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Aim: Transbronchial cryobiopsy(TBC) is a new technique in obtaining large tissue samples in diffuse interstitial lung disease(DILD) with high diagnostic yield comparable to surgical lung biopsy(SLB). Yet, the exact role of SLB in pathologic diagnosis(DX) of DILD is unclear when TBC provides no definite diagnosis. We evaluated the rate of definite DX by SLB when TBC was not diagnostic in DILD patients. Method: Consecutive consenting DILD patients(n=26) underwent TBC. An individual experienced lung pathologist(ELP) examined all the specimens. Pattern-based histopathological approach was used in examining the samples. If analysis of TBC specimens showed unclassifiable DILD, the cases would be reviewed at multidisciplinary discussion(MD) including clinicians, radiologists, and a different EPL.MD diagnosis(MDD) was recorded for each case. Then they underwent SLB. The primary outcome was diagnostic yield of SLB in unclassifiable DILD by TBC. The secondary outcome was agreement of MD diagnosis and SLB pathologic diagnosis. Result:26 patients (male=18, age:48±12yrs) were enrolled. TBC reached the specific diagnosis in 73%patients (n= 19). In the remaining, pathologic exam showed indeterminate pattern of fibrosis and cellular infiltrates; unclassifiable DILD (27%).In the 7 with non-diagnostic TBC, SLB reclassified only 3 to definite diagnoses (43%).There was high agreement between SLB diagnosis and MDD in these 3 (100%). In the remaining(n=4), SLB was non-diagnostic and didn’t reclassify to alternative diagnosis rather than MDD. Conclusion: In case of unclassifiable DILD by TBC, MD might be more helpful than SLB.

BACKGROUND Ultrasound elastography, is a pioneer sonographic modality that is conducted during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in order to increase the accuracy of sampling location. The current study aims to evaluate the usefulness of elastography during EBUS-TBNA in a population with a high prevalence of anthracosis. METHODS This prospective single-blinded study was performed on 69 lymph nodes (LNs) of patients with mediastinal lymphadenopathy undergoing EBUS-TBNA and EBUS-elastography from October 2017 to July 2018. The stiffness level of the tissue was translated into a color to demonstrate the hardness of tissue. Blue and total areas of each section were measured to calculate the hardness of each LN. RESULTS Sixty-nine LNs were evaluated by elastography. Twenty percent of LNs were malignant. There was a statistical difference between malignant and non-malignant nodes based on color dominancy (P = 0.032). However, with the exclusion of anthracosis nodes from the analysis, the difference was more significant (P

La vasectomia es un procedimiento anticonceptivo comun en los hombres. El presente estudio tuvo como objetivo explorar el impacto de la vasectomia sobre la morfologia del epididimo y los parametros espermaticos en ratones macho adultos Balb/c. Fueron utilizados en el estudio 20 ratones adultos (8 semanas de edad), con un peso ponderado de 20-30 g. Se dividieron en 2 grupos (vasectomia y Sham). Las cirugias se realizaron bajo anestesia con pentobarbital sodico (40 mg/kg de peso corporal, IP), con acceso a traves de una incision medio- abdominal inferior. La cabeza del epididimo izquierdo fue fijada para estudios histologicos y la cabeza del epididimo derecho se utilizo para el conteo de espermatozoides y evaluar su motilidad. La motilidad progresiva rapida y lenta de los espermatozoides se redujo significativamente en el grupo de ratones vasectomizados en comparacion con el grupo Sham (p

