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Background and purpose : Congential glaucoma is one of the causes of blindness in pediatric age group and the patients are resistante to drug theragy so the purpose is to determine the success rate of trabeculotomy and trabeculectomy glaucoma surgery.
Materials and Methods : All Patients (16 eyes) with congental glaucoma referred to E.H Hospital in 1971-1977 They have Trabeculotomy first , and in Cases with no respones , trabeculectomy with MMC or 5FU was done the parameters for controlling intraocular pressure (IOP) were: 1) Size of Cornea 2) haziness of cornea 3) IOP 4) Tearing 5) Photophcia Patients were under-control 4-6 weeks post operation and then every 4 months.
Results : in 16 eyes with trabeculotomy 10 eyes (62.50%) have controlled IOP with and without medication 4 eyes (31.25%) undergone Trabeculectomy with MMC or 5FU have contolled IOP, 2 eyes (6.25%) have no response to surgery so cyclocryo was for them.
Conclusion : for controllong the IOP in congenital glaucoma the best procedure is trabeculotomy or trabeclectomy with 5FU or MMC , according to patient’s condition we can repeat the surgery

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hondrosarcoma of head and neck is a very rare tumor. Ïn this article a single case referred to Ë.N.T. department of Rasoul-e-Âkram hospital is being reported. Ân extensive tumor which involved nasal, posterior ethmoidal sinuses, sphenoid and intracranial regions which could cause a difficulty in its treatment. Delay in consultation and diagnosis could be the reasons for massive extention of the tumor. The most important symptoms are nasal block and epistaxis and the treatment is complete resection by a selective surgery.

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Dermatofibrosarcoma protuberans (DFSP) is a rare coetaneous sarcoma that originates from fibroblasts of dermis and presents as a non tender coetaneous nodule. Local slow invasion, recurrence after therapy and low risk of metastasis are its main specifications. Pathology and immunohistochemistry are used to diagnose and wide surgery is the best approach for treatment. We present a case of recurrent DFSP and review the diagnostic and therapeutic modalities of this rare tumor. The patient was a 46 year old woman with 14 years history of a tumoral lesion in antero-superior part of her left shoulder and several recurrences after 4 excisional surgery for her lesion. Pathological and immunohistochemical surveys confirmed the diagnosis of DFSP. Previous studies performed on DFSP showed that it is a rare malignant coetaneous lesion that early diagnosis and appropriate treatment can lead to a better prognosis.

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Background and purpose: This is a study to compare the efficacy and side effects of betaxolol and timolol in lowering the IOP of primary open angle glaucoma or ocular hypertension.
Materials and Methods: This Double-blind randomized cross-over clinical trial was conducted on 29 eyes of 20 patients with primary open angle glaucoma or ocular hypertension. Each patient received timolol 0.5% and betaxolol 0.5% (SINA DAROU) twice daily for four weeks in two phases. Before and between the two courses of treatment there was a wash-out period. At the end of the study the effect of these two drugs on intraocular pressure (lOP), mean arterial blood pressure, pulse rate, and basic tear secretion in addition to ocular symptoms were evaluated and statistically analyzed.
Results: The study was performed on 29 eyes of 20 patients with baseline IOP of mmHg. After 4 weeks of treatment, timolol and betaxolol reduced IOP by mmHg and mmHg , respectively (P<0.001) and the difference between the two groups was also significant (P<0.001). Mean arterial blood pressure was reduced with betaxolol and timolol by mmHg (P<0.001), and mmHg (P<0.001), respectively, but the difference between two groups was not statistically significant. Pulse rate was reduced with timolol and betaxolol by beats /min, and beats /min, respectively P>0.05 . No significant difference was considered between two groups. Mean reduction in basic tear secretion with timolol and betaxolol was mm/5min and mm/5min, respectively intergroup comparison was also not significant. Patients in 62.1% of the betaxolol group and 27.2% of the timolol group complained about eye burning. The differece between two groups was significant (P<0.01). lacrimation-eye pruritis and bitter tastes was more in betaxolol group. Other symptoms were similar between two groups.
Conclusion: Timolol is superior to betaxolol in treatment of early glaucoma or ocular hypertension, but both drugs should be used with caution in patients with cardiovascular compromise.

