A rare case of Cushing's disease concurrent with papillary thyroid carcinoma.

BACKGROUND: Although a nodular thyroid disease is higher in patients with pituitary adenoma, concurrent thyroid cancer with pituitary tumor is uncommon. CASE PRESENTATION: We report a young woman with discovered papillary thyroid carcinoma after 1-year transsphenoidal surgery for Cushing's disease. Thyroidectomy was done and patient is well after three years follow-up. CONCLUSION: We suggest the patient with functional pituitary adenoma be evaluated for thyroid tumor.

Effects of Minocycline on Neurological Outcomes In Patients With Acute Traumatic Brain Injury: A Pilot Study.

Traumatic brain injury (TBI) is a public health problem worldwide. Secondary damage of brain injury begins within a few minutes after the trauma and can last a long time. It can be reversible, unlike primary injury. Therefore, therapeutic intervention can be used. The aims of this study were to assess the effects of minocycline on neurological function and serum S100B protein and neuron-specific enolase (NSE) levels in patients with moderate to severe TBI. Patients with acute onset of TBI and surgical evacuation of hematoma were randomized to receive either minocycline 100 mg orally twice daily or placebo for 7 days. The primary outcomes included changes in level of S100B and NSE at different time points during the trial. Additionally, changes in Glasgow coma scale (GCS) score were evaluated. The Glasgow Outcome Scale-Extended (GOS-E) score at 6 months after injury was assessed in discharge patients. Thirty four patients were randomized into the placebo (n = 20) and treatment (n = 14) groups. There was a marginal statistically significant differences in the normalized value of S100B between groups (p < 0.1). The reduction in serum NSE level from baseline to day 5 was statistically significant (p = 0.01) in minocycline group while it was not significantly decrease in placebo group (p = 0.2). Also, GCS improvement over time within the minocycline group was significant (p = 0.04) while was not significant in placebo group (p = 0.11). The GOS-E scores were not significantly different between minocycline and placebo group. Based on this study, it seems that the use of minocycline may be effective in acute TBI.

Immunohistochemical Investigation of Mutant BRAF V600E in Common Pigmented Skin Neoplasms, Study on a Sample of Iranian Patients.

BACKGROUND & OBJECTIVE: This study was designed for the first time for the detec- tion of mutant BRAF V600E and its correlation with clinicophathologic features in a sample of Iranian patients with pathologically proved pigmented skin neoplasms. METHODS: 82 paraffin-embedded blocks, including melanocytic nevi, malignant melanoma, Basel cell carcinoma, and squamous cell carcinoma were evaluated for BRAF V600E expression by immunohistochemistry in the patients admitted to Ibn Sina Hospital, in the city of Sari, Mazandaran province, North of Iran. The evaluation of immunohistochemical staining was performed by two of the authoring pathologists, and staining intensity was graded from negative (0), weak (1+), moderate (2+) to strong (3+). If twenty percent (or greater) of the tumor cells showed modest to strong cytoplasmic immunoreactivity (score 3+), the neoplasm was considered positive for this tumor marker. RESULTS: Among 82 studied patients, 12 cases (60%) of the malignant melanoma group revealed a high intensity of immunostaining for BRAF V600E, while a signifi- cant expression of this marker did not occur in the other investigated skin neoplasm. A great relation between BRAF (V600E) expression and the histologic type of skin cancer was noted. No significant relationship with other parameters such as gender, age, and the grade differentiation of the non-melanoma skin cancer was found. BRAF V600E was weakly correlated with the Clark level of cutaneous malignant melanoma. CONCLUSION: This data provided further evidence for the strong role of the BRAF V600E mutation in the development of cutaneous malignant melanoma, compared to non-melanoma skin cancers in the North of Iran. We advised future studies to evaluate the beneficial effects of anti-BRAF V600E target therapy on the Iranian melanoma patient who harbors this marker by way of immunostaining tumor tissue.

Eosinophilic Granulomatosis with Polyangiitis Manifested by Cholecystitis and Mononeuritis Multiplex: A Case Report.

Eosinophilic granulomatosis with polyangiitis formerly named "Churg-Strauss syndrome (CSS)" is a systemic disease with bronchial asthma, hypereosinophilia, and systemic vasculitis. We report a case of CSS with cholecystitis and mononeuritis multiplex. A 50-year-old woman with a history of sinusitis and bronchial asthma of 8 years' duration was referred with a complaint of left-hand deformity and difficulty in walking. The laboratory findings included remarkable eosinophilia, an elevated erythrocyte sedimentation rate, and a marked eosinophilic infiltration in the gallbladder biopsy. Based on the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with prednisolone and cyclophosphamide.

The effect of fennel (Foeniculum vulgare) gel 3% in decreasing hair thickness in idiopathic mild to moderate hirsutism, A randomized placebo controlled clinical trial.