Decreasing the side effects of chemotherapy in testis has been the subjects of many studies. In this study, the protective effects of Zingiber officinale extract on rat testis were investigated after chemotherapy with cyclophosphamide. Histological and biochemical parameters were compared in cyclophosphamide-treated rats with or without ginger extract intake. Wistar male rats were randomly divided into four groups each 10. The control group received a single injection of 1 ml isotonic saline intraperitoneally. The Cyclophosphamide (CP) group received a single dose of cyclophosphamide (100 mg kg(-1) BW) intraperitoneally. CP + 300 and CP + 600 groups received orally 300 or 600 mg of ginger extract, respectively, for a period of 6 weeks after cyclophosphamide injection. The morphologic and histological structure of the testis was compared in different groups of the rats. Also, factors like malondialdehyde, reactive oxygen species, total antioxidant capacity and testosterone level were assessed in blood serum as well. Our results showed that although ginger extract could not change testis weight, malondialdehyde (MDA) and ROS, but antioxidant and testosterone levels in serum were increased significantly. Also, an obvious improved histological change was seen in CP + 300 and CP + 600 groups in comparison with CP group. These protective effects of ginger on rat testis after cyclophosphamide treatment could be attributed to the higher serum level of antioxidants.

Background Diffuse malignant mesothelioma (DMM) is increasing in incidence on a worldwide basis and is linked to exposure to asbestos. Simian virus 40 (SV40), a DNA virus, was introduced inadvertently to human populations through contaminated polio vaccine during the years 1956–1963. It has been associated with various types of malignancy in animal experiments. There have been suggestions that SV40 might play a role in the pathogenesis of DMM. Objective To evaluate the association between SV40 and DMM in Iranian patients. Method In a case–control study between the years 2007–2008, isolated DNA from 60 paraffin blocks of patients with DMM and 60 controls was assessed to detect three human polyomaviruses (JCV, BKV, and SV40) using three different sets of primers by multiplex nested PCR analysis. We related the patients with diffuse malignant mesotheioma to possible sites of exposure to asbestos. Results None of the DMMs nor any patient in the control group had SV40 genome on polymerase chain reaction (PCR). All of the cases were SV40 T antigen negative. Conclusion This study suggests that DMM is independent of SV40 infection in Iran. Am. J. Ind. Med. 56:1221–1225, 2013. © 2013 Wiley Periodicals, Inc.

Background: This study was conducted to determine the antimicrobial susceptibility patterns among common pathogens in the intensive care unit (ICU) of a university hospital in Iran between 2006 and 2009. Methods: The isolates cultured in appropriate media and antimicrobial susceptibility were determined by disk diffusion tests according to the guidelines of the Clinical and Laboratory Standards Institute. Results: A total of 606 isolates were recovered from respiratory (70.63%), urine (20.13%), blood (4.95%) and wound (1.82%) specimens of 456 patients. The most common isolates were Acinetobacter baumannii (22.4%), Pseudomonas aeruginosa (20.6%), Staphylococcus aureus (11.1%), Escherichia coli (8.3%) and Klebsiella pneumoniae (4.8%). Less than 7% of A. baumannii isolates were susceptible to aminoglycosides, ceftazidime, cefotaxime, imipenem, cefepime and ciprofloxacin. None was susceptible to piperacillin and piperacillin-tazobactam. The susceptibility rates of P. aeruginosa to ciprofloxacin, gentamicin and piperacillin-tazobactam were 13.6, 17.4 and 33.3%, respectively. Methicillin-resistant S. aureus made up 96.2% of S. aureus isolates and was 100% susceptible to vancomycin and 51.9% susceptible to trimethoprim-sulfamethoxazole. Conclusion: Due to the high antimicrobial resistance in the ICU, we must focus on both a wiser use of antimicrobials and the prevention of infection.

A 24-year-old man presented to our center with a huge goiter compressing his airway. He had a previous diagnosis of Langerhans cell histiocytosis (LCH) of the lung. Core needle biopsy was consistent with histiocytosis. Thyroidectomy was performed. A very invasive mass was encountered at the time of surgery. Histopathology result was consistent with an invasive papillary cancer of thyroid co-occurring with LCH. Although association of LCH with different malignancies has been reported, co-existing invasive papillary thyroid cancer and LCH is a rare combination.

