jalali 2005-11-1 gregorian 2005 11 1 17 41 online 1 fulltext

The role of tracheal stenting in the alternative treatment of tracheal stenosis ntroduction: Tracheal stenosis due to trauma, tracheal infections, malignant tracheal tumors and after long standing intubation is seen. Most researchers think that resection and anastomosis of trachea is the best treatment of tracheal stenosis in most times, and the best results are obtained when performed by a skilled surgeon. But the important complication of tracheal surgery is post operative tracheal stenosis which leads to some limits in reoperations. The role of stenting in treatment of tracheal stenosis is as alternative treatment in patients who are not compatible with major operations and the first treatment in patients with tracheal malignancies along with involvement of near elements or distant metastasis who are not operable. The goal of this research is the study of results of stenting in Tehran Valiasr hospital between October 2002 till September 2004. Materials and Methods:This is a prospective research that is about the results of tracheal stenting in patients with inoperable tracheal malignancy, non tumoral stenosis (after long standing intubation),complication of surgery or inability to stand a major operation.stent insertion was done by rigid bronchoscopy and use of silicon stent (polyflex with introducer system). Results: 12 patients with stents (10 due to benign lesion and 2 due to malignancy) have been worked up for at least 6 months and at most one year. Average age of patients was 30 (least 13 and most 53). 9 patients were affected to stenosis after longstanding intubation due to various causes of (45.4%) and one case , stenosis due to inhalation of chemical gas (8.4%) and two cases (16.6%) due to thyroid tumor invated to trachea and adenocystic tumor of trachea. Stenosis was between 2-5cm. Four cases of stenosis were in superior & middle third and four cases in inferior third. The most important indication of stent insertion is the history of multiple tracheal operations.The most common complications of stent insertion is development of granulation tissue (58%) and medium time of lasting stent in place has been 2-6 months. The most common cause of stent removal is also granulation tissue formation (85%).30% of patients with benign disease have been cured with stent insertion and 10% were improved until they could stand a major operation. In malignant condition one patient recovered from death and lived for 3 months and the other patient gained enough time to do radiotherapy. Conclusion:The results of this research revealed that mostly in benign conditions after stent removal, patients showed signs of recurrence which needed another alternative treatment. This problem makes the role of stent insertion questionable in benign conditions. But the use of stent in malignant conditions is indicated when is the only alternative.Treatment and its role are approved and another benefit is that in malignancies the stent removal is not need . Tracheal stenting, tracheal stenosis, tracheal malignancies. 147 154

Oral Lesions at Birth Objective: The aim of this study was to determine the frequency distribution of oral lesions at birth. Method: All babies delivered in Mashhad sina hospital were examined for oral lesions immediately after birth for one year since 1.1.82. In this cross sectional descriptive study , frequency distribution was detected From data. Results: During the study period 3298 babies were delivered. Oral lesions included 76% Epstein pearls , 35% Bone nodule , 0.33% ankyloglossia, 0.12% natal teeth, 0.03% congenital epulis, 0.03% cleft lip , 0.06% cleft palate , 0.03% cleft lip and palate. Conclusion: In this study Epstein pearls were the most common lesion at birth and cleft lip, with or without cleft palate and congenital epulis, were the lowest ones. Keyword: Newborn, Oral lesion , Routine examination of the newborn Objective: The aim of this study was to determine the frequency distribution of oral lesions at birth. Method: All babies delivered in Mashhad sina hospital were examined for oral lesions immediately after birth for one year since 1.1.82. In this cross sectional descriptive study , frequency distribution was detected From data. Results: During the study period 3298 babies were delivered. Oral lesions included 76% Epstein pearls , 35% Bone nodule , 0.33% ankyloglossia, 0.12% natal teeth, 0.03% congenital epulis, 0.03% cleft lip , 0.06% cleft palate , 0.03% cleft lip and palate. Conclusion: In this study Epstein pearls were the most common lesion at birth and cleft lip, with or without cleft palate and congenital epulis, were the lowest ones. Keyword: Newborn, Oral lesion , Routine examination of the newborn Newborn, Oral lesion , Routine examination of the newborn 3 7