BACKGROUND: Hirsutism is a common symptom presenting to primary care endocrinologists, gynecologists, and dermatologists. Management is usually a long and troublesome process. This study was designed to evaluate the effect of fennel topical gel on mild to moderate idiopathic hirsutism. METHODS: The randomized, double-blind, placebo-controlled clinical trial was carried out from 2009 to 2011, in Sari, Iran. Forty four women with mild to moderate idiopathic hirsutism were randomly divided to case and control groups, each group included 22 cases. The case group received fennel gel 3% and the control group received placebo. The effect of fennel gel 3% was defined as reduction of thickness of facial hair in micrometer by microscope in comparison with placebo. Measurements were performed at zero time and 24 weeks after treatment. This study was registered in the Iranian Registry of Clinical Trial (www.irct.ir) with registration number 138901213672N1. RESULTS: The mean age of patients was 26.9±6.7 and 25.6±4.3 years in case and control groups, respectively. Hair thickness was similar between the two groups before intervention. The hair thickness reduced from 97.9±31.5 to 75.6±26.7 micron in patients receiving fennel gel after 24 weeks (P<0.001). Four patients complained of itching (3 in case group) and 4 patients complained of irritation and itching (3 in case group). However, this difference was not statistically significant. CONCLUSION: The study indicated that fennel gel 3% is effective in decreasing hair thickness in women with idiopathic mild to moderate hirsutism.

Lower Gastrointestinal Bleeding due to Non-Steroid Anti-Inflammatory Drug-Induced Colopathy Case Report and Literature Review.

The adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the upper gastrointestinal (GI) tract and small intestine are well established. The effect of such therapy on the large intestine, so called NSAID-induced colopathy, is less well described. NSAID-induced colopathy usually involves the right colon due to a higher concentration of the drug at this site, but the rectum may also be involved. NSAIDs possibly damage the normal large intestine, which presents as ulceration, colitis and stricture. Even though several studies found that NSAIDs can cause diverticular bleeding and perforation, flare-up of inflammatory bowel disease ,and play a role as an etiologic factor in lymphocytic colitis. Inflammatory bowel diseases , malignancy and infectious colitis must be ruled out before establishing the diagnosis of NSAID -induced colopathy. Discontinuation of the offending drug is mandatory. Here, we have reported the case of a 43-year-old female, NSAID user due to low back pain, who was admitted to the hospital with painless hematochezia.

Jejunal intussusception caused by a huge Vanek's tumor: a case report.

Inflammatory fibroid polyp (known also as Vanek's tumor) is a type of localized, non-neoplastic inflammatory pseudotumor or inflammatory myofibroblastic tumor that occurs most commonly in the stomach but also in the small and large bowel. It is a documented cause of intussusception in adults. We report a case of a 40-year-old woman who presented with severe, postprandial abdominal pain followed by projectile vomiting over a period of three days. Ultrasonography demonstrated a solid and echogenic mass surrounded by the typical mural layers of an invaginated jejunum. She underwent urgent laparotomy and resection of an 18 cm tumor from the distal jejunum. The immuno-histopathological diagnosis after segmental jejunal resection was a jejunal inflammatory fibroid polyp. Although inflammatory fibroid polyps are seen very rarely in adults, they are among the probable diagnoses that should be considered in obstructive tumors of the small bowel causing intussusceptions.

Immunohistochemical expression of vascular endothelial growth factor and its correlation with tumor grade in breast ductal carcinoma.

Breast cancer is the most common cause of cancer-related death in female, after lung cancer. Angiogenesis is essential for tumor growth and metastasis; therefore, antiangiogenesis strategies for treatment of cancer are currently an issue of interest. The role of vascular endothelial growth factor that assumed to be most potent angiogenesis factor is ambiguous in breast cancer. This study described the correlation between vascular endothelial growth factor expression and tumor grade, to define the breast cancer patients who responder to anti-vascular endothelial growth factor therapy. In this research, 200 cases of histological proved invasive ductal breast carcinomas analyzed for vascular endothelial growth factor expression by immunohistochemical staining via cross-sectional descriptive study. Vascular endothelial growth factor expressed in 72.54% of the breast cancers. The VEGF was more detectable in grade I (78.5%) than grade II (77.4%) and grade III (56.2%). There is a significant correlation between tumor grade and VEGF expression (P<0.05). According to this study, VEGF often expressed in invasive ductal breast carcinomas and inversely correlated with tumor grade. Anti-vascular endothelial growth factor postulated more convenience for tumor progression suppression in low grade tumor than high grade tumor.

Helicobacter pylori colonization in dental plaque and gastric infection.

BACKGROUND: With regard to the presence of Helicobacter pylori (H.pylori ) in dental plaque and its association with gastric infection, data from the literature are controversial. The aim of this study was to determine the prevalence of H.pylori in dental plaque of dyspeptic patients who underwent upper gastrointestinal endoscopy and to investigate its relationship to gastric infection. METHODS: In a cross sectional study, over one year ( February 2002-February 2003) samples were taken with separate sterile curretes from tooth surfaces of molars, premolars and incisors of 180 consecutive dyspeptic patients referred to the Endoscopy Department of Emmam Khomeini Hospital. Dental plaque samples were subjected to the rapid urease test, Giemsa staining, PCR test and culture for identification of H.pylori. During endoscopy, six biopsies were taken from the gastric antrum and corpus and histological examination, Giemsa stainings, Rapid Urease test and culture were performed. Patients were defined as infected when both rapid urease test and Giemsa stain, or when cultures were positive for H.pylori. Information concerning oral hygiene protocol were recorded. For data analysis, the chi square test was used and P < 0.05 was defined statistically significant. RESULTS: Our data proved the presence of H. pylori in dental plaque of infected and uninfected patients. There was no significant association between H. pylori colonization in dental plaque and gastric infection. In this study, oral hygiene (the frequency of dental visits and teeth cleaning) did not have a significant influence on the presence of H. pylori in dental plaque. CONCLUSION: Dental plaque is the reservoir of H.pylori with no relationship to gastric infection.