The effect of aerobic physical rehabilitation on the quality of life in patients with chronic atrial fibrillation; A randomized controlled clinical trial study.

BACKGROUND: Management of atrial fibrillation (AF), besides prevention of stroke, mainly stresses symptom control and improvement of quality of life (QOL). In patients with permanent AF, exercising may improve QOL, rhythm, and symptoms. The purpose of this study was to determine the impact of aerobic physical rehabilitation on the QOL of patients suffering from AF and admitted to a coronary care unit (CCU). METHODS: This randomized controlled clinical trial study was conducted on 50 patients who were hospitalized with chronic AF in the CCU of Montazeri Hospital, Najafabad, Iran, and had the inclusion criteria. The participants were selected using convenience sampling method, and were randomly divided into experimental (n = 25) and control (n = 25) groups. The experimental group received a rehabilitation program in the form of an educational package and scheduled physical activity of aerobics for 8 weeks, and the control group received CCU routine care. The researcher measured the patients' QOL before and after the intervention using the 36-Item Short Form Health Survey (SF-36). RESULTS: There was no significant difference in the mean score of total QOL between the control and experimental groups before the intervention (P > 0.050). However, the comparison of the mean score of total QOL after the intervention showed a significant increase in the experimental group (P < 0.050). CONCLUSION: Aerobic rehabilitation activities are effective on the QOL of patients with chronic AF.

Oral focal epithelial hyperplasia: report of three cases.

Focal epithelial hyperplasia or Heck's disease is an infrequent asymptomatic condition caused by human papillomavirus types 13 or 32 affecting the mucous membrane of the mouth and is commonly seen in young individuals. Firstly, it was described in Indians and Eskimos, but it exists in various populations. We present three cases of Heck's disease in an Afghan immigrant family group living in Iran that seem to have familial predominance. The disease was identified as oral focal epithelial hyperplasia on the basis of histopathologic and clinical findings. The lesions were reduced significantly after 4 months of good oral hygiene. Dentists should be familiar with the clinical manifestations of these types of lesions that affect the oral cavity. In fact, histopathologic assessment and clinical observation are necessary to establish the diagnosis.

A rare case of laryngotracheal chondrosarcoma in a patient with past history of radioiodine therapy for thyroid cancer.

Tracheal chondrosarcoma is a rare malignant mesenchymal tumor and there are less than 15 reports in the literature. We report a rare case of laryngotracheal chondrosarcoma in a 74-year-old man. He gave a history of radioiodine therapy for thyroid papillary carcinoma about 24 years ago. Diagnostic steps, histological presentation, and therapy are described in detail.

Absent CD56 expression in papillary thyroid carcinoma: A finding of potential diagnostic value in problematic cases of thyroid pathology.

BACKGROUND: There are inter-observer disagreements between papillary thyroid carcinoma (PTC) with other follicular lesions of thyroid in aspect of diagnosis. CD56 is present on follicular epithelial cells of the normal thyroid. We evaluated the diagnostic value of CD56 expression in PTC, follicular thyroid lesions, and follicular thyroid neoplasms. MATERIALS AND METHODS: Seventy-three cases diagnosed as follicular lesions and 73 cases diagnosed as PTC were stained with CD56 marker. A positive membranous immunostaining in more than 10% of the neoplastic cells qualified the case as "positive (+)" for CD56. RESULTS: CD56 expression was seen in 70 samples of non-papillary carcinoma lesion (95.8%) versus one case of PTC (1.3%) (P < 0.001, Chi-square). Therefore, CD56 was 98.6% sensitive and 95.8% specific in distinguishing PTC from other follicular thyroid lesions. CONCLUSION: CD56 is both a sensitive and specific marker for differentiating PTC from other follicular lesions of thyroid singly but it may be better to use a combination of markers for clinical evaluation of patients.

Bowenoid transformation in seborrheic keratosis: A retrospective analysis of 429 patients.

BACKGROUND: Seborrheic keratosis is a common, benign skin tumor. Numerous reports have shown its possibility of malignant transformation. This study was designed to demonstrate the occurrence of concomitant seborrheic keratosis and skin cancers. MATERIALS AND METHODS: Data was retrospectively reviewed from all patients with a diagnosis of seborrheic keratosis in pathology department of Alzahra Hospital and a private pathology laboratory in Isfahan, Iran over a 4-year period. We classified all demographic data and associated dysplasia or Bowen's disease and analyzed them by student-t or chi-square tests. RESULTS: From all 429 specimens, 5 (1.2%) were found to be associated with Bowen's disease and one (0.2%) with mild dysplasia in squamous epithelium. All cases arose within the clinically, atypical seborrheic keratosis. More men were affected with lesions alone and with malignancy (230/423 (54.4%) and 5/6 (83.3%), respectively) compared to women. The average age of patients suffering from lesions with and without associated malignancy was 57 and 54 years, respectively. The common site of lesion alone was head and neck but lesions with malignancy involved lower extremities. The two lesions were significantly different in site of occurrence (p < 0.001). CONCLUSION: Generally, although the association between seborrheic keratosis and skin malignancy appears to be accidental, it must always be in mind. Therefore, histopathologic examination of all seborrheic keratosis should be considered, especially when seborrheic keratosis has atypical clinical manifestations.

