ABSTRACT
The number of patients with gastric cancer is growing worldwide. In Iran [in 2009] of 74067 new cases of cancer, 6886 were diagnosed as having gastric cancer. This study was conducted to investigate 5-year survival rate for gastric cancer in Yazd province, central Iran
Methods: In this descriptive study, the medical records of patients with gastric cancer were collected from the archives of Yazd hospitals from 2001 to 2008. The data gathered included age, sex, type of histopathology, site of involvement, cancer staging, and mode of treatment, which were analyzed using SPSS software version 11.5. To investigate the survival and the factors influencing the survival time of patients, which are the main objectives of this study, Kaplan-Meier method was used and Cox proportional hazards model was fitted to the data. To compare survival function in different subgroups, the log rank test or generalized Wilcoxon test was used
Results: 295 cases of gastric cancer were enrolled in the study. The mean age of the subjects was 59.3 +/- 9 years. 5-year survival rate of the patients was calculated as 18% where the highest rate was 39% for the age group of 50-60 years and the lowest was 3% for the age group of above 80 years. 5-year survival rates in different groups were as follows: 32% in women, 13% in men; 16% in adenocarcinoma, 46% in other pathologies; 16% in gastric cardia involvement, 17% in antrum; 59% in stage 1, 31% in stage 2, 13% in stage 3, and 3% in stage 4
Conclusion: The results of this study showed that age, stage of the cancer, mode of therapy, and type of histopathology affected the survival rate of gastric cancer. No significant association was found between the site of involvement and survival rate. In general, the survival rate for gastric cancer was low, which might be due to slow but steady progress of the disease and delayed referral of the patients
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Introduction: Coughing is an airway complication that could affect the outcome of surgery following general anesthesia in adults. In this systematic review, we aimed to study the efficacy of applying laryngeal airway mask [LMA] compared with endotracheal tube [ETT] in reducing the postoperative cough in adults under general anesthesia
Method: PubMed was searched for the relevant articles. Inclusion criteria were all the randomized controlled clinical trials, which used LMA and ETT in adults under general anesthesia. Only English language articles were included in this study with no time limitation
Result: Overall, 15 articles were retrieved, which were relevant with the purpose of this study. Efficacy of LMA in reducing coughing was significantly different with ETT in adults under general anesthesia in various types of surgeries. Calculated number needed to treat [NNT] showed that using LMA would significantly reduce coughing even in one adult patient
Conclusions: Coughing has shown various adverse effects on postoperative main results in some surgeries such as cataract, cranial, etc. Applying LMA could positively decrease postoperative coughing in adults
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Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality
Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction [RRR], absolute risk reduction [ARR], and number needed to treat [NNT]
Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients' age, gender, and preoperative conditions
Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate
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Introduction: The importance of high-grade cervical intraepithelial neoplasia [CIN] as a precursor to invasive cervical cancer suggests a considerable need for accurate screening of the patients for the risk of these lesions. This systematic review aimed to study the diagnostic significance of endocervical curettage [ECC] at the time of colposcopy in the detection of CIN 2, 3, and preinvasive lesions
Methods: PubMed was searched to obtain the relevant articles based on the following search term: [endocervical curettage OR ECC] AND colposcopy. The most relevant articles were included after studying the title, abstract, and full text of the obtained articles at initial search. Only English language articles published after 1992 with at least 500 patients were included in this study
Result: Among 300 articles identified by the first search, only seven articles were in line with the purpose of this systematic review. Majority of the included studies were retrospective observational studies
Conclusion: Performing ECC has higher sensitivity in women older than 40 years and those with unsatisfactory colposcopy results. However exact diagnostic usefulness of ECC at the time of colposcopy needs to be investigated in further studies
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Introduction: Administration of methylene blue has been proposed as a therapeutic strategy in the treatment of vasopelgic shock following cardiac surgery. Major aims of this systematic review were to evaluate the effect of methylene blue on mortality rate, duration of vasoplegic syndrome, and further complications of patients with vasoplegic syndrome following cardiac surgery
Methods: PubMed was searched to obtain the most relevant articles. All the randomized control trials and cohort studies were included
Result: A total of 54 articles were retrieved at the initial search. After studying the titles, abstracts, and full text of the articles, only five articles consisted of two randomized controlled trials [RCTs] and two observational studies were included