Recurrence of Lacrimal Gland Pleomorphic Adenoma Introduction: In cases with lacrimal gland mixed tumor preoperative delicate clinical and radiological diagnosis lead to proper surgical approach. Incomplete resection of lacrimal gland mixed tumor may be complicated by severe tumor recurrence with the risk of malignant transformation. In this case report, we present 39 years old man with history of transcranial excision of lacrimal gland tumor. Six months before admission progressive proptosis and inferomedial displacement of right globe (approximately 3 cm) has been developed. Soft tissue hypertrophy of eyelids and corneal leukoma developed due to the chronic progressive course of proptosis with chronic corneal exposure. The other case also was a 38-year-old man with significant proptosis and history of two time lacrimal gland tumor excision, one from transcranial approach. The surgical procedure was performed in both cases through anterolateral orbitotomy without bone removal and the whole lesions were removed with pseudo capsule. The vision of the first patient improved from hand motion preoperatively to one meter finger count after surgery, and there was no recurrence in both cases 6 months postoperatively. In general, regarding risk of malignant degeneration and recurrence after incomplete excision or incisional biopsy of lacrimal gland mixed tumor, it is strongly recommended to perform complete excision with psudocapsule in the first surgery. Key words: Pleomorphic adenoma, Lacrimal gland, Tumor recurrence, Benign Mixed Tumor Introduction: In cases with lacrimal gland mixed tumor preoperative delicate clinical and radiological diagnosis lead to proper surgical approach. Incomplete resection of lacrimal gland mixed tumor may be complicated by severe tumor recurrence with the risk of malignant transformation. In this case report, we present 39 years old man with history of transcranial excision of lacrimal gland tumor. Six months before admission progressive proptosis and inferomedial displacement of right globe (approximately 3 cm) has been developed. Soft tissue hypertrophy of eyelids and corneal leukoma developed due to the chronic progressive course of proptosis with chronic corneal exposure. The other case also was a 38-year-old man with significant proptosis and history of two time lacrimal gland tumor excision, one from transcranial approach. The surgical procedure was performed in both cases through anterolateral orbitotomy without bone removal and the whole lesions were removed with pseudo capsule. The vision of the first patient improved from hand motion preoperatively to one meter finger count after surgery, and there was no recurrence in both cases 6 months postoperatively. In general, regarding risk of malignant degeneration and recurrence after incomplete excision or incisional biopsy of lacrimal gland mixed tumor, it is strongly recommended to perform complete excision with psudocapsule in the first surgery. Key words: Pleomorphic adenoma, Lacrimal gland, Tumor recurrence, Benign Mixed Tumor Pleomorphic adenoma, Lacrimal gland, Tumor recurrence, Benign Mixed Tumor 9 14

Myxoid chondrosarcoma of the mastoid bone, Introduction: Myxoid tumors are neoplasms with extensive myxoid stroma that make them difficult to complete removal as an essential common feature. Chondrosarcomas are primary tumors of the bone but myxoid type is more prevalent in soft tissue and is considered as an unusual and extremely rare type of chondrosarcoma in bone especially in skull bones.We present such a rare myxoid type of chondrosarcoma in the temporal bone of a 26 years-old man.The clinical and histopathological features of the tumor and the surgical treatment technique and out come are discussed with reviewing the related literatures. KeyWords: Temporal tumors, Mastoid tumors, Chondrosarcoma, Myxoid chondrosarcoma, Myxoid tumor Introduction: Myxoid tumors are neoplasms with extensive myxoid stroma that make them difficult to complete removal as an essential common feature. Chondrosarcomas are primary tumors of the bone but myxoid type is more prevalent in soft tissue and is considered as an unusual and extremely rare type of chondrosarcoma in bone especially in skull bones.We present such a rare myxoid type of chondrosarcoma in the temporal bone of a 26 years-old man.The clinical and histopathological features of the tumor and the surgical treatment technique and out come are discussed with reviewing the related literatures. KeyWords: Temporal tumors, Mastoid tumors, Chondrosarcoma, Myxoid chondrosarcoma, Myxoid tumor Temporal tumors, Mastoid tumors, Chondrosarcoma, Myxoid chondrosarcoma, Myxoid tumor 15 18