The role of VEGF in melanoma progression.

BACKGROUND: Melanoma is the most serious skin cancer. There is an established correlation between thickness and aggressiveness of the tumor. Nevertheless, the potential value of vascular endothelial growth factor (VEGF) in correlation with tumor progression remains unresolved. MATERIALS AND METHODS: Thirty seven paraffin blocks of cutaneous melanoma were obtained from Pathology department of Al-zahra hospital between 2005 and 2010. The sections were stained with monoclonal mouse antibodies (mAbs) against vascular endothelial growth factor A and evaluated by distribution of expression of VEGF in tumor cells as 0, 0%; 1, 1%--25%; 2, 25%--50%; 3, >50% and the staining intensity from 0 (negative) to 3 (strong). The sum of intensity score and distribution score was then calculated as the VEGF index. The relationship between VEGF expression (distribution, intensity, and index) and tumor progression (vertical and radial growth, Clark's level, and Breslow's depth) was studied. SPSS software was used to analyze the data by ANOVA, and chi-square tests. RESULTS: 51.4% of the patients showed vertical growth pattern. Mean Breslow's depth was 1.84 ± 1.79 mm. There was a significant association between growth pattern and VEGF distribution, intensity and index (P = 0.006, P = 0.005, and P = 0.001 respectively). VEGF distribution, intensity, and index all had correlation with Breslow's depth as well (ANOVA test: P = 0.003, P < 0.001, and P < 0.001 respectively) VEGF index had also correlation with Clark's level, but this was not seen for VEGF distribution and intensity. CONCLUSION: VEGF expression (both VEGF distribution and intensity) is associated with progression of malignant melanoma. VEGF index can explain this association better.

The expression of prostate-specific antigen in invasive breast carcinoma and its relationship with routine clinicopathologic parameters.

BACKGROUND: Invasive breast carcinoma is one of the most common cancers of women. Parameters such as lymph node status, tumor grade, and the status of hormone receptors are among the main prognostic determinants of this cancer. Immunohistochemical detection of prostate-specific antigen (PSA) is widely used to identify metastatic prostatic adenocarcinoma. However, its immunoreactivity has been found in some non-prostatic tissues. This study was conducted to assess PSA expression in invasive breast carcinoma and its relationship with routine clinicopathologic parameters. MATERIALS AND METHODS: 100 formalin-fixed and paraffin-embedded invasive breast carcinoma tissue specimens from the pathology archive of Alzahra hospital (Isfahan, Iran) were studied for the expression of estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and PSA by immunohistochemistry. Stained sections were classified according to the intensity of staining and the percentage of cells showing PSA staining. The relationship between PSA expression and other markers, age, lymph node status, tumor subtype, and tumor grade was then studied. RESULTS: No association was found between PSA expression on one hand and PR, Her2/neu, age, lymph node status, tumor grade, and tumor subtype on the other. PSA score was reversely correlated with ER expression (P = 0.015). CONCLUSION: Despite the reverse relationship between PSA expression and the immunoreactivity of ER, PSA expression was not correlated with other prognostic factors. Therefore, the detection of PSA by immunohistochemistry does not seem to be a significant prognostic parameter in patients with invasive breast carcinoma.

Diagnostic value of E-cadherin and fibronectin in differentiation between reactive mesothelial and adenocarcinoma cells in serous effusions.

BACKGROUND: One of the problems in studying serous effusion cytological samples is differentiation of reactive mesothelial cells from metastatic adenocarcinoma cells. MATERIALS AND METHODS: In this study, the immunohistochemical diagnostic value of E-cadherin and fibronectin markers for differentiation of these 2 groups of cells was studied. 50 cell block samples prepared from serous effusions were examined. Based on clinical and histological studies, 25 cases had primary carcinoma, and the other 25 were proved to be benign effusion cases. All the cases were studied for E-cadherin and fibronectin immunostaining using an envision technique. Statistical analyzes were performed employing Chi-square and exact Fisher tests, using SPSS software (version 16). RESULTS: 24 of the 25 benign cases were stained with fibronectin and 2 with E-cadherin, whereas from among the 25 metastatic cases, 2 reacted to fibronectin and 22 to E-cadherin. Considering the staining of the 2 markers under conditions that the cells were stained with fibronectin but not with E-cadherin, positive predictive value (PPV) and negative predictive value (NPV) to identify reactive mesothelial cells were 100% and 92.5% while under conditions that had not been stained with fibronectin but with E-cadherin, PPV and NPV to detect adenocarcinoma cells were 95.2% and 82.1%, respectively. CONCLUSION: Employing this short panel can be helpful for better differentiation of adenocarcinoma and reactive mesothelial cells in serous fluids.