Patient: 48-year-old white male. Chief Complaint: Fever and chills, dyspnea, and productive cough. History of Present Illness: The patient was symptomatic for 2 weeks prior to admission and unresponsive to outpatient treatments. The only positive finding on physical examination was a high oral temperature (38°C). Positive laboratory findings at the time of admission include macrocytic anemia (Hb: 11 g/dL, MCV:110 fl) associated with leucopenia and thrombocytopenia, raised ESR, positive CRP, and most notably, hyperphosphatemia (14.7 mg/dL; reference range: 2.5–5.0 mg/dL) accompanied with normal serum calcium, PTH, and mildly disturbed renal function tests (Table 1). Chest X-ray and spiral CT scan showed consolidation of the anterior segment of the right upper lobe of the lung (Figure 1). View this table: Table 1. Biochemical Data of the Case. Figure 1 Spiral CT scan showing alveolar consolidation in the anterior segment of right upper lobe. The …

Diffuse malignant mesothelioma (DMM) is increasing in incidence on a worldwide basis and is linked to exposure to asbestos. Simian virus 40 (SV40), a DNA virus, was introduced inadvertently to human populations through contaminated polio vaccine during the years 1956-1963. It has been associated with various types of malignancy in animal experiments. There have been suggestions that SV40 might play a role in the pathogenesis of DMM.To evaluate the association between SV40 and DMM in Iranian patients.In a case-control study between the years 2007-2008, isolated DNA from 60 paraffin blocks of patients with DMM and 60 controls was assessed to detect three human polyomaviruses (JCV, BKV, and SV40) using three different sets of primers by multiplex nested PCR analysis. We related the patients with diffuse malignant mesothelioma to possible sites of exposure to asbestos.None of the DMMs nor any patient in the control group had SV40 genome on polymerase chain reaction (PCR). All of the cases were SV40 T antigen negative.This study suggests that DMM is independent of SV40 infection in Iran.

Hemophagocytic lymphohistiocytosis (HLH) is still an important elusive and misdiagnosed condition despite of improved knowledge. Nephrotic syndrome associated with HLH is not a common feature and has been rarely reported in hemophagocytic syndrome. We report a 27-year-old man with HLH who progressed to multi-organ failure as well as nephrotic-range proteinuria, generalized edema, and hypoalbuminemia.

OBJECTIVE: To better understand the characteristic morphology of angiogenic squamous dysplasia (ASD) and its association with different types of common bronchogenic carcinomas using routine white light bronchoscopy.METHODS: Using a case-control design, 186 formalin-fixed paraffin-embedded blocks of bronchial tissue (136 cases, 50 controls) obtained from patients who underwent routine nonfluorescence bronchoscopy between 2004 and 2005 were studied.RESULTS: ASD occurred at a higher frequency in patients with neoplastic lesions compared with those without neoplastic lesions (28 of 136 versus one of 50). ASD was also more prevalent in patients with squamous cell carcinoma compared with other neoplasms. Seventy six per cent of the ASD patients (22 of 29) smoked cigarettes. The morphology of ASD on hematoxylin and eosin- and CD31-stained sections was characterized by prominent microvasculature and capillary projections closely juxtaposed to variable degrees of dysplasia in all of the bronchogenic carcinoma specimens, and to metaplasia in one case in the control group.CONCLUSION: ASD is a unique morphological entity that should be considered by pathologists even on bronchoscopic biopsies from patients who undergo white light bronchoscopy. The presence of ASD may represent a risk biomarker of bronchogenic carcinoma in screening programs and in chemoprevention of lung cancer.

BACKGROUND Lung cancer remains the leading cause of cancer death in the world. In Iran, lung cancer is one of the five leading tumours and its incidence has been increasing steadily in both men and women. There is a paucity of data from Iran on risk factors for lung cancer. We evaluated environmental risk factors for lung cancer in a case-control study in five hospitals of Tehran. METHODS Between October 2002 and October 2005, 242 (178 male, 64 female) patients with histologically confirmed lung cancer and two controls for each patient (242 hospital controls and 242 visiting healthy controls) matched for age, sex and place of residence were interviewed using a structured questionnaire on potential risk factors for lung cancer, including environmental and occupational exposures. Associations between risk factors and lung cancer were assessed using conditional logistic regression. RESULTS Smokers were 66.5% of all cases (85.4% of men and 14.1% of women) and smoking was the strongest correlate of lung cancer in multivariate analysis [odds ratio (OR) 5.4, 95% confidence interval (CI) 3.2-8.9]. Occupational exposures to inorganic dusts (OR 4.2, 95% CI 2.8-6.7), chemical compounds (OR = 3.4, 95% CI 2.1-5.6) and heavy metals (OR 3.0, 95% CI 1.3-7.0) were also independent risk factors for lung cancer. CONCLUSIONS In our study, smoking was the principal risk factor for lung cancer. However, preventable exposures in the environment, including occupational settings, should not be ignored.