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Background and purpose: In spite of the increasing progress in tumor treatment by current methods like surgery, chemotherapy and etc, medical sciences are unable to treat tumors. In this respect, immunology has opened a new window for tumor treatment nowadays tumor immunotherapy is an accepted strategy for treatment of some tumors at least in some animal models. The goal of this study is the evaluation of immunotherapy using gp96- tumor peptide complex and its combination with naloxon as an opioid receptor antagonist to achieve of cellular immunity against tumors
Materials and methods: In this study firstly, gp96 – tumor peptide complexes were purified from WEHI164 cells line using srivastava method. In the next stage, the mice, made tumoric befor by the injection of tumor cells, then were divided in to four groups. Control group were injected by PBS, test group1 were injected by naloxon, test group2 were injected by gp96 – tumor peptide complex and test group3 were injected by combination of naloxon and gp96 – tumor peptide complex. To evaluation the efficacy of vaccination, after several days, tumor volume was recorded then the mice were killed and the spleanic cells were extracted in sterile condition. MTT test was done for cells proliferation study. Supernatant of cultured cells were collected and assayed by ELISA kits for measuring IL-4 and IFN-γ.
Results: Result of protein purification had showen , purified gp96 Isoform has Molecular Weight of 66 kilo dalton.Results of tumor volume had shown that, there is no significant difference between test and control groups. Results of MTT test had shown that, there is no significant difference between test and control groups. IL-4 assay study had showed that, there is no significant difference between test group1, group2 and control group but test group3 has significantly decreased in IL-4 amount when compared with control group. Results of IFN-γ assay showed that, there is no significant difference between test group1 and control group, but test group2 and group3 has significantly increased in IFN-γ amount when compared with control group.
Conclusion: It can be concluded from this study is that, prophylactic immunotherapy of tumor by combination of gp96-tumor peptide complex and naloxon, can increase IFN-γ, and, probably in a higher dosage, it may stimulate immune system more to become more potent to even decrease tumor volume.

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Background and purpose: Gynecomastia -benign proliferation of male breast glandular tissue- occurs due to increased ratio of estrogen to androgen activity. Çonsidering the lack of studies on the effects of Tamoxifen on gynecomastia in Ïran, and also scarcity of such studies in other countries, this study was conducted to determine the effect of Tamoxifen in the treatment of gynecomastia.
Materials and methods: Ïn this quasi-experimental study, patients with idiopathic gynecomastia, after obtaining consent, were treated with Tamoxifen (10-20 mg/day) for 6 months. Ât baseline and after starting treatment each month, criteria such as pain, tenderness and breast size were investigated and recorded. Çriteria of response to treatment were decreased breast size and tenderness. The data analysis was done by Wilcoxon, Friedman, McNemar and Repeated measurements tests.
Results: Thirty patients entered the study, at baseline 24 patients had tenderness, but in the third and also the sixth month of treatment this number decreased to 2 patients (p<0.05). Ïn the third month, the mean decrease in breast size compared to baseline was 12.869 ± 9.79 mm (p<0.05) and in the sixth month 24.70 ± 19.71 mm (p<0.05). The size also had a significant decrease during treatment (p<0.05).
Çonclusion: Based on the results of this study, Tamoxifen is an effective medication for gynecomastia and considering the amount of reduction in breast size and tenderness, this medication is suggested for treatment of gynecoastia.