Discussion: Based on included RCTs, the mortality rate and duration of the disease decreased in patients applied methylene blue in the treatment of vasoplegic syndrome compared with those did not receive this medication
Conclusions: Bbased on included articles, application of methylene blue could be suggested as a treatment for vasoplegic syndrome, but further large multicenter RCTs are needed to certainly evaluate the efficacy of methylene blue
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Background and study aims: Colorectal cancer is a major health problem primarily affecting the quality of life [QoL] of both patient and family. With the advances in surgery and novel chemotherapeutic drugs and modalities, survival has increased and the QoL has improved. The aim of this study was to assess QoL in patients with colorectal cancer taking the situation in the Iranian city Yazd from 2006 to 2011 as an example
Patients and methods: This study was conducted on 120 patients who were diagnosed with colorectal cancer within the 5-year period of the study. Different aspects of the patients' lives were assessed using the EORTC Quality of Life Questionnaire [QLQ]-C30 questionnaire, and the results were reported in average aligned score compared with the maximum score of 100
Result: The mean age of the patients was 60.31 +/- 15.71 years [range 14-88 years]. Sixty-three patients were male and 57 female. Further, 85 patients [70.8%] suffered from colon cancer and 34 [28.3%] had rectal cancer. All patients had undergone partial or total colectomies as treatment followed by chemotherapy. The average QoL score was 77.37 +/- 8.7 in women and 76.64 +/- 8.7 in men. No significant relationship was found between the average QoL score and gender. The average QoL score was 77.28 +/- 8.86 for colon cancer and 76.5 +/- 8.47 for rectal cancer, which was not statistically significant. The maximum average QoL score was 77.89 +/- 8.79 for stage 2 of the disease and the minimum score for stage 3 [75.81 +/- 7.66], indicating no significant relationship between the average QoL score and stage of cancer [p = 0.89]
Conclusion: The results of the present study revealed that despite clinical efforts in the city of Yazd, the QoL of patients with colorectal cancer is still very poor in physical, social, clinical, and financial aspects
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To determine treatment efficacy of curettage on endometrial polyp. The quasi-experimental pre-and-post study was conducted in 2011-12 at the gynaecology department of Imam Reza Hospital, Mashhad, Iran, and comprised patients who underwent hysteroscopy for endometrial polyp. Location, size, number and base condition of the polyps were recorded before the patient underwent curettage. Hysteroscopy was then performed and the condition of the remaining polyps was compared with initial findings. Also, the remaining polyps were resected. SPSS 13 was used for statistical analysis. There were 51 patients in the study with a mean age of 33.14 +/- 8.19 years [range: 23-59 years]. Besides, there were 82 polyps; 38[46.3%] having a narrow base, and 44[53.7%] having a wide base. The mean polyp size was 2.39 +/- 2.63cm.After performing curettage, 23[28.0%] polyps were removed completely, 39[47.6%] had size reduction, and 20[24.4%] had no change in size. Curettage could not significantly remove polyps [p<0.001].Polyps smaller than 2cm were more likely to have been removed compared to the bigger ones [p=0.003].Polyps with wide base were more significantly removed than those with narrow base [p<0.001].Further, those with wide base and also smaller than 2cm were removed more significantly than others [p<0.001].The location of polyps had no effect on removal probability by curettage [p=0.114]. Curettage was not found to be a reliable method for endometrial polyp removal. If hysteroscopy is not accessible, the size of the polyp should be determined by vaginal sonograghy to estimate the probability of its removal by curettage
Subject(s)
Humans , Female , Polyps/surgery , Curettage , HysteroscopyABSTRACT
Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. Many studies have reported that dyspeptic symptoms are associated with ingestion of some foods. Current treatments for functional dyspepsia have generally ignored the potential role of diet. This cross-sectional study was done at the Gastroenterology Department of Shahid Sadoughi Hospital, Yazd, Iran from September 2008 to March 2009. Based on the diagnostic criteria for functional dyspepsia symptoms presented to outpatient gastroenterology clinics, adult patients were invited to participate in this study. Upper GI endoscopy was performed in all the patients so as to rule out any gross pathology. The patients were asked about a list of nutrients including 114 foods which is commonly used in our area. Then, the effects of specific foods were identified on the relief or aggravation of the symptoms with four degrees: low, medium, high, and very high. Of 384 patients, 152 were men and 231 were women with a mean +/- SD age of 39.16 +/- 14 years [range: 13-80 years]. The foods that caused the highest aggravation of symptoms were sausage and bolognas, pickles vinegar, soft drinks, grain, tea, salt, pizza, watermelon, red pepper, and macaroni. However, the most frequent foods that led to the alleviation of symptoms were apples, rice, rock candy, bread, caraway seed, dates, honey, yogurt, quince, and walnut. This study shows that some foods, especially spicy, pickled, and high-fat foods, strongly induced dyspepsia and aggravated the symptoms in dyspeptic patients