Minichromosome maintenance protein 6 (MCM6) is one of the six proteins of minichromosome maintenance family that are involved in the initiation of DNA replication and thus represent a marker for proliferating cells. The aim of this study was to determine the proliferation characteristics of neoplastic cells in patients with classic Hodgkin's lymphoma.Paraffin-embedded blocks of lymph node, mediastinal, subcutaneous chest wall, and lung mass biopsies of 55 patients with classic Hodgkin's lymphoma were immunostained by the proliferation-associated monoclonal antibodies; Ki-S5 (Ki-67 antigen) and Ki-MCM6 (MCM6 antigen).High MCM6 antigen expression was a striking feature of Hodgkin's and Reed-Sternberg cells (median: 85%, range: 35 - 99%) in comparison with lower Ki-67 expression (median: 63.5%, range: 1 - 98%, P0.001). This indicates that MCM6 is already expressed in the early G1 phase, a cell cycle fraction that is not covered by antibodies specific to the Ki-67 antigen. The proliferation rates were determined by two markers, independent of histologic subtype, stage, presence of B symptoms, and size.These data show that a subset of Reed-Sternberg and Hodgkin's cells is arrested in the early G1 phase and the MCM6-positive cells do not necessarily represent the real proliferating compartment of Hodgkin's lymphoma. Clinical relevance of this marker in patients with Hodgkin's lymphoma should be investigated.

Primary immunodeficiencies (PIDs) are not solely diseases of childhood. We describe the clinical presentation and outcome for 55 adult patients with previously unrecognized PIDs. This series provides unique data regarding PIDs presenting in adulthood, and serves as a timely reminder that physicians must consider the diagnosis of PIDs in their adult patients. Using the experience gained from these patients, we outline key “warning signs” suggestive of an underlying PID. Only through increased physician awareness will patients with PIDs receive timely diagnosis and optimal management.

Background: Despite many prospective and retrospective studies about the association of dietary habit and lung cancer, the topic still remains controversial. So, this study aims to investigate the association of lung cancer with dietary factors. Method: In this study 242 lung cancer patients and their 484 matched controls on age, sex, and place of residence were enrolled between October 2002 to 2005. Trained physicians interviewed all participants with standardized questionnaires. The middle and upper third consumer groups were compared to the lower third according to the distribution in controls unless the linear trend was significant across exposure groups. Result: Conditional logistic regression was used to evaluate the association with lung cancer. In a multivariate analysis fruit (Ptrend < 0.0001), vegetable (P = 0.001) and sunflower oil (P = 0.006) remained as protective factors and rice (P = 0.008), bread (Ptrend = 0.04), liver (P = 0.004), butter (Ptrend = 0.04), white cheese (Ptrend < 0.0001), beef (Ptrend = 0.005), vegetable ghee (P < 0.0001) and, animal ghee (P = 0.015) remained as risk factors of lung cancer. Generally, we found positive trend between consumption of beef (P = 0.002), bread (P < 0.0001), and dairy products (P < 0.0001) with lung cancer. In contrast, only fruits were inversely related to lung cancer (P < 0.0001). Conclusion: It seems that vegetables, fruits, and sunflower oil could be protective factors and bread, rice, beef, liver, dairy products, vegetable ghee, and animal ghee found to be possible risk factors for the development of lung cancer in Iran. Keyword: Lung cancer, Nutrition, Cancer risk