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Background and purpose: Coma results from brain damage and patients in intensive care units (ICU) are often more at risk for sensory deprivation. This study compares the effects of familiar and unfamiliar voices on recovering the consciousness level in comatose patients. Materials and methods: This double blind clinical trial (patient and assessor) was performed in 45 traumatic comatose patients with Glasgow Coma Scale (GCS) ≤8 within the age range of 15-75 years, admitted to ICU training centers affiliated to Mazandaran University of Medical Sciences. The subjects were randomly allocated into three groups. Group A was stimulated with a familiar voice, group B’s auditory stimulation was done by the researcher introduced as a nurse) and no intervention was done for group C (control group). The interventions were conducted twice a day for 1-5 minutes. The level of consciousness was measured using the GCS scale. To analyze the data descriptive and inferential statistics (Logrank Test) were used. Results: In the day before the intervention the mean levels of GCS in groups A, B, and C were 6.40, 5.66, and 5.53, respectively. Logrank test revealed significant differences between the groups in the time to reach CGS= 15 which happened sooner in group A (P<0.0001). Conclusion: Familiar voice could highly influence the auditory level of patients in ICU. Therefore, auditory stimulation programs are recommended for comatose patients.

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Endometrial stromal sarcomas are rare malignant tumors that make around 0.2% of all uterine malignancies. These tumors are divided into low grade and high grade. In this case report a 46 year-old woman is presented with history of abnormal uterine bleeding since one year ago. The ultrasound imaging showed a polypoid lesion measuring 4x3 centimeter in uterine cavity. A radical hysterectomy and omentectomy was performed. According to Microscopic and immunohistochemistry findings undifferentiated endometrial sarcoma (UES) was suggested.

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Background and purpose: Traumatic brain injury (TBI) is a public health problem around the world. The Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score are the most common tools in this patients. This study aimed to assess time-related GCS and FOUR scores evaluation in predicting outcome in TBI patients.

Materials and methods: The present prospective cross-sectional study was conducted on 120 TBI patients admitted to an intensive care unit. GCS and FOUR scores were evaluated in four times, including the first hour, and then 24, 48, and 72 hours later. For the analysis of data, SPSS V. 22 and MedCalc v13 were used. The receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values of GCS and FOUR score were evaluated to predict the patients' outcome. Patients' outcome was measured two weeks after hospitalization and for patients who were discharged earlier than this time the evaluation was done at the time of discharge using modified Rankin Scale (mRS).

Results: Sensitivity and specificity of the FOUR score in predicting the outcomes were 80% and 84.4% at first stage, 83.6% and 92.2% at second stage, 83.2% and 92.2% at third stage, and 96.4% and 79.7% at fourth stage, respectively. These values for the GCS were 81.8% and 90.6% at first stage, 87.3% and 93.8% at second stage, 85.5% and 93.8% at third stage, and 87.3% and 93.8% at fourth stage, respectively

Conclusion: Time-related GCS and FOUR scores evaluation did not have a considerable effect on predicting the outcome in this patients.

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Fibrosarcoma is a rare neoplasm associated with locally-recurring and highly metastatic malignant mesenchymal fibroblast. This type of neoplasm is more prevalent among young adults and children. Fibrosarcoma can be treated by surgery for excision of the healthy marginal tissues alone or in combination with radiotherapy. This study presents the case of a 22-year-old female patient in Arak Vali-e-Asr Hospital, Iran 2018, complaining of hemorrhage and thoracic pain between her two scapula bones. On examination, a hemorrhagic tumor necrosis was observed. Cranial nerve examination showed normal results, no tenderness was detected in cervical and lumbar vertebrae, while thoracic vertebrae were tender. The limb force was 5/5 . CT scan and MRI imaging showed a well-defined soft tissue tumor measuring 140 *126*140 mm3. It did not involve the vertebrae and spinal canals. The patient underwent surgery three days post-admission and a 2600-gram mass was excised. Pathological results indicated a fibrosarcoma (grade of 2-3) with mitosis but no necrosis.

