Renal cell carcinoma: an overview of the epidemiology, diagnosis, and treatment.

Renal cell carcinoma (RCC) is the most common type of urogenital cancer. It has a mortality rate of 30-40% and is more commonly seen in men than women. In addition to gender, other risk factors of RCC include obesity, hypertension, smoking, and chronic kidney disease. Following the improvements in diagnostic tests, such as CT and MRI imaging, the incidence of patients diagnosed with RCC has rapidly increased over the past decades. The most common type of RCC, based on histological and molecular subtypes, is clear cell carcinoma which occurs frequently due to mutations in the VHL gene. Nephron-sparing surgery is a selective technique to maintain kidneys in patients while radical nephrectomy and partial nephrectomy are used to remove small tumors. In addition to surgical approaches, adjuvant therapy and targeted therapy are applied in patients with metastatic RCC. In this review, we give an overview of the most recent research on RCC which would help physicians to better manage patients with RCC.

Preparation and characterization of a novel biodegradable film based on sulfated polysaccharide extracted from seaweed Ulva intestinalis.

Seaweeds can be a suitable, inexpensive, abundant, and renewable source for the production of biodegradable films as an alternative to plastics. Sulfated polysaccharides, which are abundant in Ulva intestinalis seaweed, have shown important biological activities such as anticoagulant, antioxidant, antitumor, anti-inflammatory, and antiviral activities. Mechanical, physicochemical, barrier, and surface properties of sulfated polysaccharide films extracted from Ulva intestinalis using glycerol and polyethylene glycol (PEG) as plasticizers were studied. Ulva intestinalis sulfated polysaccharide films (USP films) were successfully prepared by the incorporation of three concentrations of plasticizers (30, 40, and 50%). The film properties depended on the type and concentration of the plasticizer. Based on the results, by increasing the concentration of the plasticizer, the thickness, moisture content, solubility, and elongation at break of the USP films increased and tensile strength, young's modulus, transparency, and barrier properties of the films decreased. The film plasticized with 30% PEG showed the highest value of tensile strength (36.95 MPa), and the lowest value for permeability to vapor water and oxygen were 1.9 g mm-1 s-1kPa-1 × 10-11 and 7.45 cm-3.cm/cm2.s.cmHg ×10-8, respectively. Scanning electron microscopy (SEM) observations indicated that the surface of the films was free of bubbles, cracks, or fractures. Fourier transform infrared (FTIR) spectroscopy results revealed some interactions between plasticizers and the polymer.

The Prevalence and Predicting Factors of Pulmonary Thromboembolism in Patients with Exacerbated Chronic Obstructive Pulmonary Disease.

BACKGROUND AND AIMS: The risk of pulmonary thromboembolism (PTE) in patients with exacerbated chronic obstructive pulmonary disease (e-COPD) is higher than in non-COPD states. This study aimed to evaluate the prevalence and the parameters that are critical for finding the incidence of PTE in patients with e-COPD. METHODS: This cross-sectional study was performed on 68 consecutive patients with the e-COPD, referred to the Pulmonary Disease Department at the Shariati Hospital in Tehran between 2013 and 2014. In addition to collecting data on the history of disease and physical examination, arterial blood sampling, spirometry, electrocardiography and echocardiography were performed for all patients. All patients underwent the computed the tomography pulmonary angiography (CT-PA) as a method of choice for diagnosing PTE. RESULTS: Out of 68 cases (7.4%), five were had CT angiography findings suggesting PTE. These patients were all male and had a higher mean age (79 vs. 65 years), lower mean systolic blood pressure (88.36 vs. 118.33 mmHg), and a higher mean heart rate (133.12 vs 90.33 beats/min), compared to e-COPD patients without PTE. Arterial blood gas analysis in patients with PTE demonstrated a lower HC03 (2.33 vs. 9.44 mEq/l) and PC02 (44.35 vs. 51.43 mmHg) levels. The mean LVEF was lower in patients with PTE (34.14 ±4.49% vs. 46.94 ± 8.27%). CONCLUSION: The prevalence of PTE in our series of patients with e-COPD was 7.4%. According to the study results, male gender, advanced age, hypotension, tachycardia, and respiratory alkalosis are factors indicating possible PTE among patients with e-COPD.

