumour was more than 5 cm in size. Finally it was found that two-third of patients (76%) underwent modified radical mastectomy. Although this study does not address true incidence, but rather frequency, the findings suggest that the Iranian breast cancer patients are relatively younger than their western counterparts and mostly have locally advanced disease. In terms of breast cancer screening programs, these findings have some implications for public health professionals in Iran.

The EORTC breast cancer-specific quality of life questionnaire (EORTC QLQ-BR23): translation and validation study of the Iranian version

The objective of this study was to test the reliability and validity of the Iranian version of the European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23). The English-language version of the questionnaire was translated into Persian (Iranian language) and its final form was approved by the EORTC Study Group on Quality of Life and then it was used in this study. The questionnaire was administered at two points in time to a consecutive sample of 168 newly diagnosed breast cancer patients and almost all of them (99%) found the questions easy to understand and acceptable. Cronbach's alpha coefficient for multi-item scales (to test reliability) ranged from 0.63 to 0.95 at baseline and from 0.75 to 0.92 at follow-up administration of the questionnaire. Validity analysis was performed using known-groups' comparison analysis. The results showed that all functional and symptom scales discriminated between sub-groups of patients differing in clinical status as defined by their performance status and disease stage. In addition, all functional and symptoms scales detected change over time, as a function of changes in patients' performance status. In general, the findings of this study indicated that the Iranian version of the EORTC QLQ-BR23 is a reliable and valid supplementary measure of the quality of life in breast cancer patients and can be used in clinical trials and studies of outcome research in oncology.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version

The objective of this study was to test the reliability and validity of the Iranian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). The English-language version of the questionnaire was translated into Persian (Iranian language), and its final form was approved by the EORTC Study Group on Quality of Life before it was used in this study. The questionnaire was administered at two time points to a consecutive sample of 168 newly diagnosed breast cancer patients, and almost all of them (99%) found the questions easy to understand and acceptable. Crohnbach's alpha coefficient for multi-item scales (to test reliability) ranged from 0.48 to 0.95 at baseline and from 0.52 to 0.98 at follow-up administration of the questionnaire. Validity was checked using two methods: inter-scale correlation and known-groups comparison. Almost all inter-scale correlations were statistically significant in the expected direction. Known-groups comparison analysis showed that all functioning and symptom scales discriminated between subgroups of patients differing in clinical status as defined by their performance status and disease stage. In general, the findings of this study indicate that the Iranian version of the EORTC QLQ-C30 is a reliable and valid measure of quality of life in cancer patients and can be used in clinical trials and studies of outcome research in oncology.

Aneurysm of the ductus arteriosus: a congenital lesion

The objective of this study was to evaluate the clinical, radiological, and echocardiographic findings in 11 neonates with aneurysm of ductus arteriosus presented in our institutions between 1993 and 1996, and to postulate a new theory for the pathogenesis of this lesion. Medical records, radiographic studies, and echocardiograms were reviewed. All infants underwent follow-up echocardiograms every 2 to 3 days until the aneurysm spontaneously resolved or surgery was performed. The infants were predominantly term males; six had evidence of fetal distress, two were diagnosed prenatally by fetal echocardiogram, chest X ray evidenced mediastinal mass in six patients. The first echocardiogram showed structurally normal heart with an aneurysmal patent ductus arteriosus. In eight patients the aneurysm completely resolved by 5 to 10 days. One infant underwent surgical resection of the aneurysm after observation for 11 days with no change in size. Thrombosis of the aneurysm was noted in two patients; both underwent surgery. Increasing reports of ductal aneurysms in infants may reflect the availability of high-resolution echocardiography and more frequent use of echocardiography in the neonatal intensive care unit. Spontaneous resolution occurred in the majority of cases as in previous reports. We postulate that, at least in some cases, aneurysm of the ductus arteriosus is a congenital lesion that may represent poststenotic dilation of the ductus due to turbulent flow through a stenotic segment at its pulmonary artery end during fetal life. The presence of aneurysm of the ductus arteriosus should be excluded in selected cases of fetal distress, by fetal echocardiography.

Extragonadal production of 17,20-dihydroxy-4-pregnen-3-ones in vitro in cyprinid fish

Muscle, heart, eye, testis, blood, and sperm of trout and goldfish have been examined for the presence of 20-hydroxysteroid dehydrogenase by incubation with [3H]17-hydroxyprogesterone in the presence of 0, 0.1, 1, or 10 micrograms/ml of unlabeled substrate. In trout, 17-hydroxyprogesterone was metabolized only by sperm and testis, with 17,20 beta-dihydroxy-4-pregnen-3-one (17,20 beta P) as the major product and traces (< 2%) of 17,20 alpha-dihydroxy-4-pregnen-3-one (17,20 alpha P). In goldfish, maximum conversion of 17-hydroxyprogesterone to 17,20 alpha P was over 30% per 100 mg tissue in eyeball, heart, and testis, 12% per 20 microliters blood, and 18% per 20 microliters sperm, but less than 5% per 100 mg muscle. 17,20 alpha P was the only metabolite of 17-hydroxyprogesterone in all incubations of nongonadal tissue in goldfish. Within the cyprinid eye, there was no significant activity in the lens, the fluids, or the retina. The possible relationship between the teleost 20 alpha- and 20 beta-hydroxysteroid dehydrogenases, the mammalian 20-hydroxysteroid dehydrogenases, and members of the aldo-keto reductase and short-chain dehydrogenase superfamilies is discussed.