 

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Background and purpose: Osteosarcoma, as the most common bone cancer has not shown considerable response to current chemotherapy drugs. New nanotechnology-based drug delivery systems seems to be promising in cancer treatment. The aim of this study was to design and synthesize a niosomal nano-carrier for drug delivery of berberine to Saos-2 cell line, as a model of osteosarcoma.
Materials and methods: Different niosome formulations composed of cholesterol (25%) and different surfactants (75%) were prepared using thin film method. The resulting niosome with optimal properties was pegylated by adding 5% of DSPE-mPEG2000. Finally, the cytotoxicity of free form of berberine and berberine-containing pegylated niosome in normal fibroblast cell line (HFF) and Saos-2 cell line were evaluated by MTT assay.
Results: The niosome made of cholesterol (25%) and Tween 60 (75%) showed the highest drug loading and release rate and was selected as the optimal formulation. Findings showed that the optimized pegylated niosome had high loading efficiency and controlled drug release (79.34% and 66.79%, respectively). Finally, MTT assay showed that the berberine-containing pegylated niosome had more toxicity in Saos-2 cell line than the free form of the drug.
Conclusion: The synthesized niosomal nano-carrier had desirable properties such as high loading efficiency and controlled drug release, which can be used as a favorable drug delivery system with low toxicity and high delivery efficiency in order to increase the effect of the drug while reducing its dose.

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Background and purpose: Pseudoexfoliation syndrome (PEX) is a common age-related disorder, characterized by the secretion of fibrillar material from intraocular components, particularly along the anterior segment structures. This condition leads to obstruction of the trabecular meshwork impairing aqueous humor outflow and subsequently increasing intraocular pressure (IOP). These factors contribute to an increased risk of developing glaucoma, damage to the internal ocular structures, and irreversible vision loss. Therefore, screening and evaluating individuals with this syndrome may allow timely identification of glaucoma risk and implementation of appropriate preventive or therapeutic measures. Consequently, it is crucial to screen for PEX syndrome to assess glaucoma risk and take necessary actions to preserve vision and ocular health. This study aims to determine the prevalence of glaucoma in patients with PEX syndrome to accurately assess the risk of developing glaucoma. This assessment may include monitoring of intraocular pressure, preventive measures, and specific treatments.
Materials and methods: This cross-sectional study was conducted on patients over 40 years old diagnosed with pseudoexfoliation (PEX) syndrome referred to the ophthalmology department of Bu-Ali Sina Hospital in Sari from February 2019 to March 2020. Initially, comprehensive ophthalmic examinations, including autorefraction with a Topcon autorefractometer, visual acuity determination with Snellen E charts, slit lamp examination, and fundoscopy with a 90D lens, were performed for all patients. Subsequently, intraocular pressure (IOP) was measured using a Goldmann tonometer. In individuals suspected of glaucoma, an angle examination using a three-mirror goniolens to assess the trabecular meshwork, and cup/disc ratio using Cirrus HD-NFL OCT (Carl Zeiss Meditec, Inc.) was performed. Based on clinical findings, patients were categorized into glaucoma and non-glaucoma groups. The data were analyzed using SPSS version 22 software. Descriptive statistics, including mean, standard deviation, frequency, and percentage, were used to describe the data. For comparing the means of quantitative variables, the t-test was utilized, while the chi-square test was used for comparing the means of qualitative variables between the glaucoma and non-glaucoma groups. A statistically significant level of P<0.05 was considered.
Results: Among of the 100 patients (180 eyes), 27.77% were diagnosed with glaucoma, with bilateral involvement noted in 90% of glaucoma cases. 54% of glaucoma patients were male with a mean age of
73.88±7.03 years. Glaucoma patients exhibited higher intraocular pressure (IOP) and cup/disc ratio compared to non-glaucoma cases (P<0.001). Within the glaucoma group, the left eyes demonstrated higher IOP (29.12±4.75 versus 28.86±5.65, P<0.001) and a higher cup/disc ratio (0.53±0.12 versus 0.51±0.15; P<0.001) compared to the right eyes.
Conclusion: Pseudoexfoliation syndrome (PEX) is associated with a significant prevalence of glaucoma, particularly with bilateral involvement in most cases. This syndrome may be an important risk factor for the development of glaucoma and the onset of elevated intraocular pressure, especially in elderly men. These findings provide valuable insights for future research and improve our understanding of the relationship between ocular PEX syndrome and glaucoma, which may have an impact on improving patient outcomes and clinical management strategies.