A Rare Presentation of Primary Nasopharyngeal Carcinoma (NPC) in Mediastinum.

INTRODUCTION: Nasopharyngeal carcinoma among the children has been rare accounting for only 1% of all pediatric malignancies. Both genetic and environmental factors have contributed to the development of nasopharyngeal carcinoma. Among the children there was a higher rate of undifferentiated histology. The mean age of nasopharyngeal carcinoma diagnosis has been 11 years old age; and the most common site was nasopharynx. Palpable lymphadenopathy, dysphasia and neural defect were common associated signs. CASE PRESENTATION: A 15-year-old boy has presented with a mass that located near by the heart in the left side of mediastinum with invasion to anterior mediastinum from two years ago. In biopsy, nasopharyngeal carcinoma, non-keratinizing type, has diagnosed while there was no involvement of nasopharyngeal region. Patient has treated by 70 Gy (2.0 Gy/fraction) radiotherapy plus concomitant chemotherapy with base of docetaxel. But the mass had no regression. Then, the patient has treated with Cisplatin 100 mg/m2 IV on days 1, 22, and 43 with radiation, then cisplatin 80 mg/m2 IV on day 1 plus fluorouracil (5-FU) 1000 mg/m2/day by continuous IV infusion on days 1 - 4 every 4wk for 3 cycles and after remission interferon beta has added to treatment for 6 months duration as a maintenance therapy. After 1 year follow up; the patient was in complete remission. In the course of therapy, only hypothyroidism has occurred. CONCLUSIONS: Nasopharyngeal carcinoma in childhood, without nasopharyngeal involvement, initially could be detected in other sites such as pericardium. Also good results could be respected by cisplatin and 5-fluorouracil based neoadjuvant chemotherapy before radiotherapy plus interferon beta as a maintenance therapy in childhood aggressive nasopharyngeal carcinoma.

Prevalence of Congenital Heart Disease: A Single Center Experience in Southwestern of Iran.

BACKGROUND: Congenital heart disease (CHD) refers to complex abnormalities that affect the structure or function of the heart due to embryonic defects. There is little accurate statistical data about prevalence, incidence and frequency in many developing countries such as Iran. The aim of this study was to evaluate the frequency of CHD in patients who were referred to the Department of Pediatric Cardiology in a large single-center in Southwestern of Iran. METHODS: This is a retrospective, cross-sectional study. Patients with various cardiac malformations were each investigated separately. A check list was used to collect information. It was comprised of three parts; demographic characteristics, Patient's birth details and maternal data. RESULTS: The frequency of ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of fallot (TOF) were 125 (28.47%), 48 (10.93%) and 41(9.3%) respectively. Family history was reported in 26(11.1%) cases. Down syndrome, skeletal anomaly and hematological anomaly were the most common co-anomalies. Parental consanguinity was 48.7%. CONCLUSIONS: Present study showed that VSD was the most common CHD subtype followed by family history, familial marriage, extra cardiac anomalies (ECAs), birth weight, and maternal concomitant disease. But there was a controversial relationship between birth order and drug history in CHD.

Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography.

BACKGROUND: The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. OBJECTIVES: The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. PATIENTS AND METHODS: Eighty-one patients (41 males and 40 females) who were diagnosed with suspected coronary artery disease and were referred to Golestan Hospital, Imaging Department were recruited. Inclusion criteria were based on the protocol of multi-slice CT coronary angiography. The radiation dose to the thyroid and pelvis regions was measured using thermo luminescent dosimeters (TLDs). RESULTS: The mean radiation dose to the thyroid in male and female subjects was 0.32 mSv and 0.41 mSv, respectively (P = 0.032) (total mean, 0.36 mSv). The mean radiation dose to the pelvis in male and female subjects was 81 µSv and 112 µSv, respectively (P = 0.026) (total mean, 96.5 µSv). CONCLUSIONS: The total mean radiation dose to the thyroid and gonads was 0.36 mSv, and 96.5 µSv, respectively for the subjects. These values were high for one organ in a single study. Gender can affect the radiation dose to the thyroid and gonads. This can be attributed to the anatomical characteristic differences of the male and female subjects.