Biosynthesis of 17,20 alpha-dihydroxy-4-pregnen-3-one, 17,20 beta-dihydroxy-4-pregnen-3-one, and 11-ketotestosterone by testicular fragments and sperm of the roach, Rutilus rutilus

The effect of incubation time and substrate concentration on the in vitro metabolism of 17-hydroxyprogesterone by testes of the roach has been examined. There was a shift from synthesis of the 11-oxygenated androgens, 11-ketotestosterone, and androstenetrione at low substrate concentration to 17,20 alpha-dihydroxy-4-pregnen-3-one (17,20 alpha P) at high substrate. Glucuronides and sulfates were of significant importance only at low substrate and long incubation times. There was a shift from 17,20 beta-dihydroxy-4-pregnen-3-one to 17,20 alpha P with increased substrate. The results confirm that substrate affects the steroidogenic profile and that 3 hr is optimal time for such studies. Incubations of sperm with 17-hydroxyprogesterone gave predominantly 11-ketotestosterone at low substrate concentrations and 17,20 alpha P at high substrate. The synthesis of 11-ketotestosterone is demonstrated for the first time in teleost sperm.

Decreased cardiac output in infants of mothers who abused cocaine

Cocaine increases the level of circulating catecholamines by blocking the catecholamine reuptake receptors. The effect of intrauterine cocaine exposure on cardiac output was studied in 15 full-term newborn infants whose mothers used cocaine during pregnancy. A total of 22 healthy nonexposed full-term infants served as a control group. On the first day of life, cardiac output (183 +/- 12 vs 235 +/- 13 mL/kg per minute, mean +/- SD; P less than .05) and stroke volume (1.3 +/- 0.1 vs 1.9 +/- 0.1 mL/kg, mean +/- SD; P less than .005) were lower and arterial blood pressure (60 +/- 2 vs 41 +/- 2 mmHg, mean +/- SD; P less than .001) higher in the infants exposed to cocaine. On day 2, cardiac output, stroke volume, and mean arterial blood pressure were similar, probably because of the gradual excretion of cocaine and its metabolites by the infant. It was speculated that an increase in plasma norepinephrine levels is responsible for the cardiovascular effects of intrauterine cocaine exposure.

Duplex versus unguided pulsed Doppler measurements of right ventricular output in newborn infants

Noninvasive measurement of pulmonary artery blood flow has widespread implications for management of newborn infants requiring intensive care. Using a precordial, unguided, single Doppler technique, we evaluated right ventricular output in 26 preterm and 16 term infants without cardiopulmonary problems and compared it with right ventricular output obtained by duplex Doppler scanning and left ventricular output measured by a suprasternal single Doppler approach. Weights ranged from 1,120 to 3,960 g and postconceptional ages from 29 to 42 weeks. Unguided measurements of left and right ventricular output and guided and unguided measurements of right ventricular output were highly correlated (r = +0.92 and +0.95 respectively, p less than 0.001). The precordial single Doppler technique offers a reliable noninvasive estimate of right ventricular output in preterm and term newborn infants.

Pulsed Doppler measurement of left ventricular output as early predictor of symptomatic patent ductus arteriosus in very preterm infants

High left ventricular output (LVO) values are associated with symptomatic left-to-right ductal shunting in preterm infants. However, LVO data prior to the occurrence of symptomatic patent ductus arteriosus (SPDA) are lacking. To determine whether serial measurements could predict a SPDA, we measured LVO from day 1 until day 10 with pulsed Doppler echocardiography in 25 preterm infants with birth weights of less than 1,250 g and hematocrits of more than 0.40. Eleven infants never developed patent ductus arteriosus symptoms and had LVO values within the normal range (190-310 ml/min/kg) with only minimal daily variations. The remaining 14 infants developed SPDA which required treatment with indomethacin, ductal ligation, or fluid restriction on days 2-5. From day 1 until day 5 their mean LVO values were significantly higher compared to the group without left-to-right ductal shunt and this increase was secondary to higher stroke volume values. An increase in LVO of more than 60 ml/min/kg consistently preceded SPDA by at least 24 h. Serial measurements of LVO using a single-pulsed Doppler approach can be used for early prediction of SPDA.

Pomegranate seed oil rich in conjugated linolenic acids reduces in vitro methane production

The objective of this study was to determine the effect of pomegranate (Punica granatum L.) seed oil (PSO) on gas and methane (CH4) production, ruminal fermentation and microbial populations under in vitro conditions. Three treatments consisting of a control diet containing 10 mg tallow (CON); the control diet with 5 mg PSO + 5 mg tallow (MPSO) and the control diet containing 10 mg PSO (HPSO) were compared. Ten mg of the experimental fat/oil samples were inserted into a gas-tight 100 mL plastic syringe containing 30 mL of an incubation inoculum and 250 mg of a basic substrate of a hay/concentrate (1/1, w/w) mixture. In vitro gas production was recorded over 0, 2, 4, 6, 8, 10, 12 and 24 h of incubation. After 24 hours, incubation was stopped, and methane production, pH, volatile fatty acids (VFAs) and microbial counts were measured in the inoculant. Gas production at 4, 6, 8, 10, 12 and 24 h incubation, metabolizable energy and in vitro organic matter disappearance increased linearly and quadratically as level of PSO increased. Furthermore, the 10 mg PSO (HPSO) decreased CH4 production by 21.0% compared with the control (CON) group. There were no significant differences in total and individual VFA concentrations between different levels of PSO, except for butyric acid. After 24 h of incubation, methanogenesis decreased in the HPSO compared with the MPSO and CON treatments. In addition, total bacteria and protozoa counts increased with rising PSO levels, while population methanogenesis declined significantly. These results suggested that PSO could reduce methane emissions, which might be beneficial to nutrient utilization and growth in ruminants.