Oligodendrogliomas A report of 35 cases Introduction: Oligodendrogliomas are not common intracranial neoplasms. We retrospectively reviewed all of the gliomas operated in Ghaem Hospital between the years 1981 and 2000 and found only 35 cases of oligodendrogliomas (7.6% of total gliomas). survival analyses were performed on possible prognostic factors including: patient age and sex, presence of seizure, site, size, side, and treatment(extent of surgical resection , radiation dose, chemotherapy). Materials and Methods: Thirty-five patients with supratentorial oligodendrogliomas consisting of 27 males (77.1%) and 8 femals (22.9%) ranging in age from 4 to 68 years (mean age 36.9 years). Seizures were present in 20 patients (57%), headache in 20 patients (57%),vomiting and papilledema in 15 patients (43%), hemiparesis in 12 patients (34.3%).The surgical treatment of the 35 patients included gross total removal in ten patients (28.8%)and subtotal removal (including one patient who had only a biopsy) in 25 patients (71.2%). All patients had subtotal resection received postoperative radiation(median5000 rad), in patients whose tumors were progressed (ten patients) received further surgery and chemotherapy treatment were necessary. Result:Thirty–five patients with supratentorial oligodendrogliomas underwent surgery plus postoperative radiation and chemotherapy between the years 1981-2000. The median survival time and the 5-10 and 15 year survival rates for these 35 patients were 5.6years,54%, 34%, and 24% . Conclusion: Patients with pure oligodendrogliomas had better median survival time, approximately 5.6 years, respectively , compared with 3.2 years for those anaplastic oligodendrogliomas. The ten patients who nderwent gross total resection of their timors had a better median survival time compared with the 25 patients who had subtotal resection. Patients with partially resected lesions appeared to benefit from postoperative radiotherapy. The median survival period after subtotal tumor resection was better than patients without radiotherapy. Keywords: Oligodendrogliomas, Glial tumors, Combined, Treatment Modality. Introduction: Oligodendrogliomas are not common intracranial neoplasms. We retrospectively reviewed all of the gliomas operated in Ghaem Hospital between the years 1981 and 2000 and found only 35 cases of oligodendrogliomas (7.6% of total gliomas). survival analyses were performed on possible prognostic factors including: patient age and sex, presence of seizure, site, size, side, and treatment(extent of surgical resection , radiation dose, chemotherapy). Materials and Methods: Thirty-five patients with supratentorial oligodendrogliomas consisting of 27 males (77.1%) and 8 femals (22.9%) ranging in age from 4 to 68 years (mean age 36.9 years). Seizures were present in 20 patients (57%), headache in 20 patients (57%),vomiting and papilledema in 15 patients (43%), hemiparesis in 12 patients (34.3%).The surgical treatment of the 35 patients included gross total removal in ten patients (28.8%)and subtotal removal (including one patient who had only a biopsy) in 25 patients (71.2%). All patients had subtotal resection received postoperative radiation(median5000 rad), in patients whose tumors were progressed (ten patients) received further surgery and chemotherapy treatment were necessary. Result:Thirty–five patients with supratentorial oligodendrogliomas underwent surgery plus postoperative radiation and chemotherapy between the years 1981-2000. The median survival time and the 5-10 and 15 year survival rates for these 35 patients were 5.6years,54%, 34%, and 24% . Conclusion: Patients with pure oligodendrogliomas had better median survival time, approximately 5.6 years, respectively , compared with 3.2 years for those anaplastic oligodendrogliomas. The ten patients who nderwent gross total resection of their timors had a better median survival time compared with the 25 patients who had subtotal resection. Patients with partially resected lesions appeared to benefit from postoperative radiotherapy. The median survival period after subtotal tumor resection was better than patients without radiotherapy. Keywords: Oligodendrogliomas, Glial tumors, Combined, Treatment Modality. Oligodendrogliomas, Glial tumors, Combined, Treatment Modality. 19 25

The correlation between vitiligo and Hearing loose Objective: To determine the correlation between vitiligo and hearing loos. Materials and Methods: Fifty patients with active vitiligo and forty healthy subjects were included in this case control study. Pure tone thresholds were determined at frequencies between250 and 8000Hz we compared the results in control and patients group by use of chi-square test. Results: M/F ratio was 10: 40in the patients group and 10: 30 in the control group. Mean age in patients and control groups was22 and 22.6 years old respectively. The mean hearing threshold in patients was 19.5±5.7and 10±5. 7incontrol groups. High frequency sensor neural hearing loss was seen in 19 out of 50 patients (38%), whereas no hearing loss was observed in the control group (X2=19.26,P<0.001). Bilateral, right ear and left ear involvement were 63.1%, 26.3% and 10.6% respectively. Statistical difference between bilateral and unilateral involvement was significant (P>0.05). No conductive hearing loss was seen in the control and patients groups. Conclusion: Vitiligo, Which is a type of pigmentary disorder, seems to be an effective factor in hearing loss. The mechanism for this condition might be the absence of the preventive function of melanin – containing cells in the inner ear. Key Words: Hearing Loss; Vitiligo Objective: To determine the correlation between vitiligo and hearing loos. Materials and Methods: Fifty patients with active vitiligo and forty healthy subjects were included in this case control study. Pure tone thresholds were determined at frequencies between250 and 8000Hz we compared the results in control and patients group by use of chi-square test. Results: M/F ratio was 10: 40in the patients group and 10: 30 in the control group. Mean age in patients and control groups was22 and 22.6 years old respectively. The mean hearing threshold in patients was 19.5±5.7and 10±5. 7incontrol groups. High frequency sensor neural hearing loss was seen in 19 out of 50 patients (38%), whereas no hearing loss was observed in the control group (X2=19.26,P<0.001). Bilateral, right ear and left ear involvement were 63.1%, 26.3% and 10.6% respectively. Statistical difference between bilateral and unilateral involvement was significant (P>0.05). No conductive hearing loss was seen in the control and patients groups. Conclusion: Vitiligo, Which is a type of pigmentary disorder, seems to be an effective factor in hearing loss. The mechanism for this condition might be the absence of the preventive function of melanin – containing cells in the inner ear. Key Words: Hearing Loss; Vitiligo Hearing Loss; Vitiligo 25 30