Hemoptysis: comparison of diagnostic accuracy of multi detector CT scan and bronchoscopy.

BACKGROUND: Hemoptysis is the expectorating of blood from the tracheobronchial tree or pulmonary parenchyma. There is conflicting information about usefulness of radiography, MDCT, and bronchoscopy for investigating site and cause of the bleeding in patients with hemoptysis. The present study attempted to evaluated efficacy of these methods for identifying hemoptysis' cause and etiology on 40 patients with the disease. METHODS: A total of 40 patients with Hemoptysis who were referred to Golestan and Emam Khomeini hospitals were evaluated. Complete history of symptoms, volume and duration of Hemoptysis and demographic information were documented. Radiography, MDCT, and bronchoscopy were performed on all patients in order to investigate the site and cause of the bleeding. RESULTS: Results showed MDCT had higher efficacy in identifying bleeding site than radiography, while efficacy of radiography and bronchoscopy or efficacy of MDCT and bronchoscopy weren't significantly different. In addition, sensitivity of MDCT (60%) for detecting cause of the bleeding was higher than that of radiography (25%) and bronchoscopy (32.5%). CONCLUSION: The present study suggests MDCT as a suitable method in screening patients with hemoptysis, because it managed to detect site and causes of bleeding more efficiently than other methods. Additionally, we concluded that MDCT is an appropriate technique for diagnosing malignancies that cause hemoptysis in patients.

Diagnostic accuracy of magnetic resonance imaging versus clinical staging in cervical cancer.

BACKGROUND: Cervical cancer is the third most common gynecological cancer and a widespread malignancy in women, accounting for a large proportion of the cancer burden in developing countries. We compared accuracy of MRI staging with clinical staging and also concordance between the two methods for newly diagnosed patients with cervical cancer, using clinical staging as the reference. MATERIALS AND METHODS: This prospective study was conducted on 27 newly diagnosed patients with cervical cancer from Imam Khomeini hospital from June 2012 to Feb 2014. New cases of cervical cancer with positive PAP test were staged separately with a clinical exam based on the FIGO system by a gynecologist, oncologist and also with MRI by an expert radiologist. Then we compared the predicted stage for each patient with the two methods. RESULTS: Based on clinical staging 9 patients (33%) were observed at stage 1. MRI staging was in coordination with clinical staging in eight of them and for one patient MRI accorded stage 2B (88% concordance). CONCLUSIONS: MRI is a reliable noninvasive method with high accuracy for cervical cancer staging. Also presently it is easily obtainable, so we recommend using this technique along with clinical examination for staging cervical cancer patients. We also recommend to radiologists and residents of radiology to get experience with this method of staging.

Primary diffuse large B cell lymphoma of the cranial vault.

Primary non-Hodgkin's lymphoma of the cranial vault is extremely rare. This case report presents a 42-year-old man with a painless subcutaneous scalp mass which extended intracranially associated with recent mild headache. Initial computed tomography and magnetic resonance imaging revealed two lesions emanating from the skull. Biopsy revealed a diagnosis of diffuse large B cell lymphoma (DLBCL). A thorough work-up revealed no other point of involvement. This case is concerned about considering lymphoma in the differential diagnosis of calvarial lesions with both intra- and extra cranial extensions but without obvious intervening bony destruction.

Anomalous origin of posterior descending artery from left anterior descending in the presence of a diminutive right coronary artery: diagnosed by ECG gated multi-detector CT.

Coronary anomalies are easily detected on ECG gated multi-detector CT which has shown to be superior to conventional angiography is demonstrating their origin and course. We present an unusual case of posterior descending artery arising as the continuation of the left anterior descending artery (LAD) in the presence of a diminutive right coronary artery (RCA). The LAD crossed over the apex and continued its course to the base of the heart in the posterior interventricular groove as PDA. The RCA, although normal in origin, was diminutive and terminated on the lateral wall of the right ventricle. This anomaly has been rarely reported and the previous cases have all been conventional angiographic findings.