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Cancer incidence rate is increasing in the world particularly in developing countries. The awareness regarding cancer incidence and distribution helps policy makers and researchers to design comprehensive plan for controlling cancer. The aim of this study was to determine the incidence rate and trend of cancer in Yazd Province, centeral Iran. Data from Yazd cancer registry were derived from 2005 to 2009. Direct standardization through world standard population produced by the world health organization was used and Age- Standardized Incidence rate [ASR] was calculated. Data were analyzed using ASR, by EXCEL and SPSS software. The new cases of cancer were 4631 patients from 2005 to 2009. Mean age of these patients was 57.98 +/- 27.49 years and 53.5% were male. Female patients were approximately 5 years younger than males. The most frequent cancer was breast in women followed by skin, colorectal, hematologic system and stomach. The 5 most frequent cancers in men were skin, bladder, colorectal, stomach and prostate. The ASR in 2005 to 2009 was respectively 85.2, 86.1, 92.6, 102.2 and 104.7 per 100,000 populations. ASR of cancer is increasing rapidly in Yazd Province. It is necessary to have a comprehensive health policy for prevention and control of this problem
Subject(s)
Humans , Male , Female , Epidemiology , Neoplasms/diagnosis , IncidenceABSTRACT
Introduction: Coronary artery disease [CAD] is the most common type of heart disease, with a mortality rate of 385,000 person per year in the United States. There are two main methods for CAD treatments: angioplasty and bypass surgery. Coronary Artery Bypass Grafting [CABG] is one of the greatest surgical operations of the 20th century and it is presented as most effective and long-term therapies in the treatment of ischemic heart disease. There are two different methods of CABG; on-pump and off-pump. While off-pump CABG is a newer method, it decreases stroke and maintains higher mental function. We conducted the assessment of patients' outcome that underwent on- or off-pump CAGB with hemodynamic instability
Materials and Methods: In this cross-sectional study, we evaluated cardiogenic shock patients with CABG who referred to Ghaem hospital for emergency operation from January 2012 to November 2013. We collected medical records archive from this hospital and all patients' information including demographic data, clinical variables, and past medical history separately. We performed on and off-pump CABG surgery for the patients. In on pump group, we performed beating on pump method, without aortic cross clamping
Results: Twenty-eight patients who underwent CABG in two forms: on-pump and off-pump were studied. The minimal age of the patients was 34 and the maximal was 78. Patients' weight had a range between 60 to 95 kg. The minimum used graft were two and the maximum were five. Ejection fraction was diversified between 15% [min] and 50% [max]. Operation time ranged 1.50 to 5.50 hours. The ICU stay time was between 2[min] to 11 [max] days. Finally death was occurred in 5[17.9%] of patients
Conclusion: Our findings showed that CABG with beating heart could increase the survival of hemodynamic unstable patients in comparison with off-pump CABG
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Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography [ERCP] was performed for patients with suspicious to biliary colic and common bile duct [CBD] stones. Ultrasonography, Aspartate Aminotransferases [AST], Alanine Aminotransferases [ALT], Alkaline Phosphatase [ALP] and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter [OR:20; P=0.00] and elevated serum level of ALT [OR:2; P=0.04] were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP
Subject(s)
Humans , Male , Female , Liver Function Tests , Colic , Gallstones , Cholecystitis , Prospective Studies , Aspartate Aminotransferases , Alanine Transaminase , Alkaline Phosphatase , Bilirubin , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
Tamoxifen used in the treatment of breast cancer is reported to cause hepatic steatosis. This study aimed to assess the incidence and risk factors of the development of fatty liver disease, resulting from tamoxifen use, in females with breast cancer. Seventy females aged between 28 and 80 years with breast cancer were recruited from Shahid Sadoughi Clinic, Yazd, Iran in 2006-2008. The patients underwent chemotherapy followed by 20 mg tamoxifen daily as postoperative endocrine treatment. Only in patients with normal baseline liver function, negative test for hepatitis C virus [HCV] and hepatitis B surface antigen [HbsAg] and normal liver ultrasonography were included. The development of fatty changes over a 6-months period of treatment was the main outcome measurement assessed by ultrasonography. Thirty-five of 70 patients developed fatty change during follow-up, in which nine were in grade one, 20 in grade two and six patients in grade three. Risk factors associated with the development of fatty change were elevation of triglycerides [2.4, 1.2-4.8], elevation of fasting blood sugar [FBS] and low high-density lipoprotein [HDL] [3.4, 1.4-7.8]. No relation was found between the development of fatty change and age [1.3, 0.87-2.00], menopause [1.13, 0.69-1.9], previous history of diabetes [2.4, 0.7-8.4], previous chemotherapy regimen and receptors type [c-erbB2, P53, progesterone receptor [PR], oestrogen receptor [ER]] and stage of breast cancer. Further, there was no relation between the development of fatty change and hypercholesterolemia, low-density lipoprotein [LDL], arterial hypertension and body mass index [BMI]. Tamoxifen was associated with a high risk of development of non-alcoholic steatohepatitis in patients with higher triglycerides and FBS and lower HDL. However, no relationship was found with the level of BMI, LDL, hypertension, overweight and obesity